Hawaii could see a wave of COVID-19 infections in 2021 double the size of the surge the state experienced this summer, local hospital administrators warned a panel of lawmakers on Friday.

Data analysts at The Queen’s Health Systems project admissions to their hospitals will double in the new year if current case trends continue, from more than 200 admissions per month to as many as 450 new admissions in January.

Those are projections for hospital admissions mostly among Hawaii residents, not visitors, according to Jill Hoggard Green, the president and CEO of The Queen’s Health Systems who presented the findings to the Hawaii Senate Special Committee on COVID-19 at a Friday briefing.

“We’re using a series of assumptions about how disease spreads, population and generally past pandemic curves that really show fall is an important time,” she said.

Another wave of infections could significantly test local hospital staffing levels. While hospitals in the islands have been able to expand bed space and make room by transferring patients to other facilities, the state has relied on travel nurses to supplement local staff this fall. Taking care of COVID-19 patients often demands more specialized nurses and doctors.

The Queen’s Health Systems, which includes four hospitals as well as health care centers on Oahu, Hawaii island and Kauai, currently has sufficient supplies for the next 90 days, Hoggard Green said.  To increase capacity, the Queen’s Medical Center created a $12 million infectious disease unit that opened last month.

But if infection trends continue to skyrocket elsewhere in the country, Hawaii could face other serious challenges, such as acquiring equipment and supplies, Hoggard Green said.

“What I’m most worried about is given the surge happening on the continent, the ability to get additional supplies right now starts to go down, and that’s what we experienced during the first part of the pandemic,” she said.

The Queen’s hospital system plans to bring on additional staff from January through March in anticipation of a surge.

Hoggard Green and Hawaii Medical Service Association’s President and CEO Dr. Mark Mugiishi emphasized to lawmakers that a surge can be avoided if there is widespread public adoption of masks, social distancing and hand washing, along with early contact tracing.

Sen. Jarrett Keohokalole said the projections were worrisome but the lack of public conversation about a future surge in cases was also alarming.

There’s usually a lag that lasts several weeks between when cases are diagnosed and when hospitalizations increase in the islands, according to Hilton Raethel, the president and CEO of the Healthcare Association of Hawaii. Hawaii also tends to see COVID-19 cases rise a couple of months after cases surge on the mainland.

Health care workers and clinic leaders are increasingly concerned about a rise in the percentage of tests that are coming back positive in Hawaii, along with the average number of daily new cases. Hospitalizations have started to “drift up a little,” he said.

“This is something we had predicted a few weeks ago because of a number of factors — one was what was happening on the mainland,” Raethel said. “Many states are having the worst months they’ve had in the pandemic.”

Hawaii hospital administrators estimate they will collectively experience $580 million in losses and additional costs directly related to the COVID-19 pandemic, according to the association. Federal relief funds are estimated to cover approximately one-third of that financial hit.

Hawaii health officials released a guide for a safe holiday season this week and recommended people either cancel in-person gatherings or limit the number of attendees.

“Part of what we’re dealing with is pandemic fatigue,” Raethel said. “It’s been going on for a long time and it’s really hard to maintain appropriate behaviors, even though people know what the right thing is to do.”