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Public Health Essentials

A place to highlight the work of the Snohomish Health District as well as share health-related information and tips. Have an idea or question? Drop us a line at SHDInfo@snohd.org.

Jun 30

Working Toward Phase 3 of a Safe Start for Snohomish County: June 30, 2020

Posted on June 30, 2020 at 8:56 AM by Kari Bray

The three-week monitoring period between Phase 2 and Phase 3 of the Safe Start reopening plan has passed, but Snohomish County is not currently in a position to apply for Phase 3. 

There are specific metrics the county must meet to be considered for approval by the state for Phase 3. These include case rate per 100,000 residents, case investigation and contact tracing, and testing. As of the last two-week reporting period for this data (June 2 to 16), we are not meeting several of those metrics.

  • While our case rate was below the limit of 25 per 100,000 for a few weeks, we have recently seen an increase. For the period of June 2 to 16, the rate went up from about 22 per 100,000 to 23.6 per 100,000. If we look at June 13 to 27, we’re at 39.
  • Testing levels should be 50 tests per confirmed case. We’re at 37 tests per case.
  • The goal is to contact 90% of positive cases within 24 hours of receiving a positive COVID-19 test results. We are at 43% in the June 2-16 report.
  • As for the percentage of cases responding to daily monitoring, the target is 80% and we’re at 68%.
The economic impacts of the health and safety measures put in place during this pandemic have been felt throughout the county. We know that many are eagerly awaiting the next phase to bring more people back to work and resume more activities.  

We do hope to get there, and the Health District and County will continue monitoring the metrics and preparing an application to be ready for when we can submit it. But we are not there yet.

Snohomish County residents and businesses should expect to remain in Phase 2 at least through the Fourth of July weekend.

“Proceeding at maximum velocity into Phase 3 would be quite risky at the present moment given these recent findings,” said Dr. Chris Spitters, Health Officer for the Snohomish Health District. “We need a week or two to assess and control the current situation, monitor the trend in new daily case reports, and track COVID hospitalizations.”

We want to talk a bit about how to get ready for Phase 3. We also want to share some reminders that are essential if we want to continue moving forward in the phased reopening plan. 

Our success relies on keeping some level of social distancing, enhanced hand-washing, cleaning and sanitation, cloth face covers, and other health measures in place through all of the phases. 


Why reopen in phases? 
Governor Jay Inslee has laid out the phased Safe Start Washington plan. As counties are able to demonstrate that they meet requirements for health and safety, they can apply to move from one phase to the next. 

A phased reopening allows us to monitor the impact of COVID-19 as we resume more in-person interactions and have more opportunities for the virus to spread. Between Phases 2 and 3, we’ve been tracking key metrics and reporting weekly to the state.  

The key metrics include: 
  • COVID-19 cases confirmed in the last two weeks (rate per 100,000 county residents) 
  • Trends in hospitalizations and hospital/health care system capacity 
  • Testing capacity and availability 
  • Case and contact investigations, including turn-around time from the positive lab results to the case investigation and notification of contacts 
  • Outbreaks reported per week in workplaces, congregate living, or institutional settings. 
Weekly reports are now provided online on our case counts page so you can see where we’re at with those metrics. They are generally posted on Fridays. 

How can we work together be ready for Phase 3? 
Businesses not previously approved to re-open would be able to do so in Phase 3, except for nightclubs and events with more than 50 people. However, all businesses must follow health and safety guidelines, and that means there still would be limitations.  

All businesses need to develop and keep on site a written safety plan to prevent the spread of COVID-19. A template is available online to fill out. The plans are not intended to be submitted to the Health District or another agency for review or approval, but must be provided during any inspection by a regulatory agency. 

The Department of Labor and Industries (L&I) also has workplace safety information, and individual business plans cannot be any less strict than what is outlined by L&I.  

Businesses also must follow industry-specific guidance released by the state. Don’t see any guidance for your industry? Refer to the health and safety plan template and the L&I guidance linked above. 

