Hawaii is experiencing a new surge in COVID-19 cases with some of the highest daily counts since the pandemic began. And with in-person instruction in schools about to start this week, the potential of greater spread of the coronavirus to unvaccinated children is a possibility that cannot be ignored.

It may be time to ask an inconvenient question: Are we really headed in the right direction with this pandemic?

President Joe Biden in early April began the pivot to promising that America would get back on track with efforts to deploy vaccines to all adults. His promise of “no more confusing rules, no more confusing restrictions” boiled down to “get vaccinated, or wear a mask until you do.”

The strategy appeared to be working. As vaccine eligibility opened for all adults, we saw the dynamic difference it made with positive cases across the country dropping from 70,260 new cases on April 19 to a low of 7,580 cases reported on June 19. Americans relished in what seemed to be the nearing of the end of the pandemic.

Perhaps the decline in COVID-19 cases and the success of the vaccines made people too lax, and maybe some hesitating to get the vaccine thought that the decline in positive case numbers made it OK to do so.

Vaccination rates began to slow — and then the Fourth of July weekend came. Americans – including in Hawaii – cast off all restraint and partied hard like Ewoks in “Star Wars” celebrating the destruction of the Death Star. Pandemic? What pandemic!

Amid a lull in cases and medical advances last summer, Dr. Ashish Jha, director of the Harvard Global Health Institute warned that “we may be done with the pandemic, but the pandemic is not done with us.”

That statement has continued to be prophetic in 2021 as we saw COVID-19 cases skyrocket following the Fourth of July, as well as the mass proliferation of the highly infectious delta strain, which now accounts for 82.2% of all cases in the United States and 85.4% in the Department of Health and Human Service’s Region 9, which includes Hawaii.

Biden and the Centers for Disease Control and Prevention walked back dispensations for fully vaccinated people to go around unmasked after it became clear that concentrations of the delta strain in the nasopharyngeal region of vaccinated patients — so-called breakthrough cases — was almost identical to those who had not been inoculated. In plain English, some vaccinated people can spread delta just the same as unvaccinated.

Pandemic? What Pandemic!

Prior to this discovery, CDC director Dr. Rochelle Walensky had told Americans mRNA vaccines were so effective in clinical trials that a fully vaccinated person couldn’t spread COVID-19. Biden’s chief medical adviser, Dr. Anthony Fauci, explains this contradiction as “the science didn’t change, the virus did.”

And that is what should worry Hawaii residents.

State health officials have said the number of vaccinated people getting the virus is extremely low, but two policy areas of concern arise.

First, are we going to experience a “cliff effect” where people who were in the early Phase 1a group that received vaccines are going to see a marked drop in antibody protection that might make them open to a serious infection?

At present, U.S. health officials dismiss the need for a third booster shot. “Americans who have been fully vaccinated do not need a booster shot at this time,” the CDC and the Food and Drug Administration said in a joint statement.

As someone who grew up in a military and public health family background, I’ve seen enough politicianese over the years to know when someone adds the precise “at this time” caveat, that’s when you start to worry.

People who already have had a mild case of COVID-19 have shown lower levels of protective antibodies after just a few months of recovery, which means getting COVID-19 is not a lifelong pass against reinfection.

And if fully vaccinated people can have breakthroughs at the peak of their immunity, what happens a few months down the road when exposed to delta? As it is, Dr. Fauci, in a cleverly worded explanation, already has said that Israel has seen “some dimunition in protection” leading to the use of a third booster shot.

If Israel has already started giving a third COVID-19 shot to their president and to people over the age of 60 without waiting for the U.S. to say it’s safe, do they know something we don’t? This is an area that seems to need more urgent scientific study to provide clarity.

Hawaii House Vice Speaker John Mizuno said by phone while in Las Vegas that he has witnessed firsthand multiple instances of breakthrough infections among vaccinated people and seen the fear that delta has wrought on the mainland. Concerned with the recent trends of new cases in the islands, Mizuno said he “definitely supports research into whether booster shots will be necessary for Hawaii’s early vaccination groups.”

The second policy question we need to consider is whether a continued spike in cases presents an opportunity for new variants of concern to mutate and develop higher resistance to existing mRNA vaccines? Right now, the gambit has been that if we persuade enough people to get vaccinated, maybe that will kill off the COVID-19 pandemic and we won’t have to worry about future variants of concern.

But unfortunately, not enough people have been getting vaccinated, and COVID-19 is still mutating. The people of Hawaii need to know that when it comes to new strains, there are still plenty of letters left in the Greek alphabet.

And if our population is not going to comply at high enough rates, those of us who are vaccinated need to know what our next steps are going to be in the coming months.