UPDATE – Shortly after this article was published, the County of Hawaiʻi announced a large jump in COVID-19 cases identified on Hawaiʻi island, with an increase from 42 on Friday to 59 on Saturday. These are the numbers as reported by the county, which differ slightly from the state numbers. The state will publish its numbers at noon.

Hawaiʻi County Mayor Harry Kim said 27 of the 30 quarantined with active COVID-19 on the Big Island are associated with the Kona McDonald’s clusters.

(BIVN) – The active investigation of a cluster of COVID-19 cases associated with two fast food establishments in Kona – the Kona Commons McDonald’s and McDonald’s of Walmart – is continuing, says the Hawaiʻi Department of Health.

“A second case at the second location brings the total cases to 14,” said state health director Dr. Bruce Anderson during a Friday news conference, before the large jump in numbers was reported. “We now have 7 workers and 7 family members, who all lived in the same family, who have been found to be positive.”

The family lived in a “complex”, Anderson said, which was “actually two homes on a single piece of property.”

“This is another example of of what happens when a worker goes to work and works while they’re ill,” Anderson said. “Again, we haven’t finished this investigation and it’s likely we’re going to find others, as well, who have been exposed. But it is critical that we all stay home when we feel sick and and not expose others.”

“The way this all got started was one worker came to work and continued to work four days while they were actively sick,” Anderson explained, “and we all know that often the diseases spread between co-workers, who are working shoulder-to-shoulder often, and that’s a significant risk. The family members, of course, were gathering for meals and probably being exposed to each other in other ways.”

Although the State and the County have been reporting no hospitalizations on the Big Island as a result of COVID-19, Anderson said – after previously confirming one of the Kona cluster patients was flown to Oʻahu for treatment – that the “individual was a resident of the Big Island and should be in the Big Island stats.”

“As I remember it, one individual was hospitalized associated with that cluster,” Anderson said. “The most recent case, I believe, was not. When we report a hospitalization, we’re reporting where the status of the individual is at the time the case is reported. So that was probably a situation where the individual was in the hospital when we received the report and was a an individual from Kona who was sent to Oʻahu for treatment.”

Earlier this week, after announcing the cluster was identified at the two stores, officials confirmed the establishment closed its operations at both locations and was performing enhanced cleaning.

On Friday, Governor David Ige signed a fifth emergency supplementary proclamation in response to the COVID-19 pandemic, which contains this section on business operations:

C. Essential Business and Operations Requirements. In addition to the social distancing requirements set forth in the Third Proclamation, all customers and employees of essential businesses and operations identified in the Third Proclamation shall exercise the additional social distancing and protective requirements identified herein to the fullest extent possible:

1. Six-foot distances. Personnel shall monitor and enforce the six-foot distancing requirement set forth in the Third Supplementary Proclamation, whether in outside waiting lines or as customers move about inside a facility. Checkout operations shall be modified, to the extent reasonably feasible, to provide this separation or to provide a transparent shield or barrier between customers and checkout clerks.

2. Limited Customer Occupancy. Each essential business facility or operation shall determine the maximum number of customers that may be accommodated while maintaining the specified separation distance and limiting the number of customers in the facility or at the operation to that maximum number at any time.

3. Hand sanitizer and sanitizing products. Employees handling items from customers, such as cash or credit cards, shall frequently utilize hand sanitizers.

4. Disinfection. Essential businesses and operations shall regularly disinfect all high-touch surfaces.

5. Face covering. All customers shall wear a face covering as described and recommended in Section I.A., or as required by any applicable county order, while waiting to enter and while at an essential business or operation. All employees of essential businesses or operations who have any contact with customers or goods to be purchased shall wear the cloth face covering recommended by the CDC while at their place of employment.

6. High risk populations. Elderly customers, employees and others at high risk for COVID-19, including those who are sick, are urged to stay in their residences to the extent possible, except as necessary to seek medical care.

7. Online and remote access. Essential businesses and operations shall encourage their customers to do their business remotely by phone or online if at all possible.

8. Pickup at store or delivery. Essential businesses and operations shall provide for, if feasible, online ordering and purchase of goods and customer pickup of orders at a location outside the facility, or shall provide for delivery to customer locations.

9. Signage. Essential businesses and operations shall post a sign at the entrance of the facility informing all employees and customers that they should: avoid entering the business or operation if they have a cough or fever or otherwise do not feel well; maintain a six-foot distance from one another; sneeze and cough into their elbow; not shake hands or engage in unnecessary physical contact.