Well, folks, the Washington State Fair may be back but the Wildcat isn’t the only roller coaster we appear to be stuck on. After a blessedly low number of King County Covid-19 cases in the earlier half of this year, we’ve been trending back upwards over the last several months.

“Something’s definitely happening right now,” says Dr. John Lynch, medical director of infection prevention and control at Harborview Medical Center and a UW Medicine infectious diseases specialist. “You know, we’re all saying, ‘so and so has Covid’ and that’s a very informal, non-quantitative way to tell us we’re in a surge.”

While some Seattleites have doggedly donned their KN95s—long Covid patients, those at a high risk of illness—most of us have eased the masks from our faces. But with a potential surge in the making, is it time to rethink, well, everything?

Is Covid coming back?

Technically, it never went away, but the less smart-alecky answer is yes. Lynch says they’re seeing an increased number of people getting tested, and the proportion of positive results is also up, going from 1 in 10 being positive to more like 1 in 5. And that’s just for reported PCR tests, not the antigen swabs folks can do at home or the plethora of unnoticed asymptomatic cases.

The other sign Covid is back is the number of hospitalizations. “We are seeing an increased number of people in the hospital, both with and for Covid,” Lynch says.

Should we expect a fall Covid surge from now on?

The disease hasn’t quite developed a predictable seasonal pattern like the flu yet, Lynch notes, but it is affected by our behavior. With school back in session and colder weather promoting more indoor gatherings, “that leads to more transmission of lots of things, including Covid.”

What’s the latest Covid variant in 2023?

The newest variant du jour is BA.2.86, aka Pirola. Public health experts believe it is more infectious than its predecessors. “The question is what does this mean for us in terms of our health,” Lynch says.

It’s still too early to know what BA.2.86 will mean for hospitalizations, severity of illnesses, and death rates. The variant was first detected in Denmark in July 2023 and, as of early September, has been found in 11 countries, including the United States.

What’s up with the new Covid vaccine?

The Centers for Disease Control approved the new shots on September 12, making them widely available to the public shortly after. The updated vaccine was made to target the XBB.1.5 subvariant and “it looks like a really good match,” Lynch says, noting it fits the strains that are circulating right now.

Keep in mind that these vaccines are not about preventing infection completely (although they do help), but rather about keeping you from getting seriously sick if you do get Covid. 

So will we need to get a Covid vaccine every year?

In short, yes. “Unless Covid completely goes away and some magical event happens and it disappears, which I don't think is going to happen…I think we're going to be looking at annual vaccines for Covid,” Lynch says.

He adds that public health officials are noticeably shifting away from using the word “booster,” further indicating a shift to annual vaccines, likely tied to the start of fall to coincide with flu shots.

What about Covid mask mandates?

Official recommendations continue to be that masking in an indoor public setting with a high-quality mask is the best way to prevent infection. At this point, though, it’s highly unlikely that the state will revert to required masking.

On the hospital front, Lynch predicts mandatory masking will return in many health care facilities, particularly in Western Washington as Covid cases go up. “Masking continues to be a controversial topic for reasons that remain unclear to me,” Lynch says. “You know, it’s a pretty easy intervention that we know really helps protect people.”

Will we be able to get free Covid test kits again?

Yes, the U.S. government recently announced it would restart its free at-home Covid test program. Starting September 25, you can place an order for up to four free tests per household. Time to brush up on what those expiration dates really mean.