The number of patients hospitalized with COVID-19 continues to grow, surpassing 100 Tuesday, a threshold not reached since January.

The state Department of Health reported 103 COVID- 19 patients in Hawaii hospitals Tuesday, up from 90 on Monday. Of the 103 patients, 20 were in intensive care units, and 11 were on ventilators, according to the state’s COVID-19 dashboard.

The DOH also reported 162 new confirmed and probable coronavirus in­fections, the 13th day in a row of new infections in the triple digits, bringing the state’s total since the start of the pandemic to 40,984 cases.

“The rate of increase is very much a cause for concern because there’s no indication that 103 is going to be the highest number we get to,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, whose members include hospitals, skilled- nursing and assisted-living facilities, home health care agencies and other care providers. “It’s been increasing day over day. Right now we’re on the verge of still being able to manage it, but we’re getting very close to having to make some adjustments so we don’t totally overwhelm our hospitals and particularly our staff.”

Gov. David Ige and other officials have said Hawaii’s hospital capacity would be the leading factor for determining whether to reimpose restrictions as case numbers and test positivity rates continue to rise.

The largest spike in hospitalizations during the pandemic occurred Sept. 8, with 315 COVID patients. The numbers declined below the 100 mark in mid-October but began climbing again in December before hitting triple digits again in January.

The last time the number of hospitalizations topped 100 was Jan. 29, at 101.

That triple-digit threshold was the one health officials were watching out for, according to Raethel, and unfortunately, it arrived Tuesday.

“We’ve not yet had to reschedule surgeries and testings and things like that, but we run the potential of getting to that point and that’s a real concern,” he said.

Lt. Gov. Josh Green said Hawaii needs to see new cases begin to drop in the next seven to 10 days, or the state’s hospitalizations “will become too great very quickly.”

“Unfortunately we are now seeing more young people in the hospital,” said Green in a Facebook post Tuesday. “For example, at just one hospital seven of the 12 patients today are in their 20s and 30s. We are now in a preventable pandemic. Please encourage your friends and family to get vaccinated.”

Raethel said roughly 50% of COVID-19 patients in hospitals Tuesday were under the age of 50 and generally healthy, with no underlying medical conditions.

On one hand, that may be why the number of ICU patients has gone up over the past few weeks, but not dramatically, and why ventilator counts have remained relatively stable.

“They are younger and healthier, so they have a better chance for recovery,” he said. “So that is very good news. They’re not in hospitals as long as older patients. We don’t have the same death rates.”

On the other hand, the majority of new patients are not vaccinated against COVID- 19, and vaccines could have prevented them from landing in hospitals in the first place.

This is disheartening for health care workers putting themselves at risk treating infectious patents, Raethel said, and many are burned out since they have been battling the pandemic for a year and a half now.

The Queen’s Health Systems is seeing more COVID- 19 patients, and staff there have recently tested positive as well due to community- and travel-related spread, according to the nonprofit health care provider.

“Currently Queen’s has 16 caregivers who have recently tested positive for COVID-19,” Queen’s said in a statement. “All are receiving appropriate care. All are unrelated cases and believed to be community-acquired or travel related. At this time, there does not appear to be any impact to our patients, and all units remain operational. As the number of cases in the community continues to rise, Queen’s is no exception. That is why we firmly believe in vaccinations as well as taking necessary precautions such as wearing a mask and adhering to physical distancing as a way to prevent the virus from spreading.”

The Queen’s Health Systems said 80% of its more than 8,000 employees are vaccinated against COVID-19.

“The well-being of our patients and caregivers remains our highest priority, and we continue to proactively follow Federal and State guidelines to implement precautions to ensure we are a safe place to deliver and receive high- quality, compassionate health care,” the statement said.

Dr. Janet Berreman, Kauai Health District officer, on Monday said five coronavirus patients were hospitalized on the Garden Isle.

“This is the highest number of Kauai residents who have been hospitalized at one time since the pandemic began,” she said during a county briefing. “With continued rapid spread of disease, we know we will see more hospitalizations, and unfortunately, we can also anticipate more deaths.”

The highly transmissible delta variant, now the dominant strain in Hawaii and the nation, has showed no signs of letting up.

The seven-day average of daily new cases grew from 185 Monday to 190 Tuesday, and the test positivity rate inched up from 4.6% Monday to 4.7% Tuesday.

That means the number of people testing positive for COVID-19 continues to grow, with particularly high seven-day averages in Hawaii County of 7.1% and Honolulu County of 5.0%.

Vaccination rates, meanwhile, continue to stall at approximately 2,000 doses per day, which is not fast enough to get ahead of the virus, according to Raethel. Health officials reported Tuesday that 1,746,867 doses had been administered, with 59.8% of Hawaii’s population now fully vaccinated.

“We’re really running out on options here when it comes to getting more people vaccinated,” Raethel said. “A mandate is one of the last resorts.”