Are we in a fourth wave? Are the variants storm clouds on the horizon? The latest from our Health Officer on COVID-19 in King County

It can be hard to understand where we are with the COVID-19 pandemic recently. On one hand, it’s great that many people are getting vaccinated in our community. That’s bringing so much hope and relief as it helps reduce infections, hospitalizations and deaths.

On the other hand, not everyone is vaccinated yet, and we are hearing about increases in cases and increases in new coronavirus “variants” that are more contagious.

To help us make sense of this complex moment, we asked Dr. Jeff Duchin, Health Officer for King County, a few key questions.

Cases of COVID-19 are rising, but we are also hearing that deaths have thankfully decreased. Are we entering a fourth wave in King County?

Whether you call it a surge or a wave, cases and hospitalizations have been climbing at a steady pace since mid-March in King County. We can’t predict how big this surge will ultimately be, how long it will last or exactly how much damage to our health it will cause. But we are likely seeing the effects of our increasing activities at the same time that more infectious strains of the virus are spreading.

It’s deeply troubling to think that many more people could be infected in a fourth wave. That brings the potential for long-term health effects and even death, when we are just a few months away from being able to protect most people with highly effective vaccines.

How big are the increases in King County right now?

If you look at the curve of COVID-19 cases or hospitalizations on our online dashboard, the upswing is obvious. Both are now at higher levels than our summertime peak in 2020, but still, much lower than the recent fall/winter peak.

Over the past week, over 260 new cases were reported daily. That’s almost double the number of cases that were occurring in late February when the recent rise began.

And hospitalizations are also increasing since mid-March. During the last week in March, 83 King County residents were hospitalized with COVID-19, about twice as many as were hospitalized in early- and mid-March. This represents one person hospitalized about every two hours all day long every day in King County. The number of people being hospitalized for COVID-19 now is higher than during the summer surge, but only one-third of the peak level during this past winter.

At the same time, there is some good news. We are seeing far fewer COVID-19 cases, hospitalizations and deaths in adults age 65 and older – because most have been vaccinated.

What patterns are you seeing in the age and geography of who is getting infected and hospitalized?

Most COVID-19 infections are happening in young adults, with the highest rates in 18-24-year-olds, followed by 25-49-year-olds. With so many older adults protected through vaccination, the majority of recent hospitalizations have been among 40-69-year-olds, followed by 20-39-year-olds.

Still, not everyone is vaccinated yet. When COVID-19 spreads in the community, the virus can find its way to those who are at higher-risk for severe COVID-19 and still vulnerable.

Overall, COVID-19 rates are highest in the cities in south and southeast King County, including Covington, Auburn, Kent, Federal Way, Burien, Renton, Tukwila, SeaTac, West Seattle, South Seattle, Delridge and Highline, Covington, Maple Valley, Black Diamond and Enumclaw (see our Daily Summary Dashboard and click on “Geography over time”).

What do we know about where or how people are getting exposed to COVID-19 at this point?

People are increasing activities at a time of increasing risk for COVID-19. That means we need to be extra careful and take stronger precautions to remain safe. We are seeing COVID-19 spread across many settings – including in workplaces, businesses and in social settings.

For example, from our interviews and investigations with people who tested positive:

  • Nearly 30% of recent COVID-19 cases report they attended events such as family visits, group meals, parties, or weddings during their exposure period. This is up from 20% in January.  
  • In non-healthcare worksites (such as manufacturing, retail establishments, delivery, hospitality and other businesses), over the last eight weeks, there’s been a 16% increase in outbreaks.
  • Nearly 40% of people with COVID-19 reported going to work during their exposure period over the last month, while in January less than 30% of cases reported going to work.
  • 11% of positive cases reported visiting bars or restaurants, up from 5% in January.
  • In child-care and K-12 school settings, cases have increased from less than 2% of our cases in January, to 5% over the last three weeks.

And what role are the variants of concern driving this increase?

We don’t know exactly how many of our current COVID-19 cases are variants of concern because only about 10% of cases are able to be analyzed for this currently. That said, each week, more and more variants of concern are reported from the sample of cases we do test. 

Variants of concern can spread more easily, and some can cause more severe infections.  But they still spread in the same ways as the earlier coronavirus strains: person-to-person primarily through the air people breathe.

Activities such as loud talking, singing, aerobic exercise and coughing increase the risk, especially indoors. 

That means the measures we know are effective against the earlier strains of SARS-CoV-2 are now needed to protect us from the variant strains. We need to be better at prevention, including limiting indoor activities with unvaccinated people from outside the home, wearing well-made and snug fitting face masks, avoiding crowded indoor spaces, and improving ventilation at work, businesses, and at home. Good hand washing and regular cleaning of surfaces is also important.

With all the talk of vaccine, is testing still important?

It continues to be extremely important to get tested if you have COVID-19 symptoms or you’ve been exposed to someone with COVID-19. Testing allows you to take care of your own health and to prevent spreading the infection to others. It helps protect your family, friends, co-workers and community.

When someone tests positive for COVID-19, it can bring economic hardships and concerns about how bills will be paid, especially if someone has to take time off of work. King County provides financial support for people who test positive or are exposed to COVID-19 and need assistance in order to successfully isolate or quarantine.

We are also very concerned with the high test positivity rate certain areas, especially in parts of south Seattle and south and southeast King County. High positivity means that the virus is spreading more widely in that area, and many more people are infected but have not yet been tested.

Testing is free at any of the King County and Seattle sites, regardless of immigration or insurance status. To find a list of testing sites in King County, visit

We’ve come this far. We’ve been hearing from public health officials to hold on a bit longer. What is your message right now to our community?

Vaccination ultimately will bring this pandemic under control, and the impact of COVID-19 will decrease as more people are protected through vaccination. We are very close to putting the worst of this pandemic behind us, but we’re not in the clear yet. At the moment, the virus is spreading more quickly than we can vaccinate.

The threat is real and remains serious.  Although most people recover, COVID-19 infections can be severe in younger and middle-aged people. It’s important to prevent COVID-19 in all ages, not just the older age groups.

Remember how COVID-19 spreads – through the air and often from people who do not appear to be ill or before they develop symptoms.

Again, it takes a combination of actions to protect ourselves, our families, friends, co-workers and community from the increasing COVID-19 threat:

  • limit activities with unvaccinated people from outside your home
  • avoid crowded indoor spaces
  • pay attention to improving ventilation in workplaces, businesses and homes, including by opening doors and windows
  • stay home from work and get tested if you have COVID-19 symptoms or were exposed to someone who has tested positive
  • wear masks when we are in public or at work or school

For the time being, until enough of us are vaccinated, we need to continue to take COVID-19 prevention and precautions seriously. If we work hard now to prevent COVID-19 spread and get vaccinated when we have the chance, we will be able to do more of the things we want to do more safely and sooner.

Originally posted April 7, 2021