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

Jun 05

COVID-19 and Phase 2 of a Safe Start for Snohomish County: June 5, 2020

Posted on June 5, 2020 at 2:07 PM by Kari Bray

Snohomish County is now in Phase 2 of the Safe Start plan for reopening businesses and activities in Washington.

An application to move to Phase 2 was submitted Monday, June 1, and we received notice on Friday, June 5, that it had been approved by the state Secretary of Health. (Read the letter here.)

While moving to Phase 2 is an important step, we still have work ahead of us to stay in Phase 2 and, later, to move on to Phases 3 and 4. It is important for people to learn more about what moving to Phase 2 means, and what we need to do as individuals and as a community to continue making progress against this pandemic.

A phased approach to reopening
Prior to June 1, a state order was in place for Washingtonians to stay home except for essential work and errands. This was to reduce the spread of COVID-19. And while it feels like everything shut down abruptly, the reopening cannot be sudden – not if we want to maintain the progress we’ve made against this disease. 

As a state, we have moved from Stay Home, Stay Healthy to the Safe Start Plan. And while the Stay Home order has expired, many of the same health and safety precautions remain in place under Safe Start.

If we go straight from staying home and minimizing in-person contact back to the day-to-day interactions we had before COVID-19, we can expect a rise in cases and the need to re-instate social distancing measures. Increased transmission of this virus would jeopardize lives and could rapidly overwhelm the medical system, not only for those who are ill with COVID-19 but also those with other critical healthcare needs. 

Governor Jay Inslee has laid out the phased Safe Start Washington plan. The phases are not starting at the same time in every county. 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. There is a required wait time between phases, as well as criteria to meet.

While Snohomish County has met criteria to move to Phase 2, it will be a minimum of three weeks until we can apply for Phase 3. Remember, too, that we may not be ready for Phase 3 in three weeks. It is too soon to give a firm timeline. We also will need to see the next set of criteria from the state for progressing through the phases.

Qualifying for Phase 2
Measures that every county and local health jurisdiction, including Snohomish County and the Snohomish Health District, have looked at to determine progress toward Phase 2 include:
  • Health care system readiness. 
    • Hospitals need adequate surge capacity for potential increase in patients and a supply of personal protective equipment for staff. Snohomish County is in good shape on this one. Providing letters from hospitals is part of the application process for Phase 2.
  • Testing capacity and availability.
    • We are currently at about 2,500 tests per week being done in Snohomish County, which includes testing from medical providers as well as community based or drive-thru testing by the Health District. While this is slightly below the target of 4,000 to 4,500 tests actually being completed, we do have adequate capacity for testing. Countywide testing capacity is 5,000 to 6,000 tests per week. 
  • Case and contact investigations.
    • We are on track to ensure adequate contact tracing. The goal as outlined for the Safe Start plan is to be able to contact at least 90 percent of new cases within 24 hours of the positive test results, and to call at least 80 percent of the cases’ close contacts within another 24 hours. Ideally, we aim to contact everyone in a timely fashion, but these numbers give us some metrics to measure against.  
    • Exact numbers of staff needed to keep up with the caseload are expected to vary throughout this response. We have about 30 workers for investigations and contact tracing at the Health District, along with surge capacity from the Washington State Department of Health. Federal CARES Act funding that was recently allocated to the Health District also will be used to bolster disease investigation/contact tracing capacity.
    • An isolation and quarantine facility is available in Snohomish County for those who cannot isolate or quarantine at home.
  • Ability to protect high-risk populations.
    • We have been seeing one or two outbreaks in long-term care facilities per week, which is within the state criteria for Phase 2. A team at the Health District continues to work directly with long-term care facilities on testing and illness prevention and we also have teams in place to address potential outbreaks in workplaces and other settings.
What about case counts?
Things are moving in the right direction, and we believe that we currently have the infrastructure, plans and partnerships in place to enter into Phase 2 with reasonable confidence that we can continue to suppress transmission of the virus.  

Our 14-day case count for May 12 to May 26 was 18.4 per 100,000, which is within the updated state criteria of 25 or fewer per 100,000. This case rate is confirmed cases only and is calculated based on guidance from the Department of Health.

