Summer has brought novel coronavirus outbreaks to new, smaller pockets of Eastern Washington, including parts of the state previously untouched by the pandemic.

Brewster, an Okanogan County town with about 2,300 people, has 352 confirmed COVID-19 cases.

Okanogan County had only 88 cases total on July 1, and now has 550 positive cases, plus five deaths and at least seven hospitalized residents.

Adams County reported its first COVID-19 death this week in a resident of an assisted living facility.

Franklin County now has a higher incidence rate of the virus than Yakima County, which has been a major hot spot for COVID-19.

Due to outbreaks in retail stores and restaurants and families spreading the virus within households, COVID-19 cases, hospitalizations and deaths continue to increase in Eastern Washington.

Brewster’s flare -up of COVID-19 has been going on for weeks, county Health Officer John McCarthy said.

“We went to Phase 2, and everyone went back to normal,” McCarthy said.

The county initially reported cases in the single digits each day, but now is reporting about 20 cases per day.

Adams County has seen its own hot spot for cases in Othello, which has 315 confirmed cases. Karen Potts, community health director at the Adams County Health Department, said the county has seen a lot of community spread as well as family members spreading it among themselves.

“One individual will get sick and then over the course of the next 14 days, it’s like watching bowling pins,” she said. “And the family all gets sick.”

Outbreaks at restaurants and workplaces are also spreading the virus in Central and Eastern Washington.

An outbreak at a Walmart in Wenatchee led to 21 employees testing positive and needing to stay home from work. A person who went to the Cahoots bar in Colville last weekend and “had extensive interaction with other patrons” also had symptoms for the virus and has since tested positive. The Northeast Tri-County Health District is advising anyone who went to Cahoots on July 18 to monitor themselves for symptoms.

The incidence rate of disease is incredibly high in some Central Washington counties. Okanogan has seen 840 cases per 100,000 people in the last two weeks, while Adams County has had 605 cases per 100,000 people in the last two weeks. Douglas County has 576 per 100,000 people, and Franklin County has 722 cases per 100,000 people.

Benton and Franklin counties had a total of 6,031 cases as of Friday, with 136 deaths due to the virus.

Spokane County has, thus far, less disease burden than Yakima, Benton and Franklin counties, despite a sharp recent rise in cases. On Friday, the Spokane Regional Health District reported 120 new cases, for a total of 3,190.

Spokane County Health Officer Dr. Bob Lutz hopes that Spokane will not see the high incidence rates seen in other Eastern Washington counties.

“We will see a continued rise, although I hope we won’t see a rise to the degree we saw in those other counties,” