COVID-19 hospitalization and transmission rates are likely to remain at high levels through the fall, despite slight declines since peaks in August, according to new projections by the state Department of Health.

Washingtonians are at a critical moment in terms of how our actions can shape infection, hospitalization and death rates in the coming months, DOH’s latest COVID-19 modeling and surveillance situation report says.

The report found that COVID-19 prevalence — the percent of residents with an active virus infection — is at a new high at 0.94%, or about one in every 106 people in the state. The previous reported high was 0.64% this past August.

Transmission remains high but also has slowed, according to the state’s projections. At the beginning of this month, the effective reproductive number — or Re, which shows how many additional people each positive person will infect — was 1.14, compared to 1.49 at the start of August. A reproductive number above 1 means cases will continue to increase. To decline, the number must stay “well below” 1 for a “substantial amount of time,” the report says.

The drop could reflect increases in masking or other mitigation strategies as people became more aware of the surge in the delta variant, which accounts for close to all cases since mid-August.

“What this tells us is that our individual choices and behaviors today are going to determine whether or not our friends and families will have full access to health care in the near future, for any medical need, not just COVID,” Dr. Scott Lindquist, state epidemiologist for communicable diseases, said in a statement Thursday.


After peaking in August, the number of cases started to drop — continuing the downward trend through the Labor Day weekend — but have since rebounded, according to the report. Researchers say the recent rebound appears “sharper” among those 19 and younger, compared to those between 20 and 69 years old. 

Testing shortages have also been reported across the state, though researchers said it’s not yet clear how they’re impacting case counts.

Deaths, meanwhile, are also increasing again in Washington. The seven-day rolling average of deaths has increased “rapidly” from five to 10 deaths per day in July to 27 per day by the end of August, according to the report.

Hospitalizations have started to decline after peaking at the end of August with about 190 daily admissions, though the change is small. Now, the seven-day rolling average is at about 186 hospitalizations per day. According to the report, current occupancy levels still “far exceed” those recorded during last winter’s previous highs.

Two COVID-19 scenarios

The state analyzed possible scenarios based on two transmission rates — with drastically different outcomes.

In one, which assumes transmission stays constant over the next two weeks, hospital admissions could decrease by the end of December and eventually level off between 24 and 40 admissions daily. In the other, which projects a moderate increase in transmission through December, hospitalizations could increase to between 141 and 240 admissions daily, with between 1,100 and 2,000 beds occupied per day. 


In the second scenario, increased travel and holiday gatherings, increased time spent indoors with people outside one’s household and school-related transmission could quicken the virus’s spread, even though widespread vaccination provides far more protection this fall and winter compared to last year. In this scenario, Washington’s rate of immunity wouldn’t be enough to control hospital admissions and occupancy, especially among what the state estimates is about 39% of the population susceptible to infection.

The number of beds occupied by COVID-19 patients is expected to fall in both scenarios through November and overall capacity is likely to remain tight as delayed care and staffing shortages continue. In addition, the state is predicting other viral infections, like influenza, to boost hospital admissions during the fall.

While “considerable uncertainty is inherent” in both scenarios, preliminary data provides some insight into how the fall and winter months might unfold, researchers said. 

Washington’s overall immunity is increasing rapidly, however. Earlier this month, the state estimated our immunity was about 60%, from infections and from vaccinations.

“The current surge of patients is overwhelming our hospitals,” Lindquist said. “With school in session and flu season almost here, our best option for getting through the surge is to wear our masks and get vaccinated.”

The report’s recommendation for public health action was clear: Vaccinate to reduce COVID-19 transmission. Researchers also urged residents to wear a mask in public indoor settings and crowded outdoor settings, regardless of vaccination, and to get flu shots.

“In tandem, these actions will help prevent further burden on the health care system,” the report says.