Life may not look a whole lot different in Phase 2
While getting to Phase 2 is an important step that opens more businesses and activities, the overall change from Phase 1 to Phase 2 is not a drastic one. 

There are four phases of this recovery, as outlined in the Safe Start Plan. Phase 2 gets us partway down the road, but it’s not the finish line. And we expect this to be a winding road; we may have to stop or turn back at times, and stricter social distancing measures may be put in place again if cases, hospitalizations, or deaths increase.

In Phase 2, general guidelines include:
  • Gatherings with fewer than five people from outside your household per week. This includes only having small groups (you and 1-4 others) for outdoor recreation.
  • High-risk populations – such as people older than 60 and those with underlying health conditions – should continue to stay home aside from essential business and errands.
  • Non-essential travel is limited to activities approved to reopen under Phase 2, and those will come with health and safety guidance to follow. For example, restaurants may reopen at limited on-site capacity, with appropriate social distancing, cleaning and sanitation, no more than five customers per table, six feet between tables, and no bar-area seating.
  • For people who can continue to work remotely, teleworking is strongly encouraged. 
This means that a number of people may be able to return to work in certain industries, which is good news. But they will need to be dedicated to reducing the spread of disease in the workplace and at home if we hope to keep moving forward on reopening.

For personal interactions, many people will likely find that it’s a relief to be able to see a small group of friends or family in person. Remember, though, that you don’t want to expose the people you care about to this virus. So keep groups to five or less, maintain distance as much as possible, and carefully consider who you are visiting. Meeting a friend who is not high risk and has not been ill to go for a walk or to grab lunch is a better plan than a large get-together or rushing to give hugs and kisses to a loved one who is high-risk. 

As businesses reopen, there will be health measures in place
Allowing more businesses and activities to reopen does not mean that it will be business as usual. There are guidelines that employers will need to follow through all of the phases. A brief overview is below, but more is outlined in the Safe Start Plan.
  • A business is only allowed to reopen after it can implement state guidelines available at
  • Limit close interactions with customers. Arrange for six-foot physical distance between employees and patrons and use other measures, such as barriers to block sneezes and coughs, if distancing isn’t realistic for specific tasks. 
  • Ensure sanitation and hand hygiene are available to all workers and visitors.
  • Frequently clean and disinfect the workspace, especially high-touch surfaces. 
  • Follow Labor and Industries and industry-specific guidance regarding personal protective equipment or cloth face covers for workers.
  • Make a plan for addressing illness, including requiring ill employees to stay home and deep cleaning if an employee tests positive for COVID-19. 
  • Provide information to employees about COVID-19 and illness prevention. This could include signs or posters with information.
  • Follow any additional guidance that is specific to your industry, as provided by local, state or federal public health professionals.
Businesses also must wait until they have industry-specific health and safety guidance from the state before reopening within the proper phase. Guidance for all businesses may not be available at the same time. For example, Phase 2 guidance for construction was issued on May 15 while guidance for real estate was issued on May 19. The governor’s office maintains a list of guidance for industries that is frequently updated or added to. 

The City of Everett, in partnership with the Snohomish Health District, has also developed a toolkit to help small businesses navigate Phase 2. The valuable resource is available at

Some things still have to wait
Even in Phase 2, some of the activities we’ve been getting the most questions about have not been approved to reopen. 

According to the Safe Start plan, recreational sports with more than 5 people in the same area or in close contact, as well as places like gyms or pools, aren’t on the list until Phase 3, and even then the group size will be capped – no more than 50 people. Professional sports like baseball could potentially resume without a live audience long before crowds will be back in stadiums. Restaurants still have limited capacity even in Phase 3, with limited bar seating, as well. 

More businesses could resume in Phase 3, if they weren’t able to under Phase 2, but telework would continue to be strongly encouraged and certain businesses would still be restricted. Large gatherings like concerts, sports events, or other performance venues are not on the list until Phase 4. 

We don’t have a firm date or timeline for the third and fourth phases, and social distancing measures may have to be re-instated and then re-lifted along the way.

It is important to keep in mind that things could change, and that the details of what activities and businesses are allowed within each phase may be modified. Please check back and monitor guidance from the state for your specific industry. 

