Blog Header

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.

Jul 20

Dear Snohomish County, It’s Been Six Months: July 20, 2020

Posted on July 20, 2020 at 3:38 PM by Kari Bray

To our friends and neighbors in Snohomish County:

It’s been six months since the first reported case of COVID-19 in the U.S. was identified here.

A lot has happened.

We are in challenging times, facing a pandemic that has created new problems while amplifying existing hardship for many.

When we had that first case in January, the novel coronavirus was cause for concern but it wasn't a pandemic. We didn’t have a coronavirus outbreak, just one known patient who took the right steps, sought care, and was isolated at the hospital. 

The Health District was already addressing a hepatitis A outbreak. The group at the table – literally at a table in a meeting room, before so many conversations were virtual – expanded to include more staff working to contain a novel virus that didn’t have a name yet. As the weeks went on, the conversation shifted from containment to mitigation, which boils down to this: no one could put a lid on this virus. The new disease was going to keep spreading.

As the emergency response for coronavirus ramped up, many partners stepped up to support Snohomish County and the Health District. There are too many partners to name, and we are thankful for all of the agencies, organizations, businesses, staff, and volunteers who have participated in the response. 

Things changed quickly as our community worked together to address the spread of this illness. "Wash your hands and stay home if you’re sick” turned into “wash your hands and stay home except for essential work or errands.” School campuses closed and lessons moved online. Activities were canceled. Businesses and organizations closed in-person operations. Roads and sidewalks were eerily empty.

The proverbial curve flattened. The rising local case count was controlled in time to spare our medical system, while elsewhere in the world and country we saw how devastating an overwhelmed system could be.

Then came the shift to questions about reopening businesses, activities and schools. Those conversations are ongoing, and probably will be for quite some time. Careful reopening efforts are underway. Snohomish County in June moved from Phase 1 to Phase 2 of the Governor’s Safe Start Plan. And now there’s a pause on moving further in the phases because case numbers are ticking up again and we are now well into a second wave of sustained transmission in the community.

Early blog posts on this platform explained why the risk to the general public in the U.S. was considered low at the time, and that this was a rapidly evolving situation. The rapidly evolving part still holds true. Pandemics don’t take perfect, linear, easy-to-follow paths. There will be ups and downs throughout this response, which makes it especially challenging. As we’re seeing now, we can make good progress only to find we need to hit pause again because the virus is circulating.

And as for that whole low-risk piece? That’s certainly not the case anymore. But such is the nature of viruses like this – they are very, very good at getting around.

We are closely monitoring the situation, including case rates, hospital capacity, testing, contact tracing, and risk to vulnerable populations. 

We’ve learned throughout this pandemic that we must be cautious, adaptable, as clear as possible about the steps we need to take, and – perhaps most importantly – kind to one another. 

A few other things we’ve learned in the last six months:

  • There are a number of possible COVID symptoms. It’s not just fever, sore throat, or cough to watch for anymore. Body aches, nausea, diarrhea, fatigue, even loss of taste or smell are all on the list now. This illness doesn’t look the same in everyone.
  • Some people don’t even have symptoms. Or they have really mild symptoms. But you can still spread the illness even if you are not symptomatic. Recently, about 85% of positive cases in Snohomish County have been symptomatic, while about 15% have not reported symptoms.
  • Cloth face coverings over the mouth and nose help. They trap respiratory droplets that could otherwise carry the virus from one person to another. They’re most useful to protect others around the wearers, not the wearers themselves. So everyone should be wearing one in public; that way, we all protect each other.
  • Social distancing, or physical distancing, is part of our vocabulary now. We’ve all probably memorized that six feet is the minimum distance to keep between ourselves and others. And we have a lot of creative ways of measuring that. It’s the wingspan of a bald eagle, or the average length of a llama (from rump to nose), or the full stretch of a personal jump rope.
  • Some people are at higher risk of severe illness than others – including people who are over 60 years old and those who have underlying medical conditions like heart, lung, or kidney disease. But anyone can become severely ill, and this illness can be dangerous for the young as well as the old.
There have been other pandemics, and other diseases with pandemic potential. They are part of what public health monitors, prepares for, and helps respond to when the need arises. But this pandemic has had a drastic impact, and there’s been much to learn about COVID-19. It flared into outbreaks, then a crisis that caught the U.S. and other countries in its grip and still refuses to let go.

