Questions and misinformation about COVID-19 in Snohomish County

By Kari Bray / Snohomish Health District

The amount of information about the COVID-19 pandemic can be overwhelming.

So can the amount of misinformation.

This disease has disrupted our lives. The measures in place to reduce the spread have created new challenges. Misinformation makes it more difficult to come together as a community to face this pandemic.

We’ve seen questions, speculation, and some outright falsehoods, particularly on social media. We want to address some of those. We also want to remind people that, like a virus, misinformation can spread quickly and be dangerous. Please carefully consider the information you are sharing and the source of that information before you spread it further via your own social media or social circles.

Are we seeing more cases because there’s more testing?

This would seem like a logical explanation – the more you look for something, the more you find it.

But testing does not account for the increase in cases we’ve seen over the last few weeks. If you’re looking at testing data, check the proportion of tests that are positive. The Washington State Department of Health provides data on testing for Snohomish County, and we update testing data weekly on our case counts page. In late May and early June, between 2.2% and 2.9% of total tests were positive each week. By mid-June, it had climbed to 5% positive. In fact, more positive tests were reported during the third week of June than the second even though fewer total tests were done.

In brief: Testing alone does not explain the recent jump in cases counts. Cases are going up because the virus is spreading in our community more now than it was a month ago.

If someone is tested multiple times, are they counted multiple times in the case data?

No. First, most people who are tested likely won’t be tested more than once. If results are positive, they isolate – usually at home – until at least 10 days have passed since the date of their first symptom or positive test. Public health staff will check in with them during the isolation period.

If someone is tested multiple times during their illness, the individual is only counted as one case. An example would be if someone with COVID was hospitalized and needed a negative test result before they could return to a long-term care facility. Though they may have additional positive results before they get a negative, the patient would only be counted as one new case.

Does the case rate per 100,000 population include positive antibody/serology tests?

No. Serology, where a blood sample is tested for antibodies developed in response to a past infection, would indicate a previous case. The case rate per 100,000 is based on new cases during the 14-day period for which the rate is calculated. That means the calculation uses confirmed cases during that time frame. These tests are not blood samples, but rather nasal swabs to test for the presence of the virus.

Have COVID-19 deaths been over-reported?

Snohomish County’s death data reflects cases where COVID was a contributing factor to the death. Though we cannot promise that data is always perfect, public health and medical experts work to provide accurate and timely information.

There is, frankly, no reason to inflate the numbers. This disease has taken an undeniably terrible toll. As of the writing of this blog, there have been 161 confirmed COVID-19 deaths in Snohomish County, and 14 more where COVID is suspected to have contributed to the death or where the death certificate is pending, according to a Washington State Department of Health report.

Statewide, the Department of Health has identified a small percentage of deaths initially attributed to COVID-19 that were due to other causes upon closer examination. DOH has modified death reporting to be more specific.

Updates on COVID data are provided often, but the most recent dates include preliminary data. Final death data takes time to review further, and it can be weeks before the data is no longer considered preliminary. There may be slight differences between preliminary and final data, but generally it is not a large change in the numbers.

A death is counted if someone had underlying conditions worsened by COVID; if both the underlying condition (such as chronic heart or lung disease) and the COVID infection contributed to a death, it would be counted. This is not different from other communicable diseases like influenza, for which we also report deaths (during flu season).

We’ve been asked whether a death would be counted if the decedent had COVID-19 but died in an entirely unrelated incident, like a car accident. The answer is no, that person’s death would not be counted as COVID-related.

Shouldn’t we just open up and let people get exposed so we have herd immunity?

Herd or community immunity is a protective factor for many diseases. Widespread immunity for a number of once devastating illnesses has been achieved through vaccination, but people also can build immunity through exposure to an illness.

Since a COVID vaccine is not yet ready, the idea of everyone getting infected and then being immune might sound good at first. But there are a few major problems with it.

1. We don’t yet know how long immunity to COVID may last. Some immunities are lifelong, while others are short-lived. Infection with other coronaviruses that cause human disease often do not produce lasting immunity and repeat infections are not uncommon. Without a better understanding of whether there is lasting immunity to COVID, we can’t bank on it.

2. Increased exposures to this illness would overwhelm our hospitals and medical system. This has happened elsewhere in the nation and world during this pandemic, and almost happened in Snohomish County early on. Overloading hospitals and clinics would jeopardize care not only for COVID patients, but for others with unrelated health conditions.

3. There are indications that this illness can cause enduring damage. People may recover, and may even have immunity, but at the price of new health complications. The symptoms, severity and outcomes of the illness aren’t the same for everyone. Experts still are working to understand the extent of what this virus does to the human body.

If cases are up but hospitals aren’t overwhelmed, does that mean this disease isn’t that serious?