What we do know is that we have been working diligently to get to Phase 2. But getting to future phases will require everyone to contribute and cooperate. We can help our county reopen and keep people safe by: 
  • respecting social distancing (at least six feet between us and others who are not in our household)
  • minimizing travel and in-person contacts outside of our household
  • wearing cloth face covers when we go to a public place where we can’t maintain distance
  • keeping up on regular hand hygiene (wash with soap and water, and keep hand sanitizer handy if you’re going out)
  • cleaning and disinfecting in our homes and workplaces.
There is still a worldwide pandemic, and we are seeing daily cases in our community. As of June 4, we've lost 152 people in Snohomish County. As we move through the phases of the Safe Start plan, we cannot forget the importance of the individual decisions we make and the actions we take to reduce the spread of illness.

We are geared up to handle new surges in cases, and yes, that is crucial.

But ultimately, what happens next with the transmission of this virus and our ability to continue reopening our county depends on all of us.
May 27

COVID-19 and Contact Tracing: May 20, 2020

Posted on May 27, 2020 at 10:34 AM by Kari Bray

*Updated May 27, 2020, with additional languages. Links provided at end of blog.

Just as testing is a key piece of the long-term response to the novel coronavirus disease (COVID-19), disease investigation and contact tracing are crucial, as well.

These topics have generated a number of questions, as well as concerns and rumors. We aim to address some of those here.

What is disease investigation and contact tracing?
When there is an outbreak of illness, disease investigators work to identify possible sources, track the spread, and notify people who may be infected before they further spread the disease or become severely ill. It’s a routine part of public health efforts for containing outbreaks and limiting the spread of tuberculosis, sexually transmitted diseases, hepatitis, and other communicable diseases in our communities. This has been a part of daily public health operations for decades. 

Step one is case investigation, where a person who has the disease is interviewed. During the current pandemic, that means anyone who has tested positive for COVID-19. An interviewer asks questions like date of birth, address, gender at birth, race, and ethnicity. They may ask about where you work and what your job duties entail, travel history, as well as the nature and timing of the illness. They will not ask for things like your social security number, financial information, or immigration status. 

Disease investigators also ask with whom an ill person had close contact. The goal is to identify people who were exposed. For COVID-19, that’s generally anyone who has lived in the same home or been within six feet of someone with COVID-19 for 10 minutes or more while the person was infectious.

This kicks off step two, which is contact tracing. Public health staff or volunteers call the close contacts to notify them of possible exposure and provide guidance on how long to quarantine, what symptoms to watch for, and what to do if they become ill. Public health workers are trained and required by law to not reveal the identity of the person who may have exposed the contact, and to protect the personal health information of the people they call.

When is the Snohomish Health District starting contact tracing?
Contact tracing for COVID-19 isn’t new. It started on January 20, when we received notification of positive test results for the first reported case in the U.S.

As for contact tracing overall, public health nurses and other Health District staff do tracing for outbreaks of many diseases. Some examples you may have heard about in recent years include measles, mumps, whooping cough, and hepatitis. And there are disease intervention specialists who work to identify, notify and provide resources to partners of patients with sexually transmitted diseases. The District also has a program focused on preventing the spread of tuberculosis. That work involves contact tracing, too. In fact, the roots of public health in Snohomish County go back more than 100 years to efforts by Red Cross nurses to contain tuberculosis.

So it’s important to remember that contact tracing is not a new effort, not for COVID-19 or for other diseases. It is part of the DNA of public health.

But COVID-19 is different.
Yes, it is. The scale of this pandemic means that contact tracing is a much larger effort that is needed all over the county, state and country. 

The newness of this disease and the lack of both immunity in the population and pharmaceutical interventions – like a vaccine or a proven treatment – also make it unique and challenging. Unlike measles, where high rates of vaccination can help slow or stop the spread in a community, we don’t have widespread immunity to COVID-19. We’re also still learning about the virus and the disease. For illnesses we’re familiar with, there’s a clearer list of symptoms and an understanding of how the illness typically spreads, how long someone is contagious, how long the virus is viable on surfaces, who is most vulnerable, etc. With COVID-19, these are things we continue to learn about.

