Hawaii’s COVID-19 cases continued on a downward trend as the U.S. Centers for Disease Control and Prevention called for a sweeping reorganization to improve its response to public health emergencies.

CDC Director Dr. Rochelle Walensky on Wednesday said not only must the CDC move faster to respond to public health emergencies, but the agency needs to communicate better and make its guidance more clear and accessible to the public.

The news comes a week after CDC eased its COVID-19 guidelines and dropped its recommendation that unvaccinated Americans quarantine if they come into close contact with an infected person, saying there is now significantly less risk of severe illness, hospitalization and death than earlier in the pandemic.

CDC also moved away from 6-foot distancing requirements and routine surveillance testing of those without symptoms.

The Hawaii Department of Health plans to adjust its COVID-19 quarantine guidelines to align with those issued by the CDC.

DOH on Wednesday reported the state’s seven-day average of new cases fell to 404, down from 452 reported Aug. 10, a decline for the fourth week in a row after an upward blip in July in what were otherwise continued declines.

Actual numbers are estimated to be at least five to six times higher since these figures do not include home test kit results.

The state’s average positivity rate, meanwhile, continued its downward trend to 10.7%, compared with 12.4% reported the previous week, representing a decline for the third week in a row.

COVID-19 hospitalizations also appear to be on a downward trend, with the Healthcare Association of Hawaii reporting an average of 136 patients hospitalized per day over the past week, and an average of 24 new COVID-19 admissions per day.

“We continue to still have very high COVID activity in our community,” Gov. David Ige said Wednesday on the Honolulu Star-Advertiser’s “Spotlight Hawaii.” “The seven-day average is now down to 400, but remember, 400 was the peak in the delta surge more than a year ago, so it’s still a lot of virus in our community.”

But hospitalizations have not increased with the increase in case counts, he noted.

“I think we’re at a good place,” he said. “Certainly I would encourage people who are not fully vaccinated, those who are eligible for a booster and haven’t gotten it yet, I would strongly recommend that they do that.”

Ige also said he supported the state’s decision not to mandate masks indoors at public schools this year, saying “it was the right decision” and that CDC was moving toward voluntary masking as well.

In certain situations, however, he said school principals may require masks if there is an outbreak of cases on campus for certain periods of time or for certain activities.

Given that Congress has not provided additional funds to support the coronavirus pandemic moving forward, Ige also warned that tests and treatments such as monoclonal antibodies may no longer be provided for free from the government.

“So you’re going to begin to see us move back to normal where health services and tests and treatments are provided through your health insurer,” he said.

According to DOH’s variant report Wednesday, omicron variant BA.5 made up 83% of variants circulating in the state for the two-week period ending July 30.

BA.4 made up 5%, while BA.2.12.1 made up 8% of variants circulating in the state. The omicron subvariant BA.4.6 also has been detected in Hawaii.

Both BA.4 and BA.5, due to mutations in their spike proteins, are more resistant to antibody responses elicited by vaccinations and boosters or prior infections than previous omicron lineages.

Kauai’s District Health Office released the preliminary results of its survey assessing the community’s perception of the county’s COVID-19 response efforts and emergency preparedness level.

The survey, conducted door to door from July 26-30, found that 69% of Kauai households remain very or somewhat concerned about their members getting sick with COVID-19, unchanged from the level reported in 2020.

Additionally, 83% of Kauai households reported that it is very or somewhat important to wear a mask indoors in places other than their home, while 85% reported at least some or all household members are vaccinated.

More than a third, 36%, reported someone in their household experienced emotional distress related to the pandemic, which was slightly higher than 32% reported in 2020. Only 16% sought behavioral health assistance.

In rating Kauai’s local response to the pandemic on a scale of 1 to 5, the lowest, at 3.85, was for case investigation and contact tracing. Testing availability, public information and vaccine rollout and availability were rated at 4.45, 4.44 and 4.42, respectively.

“The results of this survey show us that Kauai residents continue to feel the impact of the COVID-19 pandemic in their day-to-day lives and are taking steps to protect themselves with vaccinations and masking,” said Dr. Janet Berreman, Kauai District Health officer, in a news release. “It is gratifying that residents have the tools they need to protect themselves and that they have a positive perception of the local response.”

As of Wednesday, DOH reported 77.1% of the state’s population had completed the primary series of COVID-19 vaccines, with 44.6% boosted once and 11.3% boosted twice.

More than an estimated 324,000 individuals in Hawaii remain unvaccinated.

DOH on Wednesday also reported 2,696 new COVID- 19 infections over the past week, lower than reported the previous week, bringing the total number of cases since the start of the pandemic to 335,518.

By island, there were 1,886 new infections reported on Oahu, 338 on Hawaii island, 311 on Maui, 116 on Kauai, four on Lanai and one on Molokai. An additional 40 infections were reported for out-of-state Hawaii residents.

DOH also reported 13 more deaths, bringing the state’s coronavirus-related death toll to 1,619.