Hawai‘i’s Omicron cases rise to 74; Two specimens on Maui are under investigation

Hawai‘iʻs Omicron cases rise to 74;
Two specimens on Maui are under investigation

The Hawai‘i Department of Health’s State Laboratories Division has detected 24 additional cases of the SARS-CoV-2 variant B.1.1.529, also known as the Omicron variant, bringing the total number of confirmed Omicron cases in Hawai‘i to 74.

All Omicron cases detected thus far are on O‘ahu; however, an additional four specimens from Hawai‘i Island and two specimens from Maui contain a molecular clue indicating they are “likely” Omicron, according to health officials. Whole genome sequencing will be performed to determine if they are Omicron, with completion expected over the weekend.

“Itʻs been widely reported that when Omicron is introduced to an area, itʻs market share, if you will. The percentage of cases that are due to this variant doubles every 2-3 days, so within a week, it goes up about eight fold, and within a couple of weeks it becomes the dominant strain,” said Dr. Edward Desmond Administrator of the State Laboratories Division.

“The information that we have is probably behind what is going on on the ground. So thereʻs every reason to expect that itʻs likely very widespread at this point already,” said Dr. Desmond.

“We have been trying to collect specimens from neighbor islands,” said Dr. Desmond. “We have been trying to cast a net that includes neighbor islands to look for the presence of the Omicron variant there. I think thatʻs what resulted in our ability to get the specimens from Big Island and from Maui that show the molecular clue. But we’re not doing the variant detection on every single positive in the state. We just can’t.”

Health officials monitoring hospitalizations

As far as hospitalizations, Dr. Janet Berreman, Kaua‘i District Health Officer said, “I wouldnʻt hazard a projection as to when our hospitals will be overwhelmed, but we certainly have a very rapid rate of rise in our state, which is in fact exponential… is the clearest indication that Omicron is here and is a very significant contributor to the spread of COVID-19 in our community.”

“When that overwhelms our hospitals or whether that overwhelms our hospitals, in part depends on how busy our hospitals already are with people who are there without COVID. It also depends on how severe the illness caused by this disease is; and it appears that Omicron causes less severe disease. But as it affects so many more people so rapidly, it certainly is something all of us are keeping an eye on statewide,” said Dr. Berreman.

Statewide, there were 68 people hospitalized with COVID-19 on Wednesday (Down -85% from a peak of 448 on Sept. 4), according to Lt. Gov. Josh Green. This is now down -59% from the 165 hospitalizations reported on Aug. 5, 2021. The state’s positivity rate is now at 7.5%.

There are now four people hospitalized in Maui County with COVID-19, according to counts last updated at 9 a.m. on Dec. 22, 2021, from Maui Health. Three of the current Maui COVID-19 hospitalizations are in unvaccinated individuals. Of that number, one COVID-positive patient is in the ICU and no COVID patients are on ventilators.

Will our immune system still recognize this variant?

Dr. Michael Shea, Chief Medical Director at Maui Health explained that the Omicron variant is still SARS-CoV-2–the coronavirus that we have been dealing with. “This variant has 50 new mutations, so 32 of those are on the spike protein. The spike protein is the little nub on the outside of the virus that attaches to our cells and allows the virus to get inside. Itʻs also the protein that the vaccines were designed to mimic so that our cells would attack them.”

“The concern is that with all these changes, will our immune system still recognize this variant. Thatʻs the big question,” said Dr. Shea. “Itʻs a very contagious variant… Itʻs 50-75% more contagious than Delta and it seems to have a much shorter incubation period of about 2-3 days. Theyʻre comparing it to measles as far as contagion.”

According to the World Health Organization, Omicronʻs doubling time is 1.5-3 days. “That means the number of cases can double as fast as every two days… Preliminary data indicates that Omicron does not seem to cause as severe disease–that data is out of South Africa. The problem is that most of their population is younger, so we really haven’t seen a large population with aging or folks with a lot of co-morbidities. The UK has a population a little more similar to the US, so we’re anxiously awaiting data out of the UK to see what their hospitalization rates are,” said Dr. Shea.

Health officials say the ideal situation is that this causes mild disease and that everyone gets some immunity.