The other thing that makes COVID-19 contact tracing different from other illnesses is measures like Stay Home, Stay Healthy and social distancing that are in place to help curb its spread. This puts a lot of weight on the success of investigation and tracing to allow more businesses and activities to resume while avoiding a substantial increase in cases that would threaten hospitals’ capacity to provide acute inpatient care. Quick detection and containment of outbreaks are also critical toward achieving this objective. 

So how many contact tracers do you need?
This is a long-term effort, and the exact number of staff and/or volunteers dedicated to contact tracing will likely fluctuate throughout as case numbers change.

The Health District has increased training and reassigned staff from other programs, hired new staff, and worked with volunteers through our Medical Reserve Corps to amplify our contact tracing work. 

Training is ongoing for temporary employees and volunteers with our Medical Reserve Corps to help boost that capacity from about 10 full-time equivalent positions as of early May to about 30 full-time equivalent positions for disease investigation and contact tracing. If cases and contacts get beyond the capacity of the Health District, the Washington State Department of Health (WA DOH) provides support and can draw on additional help, such as the National Guard staff who have been trained for this work by WA DOH and will be supervised by state or local public health workers.  

What happens if I test positive?
People who test positive for COVID-19 can expect a phone call from the Snohomish Health District or the Department of Health, often followed by an email with information on isolation and illness prevention. 

The phone call is to make sure you are aware of the positive test result and provide guidance on how long to isolate from others and how to prevent the spread of illness. The disease investigator also does an interview and will ask questions to identify others who may have been exposed. Then periodic follow-ups will be done via text or phone call to support adherence to home isolation directives, answer questions, or make referrals as necessary. Generally, the length of isolation is at least 10 days from the onset of symptoms and for at least 3 days after fever has resolved and cough or other symptoms have improved.

What happens if I’m a close contact of a case?
If you are called by public health because you’ve been identified as someone who was in close contact with a confirmed case, you’ll be asked to quarantine at home. That means staying home and away from others for 14 days, while monitoring for symptoms of illness. You’ll be provided with information on what symptoms to watch for, and if you develop those symptoms, we encourage you to contact your medical provider and to get tested for COVID-19.

If you develop symptoms or if you test positive, you will be asked to continue to stay home and away from others until at least 72 hours after your fever is gone (without fever-reducing medication), other symptoms are improving, and at least 10 days have passed since the start of symptoms.

Let’s talk about what doesn’t happen.
Rumors and misinformation have caused fear for some about what happens to themselves and their families if they are identified as either a case or a close contact.

First of all, the case interviews and contact notifications are almost always done by phone. Public health staff or public health-supervised National Guard members are not being sent to houses to round people up. Our priority is reducing the spread of illness, which means we want you to stay home and avoid in-person contact with others, including our disease investigators.
You may also have seen rumors about people being forced into isolation and quarantine facilities. If you do not have a safe place to stay during a COVID-19 illness due to unstable housing or inability to maintain distance from vulnerable members of your household, the county does have a location available. However, the preference is for people to isolate or quarantine at home. We do ask that you maintain distance from household members during your illness, but you can do that by keeping to your own room and limiting contact in shared spaces.

There has also been concern about children being taken away from parents or guardians if the child or parent becomes ill with COVID. If there is COVID in a household where children are present, the same steps should be taken as in other households – stay home and away from others, practice good cleaning and hygiene, and call your doctor if you (or your child) develop symptoms or if they worsen. It is a good idea to make a plan for who would care for your children if you were to become severely ill and needed to be hospitalized. We encourage you to talk to family, friends or neighbors you trust.

Our staff and volunteers also are trained to protect patient privacy. Information is provided in aggregate on our case counts page, but we do not provide personally identifiable health information. 

How can I help with contact tracing?
  1. Volunteers are welcome through our Medical Reserve Corps. They can support us with a variety of public health efforts, including drive-thru testing, call centers, and contact tracing during COVID-19. Learn more or sign up at
  2. For paid positions, including temporary positions needed during this emergency, you can monitor for job postings at

For new staff or volunteers brought on to help with contact tracing, a three-hour course is required to start training. The course is through the Association of State and Territorial Health Officials.

Additional training is required before they begin actually doing contact tracing with the Health District. They also shadow public health staff conducting contact investigations and have closely supervised training calls prior to operating independently.  

