Unique pattern of COVID-19 infection in the State of Hawai'i.

This is a brief report of an unusual observation of COVID-19 infection in Hawaii. The State of Hawaii is one of the most remote of the Pacific islands with approximately 1.4 million persons. The racial and ethnic diversity is enormous. For example, the white Caucasians make up ∼25%, Asians including Japanese, Chinese and other Asians ∼30%, Hawaiians 20%. Pacific Islanders, mostly from Micronesia and Samoa, comprise ∼4%. We discovered that COVID-19 population rates in this group were up to 10 times the rate in all the others together and made up almost 30% of cases. This unique pattern is illustrated in the only figure. Moreover, we are unaware of COVID-19 transmission from the Pacific Islanders to the other island ethnicities. It is an epidemic within an epidemic in the Island.