Citing data out of the UK, Dr. Shea discussed vaccine effectiveness saying, “If you had two shots of either of the mRNA or one shot of Janssen, you are only 0-20% protected. The good news is that if you have a booster shot of one of the mRNA vaccines, your protection goes up to 55-80%. Thatʻs a huge difference. That actually gets you to where we were with our original shots with the prior variants.”

For those with prior COVID infections, Dr. Shea said, they only have 19% protection against this variant. “Even one shot is better than nothing,” he said. “Unvaccinated folks face a 20 times higher risk of dying from COVID-19 and 10 times greater risk of testing positive than fully vaccinated people, according to a report in the CDC this week.”

“Booster shots are more important than ever. Please get your booster shot now. People who have received booster shots have much more protection from Omicron than those who have not yet gotten their boosters,” said Health Director Dr. Elizabeth Char, FACEP.

Rapid rise attributed to: gatherings, travel, loosened restrictions, Omicron

The latest 24 Omicron cases come from specimens collected from Dec. 7-13, 2021. “Omicron is circulating widely in all our communities. DOH expects Omicron cases to increase rapidly statewide,” state health officials said.

Hawaiʻi has had six consecutive days with triple digit case counts exceeding 700. There were 961 additional COVID-19 cases in Hawai‘i on Wednesday, including 866 on Oʻahu and 58 on Maui.

“We are seeing a very rapid rise in cases statewide and Dr. Char and others have attributed that to a combination of things, which is: holiday gatherings, more travel, loosening of restrictions, and the introduction of the Omicron variant into our communities,” said Dr. Berreman, “So if you will, thatʻs kind of a perfect storm for the exponential increase that weʻre seeing over the last several days.”

One of the main differences between Omicron and Delta variants is the speed with which it spreads, according to Dr. Berreman. “Given that it takes time to do whole genome sequencing once you get the samples, and it takes time to get the samples to the lab, what we’re seeing is the epidemiology of the Omicron variant is ahead of our ability to confirm it in laboratories. Thatʻs not through lack of doing good effort. Our lab is doing a high percentage of whole genome sequencing by national standards and we should all be proud of that, but the Omicron variant moves so quickly that we canʻt keep up with it in real time,” she said.

“So in saying that Omicron is likely spreading widely already in our communities–we say that based on the fact that we have detected these cases here and that weʻre seeing exponential growth so widely in our community,” said Dr. Berreman.

She added, “Anticipating a rapid increase in cases is not dependent on finding a confirmed case. So on Kauaʻi, we donʻt have any suspect or confirmed cases (of Omicron) in the cue for whole genome sequencing yet, and yet we are seeing rapid rise in our cases. So I am assuming, and we are assuming that Omicron is already here… and Maui and the Big Island and Oʻahu and the state–from the Department of Health perspective–is assuming the same thing.”

Maui Restrictions Under Consideration

Maui Now asked Mayor Michael Victorino if restrictions for business or travel are on the table for discussion, given the rapid rise in COVID cases. He responded, saying both are being considered.

“Also, really trying to put the responsibility or the kuleana on our peopole–our residents–to make sure they do what is right, because a lot of it is community spread,” said Mayor Victorino.

“There are some areas of concern on Oʻahu such as night clubs, bars, and all of that–which is transferring here to Maui County. So there are strong indicators, but there are no clusters at this time, so I would hate to punish someone or to take someoneʻs opportunity away from them because somebody else is having a problem somewhere else,” he said during a news briefing on Wednesday afternoon.

“We are monitoring and watching. We have a plan and are ready to move should the numbers continue to stay up there, and we start taxing our medical facilities,” said Mayor Victorino. “Letʻs say by no later than Monday, if any changes need to be made, we will be announcing it at that time.”

DOH encourages safe holiday celebrations

The Hawai‘i Department of Health issued a list of safety reminders ahead of the upcoming holidays.

The department provided the following list of safety guidelines to guard against COVID-19 during holiday get-togethers:

• Limit gatherings to household members
• Celebrate with fully vaccinated & boosted people
• Gather outside
• Wear masks inside
• Maintain distance
• Take extra precautions to protect kupuna and those who can’t get vaccinated

“Please, if you are eligible for a COVID-19 booster shot, get it now. Protect yourself and show aloha for family and friends by exercising caution this holiday season,” said Health Director Dr. Elizabeth Char, FACEP.

Find information on COVID-19 vaccines and tests at www.hawaiicovid19.com or https://www.mauinuistrong.info on Maui.