Please remember that one of the best things you can do to help with contact tracing and the overall response to COVID-19 is to continue following guidelines to keep yourself and others healthy. By limiting close contact with others, you reduce the likelihood that you will become ill and you reduce the number of contacts in the event that you do. This helps keep contact tracing manageable for our team and others working to address this pandemic.

This blog is available in additional languages
May 22

COVID-19 and Domestic Violence: May 22, 2020

Posted on May 22, 2020 at 8:51 AM by Kari Bray

The pandemic of the novel coronavirus disease (COVID-19) has amplified existing challenges in our community. Where there were cracks before, they’ve gotten wider, and people who were struggling to climb out are facing more obstacles. Many in Snohomish County are dealing with illness, loss, disconnects from social circles and supports, and/or economic hardship.

Domestic violence is one of the issues that is exacerbated during this crisis. This can include physical, emotional, or sexual abuse of children and adults.

The reality is that we won’t have a full understanding of just how much of an impact this pandemic has had on those experiencing domestic violence for many months or, more likely, years. 

But to get a better understanding of what we are seeing now, what resources are available in our community, and how people can help, we reached out to some local experts. We spoke with Lori Vanderburg and Anne Ewalt with Dawson Place Child Advocacy Center, Melissa Mertz with Providence Intervention Center for Assault and Abuse, and Vicci Hilty with Domestic Violence Services of Snohomish County.

What do we know about the impact of the pandemic so far?
When health orders designed to reduce the spread of illness first went into effect, namely the order to stay home except for essential business or errands, there was an initial decrease in calls for services and support related to domestic violence. 

“When people are living with an abuser in a lockdown situation, they can’t call,” Hilty said. “Domestic violence really leaves a trail of emotional pain. And when we say things like ‘stay home, stay safe,’ for some people, that’s not an option. For them, it’s stay home and try to survive.”

A few weeks later, the call volumes began to look more normal. For the last couple of weeks, calls to multiple lines have increased significantly. Questions are coming in to Domestic Violence Services about protection orders, how to navigate the legal system, and what to expect when leaving a violent situation.

Other people are struggling because they left an abusive relationship before the pandemic but now the person they left is contacting them during a vulnerable time, promising that things have changed and talking about financial support when, for many, finances are a serious concern.

“It’s hard to stay strong right now,” Hilty said.

There also likely has been fear of going in for medical care and getting exposed to COVID-19, so people may have hesitated to go in for an evaluation if they were assaulted, Mertz said. Hospitals and clinics are safe, and people should not be afraid to seek care.

“This was a problem before COVID,” she said. “It’s a new problem in the time of COVID.”

For children and teens, closures of schools and activities seem to have decreased reports during what is normally one of the busiest times of the year. Young people don’t have the same access to teachers, coaches, advisors, or other trusted adults they can confide in, and those adults (including a number of mandatory reporters) aren’t seeing children in person to notice signs of neglect or abuse and report it.

Usually, May is a busy month for reports to and referrals from Child Protective Services. That doesn’t appear to be the case this year, Vanderburg and Ewalt said.
There is good news about existing supports. Children and adults up to age 22 who were already part of programs or therapy have transitioned well to virtual or tele-health options, they said. 

Aside from unscheduled in-person visits, support services are active. People can call or message. There are hotlines and texting options. Visits can be scheduled for those who need interpreters or who are too young to effectively engage with someone on a screen. 

Overall, people are reaching out more for services as time goes on and health measures are modified or lifted. 

It will be quite some time before there’s a clear picture of how dramatic an impact this pandemic has had on domestic violence. Particularly with children, it may be years before they feel they are in a safe place to tell someone what they experienced, if they ever feel they can do so. Issues like sexual abuse remain taboo subjects for many, and the shame and fear associated with reporting can be overwhelming. There’s work to be done there to reduce shame and stigma so people feel safe in reporting violence. 

But when people are ready to talk, when they want to ask for help, the resounding message from the experts was this: “We are here.”

How can I get help?
For people who are experiencing violence, safety planning and self-care are both extremely important. 

Self-care means doing what you can to alleviate stress for you and your family. What works well for one person may not work for another. Find the things that help you manage your stress in healthy ways. Focus on what is in your control. Find safe, quiet spaces when and where you can. Look for virtual ways to connect with your social and support networks. Consider contacting the advocacy line or crisis chat if you need someone to talk to.

