The year 2023 is closing out with nearly 300 additional COVID-19-related deaths, bringing Hawaii’s total COVID-19 death toll as of Wednesday to 2,104.

While the total is a dramatic drop from last year, placing COVID-19 much lower among leading causes of death in the state this year, it still affected parts of the state population significantly.

For kupuna over age 65, Native Hawaiians, Pacific Islanders and Filipinos, COVID-19 was among the top five causes of death in Hawaii from 2018 to 2022, along with heart disease, cancer and stroke, according to a recent report by the Hawaii Health Data Warehouse.

Pandemic emergency or not, infections are still derailing lives for those sickened prior or during the holiday season. An uncounted number of Hawaii residents are still suffering from long COVID, or long-term effects that often include brain fog for weeks and sometimes years after their infections have cleared.

On Wednesday, the state Department of Health reported one more death, bringing the total reported to 2,104 in the last available metrics of the year. The man in his 80s was hospitalized, and died on Oahu.

The state DOH said based on date of death and counting only in-state Hawaii residents, the total number of COVID-19 deaths for 2023 is 288.

The department’s Office of Health Status Monitoring this year ranked COVID-19 No. 11 in causes of death, down from No. 6 in 2022 and No. 5 in 2021. The U.S. Centers for Disease Control and Prevention ranked the virus the No. 4 leading cause of death in Hawaii in 2021.

The daily average of infections remained relatively unchanged at 62 per day, slightly up from 51 per day in early December. The statewide average positivity remained at 5.9%, same as the week prior.

Across the nation, meanwhile, the CDC is detecting increasing rates of COVID- 19 activity this winter, based on emergency department visits, test positivity rates and hospitalizations.

The CDC’s National Wastewater Surveillance System places viral activity levels for COVID-19 at “very high,” with the highest increase in the Northeastern U.S., followed by the Midwest.

All eyes are on JN.1, a highly mutated omicron variant that has grown to nearly half of U.S. cases about 44% of the variants circulating in the nation in mid-December compared to 7% in late November, according to the CDC.

“JN.1’s continued growth suggests that the variant is either more transmissible or better at evading our immune systems than other circulating variants,” said the CDC in a Dec. 22 update. “It is too early to know whether or to what extent JN.1 will cause an increase in infections or hospitalizations.”

The DOH detected the presence of JN.1 via genome sequencing of a sample from Honolulu weeks ago, according to its Nov. 29 variant report. Due to a decline in PCR test samples, the DOH only releases one report every four weeks.

“At this time, the spread of JN.1 does not appear to pose additional risks to the public health beyond that of other recent variants,” said DOH in a statement. “Based on laboratory data, existing vaccines, tests, and treatments are effective against JN.1. The Hawaii Department of Health is closely tracking COVID-19 and will provide alerts as needed if the situation changes. Vaccination remains one of the best ways to protect against the severe outcomes of COVID-19.”

While the JN.1 strain was first detected in the state in October, the DOH said, it has “not yet seemed to become widespread.”

“In Hawaii, the HV.1 variant is currently the fastest spreading and now the predominant strain,” said DOH in response to Honolulu Star-Advertiser inquiries.

Wastewater surveillance of samples from Hawaii were on hiatus in mid-September due to a contract dispute between the CDC and former contractor Biobot Analytics, and resumed recently, but with much less data.

The NWSS now only lists data from six wastewater sewage sites, with five offering less than six months of data. Previously, data came from 14 wastewater sites.

Tim Brown, an infectious disease expert with the East-West Center in Manoa, sees a slight upward in COVID-19 trends, including in cases, test positivity and hospitalizations.

He noted that hospitalizations are on the rise in New York as JN.1 becomes dominant in the region.

“Since we are probably still far short of JN.1 dominance in Hawaii, we will probably not see any major impact in the islands until it grows considerably more,” said Brown in a recent summary. “I would expect that we will see that impact in the January-February time frame here.”

Vaccination rates for COVID-19, meanwhile, remain dismal.

The CDC estimates 37.3% of adults and 7.6% of children have received the updated 2023-24 COVID vaccine, which it says still works well against JN.1.

In Hawaii, the DOH data showed roughly 152,250 doses have been administered since Sept. 12, when the CDC recommended the new vaccines.

The Hawaii Public Health Institute warned via social media posts that multiple viruses are spreading this holiday season, and many are getting sick after attending gatherings.

If sick, it’s important to take an at-home COVID-19 test to help determine what to do next, according to CDC guidelines.

If positive, the CDC still recommends taking precautions to prevent spreading the virus to others, including isolation for at least five days, masking, and avoiding contact with others at high risk.

The CDC also recommends wearing a high- quality mask such as an N95 when the COVID-19 hospital admission level is medium or high; when at high risk of getting very sick; or when indoors in crowded, public spaces, DOH said.

“If you plan to visit someone who is at high risk of getting very sick, consider self-testing to detect infection before contact and consider wearing a mask when indoors with them,” said DOH. “In addition, HDOH reminds the public to stay at home when sick and avoid exposing others.”

The DOH recommends those at higher risk for serious illness seek treatment. The department also encourages vaccination against other respiratory illnesses.

The federal government is offering another round of free, at-home COVID-19 tests delivered by the U.S. Postal Service at COVIDTests.gov.

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Steps to protect yourself against JN.1 and other variants

>> Get your updated COVID-19 vaccine.

>> Test if you develop respiratory symptoms or are exposed to someone who has COVID-19.

>> Talk to a health care provider about treatment if you test positive and are at higher risk for severe effects of COVID-19.

>> Help reduce the spread of COVID-19 by improving your indoor air with a portable air cleaner or by opening windows.

>> Wear masks or respirators and increase space and distance.

Source: Centers for Disease Control and Prevention