Spokane County tied its record number of COVID-19 cases confirmed in a single day on Wednesday, when 98 residents tested positive for the disease.

Hospitalizations continue to increase as well, with 47 people receiving treatment for the virus in local hospitals, 30 of whom are county residents.

In the past week, 9.6% of individuals tested were positive for the virus in Spokane County, a rate much higher than the region has averaged in previous months. There have been 2,352 cases in county residents since the pandemic began.

With cases rising and the school year’s start on the horizon, Spokane County Health Officer Dr. Bob Lutz said he has been meeting with Spokane Public Schools on a regular basis. A lthough specifics have yet to be nailed down, Lutz said the county’s disease burden is currently too high to reopen .

“If you look at other countries where schools have started successfully, the disease incidence has been much, much lower than what we’re seeing currently,” he said.

But as case counts and hospitalizations rise and the start of in-person schooling is in jeopardy, one indicator suggests fewer people are doing what health experts say is crucial for the situation to improve: wearing masks.

In the county’s most recent observational survey of mask usage, Lutz reported that about 58% of people were complying with a statewide mandate to wear face coverings in public indoor spaces. That is down from last week, when 65% of residents were wearing face coverings.

Although the surveys are observational and not definitive, the results mean county residents need to be doing more, Lutz said.

“We need to be having a lot of people make those behavior changes,” Lutz said.

Of the three densely populated hot-spot virus regions east of the Cascades, Spokane County is increasingly an outlier when it comes to face coverings. Secretary of Health John Wiesman told reporters Wednesday that recent observational surveys in Yakima, Benton and Franklin counties indicate about 95% of residents are wearing face coverings.

“Those counties are doing amazing work,” Wiesman said.

Adhering to face-covering requirements and limiting gatherings will be crucial for counties not to regress in the governor’s plan and for schools to reopen in the fall.

“We will have to take extreme measures in the next few weeks,” Lacy Fehrenbach, deputy secretary at the state health department for the state’s COVID-19 response, told reporters Wednesday.

“We are particularly concerned about gatherings. So something we can do right now if we want our teachers and students to go back to school is to limit gatherings,” she added.

Lutz said Spokane County residents not following masking guidelines and gathering with more than five people outside their household each week has resulted in more cases.

“So much of what we’re seeing now in our cases is a function of behaviors and people not following the guidance,” Lutz said.

School don’t exist as islands, and public health officials cautioned that the disease burden in each county will have an impact on whether schools can reopen.

“What happens outside of schools is even more important than what happens at schools,” Dan Klein, senior research manager at the Institute for Disease Modeling, told reporters Wednesday.

The Institute for Disease Modeling released a modeling report for opening schools in King County on Wednesday, and King County Health Officer Dr. Jeff Duchin called it “sobering.”

The report accounted for interventions that could be implemented in schools, like universal masking, physical distancing, cohorting students together in their same groups, screening and hygiene precautions. It found that even if all these measures are taken, no interventions at school will help the pandemic from growing if community activity reaches a certain percentage. Since the report was published, case counts and the reproductive rate of the virus have increased in King County.

“It is telling us that at this time there is too much COVID-19 transmission in our community to support schools reopening,” Duchin said.

The report, while specific to King County, had implications for school districts statewide that are looking to implement safety precautions should they be allowed to reopen this fall.

Duchin pointed out that schools will need to implement measures that are challenging to abide by and difficult to enforce. For example, if cohorting students is a strategy used by a school, that could mean assigning seats on school buses so students sit with their siblings or people in their specific classes. Screening students regularly for symptoms will also be taxing for teachers and school staff members.

“I think the bottom line is, all schools will need to use similar strategies to decrease transmission, but they’re not simple for schools or local health jurisdictions, so we need to be mindful of the complexity,” Duchin said.

“The fundamental prerequisite is a decrease in community transmission to a level to make it safe to bring schools back in the first place,” he added.