The cap on gatherings also would increase in Phase 3. However, there are some important things to know: 
  1. Small gatherings are safer than large gatherings, regardless of what phase we’re in.
  2. Outside is generally less risky than indoors.  
  3. People who are at higher risk for severe illness (those who are older than 60 or who have underlying medical conditions like diabetes, heart disease, lung disease, or kidney disease) should avoid gatherings. 
  4. The cap would be 50 per event or gathering in Phase 3, not 50 at one time. We’ve received questions about whether an event could let in 50 people and, as people leave, let in additional people to fill those spots. No. The total attendance for the gathering may not exceed 50. 
  5. Health and safety guidance still must be followed during gatherings. That means physical distancing (6 feet of space between people) as much as possible, cloth face covers, readily accessible handwashing stations, and frequent cleaning and sanitizing of high-touch surfaces. 
  6. Do not attend a gathering if you have any symptoms or if you have been notified that you are a close contact of a confirmed case. 
Some events have separate guidance from the state, including faith-based organizations and weddings and funerals.

What about the Fourth of July?
The Phase 2 gathering rules apply – no more than five people outside of your household in a seven-day period. That means a small get-together with family or a few friends is allowed to celebrate the holiday, but not a large barbecue or festival. That’s a damper on many plans, we know. However, a large gathering can spread COVID quickly. One positive case at a gathering can mean that dozens of people need to quarantine, get tested, and may potentially become ill and spread the illness to others in their own households or social circles. 

Consider celebrating with small backyard barbecues or picnics, or other outdoor activities that allow for plenty of space between you and others who are not in your household. And remember the maximum limit on non-household members: five or less. Check your city’s website or social media to see what Fourth of July options they may have. Some have planned fireworks displays or parades you can enjoy from your own yard, or contests and activities you can take part in from home. Or watch fireworks displays online from cities around the country.

Will we be in Phase 3 soon? Is Phase 4 next? 
Not necessarily. The phased approach to reopening is not linear. It is meant to be adaptable so we can adjust if the spread of COVID-19 increases and there is a need to put stricter health measures back in place.  

After we receive approval for Phase 3, when that time comes, the state still has the authority to move Snohomish County back into Phase 2 or Phase 1 if needed. This could become necessary if cases increase again.

As we look ahead, particularly to the fall and winter months when respiratory illnesses like COVID tend to spread more rampantly, renewing stricter measures may be needed to preserve hospital/healthcare capacity and prevent a surge in severe illness and deaths related to COVID. The state also recently announced that they are not allowing any counties to enter Phase 4 at this time. 

So how do we keep moving forward? 
Keep up with illness prevention measures and approach reopening with an understanding that this pandemic is not over.
  • Staying home is still the safest option. Use your best judgment about the need to participate in a social gathering, the risk to yourself and others, and alternative activities that may be less risky.  
  • Support businesses that are taking the right steps. Many business owners and workers have put in tremendous effort to keep customers safe. Now is a good time to frequent those businesses or recommend them to friends and family. However, if you go to a place of business and notice that they are not meeting health guidelines, like if they are not requiring employees and encouraging customers to wear face covers, don’t patronize that business. You may also submit a complaint through the state online at https://coronavirus.wa.gov/how-you-can-help/covid-19-business-and-worker-inquiries
  • Wash your hands. You’ve heard this countless times during the pandemic, but handwashing is one of our most useful tools in reducing the spread of illness. So wash with soap and warm water for at least 20 seconds, and bring hand sanitizer with you if soap and running water won’t be available. 
  • Clean and sanitize. Whether you are at home or at work, be sure to clean up and wipe down high-touch surfaces at least daily. That includes counters, doorknobs, handles, light switches, remotes, phones, keyboards and touchpads. 
  • Wear a cloth face covering. It’s now required statewide. This helps contain the droplets from your mouth and nose that are most likely to spread the virus, which means you are protecting those around you. When they wear face coverings, they help protect you, too. 
  • Stay home if you are ill. If you have any symptoms of COVID-19, contact your medical provider about getting tested or go to www.snohd.org/drive-thru-testing to sign up for an appointment.  
  • If you test positive or if you are notified by public health that you are a close contact of someone who has tested positive, follow instructions to isolate or quarantine, and respond promptly to calls or texts from public health staff.  
As we look to what is coming for the rest of the summer and into the fall and winter, we know that things will continue to change. We will need to adapt, and that will likely bring new challenges. 

