The effects of COVID-19 can still be felt in Hawaii and the world, whether it be on the health of the population or the health of the economy.

Tim Brown, an infectious disease expert from the East-West Center in Manoa, noted that COVID-19 cases have been in a “pretty steady” state since about mid-May.

On Wednesday, the state Department of Health reported a daily average of 71 cases, an average positivity rate of 8.4%, and average of 48 COVID-19 patients hospitalized over the week.

There were also nine more deaths reported over the week, all of people ages 60 and older.

On Oahu, Brown said for the past seven weeks, cases have remained stable at about 50 per day, with a positivity rate hovering around the 10% range. On Wednesday, DOH reported Honolulu County’s average positivity rate at 10.2%.

In a recent weekly update, he warned that a substantial amount of COVID- 19 continues circulating in the community — as many still hear reports of people contracting it in their circles of friends and relatives.

Those at risk still need to take precautions, he said — test if they become symptomatic, and get Paxlovid if they do.

“There’s still a significant risk of hospitalizations, deaths for the elderly, for our kupuna,” Brown said. “We’re still losing kupuna at an average of seven per week here in Hawaii, so we’re still seeing a lot of deaths and finally, the current variants are just incredibly easy to transmit.”

He recommends that those who are older or at higher risk discuss getting Paxlovid with their health care provider in advance, should they test positive for COVID-19 with a home test, to avoid delays.

For those who are younger, with no underlying health conditions, the greatest risk is long COVID, which affects an estimated 10% of all ages of people infected with omicron variants, he said.

“Long COVID is nothing to ignore,” he said, and is a “good reason to avoid getting infected.”

Long COVID, one of several post-COVID conditions, refers to people who are experiencing long-term effects from their infection for four weeks or more. The symptoms can include fatigue, brain fog, difficulty breathing, heart palpitations and changes in smell or taste.

The ongoing health problems can last for weeks or for years — and can sometimes result in disability.

Brown said about 6% of American adults reported suffering from long COVID, according to a recent survey by the U.S. Centers for Disease Control and Prevention.

“If you’re one of those people who wants to brag about having COVID three to four times — frankly I think you’re crazy,” Brown said. “Every time you take that chance, you’re rolling the dice on getting long COVID or severe illness.”

Long COVID affects the ability of Americans to work, and likely, the ability to travel, which in turn affects tourism.

“A lot of people are probably not traveling because of illness,” he said.

He also said he recommended that people continue to mask on all forms of public transit — including Hono­lulu’s newly opened Skyline rail transit, TheBus, and on airplanes.

“I personally think probably everybody should be masking on any public transit,” he said, “if not to protect themselves, to protect kupuna and others with higher risk conditions who are taking those public transports.”

Even with good ventilation, he said, there is still opportunity for exposure when it gets crowded, and one can be breathing what’s exhaled from a cluster of people standing 2 to 3 feet away.

The most common variants circulating worldwide are in the omicron family, with XBB.1.5 most dominant in Hawaii, and other XBB variants on the rise.

The latest variant report, published Wednesday, showed that XBB.1.5, or “the Kraken,” makes up about 45%, while XBB.2.3 makes up 16%, and XBB.1.16 makes up 14%, of variants circulating in Hawaii, based on test specimen results for the two-week period ending June 17.

For the fall, the U.S. Food and Drug Administration is recommending a targeted, monovalent COVID-19 vaccine with an XBB-lineage of the omicron variant.