Infectious disease expert Tim Brown is concerned about what unmasked gatherings over the Labor Day weekend will bring to the coronavirus pandemic in the weeks to come.

Brown, a senior fellow at the East-West Center in Manoa, believes that far more stringent measures were needed sooner rather than later to stop the skyrocketing number of COVID-19 cases and the increasing strain on hospitals in Hawaii.

“Where we are now is already concerning enough that I think we need to be taking more aggressive measures to bring this under control,” said Brown during a Honolulu Star-Advertiser Spotlight Hawaii conversation on Monday.

The Hawaii Department of Health on Monday reported two new coronavirus-related deaths and 756 new infections statewide, bringing the state’s totals since the start of the pandemic to 626 fatalities and 68,265 cases. The deaths involved a woman in her 80s on Hawaii island and a man in his 60s on Oahu.

The new probable and confirmed cases include 473 on Oahu, 85 on Maui, 119 on Hawaii island, 65 on Kauai and 14 Hawaii residents diagnosed outside the state.

The Health Department also reported that a total of 448 patients with the virus were in Hawaii hospitals as of Friday, with 98 in intensive care units and 90 on ventilators.

Some hospitals are already canceling or postponing elective procedures, Brown said, and if case numbers continue at the current pace of between 700 to 800 a day, there will very soon be 500 COVID-19 patients in hospitals, cited by government officials as the “breaking point” for the state.

Brown told the Star-Advertiser afterward that needed measures include enforcing and issuing $250 fines for those who violate gathering and indoor masking rules to get the message across, particularly among younger people who are not complying or taking them seriously.

People need to understand that the delta variant is a game changer, according to Brown, given the median viral load is up to 1,000 times higher than the original COVID-19 strains, making it twice as transmissible as the virus that drove last year’s epidemic.

Wearing a mask is not only important for preventing the spread of the coronavirus, but to protect others from potentially becoming infected.

“It’s not just about protecting them, but it’s actually even more about protecting other people from them,” he said. “With COVID right now, we know a huge amount of the spread is asymptomatic. You may not think you have anything but you could still be spreading virus like crazy across the room.”

Younger people also need to understand they can land in the hospital, he said, and that they are potentially spreading a virus that is putting older people in the hospital and have a civic responsibility to reduce transmission in the community.

He believes Honolulu’s Safe Access O‘ahu program requiring proof of vaccination or a negative COVID-19 test to enter restaurants, bars and other establishments is a step in the right direction but questions why it was not implemented immediately upon announcement, before the Labor Day weekend, instead of waiting until Sept. 13.

“It’s a huge step in the right direction, but why wait two weeks to put it in place?” he said. “We should have put it in place as quickly as possible.”

There should be an efficient verification system in place so businesses can ensure vaccine cards are real.

He also recommends bringing pre-travel testing back for inbound passengers to Hawaii, considering the explosive growth of the delta variant around the nation. If possible, he would require a negative COVID-19 test 48 hours prior to departure because of how quickly the variant is able to develop.

“Then I would also probably impose a post-arrival test after two to three days,” he said. “Basically, just do a rapid test to make sure people aren’t infectious at that point because it is possible for people to slip through.”

Instead of limiting gatherings to 10 or less indoors, he would take it further and set the limit at 10 people from the same household or “bubble.”

And, yes, Brown supports some form of lockdown similar to what occurred in the early months of the pandemic to bring coronavirus cases down.

“Look, we can shut down now or we can shut down a couple weeks from now with our hospitals completely overwhelmed,” he said. “To me that’s sort of the bottom line right now. We are in such a situation. We should have shut down before this long weekend because I’m not sure what this long weekend is going to produce in terms of a boost in new cases.”

Brown explained on Spotlight Hawaii that with the delta variant, one infected person who takes no precautions such as masking or distancing could infect up to six others, compared to about fewer than three with the virus that originated in China last year.

One study also showed that the delta variant, which originated in India, builds up much more rapidly and at higher levels in the body. At the same time, he said, current vaccines are less effective than they would have been against the original coronavirus.

The vaccines still offer very good protection, Brown said, and have held up very well in protecting people against serious illness and death from COVID-19. They play a critically important role in battling the coronavirus.

“So even if there’s a breakthrough infection it tends to be of a shorter duration among people who are vaccinated or people who have had a previous infection,” he said.

However, as Brown told the Star-Advertiser in July, it also means the 70% vaccination goal for Hawaii is no longer enough to reach herd immunity. That threshold needs to be 90% or higher, he said.

“So honestly, we need to be shooting for universal vaccination,” he said. “That’s for multiple reasons. Vaccinated people are much less likely to contract the virus and less likely to transmit it on. Second, they are well-protected against serious illness and death, and I think that’s a really critical thing we need to keep in mind.”

As of Sunday, the state reported 64.3% of Hawaii’s population had completed COVID-19 vaccinations, while 72.6% had received at least one dose.