COVID-19 cases are rising — globally, nationally, in the state and in the county.

“The next month is the crux of this whole pandemic, this is it. This is going to be the most serious time,” San Juan County Public Health Officer Dr. Frank James told the San Juan County Board of Health during its Nov. 18 meeting. “It’s the time when deaths can occur.”

The majority of people will contract COVID-19 in the next four to six weeks, James explained. While San Juan County has had no deaths caused by the disease to date, according to the Washington Department of Health’s COVID-19 Data Dashboard, there have been three hospitalizations. One person is currently hospitalized with the disease, James noted.

“The state broke several records over the last couple of weeks with new cases gained. Over 2,000 new cases per day statewide for several days in a row,” San Juan County Environmental Health Manager Kyle Dodd said. “We don’t see that flattening anytime soon. That is something that is concerning and something that we continue to monitor.”

According to Dodd, the state’s daily case rate is doubling every 11 days. He said small, personal gatherings are responsible for a large portion of the cases.

State-wide, the number of diagnosed COVID-19 cases reported recently has already exceeded those of summer and is approaching that of spring.

“That’s something that is very concerning,” Dodd said, adding that Saint Joseph Medical Center in Bellingham is currently operating at around 90 percent capacity. “Their level of care could be compromised. … There’s no sign of that slowing down now.”

For 10 weeks, not a single case of COVID-19 was diagnosed in San Juan County residents, according to James.

“In the past two weeks, that has blown up,” he said.

As of Nov. 20, San Juan County has 59 cases. According to Dodd, at the time of the meeting, there were eight active cases — meaning the individuals were still within their 10 day isolation period — and 70 people were in isolation and quarantine.

There are currently some people in the county who are extremely ill, James explained, and there are likely many more possible cases locally. His concern is the capacity of hospitals to handle a surge of cases.

“The fundamentals have not changed. Forty percent of people that have these infections have no symptoms at all — they don’t know they have it,” James said. “This is not a disease we can manage by symptoms — people feel just fine.”

Health care system capacity is just one of the indicators that public health agencies look at, Dodd explained, not only for COVID-like illnesses but for people who need urgent care for other reasons. Another indicator is the reproductive rate — how many cases a single source will cause — which at the time of the meeting was at 1.4 statewide, he said. The goal is at one or lower.

“We need to be making changes as a community and a state to ensure that we can control the growth,” Dodd said.

James expressed concern over the disease being “fairly widespread” in the community and with the holiday season beginning — a time which he said is the riskiest of the year.

“It’s the time when people gather at home; they have close contact; they’re indoors; they don’t wear masks, [for a] sustained period of time,” James said. “That is a formula for transmission of this disease.”

COVID-19 is commonly spread among friends, families and neighbors, and this transmission is most likely to happen in the home as well, he explained.

“If I could beg you, I would beg you. I do beg you. Please, share this message with your family, with your friends, with your colleagues,” James said. “They have to know that this is the time when we have to act when we have to take those responsibilities seriously.”

James urged the importance of wearing masks, not traveling and maintaining social distance. All of these things, he noted, islanders have already been doing.

“We’ve had an outstanding success, outstanding success,” James said, adding that while more than 250,000 people have died from COVID in the United States so far, San Juan County has not had one death.

“That’s an achievement of our entire community by doing the right thing,” James said. “I don’t have a lot of patience for people talking about shaming. It’s just a fact. This is not the time to engage in those activities. The people that made those plans need to cancel.”

The goal, James continued, is to protect the community, and there is already community spread of disease — for the first time since the pandemic began — he explained.

“It is a dangerous situation. It grows exponentially because no one knows they have it when they spread the disease,” James said, adding he expects the number of cases and people in quarantine to double or quadruple. “We do not have the staff to do that. Our hospitals do not have the staff to manage those cases. We have to behave differently and we have to do it now. … This is the crux, this is when it matters.”

In the Nov. 18 edition of the Sounder, a letter signed by 27 community and business leaders in the islands asked residents to stay home for Thanksgiving and to not invite friends and family from off-island.

“We’re urging people to hunker down this year, remain home with their nuclear family and that is the safest thing that we can do for our community,” San Juan County Health and Community Services Director Mark Tompkins said.

