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Posted on: July 28, 2021

Advisory: Fifth COVID Wave Fueled by Delta Variant: Increase Vaccination; Mask in Public Indoors

July 28, 2021

Clinician Advisory

Fifth COVID-19 Wave Fueled by Delta Variant: 

Increase COVID-19 Vaccination

Mask-up in Public Indoor Places


Requested Actions

  • If you are a health care worker and are not fully vaccinated, get vaccinated as soon as possible to protect yourself, your family, and your patients. 
  • Ask about vaccination status among all patients. Recommend vaccination to all unvaccinated  persons aged 12 years and older, and provide vaccination yourself or refer them to a vaccination site.  This applies even for those patients with prior SARS-CoV-2 infection. 
  • Make sure people receiving a first dose of a COVID-19 mRNA vaccine (i.e., Pfizer-BioNTech or Moderna) return for their second dose to complete the series.  Vaccine immunogenicity against the Delta variant is substantially improved by completing the second dose. 
  • Communicate with unvaccinated health care workers staff, patients, and other individuals to increase confidence and promote further uptake.  CDC has many resources for providers to help increase vaccine confidence .
  • Make colleagues and patients aware of the Health District’s and CDC’s recommendation that all individuals wear masks in public indoor spaces--even if fully vaccinated, as well as the Secretary of Health’s order that unvaccinated people are required to wear masks in all public indoor spaces.  
  • Recommend that patients who are immunosuppressed continue to practice all recommended prevention measures, even after completing vaccination. This is particularly important for solid organ transplant recipients, as well as patients with hematologic malignancies, those receiving immunosuppressive therapy (e.g., TNF-alpha blockade, CD20 blockade), and dialysis patients.




The requested actions set forth above address a multi-layered response to the Delta-driven resurgence of COVID-19 occurring regionally and nationwide by emphasizing continued efforts to achieve higher vaccination coverage and recommending masking for all in public indoor places.  

COVID-19 cases and COVID-related hospitalizations are going back up again and we are now on our way up a 5th wave of transmission.  For the week ending last Saturday, July 24, a total of 634 new cases were reported, a 20% increase from the prior week and a 125% increase from the 280 cases reported just four weeks ago.  Our 2-week rolling case rate per 100,000 is now 140.  We are now in CDC’s “substantial” transmission risk level (>100 per 100K) and the number of COVID patients in Snohomish County hospitals has increased 50% in the past week.  This largely preventable return to increasing transmission and hospitalizations is being driven by three main factors: (1) stalling vaccination that leaves approximately 240,000 eligible individuals (~33%) unvaccinated county-wide in addition to 125,000 children under 12 who are not eligible for vaccination; (2) reduced mask wearing by unvaccinated individuals in public and private settings, and (3) the far more contagious delta variant that accounted for 75% of cases in the state during the first two weeks of July. 

The most straightforward way to verify that all unvaccinated people are wearing a mask in such settings is for everyone to wear a mask. This also helps better protect the unvaccinated people who account for the vast majority of cases, and it provides some additional benefit to the person wearing the mask--even if they are already vaccinated.

On Monday, July 26, the Health District and six other Puget Sound counties recommended that members of the community wear a mask when in public indoor spaces, especially when vaccination status of others in the area or the adherence to masking by unvaccinated individuals is unknown.  Of particular interest are grocery, retail, restaurant, entertainment and related settings. CDC issued similar recommendations on Tuesday, July 27.  

Recall that public indoor mask-wearing is already required by the Secretary of Health for all unvaccinated individuals. Furthermore, everyone—vaccinated or not—must wear a mask in public transportation settings, health care facilities, schools, childcare, homeless shelters, and correctional facilities.    

The University of Washington’s Institute for Health Metrics and Evaluation (IHME) predicts that if universal masking is adopted right away, 800-1300 additional deaths statewide can be prevented by November 1, 2021.  That would mean roughly 100 lives saved, hundreds more hospitalizations prevented, and thousands of cases prevented in Snohomish County.  


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