There are moments that show the strongest parts of humanity. Healthcare workers, first responders, and frontline workers have risked their own safety to keep others safe and well. Emergency response workers, volunteers, donors and leaders have stepped up to make sure people have necessities in a time of economic strain. Educators and parents rallied to teach students through challenges none of them expected. People who missed in-person interactions connected with social groups through virtual means. Crafters made and donated cloth face covers, and businesses began selling a variety of styles – there are options to showcase your favorite fandom, or to have a window of clear plastic so people can see your smile or read your lips.

We’ve also seen dark moments. More than 180 people in Snohomish County have died of this disease. The initial wave of cases came close of overwhelming local hospitals and medical resources. There wasn’t enough personal protective equipment; everyone in the nation needed it at the same time. Many in our community have been out of work for weeks or even months. Small businesses have suffered and unemployment has spiked. We’ve missed out on celebrating important milestones that would usually be marked by gatherings because it isn’t safe to bring too many people together. 

People are anxious to get back to normal. Or something that looks closer to normal. 

We miss “normal,” too. 

We’ve seen and heard your questions, concerns, worries, frustration, anger, and emotional/mental fatigue. We don’t always have answers to the questions, but we’ll keep working on it. As for the concerns and emotions – we share many of them. We want you to be safe and healthy during this pandemic. We also want you to be able to work and learn and see the people you love. 

Thank you to all who have made sacrifices to help slow the spread of this virus, whether you are a healthcare worker on the front lines or a community member who decided to cancel a birthday party or stay home from a big Fourth of July barbecue. It takes all of us. We see you, and we are immensely grateful for all you are doing during this crazy time.

We are six months in, and we can’t offer an end date. We don’t want to sound like it’s all doom and gloom, because this county is a place where compassion and resilience are abundant. However, it’s not fair or helpful to sugarcoat it: This fall and winter have the potential to be particularly rough. At this very moment we appear to be in the early stages of a rising second wave that has zero chance of being reversed without changes to our collective behavior.

We can all take steps to keep ourselves and others healthy. 
  • Avoid gatherings, parties or other get-togethers of any sort. Stick with your household and a maximum of five non-household members as your small, consistent group of social contacts until further notice.  
  • Going where there will be people other than your household members? Wear a cloth face covering. It’s the kind thing to do. It’s also required by the Governor’s order. 
  • Not feeling well? Stay home. Seriously. Are you on the fence because your throat only hurts a little, or it’s just the sniffles? Better to be cautious. Stay home.
  • See those hands? Wash ‘em. Soap and water. Count to 20 while you scrub.
  • Check your purse/pocket/glovebox. Do you have a cloth face cover and hand sanitizer with you when you go out? You should.
  • Think about the surfaces you touch most in your home and workplace. Then clean and sanitize them.
  • Stay informed. Share reliable information. Don’t spread rumors or false claims. They can be just as contagious as a virus.
  • Be kind. Be patient. Be strong.
  • Remember that you are not alone. We are in this together.
Check out a timeline of the first six months at www.snohd.org/528/COVID-19-Six-month-timeline
Six Month Timeline Snapshot
Jul 14

Addressing questions and misinformation about COVID-19 in Snohomish County: July 14, 2020

Posted on July 14, 2020 at 2:08 PM by Kari Bray

The amount of information about the COVID-19 pandemic can be overwhelming. 

So can the amount of misinformation.

This disease has disrupted our lives. The measures in place to reduce the spread have created new challenges. Misinformation makes it more difficult to come together as a community to face this pandemic.

We’ve seen questions, speculation, and some outright falsehoods, particularly on social media. We want to address some of those. We also want to remind people that, like a virus, misinformation can spread quickly and be dangerous. Please carefully consider the information you are sharing and the source of that information before you spread it further via your own social media or social circles.

Are we seeing more cases because there’s more testing?
This would seem like a logical explanation – the more you look for something, the more you find it. 