Hospitals are not overwhelmed yet, but there is concern for what may come as cases continue to rise.

The severity of COVID does vary, and most people do not require hospitalization. They can recover while isolating at home. Younger people without underlying conditions don’t tend to become as ill as the elderly or people with pre-existing health concerns. New case reports are shifting more toward a younger demographic than the cases reported earlier in the outbreak. That younger age group, as well as protective measures in place for high-risk populations, may help account for hospitals not being overloaded yet.

We can only shield vulnerable populations for so long. If COVID spreads more among people who are not high risk, it will eventually reach those who are high risk. It’s worth noting that young, otherwise healthy people can have severe complications from COVID, too.

We are still waiting to see what the recent increase in cases means for hospitals. It takes time between when someone is exposed to when they become ill, and from when they become ill to when their symptoms could be severe enough to require hospitalization.

I had to quarantine because I’m a close contact of a case. Can I go back to work if I test negative?

Not necessarily. People who have been exposed to COVID are instructed to quarantine at home for a full 14 days after their most recent exposure. This includes not going to work. A negative test result does not shorten that quarantine period.

It can take time for symptoms to appear, and no test is 100% accurate. Even if you test negative, you risk spreading the virus if you either tested too soon to detect it or if your result was a false negative.

There are some exceptions for healthcare or other essential workers. Your employer should have a health and safety plan, and you should follow instructions from public health staff when they call to inform you that you are a contact or to check in during quarantine. Do not assume you are an essential worker or are otherwise exempt from the 14-day quarantine period.

Can my doctor give me a medical exemption so I don’t have to wear a face covering in public?

Face covers are required by a statewide public health order to be worn in any indoor public setting, including businesses, or outdoors where people cannot reliably maintain a six-foot distance. Limited exemptions are outlined in the order:

• Children younger than five are not required to wear a face cover, and children younger than two should not wear one.

• People with medical conditions, mental health conditions, or disabilities that prevent wearing a face covering do not need to wear one.

You do not need to provide proof that you qualify for an exemption. If you have a medical condition and are unsure whether it would prevent you from safely wearing a face cover, please contact your medical provider about those specific questions. However, you do not need to request a note or other verification of your condition.

In general, people who have an underlying medical condition so severe that they cannot safely wear a cloth face cover should avoid public venues where they may be exposed to this virus. Businesses should make accommodations for those who cannot wear face covers.

Can businesses do anything if customers don’t wear face coverings?

Yes. Under a statewide order, businesses cannot legally serve customers who do not wear face covers. They can refuse entry if you refuse wear a face cover. If you are exempt from the order (see previous question), the business should make a reasonable accommodation such as curbside pick-up or home delivery, or making an individual appointment.

There are times when face covers may be removed, such as once you are seated at a restaurant and begin eating or when you are participating in outdoor or indoor exercise and are maintaining distance from other people.

If someone insists on entering a business without a face cover after being informed of the rules and asked to leave, employees should avoid confrontation. Law enforcement may be called to address the situation, just like with any other customer who put others at risk by not following safety requirements.

Are most new cases linked to specific events or gatherings?

While social gatherings or parties contribute to increased spread of COVID, there is no single hotspot or event. New cases are being detected throughout the county.

An outbreak does not necessarily have to be tied to a single event. It could be a social network of multiple households who become exposed to each other through one or more interactions over time. This is why we emphasize the importance of keeping social groups small (five or fewer) and consistent (the same people over a seven-day period). Even if you see only two or three people at a time, seeing different small groups in the same week can significantly increase the number of people exposed if you become ill.

Should I get tested if I went to a large gathering?

Let’s drop in another reminder to limit in-person social interactions. Large gatherings can be what’s called “super spreader” events, where a single case could lead to dozens more.

Nevertheless, we know that there have been a number of gatherings recently. If you have been to one, it’s a good idea to get tested. Don’t do so right away – a test the day after is unlikely to detect the virus if you were just exposed. Wait four to six days after you attended the gathering to get tested. Go sooner if you develop symptoms of COVID.

We advise people to quarantine at home for 14 days following a large gathering. This means no work, no errands, no visits, and no visitors.

Stay informed

As more information comes out about the virus, its impact on our community, and the steps we need to take, please remember to turn to reliable sources and avoid spreading false or misleading information. Good sources to monitor include:

• Centers for Disease Control and Prevention

• Washington State Department of Health

• Washington State Coronavirus Response page

• Governor Jay Inslee’s office

• Snohomish Health District

• Snohomish County Department of Emergency Management

• Washington State Department of Labor and Industries

• University of Washington research on coronavirus

Thank you to everyone who is stepping up to help reduce the spread of this illness. Your efforts matter.

The Public Health Essentials! blog highlights the work of the Snohomish Health District and shares health-related information and tips.