More than half of Washington counties are now poised to begin lifting some coronavirus restrictions, but stubbornly high rates of infection in many major population centers underscore the uneven and local nature of the statewide epidemic.
While Pacific County recorded only a single infection since May 3, King and Snohomish counties are nowhere near the low levels of cases Gov. Jay Inslee set as one of the criteria for applying to move to the second phase of his four-phase recovery plan. Neither are Yakima, Franklin and Benton counties.
"We're not sure how we're going to get there," said Rick Dawson, senior manager for surveillance and investigations at the Benton-Franklin Health District, where the rate of new infections is six times higher than Inslee's threshold target.
Yakima County, which has been averaging more than 75 new infections a day in recent weeks, would need to drop below two new cases a day to qualify. King County's average daily rate of more than 60 new infections would have to be whittled down to 16.
It's not clear yet whether every county will be required to meet the threshold, which was based on Centers for Disease Control and Prevention guidelines for reopening after transmission rates have been reduced to what the agency calls a "low-incidence plateau": Fewer than 10 new infections per 100,000 people over a 14-day period.
"The criterion recently used to allow additional counties to apply for a variance ... will not necessarily be the criterion used to lift the Stay Home, Stay Healthy order," Washington State Health Officer Dr. Kathy Lofy said in a statement Friday. "We are actively discussing what the criterion might be."
Inslee also made it clear that not all counties are likely to proceed to the second phase -- with more businesses opening and small gatherings allowed -- by June 1.
"As I have repeatedly said before, these are decisions that are driven by public health data and science, not by the calendar," he said in a statement Friday. "Counties that continue to have large numbers of infections are not in a position to open up stores, restaurants and services safely."
Snohomish County meets some of the criteria for early reopening, including having ample protective gear and hospital capacity in case of another surge in novel coronavirus cases, officials said Friday in a briefing. Testing and contact-tracing capabilities still fall a bit short of recommendations, but the biggest problem is infection rates, said health district officer Dr. Chris Spitters.
"We're about three-and-a-half times above where we need to be" he said. "I don't see us passing that line ... by the time we reach June 1."
King County is in the same boat, and health officials are trying to identify and target the groups and communities currently at highest risk of infection. About a third of recent cases are in nursing homes, another third are among households where someone else is infected and the remainder are essential workers, said Dr. Jeff Duchin, health officer for Public Health -- Seattle & King County.
And for every infection confirmed, there are between 10 and 15 that are undetected, he added.
"Although the public may feel like the outbreak is being well controlled, it's still lurking -- very, very dangerously -- just beneath the surface," he said.
Statewide, the number of confirmed new cases has been stuck at an average of about 200 a day since mid-April -- which likely means 2,000 to 3,000 people across Washington are actually being infected daily.
To chip away at those numbers, health officials are increasingly targeting workplaces, to reduce transmission among essential workers who don't have the luxury of avoiding others. King County is putting more effort into helping businesses take precautions and pinpoint clusters of cases as soon as possible, Duchin said.
The Benton-Franklin Health District recently distributed 6,000 masks to farmworkers and has been helping employers with infection control measures. But at the same time, Dawson said, he's increasingly seeing videos of softball games and other gatherings popping up on social media.
"We're certainly worried about that," he said. "Single events can have a significant impact on our community."
People west of the Cascades are also getting restless.
"You can just look around you and see there are more people out and about and doing things," Duchin said. As long as people keep their distance, being outside is actually a good thing -- because the risk of transmission is lower, he added.
But in the face of greater mobility and interaction, the key to bringing disease levels down is quickly identifying new infections. However, testing has actually declined recently in King County, even though the capacity remains high, Duchin said.
"We would like to see more people coming forward to be tested," he said.
Health agencies across the state are beefing up their contact tracing, which is more essential than ever to slowing the spread of the virus. The Benton-Franklin Health District has been doing a good job of alerting people who may have been exposed, but now needs to step up efforts to provide daily reminders urging those folks to self-isolate, Dawson said.
King County staff are now following up with contact tracing for about half of newly confirmed local cases, with state health department staff handling the rest. The county is also running a pilot project that involves gathering much more detailed information from infected people, in the hopes of better identifying the major, ongoing risk factors and exposures, Duchin said.
Statewide, 574 people were hospitalized for confirmed or suspected COVID-19, the disease caused by the novel coronavirus, as of May 20, according to the Washington State Hospital Association. In Seattle, the total is about 200, Duchin said.
Dr. Chris Dale, chief quality officer for Swedish Health Services, said their census of hospitalized COVID-19 patients was 62 on May 20, down from a high of 175 during the pandemic's initial peak. Like most other medical centers across the state, Swedish has ample capacity for future cases, even as elective surgeries are resuming.
"It will require vigilance," Dale said. "We are paying close attention to the numbers and what we're seeing in the community."
Duchin said the Inslee/CDC criterion for infection rates is a reasonable target to shoot for. But it might not be achievable within a reasonable period of time when measured against the economic and social costs of ongoing shutdowns.
"Ultimately, if we are not able to get to that magic number of 16 cases per day, but we see that we're still able to manage because we've got capacity in our health care system and in our public health system and our vulnerable populations are not experiencing outbreaks that are overwhelming us," he said, "then I think we'll have to consider moving forward -- very carefully."