Covid-19 cases have plummeted in recent weeks, raising hopes that the omicron-driven surge is nearing an end, but the daily death toll is reaching pandemic highs.

This spike in deaths comes weeks after the highly transmissible coronavirus variant pushed case numbers to pandemic highs, reaching a seven-day average of 4,725 cases mid-January, according to the latest state numbers.

The seven-day average now sits at 480 cases, a near 90% decline.

The drop prompted Honolulu Mayor Rick Blangiardi to say that he is inclined to drop the islandwide vaccine-or-test mandate for restaurants, bars, gyms and other venues in early March, according to Hawaii News Now.

Meanwhile, the state is reporting a weekly average of 7.3 deaths daily, with a near-record 16 deaths recorded Thursday, second only to a pandemic record of 18 deaths on Feb. 5.

Underlying Conditions

The current wave of omicron variant deaths is “not unexpected, because we’ve had so, so many cases of omicron,” state Department of Health spokesman Brooks Baehr said.

“There was a narrative out there that Omicron is not that bad,” he added. “When you’ve got that many cases, it’s still plenty bad.”

This weekslong delay tracks what the state has seen with previous surges, Baehr said. Multiple factors, such as the need to perform a toxicology test on some people who succumbed to Covid outside a hospital, make deaths a “lagging indicator.”

“Covid is a disease that progresses,” Baehr said. “First you get sick, you test positive, you may end up in a hospital, and you can be there for weeks before you succumb.”

Omicron is 91% less likely than the previously dominant delta variant to result in death, according to one study out of southern California pending peer review. Despite this, fatalities in Hawaii during the omicron surge that began in December are on track to meet levels seen with the delta variant, when averages peaked to over eight deaths a day.

Hawaii reported 193 fatalities in September as the delta variant deaths caught up, Baehr said. In the first 17 days of February, Hawaii already has reported 99 deaths.

Almost all those who died last week had underlying conditions that may have worsened due to Covid infection, with the vast majority over 70 years and older, according to state data.

“Because (older patients with underlying conditions) are high risk, their risk of dying is probably a hundredfold higher than somebody who’s healthy without an underlying condition,” said University of Hawaii epidemiologist Jim Davis.

According to the Healthcare Association of Hawaii, 151 patients were hospitalized with Covid on Wednesday. Of those, only 19% had received a booster shot, although 38% were otherwise fully vaccinated; 43% remained unvaccinated.

“You may end up in a hospital, and you can be there for weeks before you succumb.” — DOH spokesman Brooks Baehr

The state does not publish the vaccination status of those who die from the coronavirus. But with a report out of the United Kingdom showing the booster shot was 95% effective at protecting against death due to the omicron variant in people aged 50 and older, it is likely a significant portion had not opted for the additional shot.

“We’ve got almost 400,000 people in Hawaii who could get boosted … and they’re not,” Baehr said. “They would be doing themselves and all of us a great favor if they would go ahead and get themselves boosted because they’ll then enjoy that high level of protection.”

Restrictions Reconsidered

While about half of eligible Americans have received booster shots and nearly 80 million infections have been confirmed, The Associated Press reported that many more infections have never been documented. Those figures have led many experts to believe the latest surge is approaching its end.

In Hawaii, more than 75% of the population has been fully vaccinated and just under 36% has received a booster shot as of Thursday, the health department said.

There was some worry a subvariant of omicron, known as BA.2, might spark a renewed surge. But only 29 cases of the omicron cousin have been detected in Hawaii thus far, according to state data released Tuesday.

“It seems Hawaii’s high vaccination rate, coupled with people who have a degree of immunity from prior infection, may be preventing BA.2 from expanding rapidly or displacing the original omicron variant,” State Laboratories Division administrator Edward Desmond wrote in an email.

Despite this good news, Hawaii Gov. David Ige has not moved to roll back the state’s indoor mask mandate, unlike the majority of U.S. states.

Shaping the administration’s logic is that Hawaii has one of the lowest mortality rates in the U.S., which Baehr attributes to widespread vaccination and masking. That, and a sense of “deja vu.”

“We saw delta come and go in the fall. And now we’re seeing omicron came quickly and now it’s disappearing fairly quickly,” Baehr said. “We’ve seen this before.”

Blangiardi launched the Safe Access Oahu program in September but told HNN that he’s unlikely to extend the emergency order when it expires on March 5, although he stressed no final decision has been made.

“We are not quite out of this. We just want to get a little bit further before we make that call,” the mayor was quoted as saying. “We are pretty close, we are very close.”