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As Hawaii reported a record number of COVID-19 cases, Gov. David Ige called it an “alarming” reminder that the pandemic is not over and warned the state may need to consider reimposing restrictions if hospitals become overwhelmed.

On Friday, the state announced its highest daily number of infections — 622 — since the pandemic began last year. Officials stressed that number included a backlog of cases due to lab reporting delays earlier this week.

However, even with the previous undercounts, Hawaii had an average daily case count of more than 300 over the last three days and a seven-day positivity rate of 5.1%, Department of Health director Dr. Libby Char said in a joint press conference with Ige.

“The trend is clearly increasing versus what it was a week ago, or two weeks ago, and that’s really what we’re most concerned about,” she said, adding that 25% of the recent cases were children.

Despite the spike in cases, officials announced no major changes in COVID-19 safety restrictions but warned that may change if the situation worsens.

“I can assure you, at the point that I believe the hospitals have more patients than they would be able to handle, then we would take specific action to restrict movements again as necessary,” Ige said without elaborating.

Hawaii also reported that three men, all with underlying conditions, had died from COVID-19, raising the total death toll during the pandemic to 537.

The Hawaii Emergency Management Agency reported that hospitals across the state are at about 60% ICU bed capacity with hundreds of ventilators still available.

Hilton Raethel, president of the Healthcare Association of Hawaii, cautioned that the numbers are not an accurate reflection of hospital capacity because they don’t account for staff shortages.

Out of approximately 3,000 licensed beds across the state, Raethel said they only have staff for about 2,000.

“We’re very worried because hospitals are full anyway,” Raethel said. “So, we have plenty of ventilator capacity — that’s not the issue — and we also have ICU capacity. What we’re starting to run into is staffing capacity.”

Char said that cases will continue to climb if people continue to refuse vaccination, noting that most hospitalizations are patients who weren’t inoculated.

The  showing that fully immunized people who catch the delta variant may transmit the coronavirus as easily as those without vaccinations.

But Char said the number of vaccinated people getting infected is relatively low in Hawaii.

“We’re seeing roughly six people out of 10,000 getting infected, if they’ve been fully vaccinated,” Char said. She added that for unvaccinated people, that number increases to about 300.

Mayor Rick Blangiardi said that Honolulu is at a crossroads and he’s now “seriously considering” vaccine mandates for city employees.

“We at the city are committed to be models of responsible citizenship and aloha and will take the lead in stopping the spread of the virus and variant for the sake of our island and our residents,” Blangiardi said in a press release.

Ige also said he is continuing discussion on whether to implement a vaccine mandate for state workers. Until then, he said he’ll be limiting his public gatherings and outings, encouraging the community to follow suit.

“That rapid increase in COVID cases, is what keeps hospital administrators and myself awake at night,” Ige said. “And the best way forward is for people to get vaccinated.”

Raethel, meanwhile, said health care workers are exhausted and burned out after a year and a half on the front lines of the pandemic. “Are we losing some people? Yes, we are,” he said.