The state Department of Health recommends masking in public indoors during the current coronavirus pandemic, even with average case counts trending down.

During a Honolulu Star-Advertiser “Spotlight Hawaii” conversation Friday, Health Department Director Dr. Elizabeth “Libby” Char said that not only is masking easy to do, but reasonable, with the current high levels of COVID-19 in the community. “Masks work,” Char said. “We know that they work. They help to reduce the transmission — absolutely wear your mask, especially indoors, and even outdoors if you’re going somewhere crowded and you’re around a bunch of people you don’t normally stay with.”

DOH advises masking, especially with all major Hawaii counties currently ranked as orange, high-level communities for COVID-19 risks.

She said, however, that bringing a mask mandate back would be difficult, and would require the governor to declare another emergency proclamation to enforce it. Hawaii’s indoor mask mandate expired March 25, along with the emergency proclamation related to COVID-19.

Average case counts have trended down the past three weeks, she noted, from a seven-day average of 1,210 on June 1 to a seven-day average of 832 on Wednesday. However, she estimates those case counts are likely five to six times higher with home test results factored in.

At the same time, Char is keeping an eye on the rise of more transmissible omicron variants BA.4 and BA.5, which were first detected in January in South Africa. BA.4 and BA.5 are concerning because they are believed to be about 1.6 and 1.7 times more transmissible, respectively, than BA.2, and have an increased ability to evade immunity.

“Really, what we’re concerned about is that immune evasion,” Char said. “So far, the vaccines still confer good protection, but we’re seeing more and more cases of reinfection.”

People who have been previously infected with COVID-19 should not assume they are bulletproof. “You absolutely can get reinfected, especially with these subvariants,” she said. “Because of that we’re really keeping an eye on it. Could that lead to a bunch more cases in the next few months and into the fall? It’s a possibility.”

Nationwide, BA.4 and BA.5 now make up about 35% of new coronavirus infections. According to the variant report, published Wednesday, there are now 24 confirmed cases— nine of BA.4 and 15 of BA.5 — detected via genome sequencing of COVID-19 test specimens from Hawaii.

“We saw a big spike in South Africa and Portugal and it was attributed to BA.4 and 5,” she said. “We’re starting to see some cases in the U.K. right now and again across the U.S. we’re starting to see some states tick back up again.”

Char also said she strongly recommends parents get their keiki under 5 vaccinated right away, following federal approvals by the Food and Drug Administration and Centers for Disease Control and Prevention. Shipments of the vaccines arrived earlier this week and are available at providers statewide.

“I think we have a good amount of evidence from the FDA and from the studies that were done and the trials, that these vaccines are safe and that they’re effective,” she said. “I really don’t see a reason to wait at this point.”

Given the time it takes to get all of the doses — two doses four weeks apart for the Moderna vaccine and two doses three weeks apart for the Pfizer vaccine, followed by a third at least eight weeks later — it makes sense to get them now for protection before preschool and day care begins in the fall.

Additionally, the Moderna COVID vaccine is now available for kids ages 6 to 17. The Pfizer vaccine has already been available to those in this age group.

Char also acknowledged that long COVID, or long-term effects following coronavirus infections, is a genuine concern.

“I think that’s where it’s really disingenuous when people say, ‘Oh, COVID is no big deal, it’s like catching a cold, who cares? … That may be true for some people, but we also need to be cognizant that some people may end up with long COVID — and that can affect your quality of life and your ability to lead a normal life” for weeks, months or even years.

Given there’s no effective treatment for long COVID as of yet, she said, it’s important for the community to work together to prevent infection and “ride through this.”