The bulk of Hawaii’s coronavirus clusters are raging in jails and prisons in the islands.

The state’s latest cluster report released Thursday said that cases in correctional facilities made up 100% of all cluster investigations over the last two weeks on the Big Island. Covid-19 cases in prisons and jail also comprised 63% of all cluster investigations in Kauai County; 57% on Oahu and 31% in Maui.

Covid also is spreading in restaurants and bars, with the report highlighting how poor ventilation facilitates transmission among staff in those facilities. The state encouraged workers to follow federal guidance to avoid poorly ventilated spaces, but did not specify how food service workers are supposed to do that if they’re required to work in such spaces.

Covid is a respiratory illness that spreads more easily in crowded, indoor conditions like restaurant kitchens, but the state and city haven’t imposed any ventilation requirements on businesses since the pandemic began.

The Queen's Medical Center West Oahu Covid-19 triage tent.
Many hospitals, including The Queen’s Medical Center in West Oahu have set up overflow tents to deal with the high number of patients as Covid cases surge. Cory Lum/Civil Beat/2021

Thursday’s report comes at a critical time in Hawaii’s pandemic. Hospitals are overstretched and the highly contagious delta variant makes up practically every case statewide.

Cluster reports don’t account for every case but rather summarizes groups of infections that the state looked into over the past 14 days.

The Health Department usually doesn’t specify locations of Covid clusters, only broad categories. Officials previously have said that confidentiality helps with investigations, and they don’t think that specifying locations where transmission occurs will be helpful because people who get sick in one place spread throughout the community.

The Health Department did call out a Maui church by name earlier this year, saying it had to do so to prevent an imminent risk of further transmission.

Maui County was the only part of the state where other types of clusters were relatively large enough that correctional facility cases didn’t make up the majority of cluster cases under investigation over the past 14 days.

State investigators looked into 10 clusters of 92 cases in educational settings there, as well as 12 clusters of 90 cases among workers in the travel and hotel industry in Maui County, which has the lowest vaccination rate in the state.

The state emphasized that community spread among unvaccinated people is driving the pandemic in Hawaii right now, and previously said that tourists make up 1% to 2% of coronavirus cases. But the state has also acknowledged some risk from tourism —  Thursday’s cluster report described a restaurant in a “tourist area” as “high-risk,” and Gov. David Ige has discouraged tourists from traveling to Hawaii, a few of whom have been arrested for faking vaccination cards.

As of Aug. 26, 93% of Hawaii Covid cases since January were among unvaccinated people, compared with 7% among vaccinated people.

Poor Ventilation Fuels Virus Spread

On Oahu, restaurants were the second-biggest source of coronavirus clusters. The state pointed out the restaurant clusters are largely made up of employees.

“Food service workers’ risk of contracting COVID-19 has increased with the increased transmissibility of the delta variant combined with work environment risk factors, including small working areas, poor ventilation, and low vaccination coverage,” the cluster report says.

Poor ventilation is mentioned three times in the summary of clusters, including in the description of one seven-person cluster at a restaurant where five of 21 employees caught the virus.

“The restaurant has tight working spaces with poor ventilation, which probably contributed to the spread of COVID-19,” the report says. “The restaurant closed for almost a week resulting in negative financial impact for the owner and employees.”

The report urges restaurant workers to “get vaccinated, stay home if sick, avoid poorly ventilated workspaces, wear masks, practice physical distancing when possible (less than six feet), and avoid group events,” in accordance with federal guidance.

But the Department of Health didn’t say how exactly restaurant workers are supposed to avoid poorly ventilated workspaces if that’s where they’re required to show up to every day. Most people have returned to work since last year’s shutdown, and food service workers are a key part of Hawaii’s economic recovery.

In response to an inquiry about whether the Health Department would support ventilation requirements for restaurants, department spokesman Brooks Baehr said the agency recommends restaurants and businesses improve ventilation by opening windows and doors and using fans. An inquiry to Gov. David Ige was referred back to the Department of Health.

Bill Kunstman, spokesman for the state’s unemployment insurance program, said workers who quit due to unsafe working conditions such as poor ventilation may be able to receive unemployment checks, but it depends on the facts of each situation.

“It’s a case by case basis,” he said. “This is like a $64,000 question around the country.”

Breakthrough Cases

Mayor Rick Blangiardi’s administration didn’t reply to an inquiry about whether the mayor is considering ventilation requirements. But Blangiardi has imposed a requirement that beginning Sept. 13, employees and customers of restaurants and many other establishments must show proof of vaccination or a negative Covid test, with several exceptions.

Officials hope that will increase vaccination rates, which could help stem cases among food service workers.

At one restaurant, 24 of 29 employees tested positive. Another restaurant reported half of its 24 employees tested positive. Both had low vaccination rates among employees, according to the employer of both establishments. Nearly 80% of those cases were among unvaccinated people, the report said.

Hospitalizations and deaths also are far more likely to affect people who haven’t received the shots aimed at building immunity against the virus.

Still, the agency notes that vaccinated people can transmit the virus.

In one instance, a group of food service workers who were all vaccinated went to a karaoke bar, where they didn’t wear masks or maintain safe distances from each other. Seven of the 12 caught Covid.

“Vaccination reduces but does not eliminate the risk of becoming infected and transmitting COVID-19 to others,” the report said. “Everyone should take precautions to prevent COVID-19, including masking in indoor public places.”

But vaccination does protect against hospitalization and death for the vast majority of people, state data shows.

“Of the 2,419 cases involving fully vaccinated people, 68, or 3%, were hospitalized; 8, or 0.3%, died from COVID-19 related complications,” Baehr said.

He said none of the vaccinated people in that karaoke cluster were hospitalized or died.

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