After a Most Difficult COVID-19 Pandemic Year, Cautious Optimism and Gratitude

Reflections from Dr. Jeff Duchin – Health Officer, Public Health – Seattle & King County

One year ago today, King County became ground zero for an emerging pandemic due to a new respiratory virus, SARS-CoV-2, that swept us up into a storm of suffering and uncertainty that continues to buffet us physically, emotionally, socially and economically. The COVD-19 pandemic has been an exhausting ongoing year-long natural disaster, unprecedented in its duration, damage, and pervasive impact on our lives.

In King County, since the onset of the outbreak we’ve had over 82,000 cases, over 5000 hospitalizations, and have lost close to 1400 lives. So, I begin by expressing sincere condolences to everyone who has lost a loved one or friend to COVID-19, and to everyone who has been ill or is caring for someone with COVID-19. I continue to grieve with you, as do all of us at Public Health.

It’s been a terribly difficult year in many ways, and more difficult for some than for others. It’s important to acknowledge that COVID-19 has starkly highlighted and exacerbated structural inequities and resulting health disparities in our society.  Communities of color have been hardest hit by COVID-19, with higher rates of cases, hospitalizations and deaths. These higher rates are influenced by systemic inequities including discrimination in healthcare, housing, and education and less access to health care. These factors are compounded by the fact that communities of color are disproportionately represented in essential work settings where there are more chances to be exposed to the virus and often less flexibility to take off work if needed.

I also want to acknowledge the many, many people across King County of all ages – including children, who have suffered from the economic and other unintended impacts of this ongoing outbreak and its control measures.

But today, despite the fact that our situation remains precarious and with significant uncertainty, the light at the end of the tunnel is getting brighter and the path to a more normal life is becoming clearer.

Despite the uncertainty and the real and significant challenges that remain, I think there is cause for cautious optimism.

We have many reasons to be encouraged as a community. Although this has been a dreadful year in many ways, King County and our region has, until this point, weathered this storm relatively well compared to most of the rest of the country. King County has among the very lowest COVID-19 case and death rates among the 100 largest counties in the US, ranking 2nd from lowest in our total COVID-19 case rate and 6th from lowest in our COVID-19 death rate.

However, even with this relative success, 21 King County residents lost their lives to COVID-19 last week – one death every eight hours. That’s an unacceptable statistic, yet one that has improved from December when a King County resident was dying of COVID-19 every three hours.  Approximately 70 King County residents are hospitalized per week currently – a hospitalization every two-and-a-half hours – down from one hospitalization every 40 minutes in mid-December.

Our early outbreak, first recognized at Life Care Center of Kirkland, hit King County’s long term care facilities (LTCF) hard. Since then, almost 60% of all deaths have been associated with LTCFs. As recently as December 2020 and January 2021, hundreds of cases and multiple deaths were reported from LTCF’s weekly. Overall, 85% of total deaths in King County have been in people 65 years and older.  So, it’s especially gratifying for me to share that our team reported that last week was the first week since the outbreak began a year ago that we did not have a single new case of COVID-19 from a LTCF. This is tremendous news.

As of today, our outbreak is about 90% of the way back to the level of COVID-19 transmission we were at before our recent third wave, which was the largest yet – responsible for three-quarters of our total cases and half of hospitalizations and deaths.

The current outlook: Although we’ve been heading in the right direction on several fronts recently, we currently have 140 new cases reported a week, which is about twice the level we were at before the recent surge and three times the level we were at before the summertime second wave surge.  This means there are still thousands of people with infectious COVID-19 in King County each day, up to half of whom can spread the infection despite showing no symptoms.

A major concern for us are more contagious and more severe SARS-CoV-2 variants increasing locally and nationally, which pose a serious and unpredictable threat to our progress. Our current level of COVID-19 and the presence of variants of concern means we must continue rigorous COVID-19 prevention measures in order to avoid a potential large fourth wave of infections. It’s critical to understand that we remain vulnerable, and complacency now would be a major mistake. But we are in a much better place today than we were a month ago and we’re heading closer to a possible return towards normalcy in a few months – the only question is what road we will take to get there.

On the positive side, we’ve shown we can drive COVID-19 cases down by changing our behavior and our environment, limiting activities with people from outside the home, wearing well-made and well-fitting face masks, avoiding spending time in crowded and poorly ventilated indoor spaces and providing resources to allow people to take necessary actions. Continuing to pay special attention to decreasing risk in crowded, and indoor, poorly ventilated spaces by improving air quality indoors will be important.

But the best news of all for ultimately controlling the COVID-19 pandemic is the development and increasing availability of highly effective vaccines, and we are continuing to vaccinate as quickly as we can get doses. Over half of adults 65 and older and almost 60% of adults 70 and older have received at least one dose.  However, although communities of color have been disproportionately hard hit by COVID-19, vaccination rates among many of these populations lag behind that of whites, and we will continue to work to close that gap and achieve equity in vaccine access and coverage.

Vaccination is our most powerful single weapon against COVID-19, but at the moment it can’t be our only strategy. It’s essential to continue to fight this virus through both prevention measures and vaccination in order to reduce the risk for a major spring surge. If we relax too soon and fail to further suppress the spread of COVID-19, if we travel and gather to the degree we did during the summer and winter holiday seasons, we will increase the chances of experiencing another large surge in cases, hospitalizations and deaths this spring.

So, although the trajectory of our outbreak is impossible to predict with confidence, especially with the new variants spreading, I think realistic and cautious optimism is called for. If we are successful with a few more weeks of serious prevention efforts, caution in our activities and vigilance for signs of increasing danger, we may be able to put the worst of the COVID-19 pandemic behind us and turn our attention to healing, recovery and the transition to a much more enjoyable future.

In closing, I want to acknowledge the difficult work that so many of our community members have done and will need to continue to do to help contain this virus and keep one another healthy in the coming weeks and months. I especially want to recognize our healthcare workers and first responders and the many other frontline essential workers who day in and day out since the very first day of this pandemic, under stressful circumstances and in the face of personal risk and uncertainty, have been providing healthcare and other essential services that our community relies on.

And finally, I want to express my deep and lasting gratitude to each of my hundreds of amazing colleagues at Public Health who have been going all out for over a year now under such difficult circumstances, both responding to this outbreak and ensuring that essential public health functions and services continue on behalf of all King County residents.

COVID-19 Case Rates by Region

Originally posted February 28, 2021