New King County Omicron Cases Suggest Another Surge Ahead

SEATTLE — King County health officials are warning of a likely surge in coronavirus cases involving the omicron variant, which has already proven to spread more readily than delta in other countries and could present another significant challenge to the region's health care system.

Dr. Jeff Duchin, the county's health officer, held his first COVID-19 briefing in several weeks on Wednesday, detailing the current trends in the wake of the summer delta surge, and flagging new signs for trouble on the horizon.

"Over the last seven days, we've seen an average of 284 cases per day, representing a decrease of about 9 percent from Dec. 3 after a two-week post-Thanksgiving increase," Duchin said. "However, it's not clear whether this decrease will be sustained."

Genome sequencing confirmed King County's first omicron case on Dec. 4, followed by another five cases less than a week later. Three additional cases were identified on Wednesday, linked to recent outbreaks at high school wrestling events. Duchin said none of the patients with confirmed omicron cases reported international travel, suggesting local spread may be well underway.

While delta remains dominant in King County, Duchin said omicron has already shown the capacity for "explosive growth" in countries where the variant was confirmed earlier. British officials reported more than 78,000 new cases Wednesday, marking the nation's single largest increase since the pandemic began.

"We do need to expect, and I think everyone should be prepared for, eventually many of us being infected," Duchin said. "Being infected doesn't mean getting seriously ill, but it's a fact that the vaccines are less effective against infection — particularly less severe infection — with omicron than they were against delta."

Another influx of cases could overwhelm King County hospitals

The health officer said early data suggests omicron spreads much more effectively than delta, with case counts in some countries doubling every two or three days. While the latest variant appears less likely to cause severe outcomes than delta, a rapid influx of new cases could spell more problems for the region's health care system.

"Although the delta variant is currently causing the majority of COVID-19 cases locally, omicron is clearly beginning to spread rapidly and we need to take a concern about the surge in COVID-19 cases seriously. Even if most people don't require hospitalization — and clearly most vaccinated people will not — when very many are infected in a short timeframe, even a relatively small proportion of seriously ill can add up to be a large number. Our health care system does not have a lot of surge capacity at the moment."

Despite COVID-19 hospitalization rates being down roughly 70 percent from their summer peak, twice as many people remain hospitalized than before the delta surge, and King County hospitals are contending with high patient volumes across the board, with close to 98 percent of critical care beds occupied.

As The Seattle Times reported this week, while COVID-19 patients currently take up just a fraction of beds, the rest are nearly full due to other illnesses and patients who are awaiting a place to be discharged. A rapid spike in omicron cases could quickly compound the problem.

"We really do need to be prepared for a potential surge in cases again," Duchin said. "It's not something that we were expecting, or that we're very happy about. I think in the context of preparation, our community has an important role to play here. If we can decrease the number of people who become infected, we can decrease the risk of a very unprecedented surge in our health care system that could compromise the type of care that we want to get and that we need to get when we have serious illnesses."

Omicron is better at breakthroughs, but vaccines and boosters limit effects

The health officer said omicron has shown to be more effective at reinfecting people who previously had COVID-19 and evading some vaccine protection. However, fully vaccinated people, especially those who have their boosters, still have a much lower risk of experiencing severe outcomes.

"Vaccines will continue to protect us from severe infection," Duchin said. "Omicron also evades antibody protection from past infection — this is really important — vaccination has been recommended for people with past infection for this exact reason. It leads to better immune response against variant viruses. Even if you've had a past infection, if you've not been vaccinated, it's important to do so because you're increasingly susceptible to omicron compared to reinfection with delta, for example."

For those who were already fully vaccinated, Duchin said seeking out a booster shot should rank among the top priorities for King County residents.

"We should expect to see an increasing number of breakthrough infections in vaccinated people and people who've had past infections, but the vaccine will continue to work against severe infections," he said. "For this reason, the single most important thing you can do is to get vaccinated and boosed when eligible, even if you previously had COVID-19. Preliminary data on booster doses from the UK suggest they appear to restore very good protection against infection."

