Measuring COVID-19 infections complicated by self-testing - Salish Current
September 29, 2023
Measuring COVID-19 infections complicated by self-testing
Questen Inghram

Explicit COVID-19 instructions provided by the Center for Disease Control beginning in 2020 supported at-home self-testing. Free at-home test kits are being provided once again, along with online help. (CDC image)

September 29, 2023
Measuring COVID-19 infections complicated by self-testing
Questen Inghram


Over 16,000 Washingtonians have died from COVID-19  — but tracking how many more are infected now is made difficult because the one tool that made testing for COVID-19 more convenient has made tracking it much more complicated. 

This week, the Biden Administration again made free at-home COVID-19 test kits available to order by mail through Every U.S. household is allowed to order up to four kits. 

The arrival of readily available at-home test kits and the end of mass testing sites that were the norm in the early stages of the pandemic has meant a smaller pool of reported data from which public health officials can gauge the level of infections in a community. Now, public health officials are relying on hospitalization rates and a newer method, wastewater surveillance, to understand the rate of infections in communities. 


Last week, the Washington Department of Health retired its COVID-19 Data Dashboard. Its replacement, the Respiratory Illness Data Dashboard, groups COVID-19, RSV (respiratory syncytial virus) and the flu together, showing percentages of hospital admissions, emergency room visits and ICU beds. It also shows wastewater surveillance data, which is only being taken in some wastewater plants in the region. 

North of Everett, wastewater is tested in Lynden, Oak Harbor, Stanwood, Coupeville and Arlington. Two of the four wastewater treatment plants in Skagit County will be tested beginning next month. 

Data thus far collected over 15-day intervals shows wide variations in COVID-19 concentrations due to variables such as the amount of rainwater mixed in the wastewater system. That data needs to be interpreted in the context of other measurement like hospitalization rates, said Ron Warner, Whatcom Health and Community Services communications specialist. “We are still in the early stages of collecting this data, so it has its limitations in providing valuable insights.”

Change in strategy

There’s been a big shift in how the pandemic has been treated since the end of the public health emergency declaration in May, Jessica Nye, San Juan County Community Health Services manager told the Salish Current. It’s now a more “privatized, individualized” response, similar to how influenza outbreaks are handled. 

It’s hard for San Juan County to get an estimate of COVID-19 case numbers, since many people are testing at home and not self-reporting, Nye said. Whatever numbers that they could report would “not be reflective of the full burden of disease.” As such, the county hasn’t reported case numbers since January.

Nye said their primary focus is promoting education and information about how to be safe and healthy in times of respiratory illness, including resources on how to get a vaccine. 

“It’s important to be conscientious of each other and do the things that protect folks from getting these illnesses,” Nye said. 

Stay home and test

If you do get sick, it’s advised to stay at home and test if you think you have COVID-19. If you do, you should isolate for five days after symptoms began or your positive test and until symptoms resolve. You should continue masking around others for another five days. 

At St. Joseph’s Hospital in Bellingham, COVID-19 hospitalizations are about the same as at this time last year, Bev Mayhew, PeaceHealth’s senior director of marketing and communications, said in an email. There are about 10 to 20 COVID-19 positive patients a day, the majority of which were at the hospital for unrelated reasons. 

In Skagit County, cases are on the rise, but hospitalizations and deaths are not. Skagit County Communicable Disease Manager Polly Dubbel said cases in Skagit began to rise in mid-July and have risen faster since the start of school. Still, by CDC standards, the threat level of Skagit County is low. 

“People are getting it, but most infections are mild and not so serious,” Dubbel said. 

Behind in vaccinations

According to state Department of Health data, only a quarter of Washingtonians are up to date on their COVID-19 vaccinations. 

Earlier this month, the FDA approved an updated Moderna and Pfizer boosters aimed at a recent omicron variant, XBB.15, available for everyone 6 months and older. 

The CDC recommends a dose of the updated vaccine for everyone 5 years and older, so long as it’s been at least two months since their last dose. People who are immunocompromised may be eligible for more than one dose. For children ages 6 months to 4 years old who have not yet been vaccinated, they’ll need two to three doses of the update vaccine to be up to date, or one or two if they have been vaccinated. 

Local pharmacies and healthcare centers should already have the updated vaccine. Whatcom County Health and Community Services is offering vaccine clinics that are free whether or not the patient is insured. People who do not have health insurance in Skagit County can call Skagit County Public Health or SeaMar to learn if they can get financial assistance for their COVID-19 vaccination.

Island Health Director of Marketing and Communications Laura Moroney said the Anacortes hospital is encouraging their patients to get their COVID-19 shots just as they would their annual flu shots. 

“It’s more of a way of life unfortunately,” Moroney said. “We’re treating it as any other disease.” 

Dubbel has been working in her role for four and a half years – the entirety of the pandemic. Reflecting on over three years since the beginning, Dubbel said her faith in humanity increased as people came to work together to fight the virus. 

“Skagit County did a good job,” she said. 

On Fidalgo Island, Island Health in Anacortes has been monitoring COVID-19, but otherwise operating normally. 

Director of Marketing and Communication Laura Moroney said the hospital’s director of quality reviews the number of COVID-19 infections of staff members to assess whether a change in policies are needed.  

Since May, masking has only been required week for patients who have symptoms associated with COVID-19. That could change if a two-week trend has staff infection rates above five percent. 

So far, that hasn’t happened.  

— Reported by Questen Inghram

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