Hawaii’s COVID-19 cases leveled off, but masking was still called for

Although daily averages of new COVID-19 cases in Hawaii are falling, health officials are warning the public that levels are still high enough to warrant indoor masking.

The state’s seven-day moving average for new cases fell to 832 on Wednesday, marking the third consecutive week of a downward trend, according to the Hawaii Department of Health. The average reflects new cases per day over a period from June 11-17.

The state’s average positivity rate also fell to 17.1%, according to the DOH, compared to 18.9% reported on June 15, marking the second straight weekly decline. The positivity rate reflects test results from a different set of seven days – June 14-20.

DOH also reported 15 more deaths on Wednesday, bringing the total coronavirus death toll to 1,489.

Based on trends over the past few weeks, health experts believe cases in Hawaii have plateaued — at least for now.

On June 16, the Hawaii Pandemic Applied Modeling Work Group said daily cases were leveling off in Honolulu, Maui, and Hawaii counties. Kauai County has also been on a plateau, the working group said, with daily cases declining slightly, but assuming reinfection occurs six months after initial infection, a potential new spike could soon be on the horizon.

Because Kauai County experienced the largest surge of omicron BA.1, it is expected to be the first county to experience a reinfection phase, HiPAM said, but noted that this was “purely an estimate.”

Hospitalizations appeared to be leveling off this week, with the state dashboard reporting 196 patients with COVID-19 in hospitals in Hawaii on Wednesday, up from 218 the previous Wednesday. Of the 196, 10 were in intensive care and three were on ventilators.

The highest daily number of hospital admissions came on June 16, with 225 COVID patients, according to the Healthcare Association of Hawaii. The seven-day moving average for the week was around 200.

HAH expects hospitalizations — a lagging indicator — to continue increasing into July, but doesn’t expect them to hit the same highs seen during the delta rise.

The U.S. Centers for Disease Control and Prevention on Wednesday still ranked counties of Kauai, Honolulu, Maui and Hawaii as high-level communities for the impact of COVID-19.

According to CDC guidelines, people living in high-level communities should wear a well-fitting mask in indoor public places and on public transportation, regardless of vaccination status. Those in mid-level communities should consider masking based on personal risk.

The community-level rankings — based on case counts and hospitalization rates per 100,000 and percentage of hospital beds occupied — are updated every Thursday.

Tim Brown, an epidemiologist at the East-West Center in Manoa, warned that transmission rates are still high across the islands and the matter should not be downplayed.

“We’re still in a very epidemic situation, but we’re downplaying it,” Brown said during Honolulu Star-Advertiser’s “Spotlight Hawaii” live webcast, which aired Monday. “We’re acting like there’s nothing going on, but the reality is people should be masking.”

Brown estimated Hawaii is probably about a week away from the peak of the current surge, but said the way down will be slow.

“Even though we’re down, it’s slowly going down,” he said. “We’ll likely still have high community spread rates through mid-July as we’re declining now.”

In addition, the unknown effects of the omicron subvariants BA.4 and BA.5 still need to be considered, leaving the question of whether the downtrend will continue or not.

Omicron subvariants BA.4 and BA.5 are on the rise in Europe, he said, driving up hospital admissions in Portugal and Ireland.

Nationwide, BA.4 and BA.5 are also on the rise and now account for about 35% of new coronavirus cases in the US, while BA.2.12.1 accounts for 56%, according to the latest data from CDC.

DOH’s variant report states that BA.4 and BA.5 are estimated to be about 1.6 and 1.8 times more transmissible than BA.2, respectively, and may have an increased ability to evade antibodies raised by vaccination or previous infection were caused.

BA.2.12.1 is now the dominant lineage in Hawaii, accounting for 57% of the variants circulating in the state, but cases of BA.4 and BA.5 are increasing.

According to the latest report, there are now 24 confirmed cases — nine of BA.4 and 15 of BA.5 — in Hawaii through genome sequencing by the DOH’s State Laboratories Division — triple the number in the previous report.

While the two variants were previously only spotted in Hawaii and Honolulu counties, they are now present in all four major counties — most in Honolulu, four in Hawaii County, two in Maui County, and one in Kauai County.

Many epidemiologists are concerned about the ability of the newest omicron subvariants to evade immunity and encourage reinfection.

dr Eric Topol, a professor of molecular medicine at Scripps Research in San Diego, is concerned about a new study on COVID reinfections.

The study, which has not yet been peer-reviewed, analyzed more than 5.6 million people from the US Department of Veterans Affairs database. Divided into cohorts with primary infections, reinfections and an uninfected control group, the study showed an increased risk of repeated infections.

“We show that reinfection carries additional risks for all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and multiple extrapulmonary organ systems compared to people with primary infection,” the authors concluded in their abstract.

Therefore, “Reducing the overall burden of death and disease from SARS-CoV-2 will require strategies to prevent reinfection.”

Topol said these results are concerning because reinfection was fairly rare before the arrival of the Omicron wave, but reinfections have now become much more common.

“Omicron BA.2, BA.2.12.1, BA.4 and BA.5 have progressively increased immunity and there is limited cross-immunity with BA.1, the Omicron version that about half of Americans become infected with early has in the year 2022,” Topol wrote in his newsletter Ground Truths.

Brown emphasized the importance of continuing to dress up and empowering more eligible Hawaiians. This up-and-down cycle could potentially go on for years, he said, if transmission continues.

“Right now, this calm attitude is actually contributing to the faster development of the virus,” he said, “and therefore helping to circumvent our existing protective measures.”

The DOH, meanwhile, gave the green light to vaccines for Hawaii’s Keiki ages 6 months to 4 years after federal approval on Saturday. Hawaii Pacific Health, pediatric offices and others are now accepting appointments.

As of Wednesday, 77.9% of Hawaii’s population had completed their primary COVID-19 vaccination, with 41.2% receiving one shot and 8.6% receiving two.

DOH estimates that approximately 80,000 children under the age of 5 are currently eligible for the vaccines.

Websites offering COVID-19 vaccines and boosters are listed online at hawaiicovid19.com/vaccine.