Hawaii’s downward trend in COVID-19 cases appears to continue, with lower average counts and positivity rates than the previous week, but omicron subvariant BA.5 is now a national and global concern.

The Hawaii Department of Health on Wednesday reported the seven-day average of new cases at 558 compared with 651 reported July 6, which dropped for the sixth week in a row. The state’s average positivity rate also dropped to 13.8% from 15.1% reported the previous week, the fifth weekly decline in a row.

Another 11 coronavirus- related deaths were reported, bringing the state’s COVID-19 death toll to 1,535.

All eyes, however, are on BA.5, which has swiftly become the dominant variant in the U.S., making up 65% of new cases as of Saturday, according to the Centers for Disease Control and Prevention. BA.4 makes up about 16.3% of new cases in the U.S., while the proportion of BA.2.12.1 has decreased to 17.3%.

Dr. Scott Miscovich of Premier Medical Group says he is expecting another jump in COVID-19 cases in Hawaii driven by BA.5.

“We have just a very slight lull,” Miscovich said. “We have gone down a little bit, and we may have a week or two with a slight decrease, but most of us are predicting we are going to hit a flat line of a plateau for a couple of weeks, and then we’re going to have another surge and it may go even higher.”

Miscovich thinks it is unavoidable with BA.5, which is described by epidemiologists as more transmissible than earlier versions of omicron, with a greater ability to escape immunity due to the extent of its mutations.

In Hawaii, the latest available variant report revealed that BA.4 and BA.5 now make up roughly 20% of variants circulating in the state, based on sequencing for the two-week period ending June 18.

All four of the state’s major counties — Kauai, Honolulu, Maui and Hawaii — now have both BA.4 and BA.5 present in their communities.

On Tuesday morning, the Biden administration’s COVID-19 response team said it was closely monitoring BA.5 and urged Americans to exercise renewed caution due to the highly transmissible variant, noting that many are under- vaccinated.

Dr. Ashish Jha, White House COVID-19 coordinator, urged Americans to stay up to date on their vaccinations, calling vaccines “our single-most important tool to protect people against serious illness, hospitalizations and deaths.”

In a media briefing alongside CDC Director Dr. Rochelle Walensky and Dr. Anthony Fauci, President Joe Biden’s chief medical adviser for the pandemic, Jha urged those eligible to get their boosters, and those ages 50 and older, in particular, to get their second boosters if they have not done so already.

“Don’t delay,” he said. “Do it now. Getting vaccinated now will not preclude you from getting a variant- specific vaccine later this fall or winter.”

Tools are already available to manage and reduce the spread of illness, he said, even in the face of BA.5 — such as testing, masking and improving ventilation.

“There is broad consensus in the scientific community that wearing a high-quality mask in indoor public spaces is an important tool to control the spread of COVID-19 — prevents you from getting infected, and prevents you from spreading it to others,” he said.

On Tuesday afternoon, DOH announced that it would drop universal indoor masking for Hawaii’s public schools, which will instead be optional in the new school year starting Aug. 1.

Masks will be “highly encouraged,” however, when CDC rates the counties as medium or high levels.

As of Wednesday, CDC continued to rank Honolulu, Maui and Hawaii counties as high-level, orange communities, as has been the case for the past few weeks, where masking is recommended in public indoor spaces and on public transportation. Kauai County is ranked a medium- level, yellow community.

So far, health experts said there is no indication that BA.5 is associated with greater disease severity compared with earlier omicron subvariants.

“We do not know yet about the clinical severity of BA.4 and BA.5 in comparison to our other omicron subvariants,” Walensky said, “but we do know it to be more transmissible and more immune evading. People with prior infection even with BA.1 or BA.2 are likely still at risk for BA.4 or BA.5.”

In Hawaii, hospitalizations of patients with COVID-19 rose to 177 on Wednesday, according to the state’s dashboard, compared with 164 reported July 6. Of the 177, 13 were in intensive care and three on ventilators.

The seven-day rolling average of hospitalizations for the week was at 167, according to the Healthcare Association of Hawaii, with about 29 new COVID-19 admissions per day.

On Monday’s Honolulu Star-Advertiser’s “Spotlight Hawaii,” Dr. Todd Allen, chief quality officer of The Queen’s Health Systems, said many patients recently landing in hospitals with COVID-19 are vaccinated elderly with chronic illnesses such as heart, kidney or lung diseases.

He called BA.5 a “remarkable variant” with major differences in its spike protein and genetic sequence.

“We’re going to have to be careful with this version of the virus,” he said. “We’re going to have to think a little differently about how to mitigate it and prevent infections, and we’re going to have to act differently, I think, as a community and as a nation to help keep the infections down.”

Queen’s also is challenged by staffing shortages — a statewide problem — due to health care workers getting sick or exposed to COVID- 19. In June, Queen’s was down between 300 to 400 workers at any given time, Allen said.

Workforce shortages have been a constant and growing concern during the omicron wave, according to Hilton Raethel, president and CEO of HAH, and remain a critical vulnerability. Hospitals have enough beds, he said, but not enough staff.

On any given day, some 800 front-line health care workers are out due to COVID-19, but with BA.5 and the potential of reinfections, this could grow to more than 1,000, he said.

“We expect numbers through July and August to get worse in terms of infection rate and therefore the impact on the health care workforce will be worse in July and August,” he said.

Hawaii hospitals are full, even if there’s not an influx of COVID-19 patients. On Wednesday more than 2,400 patients filled Hawaii hospital beds.

This is due, in part, to difficulties transferring patients to long-term care facilities, which are also short staffed.

Daily cases are on the rise in more than half of U.S. mainland states, according to The New York Times database, which now ranks California the No. 1 U.S. state in daily average cases per 100,000.

Nationally, hospitalizations have also been on the rise, with admissions about double what they were in the spring. CDC lists an average of 342 new COVID-19 deaths per day, a number that the White House COVID-19 response team said is too high.

Fauci said the good news is that antiviral medications and other treatments still appear to be effective against BA.5.

“We should not let it disrupt our lives,” he said, “but we cannot deny that it is a reality that we need to deal with.”

Lowering transmission, he said, is important to prevent the virus from continuing to evolve.

“We need to keep the levels of the virus to the lowest possible level and that is our best defense,” he said. “If a virus is not very robustly replicating and spreading, it gives it less of a chance of a mutation, which gives it less of a chance of the evolving of another variant.”

As of Wednesday, DOH reported 76.7% of Hawaii’s population had completed the primary series of COVID-19 vaccines, with 43.5% boosted once and 9.8% boosted twice.

Approximately 3% of Hawaii’s keiki under 5 who are now eligible for the vaccines have received their first COVID-19 shots.

In a new public service announcement, DOH urged all eligible residents to get that second booster, noting that only about 26% of Hawaii residents ages 50 and older have done so. People ages 12 and older with compromised immune systems are also eligible for a second booster.