State and county officials are seeing unprecedented COVID-19 case numbers and are encouraging a re-commitment to safety measures to prevent a return of lockdown measures.
"If we had a dashboard, every light would be blinking red," said Snohomish County Executive Dave Somers during a Nov. 10 county briefing.
"We're breaking COVID case records and really heading into uncharted territory. The third wave appears to be the largest wave yet," he said.
For the county that means an average of 187.7 cases per day per 100,000 people from Oct. 25 to Nov. 7. That breaks the county's previous two-week record of 129.1 cases per 100,000 people.
County and state officials have put the target at under 25 cases per 100,000 people for a safe reopening.
Snohomish County is doing better than some other parts of the state though, which are seeing even higher rates.
"The number of cases per day steadily increased, starting in early September," said Dr. Kathy Lofy, state health officer with the Washington State Department of Health, during a Nov. 10 state briefing.
"What's very concerning to me is that there has been an accelerated rate of growth," she said.
The number of cases in the state is also higher than it has ever been and occurring throughout both eastern and western Washington.
Lofy said the increased numbers are not a result of an increase in testing, since the amount of testing done in the state has remained relatively stable since July.
Local cities are also seeing higher numbers with both Arlington and Marysville at relative peaks.
Arlington's most recent count saw 117 active cases, the highest of any weekly count.
The most recent report from Marysville saw that the COVID-19 rate was more than 300 cases per day per 100,000 people, which is higher than it has ever been during the pandemic.
Spitters said local contact tracing shows new cases coming "in from all directions," including from people gathering socially indoors, from individuals going to work and from school cases.
"Unfortunately, too many people are getting tired and increasingly frustrated with the need to follow public health interventions," said Spitters. "While that is understandable, recent data is highlighting the consequences of that."
"Pandemic fatigue" can cause many people to be frustrated with continued social distancing, said Dr. Kira Mauseth, of the Washington State Department of Health's Behavioral Health Strike Team.
"The exhaustion we're feeling is totally real right now," she said. "All of us have a need to have a fun celebratory holiday, and the temptation there is to downplay the risks to get back to that normalcy, but it's really critical not to let our guard down."
Officials do not want to go back to measures taken in the spring to lockdown all but the most essential businesses.
"If we don't push the curve back down we will almost certainly have to go backwards," said Somers.
"We're at the point where if we cannot take actions socially than we will have to take actions that will hurt our economy, and no one wants to do that again. Unfortunately if we continue on this trajectory, at some point we may need to," said Lofy.
Somers said previous local action was taken in conjunction with state action and expects the county to continue working with state health officials.
"Throughout this year we've tried to coordinate with adjacent counties and the state," he said. "It's better to have a widespread, broad reaction to this."
A second 'stay-at-home order' is on the table, said Somers, although if those orders are given again they will likely be "more nuanced."
The biggest concern for health officials is a hospital system stretched beyond its capacity.
Too many COVID-19 cases "would overwhelm our hospital's ability to provide care, not just for COVID, but for all needs," said Dr. Chris Spitters, health officer for the Snohomish Health District.
Hospital capacity can falter through many different avenues, said Spitters.
"It's not just bed, and personal protective equipment, but staffing is a major problem," he said.
Dr. John Lynch, medical director of the Infectious Diseases Clinic at Harborview Medical Center, said during the state briefing that COVID-19 treatment has improved, but it is still not safe.
"Despite learning about this and having more tools than ever, people are still getting very, very sick, ending up in the ICU and dying," he said.
Many hospitals have been preparing for a third wave of cases in the fall but they are still limited by staff available, said Lynch.
"We need those folks to be able to come to work and continue providing care," he said.
The coronavirus is most fatal to elderly individuals, but COVID-19 still remains dangerous to all age groups.
"Although our older adults are more likely to get severe disease, end up in the ICU or die, all ages can have bad outcomes," said Spitters.
He noted that 20 percent of Snohomish County deaths over the last couple of weeks have been from people under 50 years of age.
Since hospitalization typically comes two to three weeks after initial case reports, Spitters is concerned about hospital capacity in the near future and said even drastic measures taken now may not be enough to avert a crisis.
"It's much like we're driving on ice. Even if we hit the brakes we're still going to see movement," he said.
Officials are encouraging similar safety measures as they have in the past, including the use of masks, postponing all gatherings, avoiding businesses that don't follow health guidance and to make a bubble of five or fewer social contacts outside the household.
With the holidays coming up, officials are requesting individuals to not have large family gatherings.
"For those of you that want to have a small Thanksgiving, please make it outdoors and please make it no more than five people outside your home, and include a two-week quarantine before," said Lacy Fehrenbach, deputy secretary of health for COVID-19 response with the Washington State Department of Health.
Many individuals are hoping for a vaccine soon, but a realistic timeline to deploy one means we are likely still months away from seeing any benefits, even if an effective vaccine has been found.
"The fruits of a vaccine are not imminent. They will not help us with this wave and are unlikely to help us with a fourth wave," said Spitters.
Michele Roberts, acting assistant secretary with the Washington State Department of Health, said the newest reports of a vaccine appear to be good so far.
"We are encouraged by reports of high efficacy and low safety issues," she said. The long-term effectiveness is still in question for the vaccine though, she added.
Any vaccine produced will have to meet the same safety standards a normal vaccine would. "We know that vaccine safety is a big priority for the people of Washington," she said.
The state does not know how allocation or timing of handing out a vaccine will go and has to wait for manufacturer reports before they can plan those details out, said Roberts.
On Sunday, Nov. 15, Washington Gov. Jay Inslee announced a four-week statewide set of restrictions in response to the increase in COVID-19 cases. For more information about those restrictions go to https://bit.ly/2H7jsKX.