Nearly 19% of all of Hawaii’s coronavirus-related deaths since the start of the pandemic have been reported in the past six weeks, with the total death toll jumping from 789 on Oct. 1 to 971 as of Thursday. Just this month, the state Department of Health reported 43 new deaths.

The jump in the number of COVID-19 deaths stands in contrast to Hawaii’s declining case counts and hospitalizations. The number of patients so sick with COVID-19 that they had to be admitted to an intensive care unit began a steady decline in early September, and has remained at less than 30 statewide for the past month.

Brooks Baehr, a DOH spokesman, said that typically several weeks pass between the time someone tests positive for COVID-19 and dies, which creates a lag between falling case counts and the number of deaths.

State data also indicates that many of the deaths reported in recent weeks actually occurred in August and September when the delta variant caused a surge in cases, suggesting that in some cases it’s taking weeks to confirm the cause of death.

Baehr said that attending physicians, hospitals and medical examiners determine the cause of death and then forward death certificates to the Department of Health, which then releases the COVID-19 death figures.

The state’s COVID-19 mortality chart, which is populated based on when the death occurs, shows that coronavirus related-deaths have been declining since early September. The data includes Hawaii residents who died of the virus both within and outside the state, as well as visitors who died while in Hawaii.

Overall, Hawaii health officials say the state is faring well in managing the virus. The average number of new coronavirus cases reported over the past week stood at 101 on Thursday, with 1.7% of COVID-19 tests coming back positive. COVID-19 hospitalizations have also remained low. Statewide, there were 15 COVID-19 patients in ICUs and 14 on ventilators.

But DOH Director Dr. Libby Char this week expressed concerns about a potential rise in cases over the holidays and said she’s closely watching the current case surge in Europe, which could foreshadow a similar trend in the United States.

The World Health Organization has warned in recent days that Europe could see a half million more COVID-19 deaths by February and that the United States should pay attention.

“We are definitely watching that here,” said Char during a Wednesday pandemic briefing before select members of the Hawaii Senate and House of Representatives. “It is a lot of countries in Europe that are flaring.” She said that typically such surges hit the U.S. East Coast and spread from there.

Despite pandemic fatigue, Char urged Hawaii residents to remain cautious during the holidays.

“I think it’s so important to be able to spend time with family and friends, especially over the holiday season,” Char said. “I think it’s really, really important that we have that time together. So it’s really a question of how can we have these gatherings and get together with our loved ones and families in the safest possible ways.”

Char suggested that during indoor holiday gatherings, people wear masks when they are not eating or drinking and that residents consider having several smaller parties, rather than one large one.

“I think if someone in the family has very fragile health, then it would make sense for them to come over maybe just for a quick visit and stay outdoors and not stay for a long time so that we could protect them,” she said.

Char also briefed lawmakers on booster shots, which federal health officials have recommended for certain populations to counter waning immunity.

Anyone who received the one-dose Johnson &Johnson vaccine, and two months have passed, should get a booster. Booster shots for the Moderna and Pfizer vaccines are available for anyone who is 65 and older and all adults who have risk factors for severe illness or high exposure. Those shots are available after six months have passed since being fully vaccinated.

Char said current criteria for who can get a booster are quite permissive, and advised anyone who felt that they were at risk to get one.

As of Thursday, 72% of Hawaii’s population of 1.4 million people was fully vaccinated and 83.2% had received at least one dose of a vaccine, according to state data. For those ages 12 and up, 84.3% of the population is fully vaccinated and 97.4% has received at least one dose.

The rollout of vaccines for children ages 5 to 11 began last week and 4% of children in that age group have received their first dose of the Pfizer vaccine. Char said that children under the age of 5 could be eligible for the vaccine early next year. Clinical trials are ongoing.

DOH on Thursday reported three new corona­virus-related deaths and 130 new infections statewide.