More than 160 cases of the coronavirus across Washington state have been confirmed so far among people who attended the recent Watershed Music Festival at the Gorge Amphitheatre, the Grant County Health District said Friday.

More than 25,000 fans packed the Gorge, in George, Grant County, for the three-day outdoor country music festival July 30-Aug. 1. It marked the state’s biggest concert, by far, since the pandemic hit more than a year ago. A slate of other upcoming concerts and festivals are scheduled at the Gorge, including a Brandi Carlile concert Saturday and the Bass Canyon electronic music festival Aug. 20-22.

“The outbreak is the first one traced to an outdoor entertainment event since the lifting of statewide COVID-19 prevention measures at the end of June,” Laina Mitchell, communicable disease coordinator for Grant County Health District, said in a news release.

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The cases are tied to residents in multiple counties, including King, Grant, Pierce, Skagit, Kittitas, Okanogan, Whatcom, Kitsap, San Juan, Lincoln and Stevens. There’s also one case tied to an Oregon resident.

Grant County Health District expects more cases associated with the festival to be confirmed in the coming days and investigators are working with those who have tested positive and with local public health officials to identify other cases. Public health officials urge that anyone who attended the festival self-quarantine and get tested.

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Watershed festival organizers, who said some 28,000 people attended, issued a statement Friday, saying that they “worked to ensure all recommended guidelines from local officials were followed, and at this time less than 1% of attendees have tested positive. We are encouraging everyone who attended to engage in regular testing for COVID-19 so we can all do our best to protect one another. Watershed Music and Camping Festival also encourages anyone who is eligible, aged 12 years and older, to get a COVID-19 vaccine as soon as they are able.”

Proof of vaccination was not required for entry, though Watershed said on its website that “we strongly encourage anyone coming to Watershed Festival to have it.” Masks were recommended for unvaccinated attendees, while not required for vaccinated ones.

Live Nation, which operates the Gorge and White River amphitheaters, had been leaving the decision on vaccination requirements up to the artists. For Saturday’s Carlile show at the Gorge, no requirements had been planned, but Phish fans will need to prove they’re vaccinated or COVID-free when the jam rock titans roll through Aug. 27-29.

That will change starting Oct. 4, though.

“Vaccines are going to be your ticket back to shows, and as of October 4th we will be following the model we developed for Lollapalooza and requiring this for artists, fans and employees at Live Nation venues and festivals everywhere possible in the US,” Michael Rapino, president and CEO of Live Nation Entertainment, said in a statement Friday.

More on the COVID-19 pandemic

Recent news has emerged of cases associated with other music festivals.

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On Thursday, Chicago health officials reported 203 cases of the coronavirus connected to Lollapalooza, casting it as a number that was anticipated but not yet linked to any hospitalizations or deaths.

About 385,000 attended Lollapalooza at Chicago’s Grant Park July 29-Aug. 1. Festival goers had to show proof of vaccination or a negative coronavirus test and city officials said about 90% were vaccinated.

Dr. Allison Arwady, of Chicago’s Department of Public Health Commission, said the case count was not unexpected: “No sign of a ‘superspreader event’. But clearly with hundreds of thousands of people attending Lollapalooza, we would expect to see some cases.”

Arwady said the number of positive cases included those who tested positive after or during Lollapalooza, which could include people who might have arrived already infected.

According to Misty Aguilar, public information officer with the Grant County Health District, it’s difficult to immediately determine the extent and impact of the Watershed cases “because it’s so early,” and numbers can change as more cases come to light. But she said that the health district was “working with Live Nation to make these events as safe as possible.”

Tara Lee, executive director of communications for Gov. Jay Inslee, said the governor has not yet released any guidelines for large outdoor gatherings like the Watershed festival, but added: “This is definitely one area we are looking at.”

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The outbreak comes amid a number of concerns for public health officials in the state: a heat wave, poor air quality due to wildfire smoke and the rise of the highly contagious delta variant, which has resulted in a new spike of COVID-19 cases.

In a news release Friday, the state Department of Health said that COVID-19 cases and hospitalizations had increased statewide, with Grant County among the areas facing notable upticks.

While DOH is advocating for vaccination to mitigate the spread, Secretary of Health Dr. Umair A. Shah also recommended that Washingtonians “avoid large, crowded settings, vaccinated or not.”

Information from The Associated Press was used in this report. Seattle Times staff reporter Michael Rietmulder contributed to this report.