Safety planning includes knowing the resources that are available and where you would go or who you would trust in a personal crisis, such as escalating violence in the household.

You can call Domestic Violence Services or Providence Intervention Center for Assault and Abuse to talk with someone who can help walk you through safety planning. You can call anytime, day or night. Calls are free and confidential.
  • Providence Intervention Center for Assault and Abuse: 425-252-4800
  • Domestic Violence Services: 425-25-ABUSE (425-252-2873)
No one can tell you what to do, and the people on the other end of the line are there to help, not to order. You know your situation best, and the goal is to help you make the best and safest decisions for you. 

If you are in an emergency situation, you can text 911 if you are worried about being overheard on the phone.

Other resources:
  • National Crisis Text Line: 741741
  • National Domestic Violence Hotline: Call 1-800-799-7233 or 1-800-799-7233 for TTY, or if you’re unable to speak safely, you can log onto or text LOVEIS to 22522.
  • Care Crisis Line: 800-584-3578 or 425-258-4357
    Care Crisis Chat: 
  • Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746.
  • The Disaster Distress Helpline provides crisis counseling and support for anyone in the U.S. experiencing distress or other behavioral health concerns related to any natural or human-caused disaster, including public health emergencies.
  • Dial 2-1-1: If you need assistance finding food, paying for housing bills, accessing free childcare, or other essential services, visit or dial 211 to speak to someone who can help. 
How can I help someone in my life who may be experiencing domestic violence?
Everybody has a role in reducing violence.

Adults who usually make the call about a child who may be in danger are not interacting as directly with children. Other adults can step up. Friends, family or neighbors should call Child Protective Services if they believe a child is being abused. The statewide End Harm line is 866-363-4276, and the number for the region that includes Snohomish County is 866-829-2153. Making the call doesn’t automatically get someone in trouble or divide a family, said Vanderburg and Ewalt. It notifies someone who can look into the situation. Anonymous reports are allowed.

People can also contact Dawson Place at 425-789-3000. They have resources and support for child victims of physical or sexual abuse, and for their families. 

It can be challenging to help an adult in your life who is in a dangerous situation. You cannot force anyone to leave, nor should you.

Safely getting out of a domestic violence situation can look very different for different people. It’s easy for well-meaning friends or family to say “Why don’t you just leave?” without understanding the complexities. 

Violence tends to spike when someone tries to leave. The economic challenges and the fact that safe spaces may be limited during a pandemic create new hardships for those who want to leave.

If you are concerned about a friend or family member who may be experiencing domestic violence:
  • Talk to them. More importantly, listen to them. Call, video chat, or text. Use the mode of communication they are most comfortable with, and let them know that you are there to support them.
  • Don’t judge. Don’t blame or pressure. Trust them to know their situation best, and be there to support them as they navigate the difficult personal choice of whether and when to leave.
  • Know the resources. Have them available for the person you are talking to, and for yourself. Anyone can call the hotlines. If you are worried about someone you care about, call and have an expert talk you through things.
  • Speak up for children. If you are concerned about the safety of a child, you can contact Dawson Place at 425-789-3000 or call Child Protective Services at the statewide End Harm line (866-363-4276).
  • Be open about your own experiences, if you are in a place to do so. Talking about subjects that have been taboo, like child sexual assault, can help take away the shame and make others feel safer and less alone in reporting abuse. Investigations are more effective when people feel they can speak honestly and without fear of judgment.
  • Approach every conversation with the mindset of “What do you need? How can I help?” rather than “Here is what you should do.”
The experts we talked to agreed that it’s important for people to remember that not everyone is in a safe situation right now. Awareness of what others may be going through and a willingness to listen and support are crucial all the time, but especially during this crisis.

“In this time when people are focused on their physical safety and health, it’s important to talk about this, too,” Ewalt said.

Reminder: There are people ready to help, for those who are experiencing domestic violence and for those who are worried about someone else.
  • Providence Intervention Center for Assault and Abuse: 425-252-4800 (24/7)
  • Domestic Violence Services: 425-25-ABUSE, 425-252-2873 (24/7)
  • Dawson Place Child Advocacy Center: 425-789-3000 (M-F, 8-4:30)