But testing does not account for the increase in cases we’ve seen over the last few weeks. If you’re looking at testing data, check the proportion of tests that are positive. The Washington State Department of Health provides data on testing for Snohomish County, and we update testing data weekly on our case counts page. In late May and early June, between 2.2% and 2.9% of total tests were positive each week. By mid-June, it had climbed to 5% positive. In fact, more positive tests were reported during the third week of June than the second even though fewer total tests were done. 

In brief: Testing alone does not explain the recent jump in cases counts. Cases are going up because the virus is spreading in our community more now than it was a month ago.

If someone is tested multiple times, are they counted multiple times in the case data?
No. First, most people who are tested likely won’t be tested more than once. If results are positive, they isolate – usually at home – until at least 10 days have passed since the date of their first symptom or positive test. Public health staff will check in with them during the isolation period. 

If someone is tested multiple times during their illness, the individual is only counted as one case. An example would be if someone with COVID was hospitalized and needed a negative test result before they could return to a long-term care facility. Though they may have additional positive results before they get a negative, the patient would only be counted as one new case.

Does the case rate per 100,000 population include positive antibody/serology tests?
No. Serology, where a blood sample is tested for antibodies developed in response to a past infection, would indicate a previous case. The case rate per 100,000 is based on new cases during the 14-day period for which the rate is calculated. That means the calculation uses confirmed cases during that time frame. These tests are not blood samples, but rather nasal swabs to test for the presence of the virus.


Have COVID-19 deaths been over-reported?
Snohomish County’s death data reflects cases where COVID was a contributing factor to the death. Though we cannot promise that data is always perfect, public health and medical experts work to provide accurate and timely information. 

There is, frankly, no reason to inflate the numbers. This disease has taken an undeniably terrible toll. As of the writing of this blog, there have been 161 confirmed COVID-19 deaths in Snohomish County, and 14 more where COVID is suspected to have contributed to the death or where the death certificate is pending, according to a Washington State Department of Health report.

Statewide, the Department of Health has identified a small percentage of deaths initially attributed to COVID-19 that were due to other causes upon closer examination. DOH has modified death reporting to be more specific.

Updates on COVID data are provided often, but the most recent dates include preliminary data. Final death data takes time to review further, and it can be weeks before the data is no longer considered preliminary. There may be slight differences between preliminary and final data, but generally it is not a large change in the numbers.

A death is counted if someone had underlying conditions worsened by COVID; if both the underlying condition (such as chronic heart or lung disease) and the COVID infection contributed to a death, it would be counted. This is not different from other communicable diseases like influenza, for which we also report deaths (during flu season).

We’ve been asked whether a death would be counted if the decedent had COVID-19 but died in an entirely unrelated incident, like a car accident. The answer is no, that person’s death would not be counted as COVID-related. 


Shouldn’t we just open up and let people get exposed so we have herd immunity?
Herd or community immunity is a protective factor for many diseases. Widespread immunity for a number of once devastating illnesses has been achieved through vaccination, but people also can build immunity through exposure to an illness.

Since a COVID vaccine is not yet ready, the idea of everyone getting infected and then being immune might sound good at first. But there are a few major problems with it.
  1. We don’t yet know how long immunity to COVID may last. Some immunities are lifelong, while others are short-lived. Infection with other coronaviruses that cause human disease often do not produce lasting immunity and repeat infections are not uncommon. Without a better understanding of whether there is lasting immunity to COVID, we can’t bank on it.
  2. Increased exposures to this illness would overwhelm our hospitals and medical system. This has happened elsewhere in the nation and world during this pandemic, and almost happened in Snohomish County early on. Overloading hospitals and clinics would jeopardize care not only for COVID patients, but for others with unrelated health conditions.
  3. There are indications that this illness can cause enduring damage. People may recover, and may even have immunity, but at the price of new health complications. The symptoms, severity and outcomes of the illness aren’t the same for everyone. Experts still are working to understand the extent of what this virus does to the human body.
If cases are up but hospitals aren’t overwhelmed, does that mean this disease isn’t that serious?
Hospitals are not overwhelmed yet, but there is concern for what may come as cases continue to rise. 