Planning for the continued response to this virus includes face coverings and physical distancing, in some capacity, for the foreseeable future. There is no magic “return to normal” date. We need our community to persevere in the efforts that have gotten us this far.  

We also want to extend our gratitude: Thank you for all you have done and continue to do to fight COVID-19. 
Jun 25

Cloth face covers required. What to know: June 25, 2020

Posted on June 25, 2020 at 4:42 PM by Kari Bray

Wearing a cloth face cover in public has been a strong recommendation for a couple of months, and now it’s the law. A new statewide public health order goes into effect Friday, June 26, that requires people to wear a cloth facial covering in public.

There is a lot of great information out there, including from the Washington State Department of Health, the Centers for Disease Controls and Prevention, the Department of Labor and Industries, Governor Jay Inslee, and Restart’s #WearAMaskWA Initiative. We encourage you to check out those resources and review the information below.

Are cloth face coverings required in Snohomish County?
Yes. The order is statewide. The Snohomish Health District supports the order.

“Wear cloth face coverings when out of the home, especially when you're indoors in public places, like shopping, but also when you're outdoors if you cannot maintain a sustained gap of six feet between you and all others,” said Dr. Chris Spitters, Health Officer for the Snohomish Health District. “When I do that, I’m protecting you. And when you do that, you’re protecting me. It's about all of us working to protect each other. So even if I'm not worried about me getting sick, I can't make that decision for other people.”

What kind of cloth face covering should I wear?
Good news! There are a lot of options. If it covers your mouth and nose and does not have holes or gaps, it counts. That means a sewn cloth covering with ties or straps, which you can make or buy, qualifies. A scarf or bandana works, too. The key is to make sure that you can wear it over your mouth and nose comfortably for a stretch of time.

If you are in a field like healthcare or emergency response, you may have professional grade personal protective equipment for work. People who do not need to wear medical grade masks should not do so. It is still important to prioritize those for healthcare and first responders.


Does everyone have to wear a face cover?
Just about everyone, yeah. Unless you meet one of the exceptions, the face cover order does apply to you.

Exceptions are:

  • Children younger than 2 years should not wear one.
  • Children ages 2-4 are not required to wear one, but it is recommended that they do so in indoor settings where 6 feet of separation cannot be maintained from non-household members.
  • People who have a medical condition, mental health condition, or disability that prevent wearing a face covering do not need to wear one.
If you see someone who is not wearing a mask, do not assume that they are ignoring the order. They may have a valid reason.

Do people have to wear face covers at work, school or child care?
Yes, you need to wear a cloth face cover if you will be around other people during work, school or child care. You do not need to wear a cloth face cover in your car, at home, or outdoors if you have plenty of space from other people.

Schools were closed through the end of this school year, but we are looking toward the fall. Staff, students and visitors are required to wear face coverings in schools. Check out the Reopening Washington Schools 2020 District Planning Guide for more information. And remember to watch for updates from your school district about fall plans.

As for higher education, monitor guidance from the state and from your higher education institution. Face covers will be required in common areas but not in closed dorm rooms.

At child care facilities, young children (under age 5) are not required to wear face covers, and babies or toddlers (under age 2) should not wear them. However, staff and children age 5 or older must wear face covers at child care, preschool or day camps when they are indoors. More health and safety information is available in the Guidance for Child Care and Early Learning and the FAQ for Child Care Facilities and Other Youth Programs.

