COVID-19 testing and vaccinations

A conversation with Dr. Jeff Duchin – PUBLIC HEALTH INSIDER

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Now that we’re through the thick of winter, what’s happening with COVID-19 locally? We asked our Health Officer, Dr. Jeff Duchin, to share his thoughts on what’s happening now in King County.

Dr. Duchin, how is King County currently doing with COVID-19 cases, hospitalizations, and deaths?  

Although COVID-19 continues to circulate in our community, hospitalizations and deaths are much lower recently compared to past peaks, especially last winter’s peaks. Rates of hospitalizations and deaths still fluctuate but have been slowly dropping since early December and are close to, but slightly higher than, past lows.

It’s very good news for individuals and our health care system that as of today, we have not had a large COVID-19 surge this fall and winter. That said, we should keep in mind that COVID-19 cases are greatly undercounted. More people are using at-home COVID-19 tests (rapid tests) that are generally not reported to Public Health and fewer people are seeking PCR testing as well. Additionally, not all people decide to test for COVID-19 even when they are symptomatic. Our colleagues at the Institute for Health Metrics and Evaluation at the UW estimate that only about 5% of COVID-19 cases were reported in December 2022. 

Nationally, there is still a lot of severe illness from COVID-19. In the U.S. 2,407 people died in the past week from COVID-19. Over the past week here in King County someone was hospitalized for COVID-19 every 3 hours and there were 51 deaths from COVID-19 over the past 28 days. About two-thirds of the people hospitalized for COVID-19 and 90% of deaths due to COVID-19 in the past 28 days are people 65 years and older.

How are we doing at staying up to date with COVID-19 vaccination?

In King County, our up-to-date vaccination rates are highest among people 65 years and older at approximately 68%, but across all age groups, the number of people who’ve had the updated booster (also known as a bivalent booster) is not nearly so high. The rates are particularly low among people younger than age 65 years and there continue to be disparities in these vaccination rates by race/ethnicity. This means that many people remain vulnerable to severe illness.

Why is it important to get an updated booster this far into the pandemic?

The virus that causes COVID-19 continues to circulate widely and protection from both vaccines and past infections decreases over time. The updated (bivalent) booster protects better against the Omicron variants that are currently circulating in our communities. The updated booster provides protection to people of all ages for whom it is recommended, and the protection the booster provides is especially important for adults and people with risk factors for severe disease.

Everyone 6 months of age and older should stay up-to-date with recommended vaccinations including the updated bivalent booster, and especially people ages 50 years and older and those who are immunocompromised. The updated boosters provide additional protection even if you’ve already had COVID-19 or received earlier boosters.

We’ve heard from people who got their updated booster in the fall who want to know whether they should get another booster. If you’ve already gotten your booster, what’s next?

There are no additional recommendations at this time for people who have received an updated booster. It’s possible additional guidance will be provided by the FDA and CDC for certain people in high-risk groups in the future.

At this time, CDC recommends one updated booster dose for everyone ages 5 years and older who completed their primary series and for children ages 6 months–5 years who completed the Moderna primary series. There is no booster recommendation for children aged 6 months–4 years who got the Pfizer-BioNTech COVID-19 vaccine primary series.

The federal government COVID-19 emergency declaration will expire in May. What does this mean for vaccination and treatment?

The expiration of the emergency declaration doesn’t mean that the pandemic is over, but it does end the flexibility that the government has had to support some COVID-19 efforts.

What we know right now is that for as long as the federal government’s large supply of vaccine and medication lasts, COVID-19 vaccination and antiviral medications will remain free, even if you don’t have insurance. The supplies are predicted to last through the summer.

After that, COVID-19 vaccines will shift to the private market. Getting a COVID-19 vaccine will likely be like flu shots and other routine vaccines. It will continue to be free for children under 18 years in Washington.

Later this year, people will likely have out-of-pocket costs for COVID-19 treatment, depending on the type of insurance they have. This would be like the costs people have for other drugs through traditional coverage.

Let’s talk about masking. What role does masking have at this point in the pandemic?

