Hawaii hospital resources and staff are more stretched than they’ve been at any other point in the pandemic, prompting Hawaii to bring in more medical staff from the mainland to handle the growing COVID-19 cases and other patients.

The influx is prompting some hospitals to set up triage tents while the state is bringing in more than 500 nurses and other medical staff from the mainland as reinforcements.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said that while Hawaii hospitals were inundated with COVID-19 patients in the early stages of the pandemic, they had far fewer people hospitalized for other reasons, with fewer than 2,000 total patients statewide at this time last year.

Now, there are between 2,100 and 2,200 patients in Hawaii hospitals, including at least 1,900 non-COVID patients, Raethel said.

“Right now hospitals are really stretched across all the islands because they are already full and the COVID count continues to climb,” Raethel said.

Hilo Medical Center's new vacination site is below Hilo Medical Center at the Arc of Hilo. Photo: Tim Wright
Hilo Medical Center’s intensive care unit is full. Tim Wright/Civil Beat/2021

Coronavirus-related hospitalizations are also rising. As of Tuesday, there were 241 coronavirus patients in Hawaii hospitals, up 10% from the day before.

That’s six times more than July 1, when there were just 40 COVID-19 patients hospitalized statewide. Hospitalizations shot up exponentially in July and August as the delta variant spread. Still, daily hospitalization figures haven’t reached last year’s Sept. 8 peak of 315.

Unlike last year, the availability of ventilators isn’t a concern because so many of the cases are affecting young people. There’s a rubber glove shortage, but other personal protective equipment is generally available, Raethel said.

But the availability of intensive care unit beds is a concern, especially on Hawaii island, where 22 of just 24 ICU beds are already filled.

Nine of those patients are COVID-19 patients and 13 are non-COVID patients.

Monique Chyba, a University of Hawaii mathematics professor who is part of the Hawaii Pandemic Applied Modeling Work Group, said their analysis based on existing vaccination rates suggests hospital facilities on the Big Island could be overwhelmed as early as the end of this month.

Maui could be next, she said. Right now, just over half of Maui County’s ICU beds are in use, but the county has the lowest vaccination rate in the state at 55%.

“Right now all eyes are on Hawaii Island but I see Maui following in their footsteps,” Chyba said. “They seem to be just a little behind but getting there.”

No ICU Beds Left

At Hilo Medical Center, every single ICU bed is full. Elena Cabatu, spokeswoman for the Hawaii island hospital, said one ICU patient is being housed in the emergency room due to the lack of beds in the intensive care unit.

Four of the 11 ICU patients have coronavirus, including three who are long-haulers. Just last month, the hospital re-opened its COVID-19 unit where there are now seven patients, including a fourth long-hauler.

Cabatu said long-haulers on average are hospitalized about four weeks, but one has been in the hospital for more than 90 days.

None were vaccinated. In contrast, two patients who were vaccinated against COVID-19 were hospitalized for only a handful of days.

COVID-19 hospitalizations in Hawaii shot up in July. Click here for the interactive graph.  Courtesy: HI-EMA

“You can see how the unvaccinated are taxing the health care system,” Cabatu said.

Hilo Medical Center staff have been working overtime to handle the load, and the hospital is expecting additional health care providers from the mainland to start next week.

Raethel from the Healthcare Association of Hawaii said hospitals are partnering with the state and federal government to bring in ICU nurses, med-surg nurses, respiratory therapists and other staff to help manage demand, with the first group arriving in Hawaii this weekend.

In addition, some hospitals like The Queen’s Medical Center are already reducing their non-essential services in order to have enough capacity for rising coronavirus cases.

Hilo Medical Center hasn’t done that yet.

Get Vaccinated

Cabatu said she hopes more people get vaccinated to prevent further hospitalizations and deaths. At 57%, Hawaii County’s vaccination rate is second-lowest in the state, although the county had the state’s second-highest COVID-19 positivity rate as of Tuesday.

“People who are not vaccinated are really putting themselves and their loved ones at risk especially their keiki who cannot get vaccinated yet,” Cabatu said.

A sharp rise in vaccinations could temper the dire projections by the Hawaii Pandemic Applied Modeling Work Group.

What we’re seeing right now was totally preventable,” said Thomas Lee, an assistant professor of public health at the University of Hawaii and co-chair of Hawaii Pandemic Applied Modeling Work Group. “Where we go from here is really up to the unvaccinated population.” 

But Raethel said even if many people rushed to get vaccinated, the next few weeks will still strain the hospital system because of the time it takes for vaccinations to be effective.

“Even if we were to get a whole bunch of people vaccinated, the full impact of that is not going to kick in for a number of weeks,” he said.

Raethel supports Gov. David Ige’s decision to cap social gatherings at 10 people indoors and 25 people outdoors.

“Ideally from a public health perspective we’d go into a lockdown but that’s not going to happen,” he said, referring to a lack of political will for another shutdown.

He’s hopeful the lower limit on gatherings will help.

“The worst of this surge is still in front of us,” Raethel said.

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