Dodd explained that in response to a cluster of cases on Orcas Island, the San Juan County COVID Response Team responded by testing an additional 34 people and were still awaiting results. According to a press release from Orcas Island School Superintendent Eric Webb on Nov. 13, two of the previously reported cases were of people connected to the school.

On Nov. 19, three new cases on Orcas were added to the county’s record. Webb said in a press release that one of the 33 people tested in connection to the school outbreak was positive, one came back inconclusive, the other 31 were negative.

“We have really prioritized case investigation and close contact follow up to the point that those case investigations are happening the same day, real-time,” Dodd said. “Identifying individuals, notifying them that they are to remain in isolation. Starting the work right away on identifying those close contacts and that contact tracing work.”

Dodd noted that the response team has been successful in exceeding the state’s guidelines for COVID spread investigations. He said he hopes the team is able to continue that work and ultimately limit the number of cases that typically result from contact with someone who is positive for COVID.

The county has received several requests for asymptomatic testing, according to Dodd. He explained that the response team has prioritized working case investigation and contact tracing then focusing on ring testing around clusters or small outbreaks. He added the county hasn’t focused on asymptomatic testing for quite some time and is directing residents toward utilizing one of the various at-home testing options.

“Those are equivalent tests to the PCR tests that are done as part of our efforts and sent to Northwest Labs,” Dodd said.

On Nov. 15, Gov. Jay Inslee announced several restrictions, including the closure of restaurants and bars to the public for dine-in services and prohibiting indoor social gatherings statewide.

“With the idea that limiting close personal contact indoors with people that are unmasked is a way that we’re going to flatten this latest curve,” Dodd said. “We as a response team and as a community all play a part in flattening that out. We’ve done a great job of that with the previous two curves, both in the spring and summer, and this is just the latest challenge in front of us.”

County Councillor Bill Watson asked at what time James would consider issuing a public health order akin to the ones he issued this summer ceasing transient lodging within the county.

“We will provide orders as needed. It will depend on what happens. So far, I’ve had outstanding cooperation from the people that matter,” James said.

Island schools are making wise choices, and don’t need orders to tell them what to do, James noted.

“I’m very proud of that. I’m proud of our schools,” James said. “I’m proud of the leaders in youth sports activities that changed what they were doing to make it safer.”

Additionally, James added, Inslee has done much of the heavy lifting by introducing restrictions early.

“He’s made very difficult and unpopular decisions but I believe he’s done the right thing. We need to make sure that what he’s suggested or ordered actually gets done,” James said. “Now is not the time to lose heart about that and if orders are needed to make these things stick, we will have orders that require things with penalties.”

James credited the island community with being “very enlightened.” He added that the county government’s relationship with the business community is excellent and that most calls with businesses are informational as opposed to being a reprimand for poor behavior.

“In public health, you can either be a cop or you can be an educator and to the extent that we possibly can be, we need to be educators,” James said. “We need to have people trust us and come to us with questions.”

As the county’s public health officer, and in an emergency, James said he will issue orders which may seem Draconian if necessary. But for right now, he feels it’s best to just educate people.

“If we need more action, I’ll definitely take it. There’s no imminent plan [or] actions I’m considering now,” James said.

He said he’s in support of allowing for voluntary compliance before requiring orders to be written.

“Our community is far ahead of any community I know of in doing exactly that,” James said. “You give people the right information, they can do the right thing.”

It isn’t all doom and gloom for James, however. He noted good news including promising treatments and recently announced vaccines that are proving to be “highly effective and very safe.” The first two vaccines are showing 95 percent efficacy, even in elders, he explained.

James expects the first vaccines to start being distributed around December, with more coming in between January and March, and finally, anyone who wants one being able to receive it by April.

“Until then, and certainly, for now, it is time to double down in our commitment to prevent the spread of this disease,” James said.

In 2003, the first outbreak of Severe Acute Respiratory Syndrome entered the world. Even without tests available, 8,098 people contracted the virus and 774 died. James contributed the low case numbers and deaths in that outbreak to isolation and quarantine, social distancing and mask-wearing.

“These are things we know work and work well,” James said. “We just can’t be complacent, we can’t be fatigued, we have to do it. If each of you makes that commitment to yourselves, each of you shares that information with your family, each of you shares that information with your colleagues, we can have a different outcome. If we don’t have that standard set as a community expectation, we will suffer and will suffer greatly. … This is the time of action. This is the critical time.”