SEATTLE — With King County poised to enter the second reopening phase Monday, restoring numerous indoor and social activities, the county's health officer is urging "extreme caution" and warning against a return to normalcy at a critical moment.
Gov. Jay Inslee announced this week that seven Washington counties are now qualified to enter Phase 2 of the Healthy Washington plan under adjusted guidelines that now require each region meet just three of the state's four metrics to move forward.
But with the specter of the more transmissible B117 variant looming over King County, Dr. Jeff Duchin said residents need to proceed carefully, especially as more things begin to open up. The variant, first identified in the U.K., was detected in neighboring Snohomish and Pierce counties last week, and at least two other variants of concern have arrived in the U.S. Duchin said Friday morning he was confident B117 was already in King County — a prediction that would prove to be true just a few hours later.
"Although our levels of COVID-19 are decreasing again, they remain very high by most standards, and I need to be clear again that we should expect the variant strain to become widespread here," Duchin said. "That will make our outbreak much harder for us to control. If the outbreak takes off from a very high level of COVID-19, it will be like falling off a cliff, compared with falling off a curb."
Duchin pointed to Europe as an example of a worst-case scenario should a variant strain become dominant amid already high rates of community spread, likening its speed to that of an F-16 fighter jet.
"Multiple counties in Europe have had to resort to more severe lockdowns — the word we do not want to hear — in an attempt to control the B117 variant, and this is, partially, because they let the virus spread too widely before taking needed actions," Duchin said. "We will need to be vigilant and act quickly and decisively if we see a rebound in our COVID-19 outbreak, but we do have the advantage now of an early warning to help us prepare by getting transmission as low as possible as quickly as possible."
That goal becomes even more challenging as portions of the economy reopen since any version of the coronavirus spreads much more readily indoors. However, Duchin said, the same prevention strategies that protect against earlier strains of the virus are effective against more infectious variants if everyone commits to them consistently.
"To stop the spread, we need to take a fresh look at how we can be better at taking all possible precautions in our personal and social lives, workplaces and wherever people gather," Duchin said. "This means decreasing nonessential activities outside the home. Remember, just because you can do something doesn't mean you should."
Other precautions include avoiding crowded and poorly ventilated indoor spaces and continuing to keep socializing outdoors whenever possible, despite the relaxed rules. Another essential defense is using a well-made, snug-fitting mask consistently, especially indoors, when journeying outside the household.
"Well made means multiple layers, and [fitting] well means snug against the face," Duchin said. "If there is air going out the sides, or up the top and fogging your glasses, it's not working as well as it should be."
Most important considerations when selecting a cloth mask include: •2-3 fabric layers•Made of tightly woven fabrics such as cotton/cotton blends•Breathable•Snug fit without gaps•Comfortable to wear the consistently whenever around others outside the home. 5/
— Jeffrey Duchin, MD (@DocJeffD) January 29, 2021
Asked whether he thought moving into the second phase was a bad idea, given the real threat of a potential explosion in cases, Duchin said he did not consider the move "reckless," but being successful would require considerable vigilance.
"It's understandable that we're moving forward and...there are benefits, economically, to moving forward and to people socially as well," Duchin said. "However, we need to go with extreme caution. As I said, we're skating forward into Phase 2 on a lake not knowing how thick the ice is. We really need to able to very nimbly pivot if we see things heading in the wrong direction again."
While the state's four metrics for reopening rely on data that can lag by two or three weeks, Duchin said he would be keeping a keen eye on case counts and hospitalization rates, which can provide an earlier indicator of a burgeoning crisis. If necessary, counties have the authority to implement restrictions independent of the state, but Duchin said the goal is to keep decisions streamlined within our designated region, which includes Pierce and Snohomish counties.
In the governor's announcement Thursday, Inslee said a key factor in his decision to allow counties to move forward was a promising outlook that Washington could vaccinate almost 90 percent of its most vulnerable populations before variant strains gain a foothold. Duchin said he had not personally seen the modeling, but questioned whether supply would increase quickly enough to meet that goal.
Even if it were possible, Duchin said vaccines alone will not prevent a surge brought by variant strains.
"I don't think we're on track, either locally or nationally, to vaccinate our way out of the threat of the variance, particularly the B117 variant," Duchin said. "There simply aren't enough doses being produced nationally to get enough people vaccinated to have herd immunity."
The state's most populous county has received roughly 25 percent of the state's total allocation, and already administered about 80 percent of its doses, Duchin said. Sporadic weekly shipments, ranging from as low as 12,000 to as high as 73,000, continue to complicate long-term planning efforts.
While the Biden administration has pledged a 16 percent boost to Washington's supply in February, Duchin said he was not expecting a notable increase by next week. Right now, King County has 250 licensed providers, but only 71 of them received vaccines from the state in the last week. Statewide, Duchin said, only a third of requested doses are arriving, failing to keep pace with expanded eligibility needs.
For now, the focus remains on vaccinating the most vulnerable groups, especially those above 65. According to the Centers for Disease Control and Prevention, people between 65 and 74 years old are 90 times more likely to die and 5 times more likely to be hospitalized from COVID-19, compared to younger adults between 18 and 29 years old. That risk builds exponentially for those ages 75 to 84 and higher still for people 85 and above.
To aid in that goal, the county will open its first two mass-vaccination sites Monday in Kent and Auburn, tailored specifically for older adults and their caregivers.