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Brian Keaulana, a waterman and community leader from Makaha, thought he had been through the worst of the pandemic when his father-in-law died from COVID-19 in February.

But Keaulana has been devastated to see the Westside suffer the highest number of new coronavirus cases over the past two weeks amid a nationwide surge that health officials blame largely on unvaccinated people and the aggressive delta variant.

On Thursday, the reported 365 COVID-19 cases in the three main neighborhoods that comprise the Westside within the past two weeks — nearly a quarter of the 1,532 cases on the island.

Waianae had 132 cases, the most of any other area on Oahu, followed by Ewa with 129 and Kapolei with 104. Those neighborhoods also have among the lowest vaccination rates on the island, between 35% and 45%.

Jacob Schafer, the director of infection control at the Waianae Coast Comprehensive Health Center, said the numbers are only a fraction of the active cases spreading throughout the community due to asymptomatic carriers and those infected who are not tested.

“Looking at epidemiological models, the true number is usually anywhere from six to 24 times that,” Schafer said. “So, based on the models, there’s probably about 1,000 active cases out there.”

Schafer said it’s been a “nightmare” for contact tracers trying to keep up with the rapid spread.

“By the time you identify a positive case, they’ve become sick, and they’ve started to spread this on to other people around them,” he said, adding that 15% of those who tested positive had been vaccinated.

Health officials say the recent spike, which followed months of relatively low numbers that had raised hopes, is largely due to the delta variant as well as a slowdown in vaccinations.

“The areas where there’s the most COVID really coincides conversely with the areas that have the least vaccination,” Schafer said.

He also attributed the rise in numbers to “pandemic fatigue,” noting that most people are tired of masks, social distancing and limited gatherings.

Keaulana believes that one reason people in his community are resistant to getting vaccines is years of perceived neglect as the area has long faced disparities in housing, education, health and infrastructure compared to wealthier areas.

“There’s a lot of lost trust,” Keaulana said.

The former lifeguard captain urged people to get the vaccine, calling it a life saver.

“You’re gambling with not only your life, but the people you’re surrounded by — people that you love,” he said.

A team from the Centers for Disease Control and Prevention traveled to Oahu this week and will spend next week on the Westside collecting data for a rapid community assessment. Their team is gathering information from Native Hawaiian and Pacific Islander communities to understand the practical and social reasons behind vaccination hesitancy.

Leinaala Kanana, director of community health services at the Waianae center, also noted that many households in the community are multigenerational, creating a larger net of shared views across different age groups.

“By the time you identify a positive case, they’ve become sick, and they’ve started to spread this on to other people around them.” — Jacob Schafer, Waianae Coast Comprehensive Health Center

Kanana frequently speaks with people who are hesitant to take the vaccine. She said some are fearful of possible negative long-term effects while others may feel threatened by what they feel is strong “propaganda-like” messaging from the government.

Many also have expressed feelings that vaccination conflicts with their religion, she said.

“A lot of people will end up changing their minds if there’s an incident in their family or in their close friends’ bubble that really hits home,” Kanana said.

On Thursday, all Waianae Coast Comprehensive Health Center employees received notice by email that they must get vaccinated by Oct. 1 due to the uptick in community spread, Schafer said, advising anybody experiencing minor symptoms like headaches or coughs to get tested.