Health Officer Recommends Masking As Delta Surges In King County

SEATTLE — COVID-19 case counts and hospitalizations are on the rise for the first time in weeks, and King County's top health official is calling on residents to keep wearing masks in indoor public spaces, regardless of their vaccination status. Dr. Jeff Duchin, the county's health officer, hosted a news briefing Friday to offer some context for the latest trends and a few reasons to keep masking up.

"After about two months of decreasing numbers, the trajectory of our COVID-19 outbreak has changed, and cases and hospitalizations in King County are rising," he said. "Over the last seven days, we're reporting 141 new cases daily. The number of new cases has more than doubled in just three weeks, since June 29, when the mask directive was lifted. That's a 130 percent increase."

Duchin said the highest rate of new cases were among age groups with the lowest vaccination rates, and the sharpest increase is seen among people under 49. King County's seven-day rate of cases remains in the "moderate" range, as classified by the Centers for Disease Control and Prevention, but is headed back to the "substantial" classification. Duchin said 45 people were hospitalized for COVID-19 over the last week, a 32 percent increase from the week before.

Despite the increase of cases, Duchin said an analysis of King County data over 30 days showed vaccines continue to prove highly effective, even as the more infectious delta variant became dominant in King County. Between early June and early July, epidemiologists confirmed most new infections, hospitalizations and deaths were among people without their full course of immunizations.

94% of new hospitalizations and deaths are among the unvaccinated

"About 14 percent of people who tested positive for COVID-19 were fully vaccinated, compared with 86 percent who are not," Duchin said. "Because the most important thing our vaccines are supposed to do is not prevent mild infection — the so-called 'breakthroughs' are mostly mild — but prevent serious infections. It's most important to know the vast majority of recent COVID-19 hospitalizations and deaths are among people who are not fully vaccinated. Over the past 30 days in King County, 94 percent of hospitalizations and 94 percent of deaths due to COVID-19 occurred among people who are not fully vaccinated."

An analysis of overall COVID-19 risk between vaccinated and unvaccinated people found infection rates 15 times higher among unvaccinated people, 34 times higher for hospitalizations and 43 times higher for death.

"It should be clear from this that the bottom line is that vaccines make it much less likely — but not impossible — that a person will catch and transmit COVID-19, but that they are highly effective at preventing serious illness and hospitalization," Duchin said.

Delta is the dominant variant in recent COVID-19 infections

The most recent round of genetic sequencing analyzed 20 percent of positive COVID-19 cases and found the delta variant in 56 percent of the samples, followed by the alpha and the gamma variants, according to the health officer. Altogether, variants of concern represent 95 percent of sequenced cases. That means those who remain unprotected against the virus are more at risk than ever to catch and spread the disease.

"When you're exposed to COVID-19 today in King County, it's most likely you're being exposed to the delta virus," Duchin said. "This is concerning because the delta variant is so highly contagious. Infected people produce about 1,000 times more virus and are more contagious for that reason, and they are contagious for longer periods."

Some good news, Duchin said, is that roughly 80 percent of King County residents 12 and older have at least one dose, and nearly 75 percent have completed the series. Making sure to receive both doses of Pfizer or Moderna is essential to curb the chance of delta breakthroughs.

"It's important to be clear that our vaccines offer excellent protection against the delta virus, but the complete series is required," Duchin said. "If you want to be protected, as you should, remember it takes five or six weeks after the first dose for full protection."

While King County's immunization rates are up there with some of the highest in the country, the health officer noted hundreds of thousands are still at-risk to catch and spread the virus, whether by choice, by compromised immune systems, or by being too young to get a shot. Duchin said roughly 700,000 residents remain unvaccinated and susceptible to surge in delta-driven infections, including 390,000 people who are eligible for shots, 308,000 children under 12 who cannot get vaccinated, and tens of thousands of residents who are immunocompromised.

Health officer recommends continued masking in indoor spaces

As uncertainty over the trajectory of delta and other variants continues, Duchin said keeping up a few simple precautions on top of vaccination was the easiest way to reduce opportunities for infection for all, especially in public places where there is no way to know if others are vaccinated.

"I'm recommending at this time that all people, regardless of their vaccination status, once again voluntarily wear masks in indoor public settings as an extra layer of protection to help us all start safer, including the unvaccinated adults and the 300,000 children in King County who are not able to get vaccinated yet, and the many thousands of people who have immune systems that are weakened or suppressed, and to a much lesser extent, vaccinated persons," Duchin said. "I know this is frustrating and may be disappointing to many — it certainly is to me, I did not want to be in this position. I acknowledge that changing communication on masking has been a real problem nationally. But we in public health have an obligation to be realistic about the changing situation and provide the best guidance possible."

The health officer noted that when the CDC lifted its mask requirement for vaccinated people in May, the prevalence of the delta variant was just 1.4 percent across the nation, compared to the 56 percent in King County today. With most restrictions lifted across Washington, and more people taking part in activities outside the home, the chances for infections naturally increase.

"The more exposures you have...the more activities you do, the less precautions you take, the more likely you'll become infected," Duchin said. "If you're vaccinated, the fact is if you become infected you're unlikely to become seriously ill, hospitalized or die. But there's a small chance you could develop an infection that's unpleasant."

While Duchin's recommendation is not an official order, mandate, or directive, he said the more people who choose to wear face coverings in places like grocery stores, shops and theaters, the more effective the "layers of protection" would be.

"Universal masking in indoor public spaces provides a more reliable way to ensure that everyone is safer for now as we monitor the current increasing disease trends," he said. "Making in public spaces is also beneficial for those who are in close contact with someone at increased risk, to model mask-wearing behavior for children and to protect from other respiratory illnesses or allergies."

Duchin said he felt it was unlikely he would need to reinstate a formal mask mandate, as some parts of the country have begun to do, thanks to King County's high immunization rates overall.

"I don't think we're going to get there," he said. "I think that the level of vaccination that we've achieved in King County will protect us from a severe outbreak that would threaten our health care system. On the other than, I think all of us need to be aware of the risk the delta variant poses."

For now, Duchin said the best defense continues to be a compounded defense of vaccination, masking and ensuring good airflow indoors.

"At this point, I think we need to rely on the good sense and the voluntary cooperation of King County community members to understand the situation we're in and that we have a simple, easy, effective way to add to the protection we see from vaccination, through masking and ventilation," he said. "Many communities are going to recommend this as they experience delta surges, there's very little downside. We've done it before, we know how it works, it doesn't cost very much, it's easy and it works."