But how do I eat?
There are times when you can take off your face cover in public locations. If you are seated at a food establishment – where tables are required to be distanced – you may remove your face cover to eat and drink. If you are doing outdoor activities and can keep at least a six-foot distance from others, you may remove the face cover. If you or the person you are interacting with is deaf or hard of hearing, you may remove the face cover if it is essential for communication. For a full list of when people may remove their face cover in a public setting, see the public health order.


Do face covers work?
The research thus far says yes. The science supports the importance of wearing cloth face covers, and public health officials are confident that face covers can reduce transmission of the virus.

The reason they help is straightforward. We know that COVID-19 and other respiratory illnesses spread largely through respiratory droplets that leave our mouth when we speak, cough, sneeze, sing, shout, and breathe. Even if we can’t see them, we spread these droplets – which can carry the virus if we’re infected. A cloth face cover over our mouth and nose captures the majority of the droplets and reduces the likelihood that they will carry the virus to someone near us.

Cloth face covers are an extremely useful tool for helping during this pandemic. We know they aren’t perfect. They don’t filter the air like a medical grade mask, and their primary job is not protecting the wearer. Their purpose is to protect those around the wearer by reducing the range of potentially virus-carrying droplets. And since people can be infected with COVID-19 without showing symptoms, wearing a cloth face cover helps prevent unintentionally spreading the virus. 

Will wearing a cloth face cover put me at risk? What about lack of oxygen or overload of carbon dioxide?
No. Wearing a cloth face covering is extremely unlikely to restrict oxygen or cause you to breathe excessive carbon dioxide. They are not airtight.

You may be uncomfortable wearing a face cover, especially when you are first getting used to it. Covers should be easy to put on and remove. If you feel dizzy or lightheaded, sit down at least six feet away from other people and remove the cover.
If you have concerns that an existing respiratory condition or other health issue will make wearing a cloth face cover problematic, please contact your medical provider with questions.

And no, wearing a face cover isn’t shown to increase your risk of illness. Any germs that get trapped are the ones that came from you, and it won’t weaken your immune system by protecting you from other germs you need to build immunity. Don’t sell your immune system short. It, and you, will be fine without those extra germs.

It is important to avoid fidgeting with the face cover while wearing it, and to wash and dry it between uses. You don’t want to transfer germs to your hands and then to other surfaces you touch.

Don’t forget to also keep up with handwashing, cleaning and sanitizing high-touch surfaces, and physical distancing (at least six feet from others).

What if I see someone who isn’t wearing a face cover?
Enforcement of the face cover requirement is a challenge, and we know that can be frustrating. The statewide public health order carries the force of law and violators may be subject to criminal penalties. However, remember that there are exceptions and people may have an allowable reason not to wear one.

Here are some resources and tips:
  1. If someone isn’t wearing a cloth face cover, don’t confront them. The safest thing to do is maintain your distance. Wear your own face cover and lead by example. They may have a good reason for why they cannot wear one. Be kind.
  2. If you are an employee and your workplace is not enforcing health measures, you can contact the Labor & Industries Call Center to submit a health and safety complaint: 1-800-423-7233.
  3. If you are a customer and have a concern about a business that is not following health measures, go to the state’s online form for Business and Worker Inquiries and select “File a complaint against a business.”
  4. Also, if you notice a business is not following health measures – for example, if employees are not consistently wearing face covers and customers are not being actively encouraged to do so – do not patronize that business. Support the many business owners and workers who are taking the right steps to keep you healthy.
We know that cloth face covers aren’t comfortable for everyone. We also know that many people don’t like being told to wear one in places where they’ve never had to mask up before. This pandemic has required all of us to make changes to our routines in order to protect our loved ones and our community.

Yes, you should wear a cloth face cover because it’s the law. You should also wear a cloth face cover because it is kind. Face covers, hand washing, physical distancing, cleaning and sanitizing – these are all important tools to protect others. Please use them all.
Snohomish County DEM staff in face covers
Jun 19

COVID-19 & Testing - Who should be tested, how to get tested, and more: June 19, 2020

Posted on June 19, 2020 at 10:29 AM by Kari Bray

Testing is one of the key pieces of the COVID-19 response, and it is something that has changed and expanded over time. Testing will continue to play a crucial role in reducing the spread of illness, responding to outbreaks, tracking this pandemic, and – ultimately – being able to reopen more of our economy and activities.