The severity of COVID does vary, and most people do not require hospitalization. They can recover while isolating at home. Younger people without underlying conditions don’t tend to become as ill as the elderly or people with pre-existing health concerns. New case reports are shifting more toward a younger demographic than the cases reported earlier in the outbreak. That younger age group, as well as protective measures in place for high-risk populations, may help account for hospitals not being overloaded yet.

We can only shield vulnerable populations for so long. If COVID spreads more among people who are not high risk, it will eventually reach those who are high risk. It’s worth noting that young, otherwise healthy people can have severe complications from COVID, too.

We are still waiting to see what the recent increase in cases means for hospitals. It takes time between when someone is exposed to when they become ill, and from when they become ill to when their symptoms could be severe enough to require hospitalization. 

I had to quarantine because I’m a close contact of a case. Can I go back to work if I test negative?
Not necessarily. People who have been exposed to COVID are instructed to quarantine at home for a full 14 days after their most recent exposure. This includes not going to work. A negative test result does not shorten that quarantine period.

It can take time for symptoms to appear, and no test is 100% accurate. Even if you test negative, you risk spreading the virus if you either tested too soon to detect it or if your result was a false negative. 


There are some exceptions for healthcare or other essential workers. Your employer should have a health and safety plan, and you should follow instructions from public health staff when they call to inform you that you are a contact or to check in during quarantine. Do not assume you are an essential worker or are otherwise exempt from the 14-day quarantine period. 


Can my doctor give me a medical exemption so I don’t have to wear a face covering in public?
Face covers are required by a statewide public health order to be worn in any indoor public setting, including businesses, or outdoors where people cannot reliably maintain a six-foot distance. Limited exemptions are outlined in the order:

  • Children younger than five are not required to wear a face cover, and children younger than two should not wear one.
  • People with medical conditions, mental health conditions, or disabilities that prevent wearing a face covering do not need to wear one
You do not need to provide proof that you qualify for an exemption. If you have a medical condition and are unsure whether it would prevent you from safely wearing a face cover, please contact your medical provider about those specific questions. However, you do not need to request a note or other verification of your condition.

In general, people who have an underlying medical condition so severe that they cannot safely wear a cloth face cover should avoid public venues where they may be exposed to this virus. Businesses should make accommodations for those who cannot wear face covers.


Can businesses do anything if customers don’t wear face coverings?
Yes. Under a statewide order, businesses cannot legally serve customers who do not wear face covers. They can refuse entry if you refuse wear a face cover. If you are exempt from the order (see previous question), the business should make a reasonable accommodation such as curbside pick-up or home delivery, or making an individual appointment.

There are times when face covers may be removed, such as once you are seated at a restaurant and begin eating or when you are participating in outdoor or indoor exercise and are maintaining distance from other people.

If someone insists on entering a business without a face cover after being informed of the rules and asked to leave, employees should avoid confrontation. Law enforcement may be called to address the situation, just like with any other customer who put others at risk by not following safety requirements. 


Are most new cases linked to specific events or gatherings?
While social gatherings or parties contribute to increased spread of COVID, there is no single hotspot or event. New cases are being detected throughout the county. 

An outbreak does not necessarily have to be tied to a single event. It could be a social network of multiple households who become exposed to each other through one or more interactions over time. This is why we emphasize the importance of keeping social groups small (five or fewer) and consistent (the same people over a seven-day period). Even if you see only two or three people at a time, seeing different small groups in the same week can significantly increase the number of people exposed if you become ill.


Should I get tested if I went to a large gathering?
Let’s drop in another reminder to limit in-person social interactions. Large gatherings can be what’s called “super spreader” events, where a single case could lead to dozens more.

Nevertheless, we know that there have been a number of gatherings recently. If you have been to one, it’s a good idea to get tested. Don’t do so right away – a test the day after is unlikely to detect the virus if you were just exposed. Wait four to six days after you attended the gathering to get tested. Go sooner if you develop symptoms of COVID. 

We advise people to quarantine at home for 14 days following a large gathering. This means no work, no errands, no visits, and no visitors.


Stay informed
As more information comes out about the virus, its impact on our community, and the steps we need to take, please remember to turn to reliable sources and avoid spreading false or misleading information. Good sources to monitor include:



Thank you to everyone who is stepping up to help reduce the spread of this illness. Your efforts matter.
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.