Has Hawaii’s COVID-19 surge reached a plateau yet?

The state Department of Health is not declaring that just yet and continues to urge caution as case counts remain high, but said trends this week are encouraging.

The state’s seven-day average of new cases was at 976, down from the 1,085 reported June 8, a decrease for the second week in a row after weeks of consecutive increases. The average reflects new cases per day from June 4-10.

On Wednesday the statewide average positivity rate also decreased for the first time in more than two months to 18.9% compared with 19.2% on June 8, according to DOH. The rate reflects results from a different set of seven days — between June 7 and 13.

“We’re optimistic the slight drop in daily average case counts the past two weeks signals the surge has hit a plateau and counts will continue to fall,” said DOH spokesman Brooks Baehr in an email. “However, it is important to remember the CDC still says there are high levels of COVID-19 on Oahu, Maui, and Kauai.”

While Hawaii island is categorized as having a medium level of COVID-19, the daily average case count there is on the upswing, he added. Also, the state is still averaging nearly 1,000 new confirmed cases a day, with actual cases likely much higher.

DOH Director Dr. Elizabeth Char said on “Spotlight Hawaii” in May that they could be five to six or seven times higher based on studies she has seen. She stood by that estimate Wednesday, acknowledging there is no way of knowing for sure.

Jeffrey Shaman, an infectious disease specialist at Columbia University who has done modeling studies since 2020, estimates the true number of COVID-19 cases, previously four to six times higher, could currently be about eight times higher due to the widespread availability of home tests, National Public Radio reported.

“We know many more people not counted in the data are testing positive with at-home tests,” Baehr said. “Any way you slice it, we still have a whole lot of COVID-19 circulating. Masks, vaccines, boosters and smart decisions about gathering will help keep people from getting sick.”

Hospitalizations climb

The number of patients with COVID-19 in Hawaii hospitals, meanwhile, continued to climb, to 218 on Wednesday, up from 190 reported June 8. Of the 218, 10 were in intensive care and five on ventilators.

The number of COVID-19 patients surpassed 200 over the weekend, according to the Healthcare Association of Hawaii, with 207 on Saturday and 210 on Sunday.

Given that hospitalizations are a lagging indicator, HAH President and CEO Hilton Raethel expects them to continue rising into July.

“Even if we have reached a plateau this week, our hospitalization numbers will continue to climb for a couple more weeks yet,” Raethel said. “There’s a high probability our hospitalizations will continue to increase through the rest of this month and into Fourth of July weekend before they come down again.”

Staffing shortages continue to present the greatest challenge, he said, with more than 800 health care workers in acute care out on a given day.

Hospitals are footing the bill for bringing help from the mainland, now numbering close to 300. Registered nurses are paid $135 an hour for 48 hours a week in Hawaii, for a shift of eight to 12 weeks.

Hospitals are also fuller than they were during pre-pandemic times, said Raethel, with more than 2,300 hospital beds occupied recently. Part of that is due to the inability to transfer patients to long-term care facilities, which are also short-staffed.

The potential impact of more contagious omicron subvariants BA.2.12.1, as well as BA.4 and BA.5, on the current COVID-19 wave also remain unknown.

In Hawaii, BA.2.12.1, which is believed to be 1.3 times more transmissible than BA.2, now makes up about 41% of the variants circulating in the state, according to the latest variant report released June 8.

There are now three cases of BA.4 and five cases of BA.5 confirmed in the state through genome sequencing, up from just one case of each first reported in the May 25 variant report. Most of the cases were detected in samples from Honolulu County and at least one in Hawaii County.

BA.4 and BA.5 are believed to be about 1.6 and 1.8 times more transmissible, respectively, than BA.2, according to the report.

Preliminary studies suggest that the three omicron subvariants also exhibit an increased ability to evade therapeutic antibodies and antibodies elicited by vaccination and prior infection.

Keiki vaccinations

COVID-19 vaccination rates in Hawaii have slowed, but a new subset of the population soon may be eligible for them.

The Hawaii Department of Health has preordered COVID-19 vaccines for children under 5 to ensure they are available, pending the Food and Drug Administration’s emergency use authorization and CDC’s recommendation, possibly as soon as this weekend.

DOH said it has placed preorders for 16,200 doses of Pfizer vaccines for children ages 6 months to 4, and 11,200 doses of Moderna vaccines for children ages 6 months to 5. The first wave of vaccines is expected to arrive as early as Monday, and no later than June 24.

The vaccines will be distributed to hospitals, pediatrician’s offices, clinics and community health centers, and will be listed at hawaiicovid19.com when available. Additionally, pharmacies and community health centers are able to order vaccines independently.

“We know lots of parents are excited their children may soon be eligible to receive COVID-19 vaccines,” said DOH in a statement. “We advise parents contact their pediatricians now to ask whether they will be offering the new vaccines should they be approved.”

DOH on Wednesday also reported 7,199 new COVID-19 infections in the past week, bringing the total since the start of the pandemic to 297,851 cases.

There were nine more coronavirus-related deaths, bringing the state’s COVID-19 death toll to 1,474.