COVID-19 testing is much more widely available now than it was in the early days of the pandemic. Snohomish County currently has more testing capacity than demand. In some ways, that can be good news, as it may signal that fewer people are in need of testing. But ideally, we want to be testing more people so that we can track the status of COVID-19 in the community. It shapes our understanding of this pandemic and informs our efforts to curb the spread of this disease by isolating cases, identifying their contacts, and making sure they're quarantined.


How much testing do we need?
The goal is to conduct about 50 COVID-19 tests for every positive case in the county. We’re currently at about 25 to 30 tests being done per case, but there is capacity through medical providers as well as Health District testing sites to reach that 50-per-case level. 

The goal is to test to the point where we are catching as many new cases as possible before they spread the virus. That means we want to test people with symptoms, people who are close contacts of confirmed cases, people who are at higher risk of infection based on where they live or work – more on that later in the “Who should get tested” section. Ideally, we’d like to see a lot of testing, but not a high positivity rate. If you have 50 tests per positive case, that’s a positivity rate of 2 percent.  

Getting the testing numbers to where we’d like to see them in order to feel more confident in reopening requires people to access testing when they need it. 

Who should get tested for COVID-19?
The highest priority for testing is still people with symptoms. If you are ill with any of the following symptoms, please seek testing as soon as possible. 
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
The exception is if your symptom is clearly attributed to an existing condition and is not unusual for you. For example, people may experience headaches or have limited taste or smell due to existing conditions, so the symptom is not new and they do not necessarily need to be tested for COVID-19. 

However, if you do experience one or more of these symptoms and they are not attributed to an existing diagnosis, get tested even if those symptoms are mild. Also, if you are not sure whether something is related to an existing condition or whether it may be a new illness, talk to your medical provider and consider getting tested for COVID-19.

People without symptoms may also need to be tested.
There are a number of people who do not have symptoms but should consider testing because they are at higher risk of being asymptomatic or pre-symptomatic cases. This means they could be unknowingly spreading the illness to others.

People who should consider testing even if they do not currently have symptoms include anyone who:
  • Is a close contact of a confirmed case
  • Lives in a congregate setting, like a shelter, group home or assisted living facility
  • Works in a location that has had a case
  • Is part of a family or social network that has had a case
  • Works in healthcare, EMS, law enforcement or other fields with a higher risk of catching or spreading COVID-19
  • Is part of a racial or ethnic group that has been disproportionately impacted by this virus in terms of rate or severity of cases (this includes people who are Black, Latinx, Native American/Alaskan Native, or Pacific Islander)
  • Requires testing for employment or travel
  • Requires testing prior to a medical procedure.
People also may be tested in a healthcare setting at the discretion of their medical provider. This could include pregnant women who are going into the hospital for labor and delivery, or people who will be participating in procedures or tests that may generate a cloud of droplets and increase risk of transmitting the virus.

Why not test everyone?
A couple of reasons. First, while testing capacity has much improved, resources like supplies, lab capacity, and staffing are not limitless. We need to ensure that there is plenty of capacity for people who are symptomatic or who fit into one of the other categories above. That is the most effective use of testing for disease control.

Also, the test for COVID-19 is highly accurate, but it is not perfect. There can be false positives, though they are rare. Applied over a population of 800,000-plus people in Snohomish County, even rare false positive results would add up and outnumber true positive results, diverting resources for public health follow-up toward these misidentified cases and requiring some people to isolate and quarantine unnecessarily.

How do people get tested?
Most testing continues to be done through medical providers. You can contact your regular healthcare provider or local clinic to ask about testing. Please call ahead and follow instructions from your provider, particularly if you are experiencing symptoms. It is also a good idea to check your provider or healthcare organization’s website. A number of them have information regarding their COVID screening and testing, and some have online screening tools or risk assessments. 

