Like much of Washington state, Snohomish County saw an increase in coronavirus cases at the end of June.
"This is the highest two-week rate we've seen since late April," said Chris Spitters, Snohomish Health District health officer, at a June 30 briefing.
"We have officially passed 4,000 cases of COVID-19 in Snohomish County," he said.
The target for safe re-opening is 25 cases per 100,000 people, which the county was able to get under at the end of May to mid-June, however that rate has jumped back up to 39 cases per 100,000.
"We had a nice honeymoon period there where most of the days had 10 to 15 cases reported," said Spitters.
The increase in cases is not believed to be because of increased testing.
"We believe that represents an increased rate of transmission and is not just an artifact of counting," said Spitters.
Since early March the Snohomish Health District has tested between 2,300 and 3,800 individuals each week, with 3,594 and 3,400 tests given for the final two weeks of June.
In Arlington, the Health District reports 156 cases total with 129 recovered. In Marysville there are 364 total cases with 245 recovered. Tulalip had 28 cases with 23 recovered.
"Deaths are down from their peak but we're still seeing one to three people die every day from COVID," said Spitters.
"With this recent surge of cases, if that leads to hospitalizations and deaths, that's going to happen in a week or two," he said.
At this point the Health District does not know if the increased cases are a temporary random increase or the beginning of an upward trend.
"We're monitoring the data to see if it's a blip or a signal," said Spitters.
County Executive Dave Somers encouraged continued use of social distancing and masks.
"We know what works: social distancing and wearing masks," he said.
"It's really sad to what's happened in Texas and Florida. They opened too soon and now they are backsliding, and we don't want that," he said.
Going back to Phase 1 with most businesses closed is not something people want to do, said Somers, but is now a possibility.
"A week or so ago I would have thought it was a remote possibility. Now I think it is clearly one of the options that could be in front of us," said Somers.
"Watching the other places around the country with huge spikes, if that happens here and we're maxing out our hospital capacity, there will be calls for that," he said.
"It's conceivable if hospitals started filling up that's the thing that might have to occur," said Spitters.
He encourages people to not gather with more than five people at once, and if they have been at a large gathering or think they've been exposed to stay home for 14 days.
More young people are testing positive recently and Spitters said there could be a number of possible causes for that.
"Young people are more likely to work in retail and see exposure there," he said. He said they are also more likely to have impromptu gatherings that exceed the recommended size.
"They don't get sick as often but they can still be hospitalized," he said.
As the pandemic continues, Somers acknowledges that isolation and quarantine have been difficult for many people.
"Some are feeling helpless. We all want the pandemic to be over and get back to our regular lives, paychecks and visiting families and friends," said Somers.
"The virus could easily be with us for a year or much longer. We're in the stage where everyone is tired and wants it to be over, but we really need to stay strong," he said.
Stressors including parenting overload, financial and job anxiety, and relationship stress are continuing to compound, he said.
"We are seeing there is an increase in people with housing insecurity," said Pat Morris, Volunteers of America Western Washington's senior director of behavioral health.
"We're going to be having, through the CARES Act, some very generous rental vouchers and rent subsidies," she said.
Renters currently have state protection because of orders from Gov. Jay Inslee, but those will not last forever.
"Our biggest concern is when the eviction moratorium is lifted and we have clients who may be asked by their landlord to have two or three months of rent payable after that moratorium," said Morris.
Through the federal coronavirus relief bill many nonprofits have been given funding to begin reaching out to those individuals.
Beginning July 13 the Volunteers of America Western Washington will be sending out a team to proactively contact individuals.
"To go out to areas in Snohomish County to reach out to those who might be in a food distribution line, or their at a urgent care center, or their at a medical clinic or a resource center, and approach them and ask if there are more resources that they may need," said Morris.
She said the nonprofit's mental health line call volumes have climbed throughout the crisis.
"They have doubled on a day-to-day basis, primarily because people are more and more concerned and their life situation is becoming more and more stressed," she said.
"If anyone needs to talk to a mental health counselor they can dial 211," which is staffed from 9 a.m. to 5 p.m.