Hawaii’s sharp rise in Covid-19 cases in July was largely fueled by cases in correctional facilities, restaurants, an indoor wedding reception and an indoor concert where the band wasn’t vaccinated, according to the state’s latest report on clusters.

The state reported four more Covid deaths on Thursday, and more than 750 new cases. Covid hospitalizations hit a record single-day high at 352, according to the Hawaii Emergency Management Agency.

The highly contagious delta variant now makes up 93% of recent Covid cases in the islands, according to the new variant report released this week. Health officials say community transmission is responsible for the latest surge.

“We are certainly at a critical juncture,” Sarah Kemble, state epidemiologist at the Hawaii Department of Health, told reporters on Thursday.

Dr. Sarah Kemble, acting state epidemiologist, says Hawaii is at a “critical juncture” in the pandemic. Eleni Avendaño/Civil Beat/2021

Hawaii hospitals are struggling to handle a combination of Covid and non-Covid patients, with Straub Medical Center operating at up to 125% of its capacity. Meanwhile, the Hawaii Fire Department ordered three morgue trailers to prepare for a potential increase in casualties, Hawaii News Now reported.

The surge has caused some to question whether the state and counties should strengthen restrictions on socializing. House Speaker Scott Saiki has called on Gov. David Ige to limit access to establishments like restaurants and gyms to people who have been vaccinated.

On Thursday, Kemble said that Saiki’s suggestion “certainly is one way to improve safety and reduce transmission of Covid.”

She said policymakers must weigh the cost and benefits of such decisions but added, “I think we need to find a way to have social gathering sizes reduced.”

Hawaii currently caps indoor social gatherings at 10 people and outdoor social gatherings at 25, but exceptions abound. Event organizers may allow hundreds or thousands of people to attend indoors and outdoor events, as long as they submit mitigation plans.

Offices may allow more than 10 people indoors. Bars and restaurants may do so also, as long as they’re below 50% of their capacity, regardless of how well or poorly the spaces are ventilated.

Jails and prisons were the site of the biggest Covid clusters under investigation over the last 14 days: 120 cases on Oahu, 99 on Maui and 50 on Kauai.

During that time, the state also found that 10 separate clusters at Oahu restaurants spawned 97 cases.

“They’re almost exclusively in staff,” Kemble said of the cases in restaurants, noting that crowded conditions in the back of restaurants contribute to spread.

Hawaii’s pandemic has disproportionately affected certain communities of color, including Pacific Islanders and Filipinos, that tend to work in the service industry.

The spike in coronavirus cases also comes as people are returning to work, as tourists have returned to the islands and many businesses have resumed operations after months of relatively low numbers.

Hawaii’s unemployment rate dropped to 7.3% on Thursday, still far above pre-pandemic levels but far below pandemic highs.

Unvaccinated Wedding Attendee Dies

Resuming pre-pandemic life has come with risks, particularly for those who are not vaccinated.

One July cluster the state investigated involved 23 people at a concert at an Oahu bar, including staff, customers and band members. Twelve of the 16 people who tested positive at the bar and seven people who were infected secondarily were unvaccinated.

“Band members performed while sick and shared microphones and instruments, which probably contributed to COVID-19 spread. None of the band members were vaccinated,” the report said.

That cluster was linked to two more groups of cases at a workplace and another concert, the report said.

An indoor wedding held at a banquet hall involved 17 cases. Fewer than a third of wedding attendees were fully vaccinated and 76% of those who tested positive were unvaccinated. One unvaccinated person was killed by the virus.

“A member of the wedding party and their spouse both had COVID-19 symptoms and exposed the bride and groom during wedding rehearsals held at the same venue,” the report said “Family and friends who attended the wedding events expressed a false sense of security because they knew everyone in attendance.”

The new cases reported Thursday raised the state’s total to 53,598, with 558 deaths.

Booster Shots for Some

Health officials emphasize vaccination, which is free and available to all Hawaii residents who are at least 12 years old regardless of their ability to pay or immigration status, is the best way to prevent the virus from spreading.

But as more people who are vaccinated catch the virus, Hawaii residents who got the shot worry about their risk of being a breakthrough case.

The state doesn’t report what percentage of people who test positive are vaccinated or unvaccinated in its daily case counts because case investigators don’t get that information immediately.

Kemble said the state sometimes gets that information in follow-up calls if they are able to reach the infected person.

“Overall if you look at the total number of people vaccinated in the state, we’re still tracking about 0.2% of breakthrough cases out of all of the people who have been vaccinated,” she said on Thursday.

State data shows unvaccinated people make up 90% of hospitalized Covid patients in the state.

New guidance from the Centers for Disease Control and Prevention says some people may need extra shots.

Kemble said Thursday that immunocompromised people should get booster shots of the Pfizer-BioNTech and Moderna vaccines at least 28 days after their second dose.

The Washington Post reported that President Joe Biden’s administration is expected to announce booster shots will be recommended for most Americans.

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