For those who do not have a regular healthcare provider or otherwise need another testing option, the Snohomish Health District is offering drive-thru testing sites on multiple days each week. These testing sites use nasal swabs that are sent to a lab, and results are expected to be communicated back to people within 2-3 days. The Health District’s testing sites are being operated with volunteer support from the Medical Reserve Corps and in an ongoing partnership with Sno-Isle Libraries and Snohomish County Parks and Recreation. 

Schedules for drive-thru testing, and the link to register for an appointment online, are available at www.snohd.org/drive-thru-testing

If you are severely ill, do not wait to set up an appointment or hear back from your medical provider. People in need of urgent care should go to an urgent care clinic, hospital emergency room, or, in a medical emergency, should call 911. 

Won’t more testing make it harder to reopen things?
We’ve heard some concerns that more widespread testing will detect more cases, thereby triggering renewed restrictions on business and activity. 

To be clear: Do not avoid testing if you have symptoms or fit into one of the other categories for which testing is recommended.

In order to continue reopening, we need to maintain adequate testing. This is crucial to meet the state’s requirements for moving through the phased Safe Start reopening plan. More importantly, it is an integral piece of monitoring outbreaks, intervening, and reducing the spread of this disease. Widespread testing has been found to be a key ingredient for success in nations where COVID-19 has been well-controlled.

If people avoid testing and cases are not identified, we will still find out when there is an uptick in transmission – but instead of learning in time to take action, we will learn when numbers of emergency calls, hospitalizations and deaths begin to go up. Avoiding testing is not a good way to encourage opening the economy. In fact, it is likely to have the opposite effect. 

Do I have to quarantine if I get tested?
Yes. While you are waiting for your test results, you need to stay home and avoid close contact with others. 

What if I’m a close contact of a confirmed case but my test comes back negative?
A negative test result can be a big relief, but it does not mean you are able to ignore the required 14-day quarantine period for close contacts of a confirmed case. It can take up to 14 days after exposure for symptoms to develop. If you are tested five days after your last exposure to a confirmed case and get a negative result two days later – so seven days after your last exposure – you still need to quarantine at home and monitor for symptoms for the remaining seven days of the quarantine period.

If you are tested as a precaution but you are not notified that you are a close contact of a confirmed case, you should quarantine until you receive your result but may end your quarantine if your test comes back negative. An example would be if there is a case in your workplace and you are tested as a precaution but were not in close contact with the case. For an asymptomatic person who is not a contact to a case and who is waiting for results, it would be acceptable for them to do essential errands as long as they follow guidelines for use of face coverings, physical distancing, and hand hygiene when they leave home.

What does the test entail?
The most common test is done with a nasal swab. At the drive-thru testing sites, a mid-nasal swab is used. A trained staff member or volunteer will provide you with a sterile, sealed swab and a small container of liquid. You open the swab and insert it about halfway into your nose. It is uncomfortable (speaking from experience) but shouldn’t be painful. You wiggle the swab around in one nostril, then the other. Then you deposit it into the container of liquid and screw the cap on tightly before placing it into a bag, sealing it, and returning it to the staff member or volunteer. From there, the specimens are sent to a lab for processing.

Some people may be interested in serology or antibody tests, which involve drawing blood and testing for antibodies. These would indicate a past infection rather than a current one. The Snohomish Health District does not offer antibody testing at this time, but people can contact their medical provider to see if their provider offers antibody testing and whether they would be a good candidate. It is a good idea to check with insurance on coverage for antibody testing. While the nasal swab tests like those at the Health District sites are covered with no co-pay and at no cost to the client, antibody testing may not be covered or coverage may vary based on your insurance plan.

The details of testing plans may continue to change, but we know that testing will remain an important piece of the COVID-19 response. For people who fit into any of the categories for testing – especially people with symptoms – getting tested promptly is one way to help us fight this pandemic.