For me, wearing a high-quality, snug-fitting mask like an N95 or KN95 is a relatively easy way to both reduce my risk of getting COVID-19 and of spreading it to others. Wearing a high-quality, well-fitting mask in indoor public settings is particularly important to reduce risk for people who are 65 years and older and people of any age who have underlying high-risk conditions, for those who spend time with these folks who are at higher risk, and anyone who wants to reduce their risk for COVID-19 and its complications. In addition, wearing a mask in indoor public settings can help reduce your risk of unintentionally spreading your illness to others earlier in the illness course when symptoms may be absent or minimal.

The Washington State Department of Health (DOH) will be lifting masking requirements in healthcare and other settings on April 3rd, 2023. Current requirements are in effect until that date. Even after the requirement is lifted, DOH infection prevention and control guidance will continue to recommend masks for patients, healthcare providers, and visitors in healthcare settings. Based on the current status of the COVID-19 outbreak, we agree with this recommendation. Licensed healthcare facilities are required to have infection prevention policies and programs consistent with CDC guidance. Providers may choose to set their own policies and require masks in their workplaces. 

What about testing for COVID-19?

If you think you may have COVID-19, because you have symptoms or may have been exposed, test for COVID-19. Testing is important so you can quickly begin COVID-19 treatment if it’s recommended by your healthcare provider and so that you can notify close contacts.

As federal funding has diminished and testing demand has decreased, many COVID-19 PCR test sites in King County have closed, and we anticipate more sites will close in the coming months.

While less sensitive than PCR tests, at-home antigen tests (and other “rapid tests”) are a good alternative to PCR tests. At-home tests are more likely to give a false negative result than PCR tests early in the infection, even when symptoms are present for a few days. If you are concerned that you might have COVID-19 because you were exposed or have COVID-19 symptoms, and your initial at-home test was negative, then we recommend isolating yourself and conducting another at-home test 24-48 hours later and again on day five or later. If you’ve been exposed to someone with COVID-19, it’s also important to wear a high-quality mask any time you are around others inside your home or indoors in public and take extra precautions if you will be around people who are more likely to get very sick from COVID-19.

You can still order free COVID-19 home tests (antigen tests) each month from Washington’s If you prefer a PCR test, Public Health has a list of testing sites in King County. The federal government also has an online tool to find local no-cost COVID-19 testing locations.

After May 11, we expect that COVID-19 testing will have costs that will vary by test type and your insurance.

How would you characterize where we’re at? What’s looking better and what are you still concerned about?  

Compared to earlier in the pandemic, we’re in a much better place and COVID-19 is not currently a major stressor for our fragile healthcare system. Due to vaccinations and infections, most people are at much lower risk for severe outcomes than before the COVID-19 vaccine era, but many remain vulnerable. The durability of protection from vaccines and infections and the impact of possible future variants that might evade our immunity or cause more severe disease are unknown at this time.

COVID-19 continues to cause many infections and too many hospitalizations and deaths – primarily, but not exclusively – among older adults. In addition, long-COVID and other post-COVID complications, including heart attacks, strokes, blood clots, diabetes, and neurological symptoms, have been reported in a fraction of people recovering from COVID-19. Although we don’t currently have a good way to accurately measure the burden of these complications, even a small percentage long-COVID and post-COVID complications among the many infections still occurring adds up to a lot of people. Even mild infections in healthy people carry some risk for long-COVID and other post-COVID-19 condition health problems. Studies suggest vaccination can lower, but not eliminate, the risk for long-COVID.

For these reasons, taking steps to reduce our risk for COVID-19 (and for reinfections) still makes sense. Most important is to stay up to date on recommended COVID-19 vaccinations. Risk can be further reduced by:

  • wearing a high-quality, snug-fitting mask in indoor public spaces including on public transportation (e.g., N95, KN95),
  • improving indoor air through ventilation, filtration and in some settings, UV technology, and
  • staying home and away from others and test for COVID-19 if symptoms develop and while sick and get treatment promptly if you have COVID-19 and are eligible.

It is important to remember that predicting the future of COVID-19 is not possible. We at Public Health continue to monitor COVID-19 data locally and nationally. There are no COVID-19 tidal waves visible on the horizon, but the tide is still relatively high and rogue waves are possible in the future. Don’t turn your back on the water.

More information:

For information about drop-in COVID-19 vaccination at our Auburn Outlet Mall vaccination site and other locations:

All COVID-19 resources:

Originally published on March 3, 2023.

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