Intensive care units at nearly every hospital on Oahu were over capacity on Friday as Covid-19 cases rapidly spread, prompting dire warnings from Gov. David Ige and county mayors that more stringent measures may be needed if large gatherings over Labor Day weekend lead to new outbreaks.

Seven people died of Covid-19 Friday, with a seven-day average of nearly 870 new cases per day, according to the Health Department. Meanwhile, 446 Covid patients were hospitalized, a record number since the pandemic began in March 2020.

Mindful that holidays have historically led to greater spikes in cases, officials pleaded with people to adhere to Covid safety measures including wearing masks and maintaining social distance. Ige announced that anybody violating statewide limits of 10 people indoors and 25 outdoors would be fined $250.

Ige also said he would consider implementing broader stay-at-home orders and other measures if the number of hospitalizations hits 500.

“Because of Covid, the hospital systems across the state are in danger of moving toward the worst case scenario,” Ige said at a press conference. “If that happens, we have heard from our health care leaders that people will not receive the care that they need, and certainly some may die.”

Inside view of Straub Medical Center’s tent outside the Emergency room during Covid-19 surge.
Straub Medical Center and other hospitals have set up triage tents to help cope with the influx of patients as the delta variant causes Covid cases to spike. Cory Lum/Civil Beat/2021

Statewide, the health care system is already reaching crisis points.

Hilton Raethel, president of the Healthcare Association of Hawaii, said the state has a total of 223 licensed ICU beds. But as of Friday, there were 224 adults in ICUs.

Raethel told a panel of state senators Friday that Hilo Medical Center on the Big Island along with Adventist Health Castle, The Queen’s Medical Center, Wahiawa General Hospital, Pali Momi Medical Center, Straub Medical Center and Kuakini Medical Center on Oahu have all exceeded their licensed ICU bed capacity. Two additional hospitals are at capacity.

Only Tripler Army Medical Center and Kapiolani Medical Center have not reached that threshold yet. About half of all ICU beds in the state are occupied by Covid-19 patients. About 85% of those cases are unvaccinated.

Raethel said many Covid patients at hospitals who previously refused to get vaccinated ask for any treatments available to them.

He’s heard from hospital staff that some even ask to get vaccinated at that point.

“Some show up and say ‘Give me the vaccine,’” he said. “We say ‘It’s too late.’”

Raethel and state Health Director Libby Char said that while the state could try to create field hospitals, staffing would be a limiting factor.

To put things into perspective, Raethel said Covid hospitalizations in the state have risen 300% since Aug. 1.

Determing how much cases and hospitalizations will increase is a difficult science. Monique Chyba, a University of Hawaii math professor who works with the Hawaii Pandemic Applied Modeling Work Group, warned the senators that models showing projections for case counts should be used as an informative tool rather than one that accurately predicts the future.

But what’s certain is that small changes — an uptick in vaccination rates or mitigation measures — “can really impact the curve, and smush it down,” Chyba said.

State Health Director Libby Char said she and Raethel have pushed for more stringent measures to control the virus.

“Anything that would reduce the amount of person-to-person contact,” Char said, calling for a pause on any indoor activity that allows people to go without wearing masks in close proximity and for a prolonged period of time. She wasn’t more specific.

Department of Health Director Dr. Elizabeth Libby Char.
State Health Director Libby Char is calling for a pause on most indoor activities where people go prolonged periods with no masks. Cory Lum/Civil Beat/2020

Lt. Gov. Josh Green earlier this week proposed a 72-hour stay-at home-order for the Labor Day weekend. But Ige and county mayors have been reluctant to take such drastic steps with memories still fresh about the economic downturn that results from shutdown orders last year.

Government leaders are trying to balance the public’s health with the health of the local economy.

Ige noted that businesses in Hawaii have less access to federal paycheck protection programs than they did a year ago.

Honolulu Mayor Rick Blangiardi has said he is not in favor of a full economic shutdown or stay-at-home orders. But he said he is willing to ask the governor for new resrictions if the situation gets worse.

“We’re going into a holiday weekend asking people to use common sense and to use good judgment,” Blangiardi said. “If worse were to come to worse, I will be prepared to ask the governor for a curfew and to impose that.”

Many steps taken by the mayors to contain the virus have also been met with pushback.

Weeks of fierce protests against vaccine mandates have added to the concerns of the spread of the virus.

On Thursday, 250 people testified online before a Honolulu City Council meeting, while thousands more submitted written testimonies against vaccine requirements for patrons of restaurants, bars, gyms and other establishments.

Other mayors are considering similar programs.

Maui Mayor Michael Victorino said he would have more details on Sept. 15. As an example, Maui’s program would require customers entering restaurants to show proof of vaccination, but those who didn’t have that could sit outside or order takeout.

Kauai Mayor Derek Kawakami said the island has a so-called vaccine passport for events and is looking into the possibility of expanding it to other businesses.

Hawaii Island Mayor Mitch Roth said he’s considering a vaccine program, but is still worried about the potential effects on local businesses and workers.

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