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Hawaii’s hospitals are gearing up for a rise in COVID-19 patients as the omicron variant takes hold in the islands.
As of Tuesday, 60 COVID-19 patients were hospitalized statewide, with nine in intensive care units and seven on ventilators, according to the Hawaii Emergency Management Agency’s COVID-19 dashboard. Although considered manageable, that number is expected to rise in the coming weeks.
“If the infection rate and positivity rate continues to increase, then that is a very strong determinant of a subsequent increase in hospitalizations,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii. “The infection rate and positivity rate occurring this week will result in hospitalizations next week after Christmas. If there continues to be an increase, then in the new year we’ll get another bump from that.”
The nonprofit Healthcare Association of Hawaii, which represents health care providers, is particularly concerned about what happens between Christmas and the start of 2022, and is in crisis preparation mode.
Hawaii’s hospital beds are already full of noncoronavirus patients, according to Raethel, with 2,239 of about 2,600 available beds filled as of Tuesday, just shy of the 2,365 during the peak of the summer delta surge.
“Our hospitals are already pretty full and fairly close to the peak we had during the (delta) surge, which is why we’re very concerned,” he said. “It would be a surge on top of hospitals that are pretty full.”
Coronavirus cases spiked to a high of 972 on Sunday, 840 on Monday and 707 on Tuesday.
The highest infection count by island Tuesday — 647 — was on Oahu, where 49 omicron cases have been confirmed so far. The location of a confirmed 50th case has yet to be disclosed.
The seven-day statewide daily average of new cases jumped 540% over the past 14 days to 634, the state Department of Health reported Tuesday, and the average positivity rate grew to 7.0% from 4.2% Friday. Some health experts are expecting those numbers to rise even higher in the weeks ahead.
Tim Brown, an infectious disease modeler at the East-West Center in Manoa, predicts Hawaii’s case count will reach a new record high — higher than the peak of the delta surge — and that there probably will be 2,000 cases a day by Christmas at the current rate of growth if no further restrictions are implemented.
During a webinar Tuesday, he warned that the trajectory would be steeper compared with the delta variant, with cases doubling every one to two days, based on trends seen in other countries.
Although the omicron variant was discovered in South Africa less than a month ago, it has been detected in at least 95 nations and 47 U.S. states. It is on track to become the predominant variant worldwide by January, Brown said, including in countries like Denmark that have a relatively high vaccination rate.
The Hawaii Pandemic Applied Modeling Work Group on Monday updated its forecast models to take into account the exponential spread of the omicron variant.
HiPAM forecasts Honolulu coronavirus cases could grow to anywhere from 2,000 to 15,000 cases a day by Jan. 1. The former is the best-case scenario, and the latter is the worst-case scenario, depending on numerous variables including the transmissibility rate and effectiveness of vaccines.
HiPAM, a voluntary partnership of Hawaii-based epidemiologists, data scientists and health professionals, also forecast 90 to 800 COVID-19 hospitalizations a day on Oahu by Jan. 1, assuming a higher ratio of cases to hospitalizations, and 375 to 1,150 by Feb. 1 in the worst-case scenario.
The numbers cannot account for human behaviors or mitigations, which can affect the trajectory, the group said. There are also many uncertainties, such as the actual extent of the spread of omicron as well the unknown number of COVID-19 cases and hospitalizations among the vaccinated.
Staffing concerns
Raethel said the state’s largest vulnerability is a staffing shortage at Hawaii hospitals.
The association already set wheels in motion to bring additional medical personnel from the mainland to help care for COVID-19 patients as it did during the delta surge.
Over the summer, 740 staff from the mainland were flown in for temporary duty, thanks to funding from the Federal Emergency Management Agency. All FEMA funding ended in early November, Raethel said, and those workers went home except for about 200 hired directly by hospitals.
Hawaii will need to reapply for FEMA support, and the process of securing funding and staff could take two to three weeks, at minimum.
“Right now all indicators are that we’re going to need to bring in additional help,” Raethel said.
The Healthcare Association of Hawaii also is checking on personal protection equipment, talking with oxygen suppliers and making sure ventilators are ready to go. And hospitals are preparing to once again roll out triage tents and postpone elective surgeries if necessary.
When Hawaii hospitals have reached a total of 100 COVID-19 patients, he said that would be a trigger point for putting plans into action.
While Hawaii ended up with the best-case scenario of HiPAM’s forecast during the delta surge, Raethel said it’s possible omicron could be worse, adding that “things can move very quickly,” which is why the association is trying to get ahead of the anticipated surge.
Omicron threats
In a presentation Tuesday for the East-West Center, Brown said the omicron variant is concerning because it has massively transformed itself and contains more than 30 mutations on its spike protein, which penetrates host cells and causes infections.
Based on recent studies, protection from two doses of Pfizer and Moderna against omicron are less effective — as low as 35% effective for the former — unless followed by a booster.
This also holds true for the effectiveness of most monoclonal antibody treatments, he said, which studies found also waned against omicron. It is “far too early” to conclude whether omicron is less virulent than other variants, according to Brown.
This is why there needs to be more urgency in getting Hawaii residents boosted and why people need to be especially careful during holiday gatherings, he said.
As of Tuesday only 22.6% of the state’s population had received third vaccine doses, according to DOH. Of those eligible, the department estimates about 40% has received boosters.
According to an AARP analysis, only about 44% of nursing home residents in Hawaii — and 27% of nursing home staff — had received COVID-19 boosters as of mid-November. The number of coronavirus cases week to week in those settings was also on the rise in November.
“AARP calls on nursing homes, state and federal authorities, and others to increase access to and receipt of COVID-19 boosters for both nursing home staff and residents,” said AARP Hawaii State Director Keali‘i Lopez in a statement. “As new variants emerge and vaccine immunity wanes, the low number of residents and staff who have received a booster creates an unacceptable level of risk since the disease spreads so easily in these environments.”
DOH spokesman Brooks Baehr acknowledged the number of boosters administered in the state needs to be much higher. He said there are more than 500 locations statewide offering COVID-19 vaccines and boosters.
Brown said kupuna, especially those with underlying conditions such as diabetes, are particularly vulnerable during the omicron surge. He noted that two-thirds of COVID-19 deaths in Hawaii in the past six months have been among residents age 60 and older.
As for holiday gatherings, he warned that the combination of omicron’s contagiousness and the waning effectiveness of vaccines without boosters can result in outbreaks.
Holiday get-togethers and parties are at the top of the potential cluster list, along with restaurants where diners gather indoors without masks, and nightclubs, the source of two recent clusters in Honolulu.
Hawaii residents need to get boosted, Brown said, up their masking game with KN95 masks and avoid crowds. Also, extra care should be taken around kupuna. He suggested everyone take a rapid COVID-19 test at the door, just before gathering for a holiday party, if possible.
President Joe Biden on Tuesday announced that starting next month, the federal government would send 500 million free COVID-19 rapid tests to Americans and increase support for hospitals under strain. He urged all who are eligible to get vaccinated and boosted against COVID-19.
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