King County ramps up booster efforts; more than 500K administered

To that end, King County is ramping up its efforts to connect people with booster shots, which are now available to everyone 16 and older. So far, roughly 86 percent of residents in that age group previously received their full immunization series, and the county estimates half a million residents have received a booster or third dose. That number includes about two-thirds of residents 65 and older, but younger age groups are still below 50 percent, Duchin said.

"Due to the increasing number of people who have been recommended to get boosters recently, lots of people are trying to get vaccine appointments at the same time right now," he said. "In response, we've been increasing our vaccine capacity."

The health officer said it has increased capacity at its fixed sites by more than 50 percent over the last month, and mobile clinics are deploying to South King County. More events are in the works for January and February, and the county is working with medical associations and nursing programs to secure enough volunteers to staff future events.

"If you're seeking a vaccine, understand there will be capacity to vaccinate and boost everyone who is eligible in King County," Duchin said. "But, it is important to get on a waitlist as soon as possible to ensure you get your shot in the most timely way."

Wait times can range from a few days to weeks, and length varies greatly by location.

Here are a few ways to seek out a booster around King County

• The city of Seattle recently expanded its high-volume vaccine clinic at the Amazon Meeting Center in South Lake Union, with thousands of appointments available each weekend.
• The University of Washington Medical Center maintains a waiting list across its facilities.
• King County operates a waiting list for its vaccine clinics, with signups available online or by calling 206-477-3977.
• Other pharmacies, clinics and health care facilities may have openings listed on the state's VaccineLocator tool.

Beyond expanding access to boosters, King County is also working to provide free, rapid antigen tests across the county, starting with a pilot program in South King County. Once the state provides more supplies, health officials plan to distribute the kits widely, including to local libraries.

"We are expecting weekly deliveries of tens of thousands of rapid antigen at-home test kits coming from the Washington State Department of Health," Duchin said. "We hope they are going to be available by the end of the year, and we're working on planning with community partners to distribute these tests at key access points."

Managing risk with layered precautions

While there is still much to learn about omicron, Duchin said the fundamental defenses remain the same.

"The most important things to know about omicron is that it spreads through the air the same way as delta — only a whole lot better — and that vaccines are the most important thing we can do to reduce our risk. But they must be used in combination with other strategies. That means we can reduce risk using the same layered COVID-19 precautions we used against delta, but this virus is less forgiving and we will need to take advantage of as many layers as we can and apply them as effectively as we can."

Those strategies include things like wearing good quality, well-fitting masks, taking steps to improve indoor air quality, reducing chances for high-risk exposures and avoiding crowded areas. While the risks will never be zero, Duchin said taking a layered approach can go a long way.

"It's important to remember that risk is additive, and risk is increased with higher levels of community transmission, gathering with unvaccinated people, gathering indoors with more people, and having close contact in poorly ventilated spaces, with crowding, loud talking, singing, shouting, and aerobic exercise," he said. "On the other hand, risk is lower with gatherings where everyone is vaccinated or boosted, with well-ventilated spaces or the use of HEPA filtration, when gatherings are outdoors, when wearing good quality well-fitting masks or respirators, when distancing is maintained, and when rapid-resting on the day of gathering is used."

Duchin closed out his Wednesday briefing by acknowledging another frustrating detour on the road to recovery, but with the hope that lessons learned from previous surges will help with what may lie be ahead.

"The emergence of omicron is a disappointing setback from where we had hoped to be two years into this pandemic. The virus clearly does not care about our hopes or expectations. Despite this, we're not going back to square one of the pandemic. We have effective vaccines that prevent serious illness and we know what works to prevent COVID-19 spread in the community. Over time, I am confident that increasing immunity from vaccination and, for some, exposure to the virus, will make COVID-19 less and less of a threat. But for now, we should expect more omicron cases over the coming days and weeks and take whatever precautions we can to reduce the risk, both to individuals and to our community."