Hawaii health care leaders are bracing for increases in Covid-19 hospitalizations as the omicron variant surges throughout the state, with four deaths and a record 4,789 cases reported on Thursday.

While hospitalization rates remain below previous peaks, officials said it’s inevitable the number will increase along with case counts. Further complicating the situation are staffing shortages and a scarcity of outpatient treatments such as monoclonal antibodies and recently approved oral antivirals.

Over the past 14 days, coronavirus cases are up 555% in Hawaii County, 432% in Maui County, 397% in Kauai County and 129% in Honolulu. The statewide Covid test positivity rate was 18.5% on Thursday.

Brooks Baehr, spokesman for the Health Department, said the spike reflects some people infected during New Year’s celebrations last week and he expects to see more in coming days.

He noted that Thursday case counts are often higher than other days of the week because of the public’s testing habits and when cases are reported by labs.

“Buckle up. And more importantly, mask and boost,” Baehr said. “This roller coaster is still climbing.”

Hawaii’s coronavirus data suggests the omicron variant is correlated with fewer hospitalizations than the delta variant, reflecting similar trends nationally and internationally. Still, Covid hospitalizations climbed to 236 Thursday, according to the Healthcare Association of Hawaii. During the peak of the delta surge they reached 436 on a single day.

Health care officials estimate 30-40% of Covid hospitalizations are breakthrough cases, where patients are vaccinated, but the majority of people hospitalized for Covid continue to be unvaccinated.

A larger percentage of Covid hospitalizations also are incidental — meaning the patient went to the hospital with a non-Covid illness but was diagnosed with the virus after being tested — compared with the delta surge.

The stress on the hospital system is a key concern for Hawaii leaders in part because hospitals are relatively full with non-Covid patients and the highly transmissible variant is also putting many health care providers out of work. The state has requested additional funding for health care workers from the Federal Emergency Management Agency.

The state also reported Thursday that four more people have died of Covid-19. The omicron variant is milder than the delta variant of the coronavirus, but it’s still severe enough to kill, particularly people who have pre-existing health problems and haven’t been vaccinated.

Preventing Hospitalizations

Like other states, Hawaii is suffering from a shortage of outpatient treatments for Covid, including monoclonal antibodies and oral antivirals that were just approved for use against Covid, says Hilton Raethel, president and chief executive officer of the Healthcare Association of Hawaii.

Raethel said monoclonal antibodies are typically infused into the bloodstream through an IV, a process that can take up to three hours, including an hour of observation. But only one type of monoclonal antibody treatment appears to be effective against the omicron variant, driving a national shortage of the treatment.

The limited availability of Covid medicine has prompted a process by which the federal government allocates drugs to each state and then the state works with health care leaders to allocate drugs to each hospital.

“It’s frustrating that we cannot treat everyone that we believe will benefit,” Raethel said. “It is very highly probable that we’ve had hospitalizations and potentially even deaths in this state because of a shortage of drugs.”

He doesn’t expect the supply of new antiviral pills to meet patient demand until April.

Changing Recommendations

The shifting pandemic is continuing to drive changing federal and local public health recommendations. Adults who got Pfizer vaccines at least five months ago are now eligible for boosters. Previously they had to wait six months to get boosters.

The Health Department has for more than a month recommended that all adults get boosted if they received Moderna or Pfizer vaccines more than six months ago or Johnson & Johnson vaccines more than two months ago.

The Health Department is now recommending that kids age 12-17 receive boosters as well.

The agency is investigating clusters of cases associated with concerts and other large gatherings, including Hawaii’s Finest Music Festival at Bishop Museum and its after party at Moani’s Waikiki on Dec. 17 and 18; a live concert at Paddlers Restaurant and Bar on Molokai on Dec. 18; and patrons, vendors and guests at the Plantation House on Dec. 20 on Maui.

The state’s latest cluster report released Thursday also details clusters at shelters on Maui and Hawaii Island.

Hawaii’s political and health care industry leaders are hoping to entice more people to get vaccinated and boostered, which can prevent severe illness, hospitalization or death from Covid.

Queen’s is offering vaccinations at the Blaisdell Medical Center and appointments can be made online.

Hawaii Pacific Health is hosting a mobile vaccine clinic on Saturday at Manana Elementary School between 9 a.m. and 12 p.m., as well as providing vaccinations at Kapi‘olani Medical Center for Women & Children, Straub Medical Center and Wilcox Medical Center.