With officials fearing new momentum in the fall wave of COVID-19 from Thanksgiving gatherings, Public Health has provided the clearest information yet in this “third phase” of the pandemic about how King County and Seattle residents are becoming sick. The answers won’t allay Thanksgiving and holiday fears — and they won’t be easy to address under current restrictrictions and mandates.

In a new report released before the holiday weekend, county health officials said contact tracing shows that most people becoming infected by the virus here since late September are being exposed within their own household. How it is being introduced into the household is a larger, more complicated answer. Officials Wednesday said they don’t have a clear view of how “household” exposures are starting because people are reporting a wide range of contact environments, and often report multiple possible exposures. Contact tracing here has also been complicated by those becoming ill either intentionally or unintentionally providing incomplete tracing information.

But given the most recent tracing, the report (PDF) shows the most commonly reported environments after “household” are community and social gatherings followed by “non-healthcare workplace” indicating many people are becoming sick from meeting with people outside their households or going to work. The graph shown here represents categories that may overlap — tracing often shows more than one possible exposure environment — so it’s not as simple as adding “essential worker” to equation to the “non-healthcare workplace” category but it’s clear that employment is a massively important factor in the continued spread of the virus.

Officials said Wednesday these factors are amplified in communities of color where hospitalization and death rates are also higher.

Washington is currently under a month-long lockdown on many business activities and nearly all in-person gathering though many essential employees and those employed in restaurants and retail still continuing to report for in-person work. The restrictions are hoped to be lifted by mid-December if the numbers improve.

That target seems unlikely.

In Seattle, the city’s free testing facilities continue to be busy and wait times have increased. Officials have asked people to avoid seeking tests to allow gathering or travel over the holidays. Gov. Jay Inslee has discouraged travel and asked people who are taking flights to observe 14 days of “self-quarantine” before and after. Meanwhile, new testing partnerships with the city will soon include a “mobile” test site in the Central District and Capitol Hill area.

There is hope. Washington has begun preparing for the arrival of vaccine as part of a “multi-state workgroup.” A vaccine for COVID-19 is expected to begin to be available to the state by mid- to late-December if federal and CDC testing continues as expected. Distribution will likely play out over much of 2021 with priority for health and hospital workers, first responders like police and firefighters, plus highly vulnerable populations and older people and those at high risk.

The path to get there will continue to be devastating though the feared worst economic impacts may be able to be staved off with a successful 2021 deployment of vaccine.

But, now, the spike in new cases continues to crest even as medical leaders across the country wait for what will likely be a new wave of infections. In King County, there are now an average of 676 new cases a day and hospitalizations have begun to tick higher. King County is currently averaging more than 20 new hospitalizations a day and two COVID-19 related deaths. With around a 2% mortality rate, we can expect to see more than a dozen people die a day from the virus here in December.

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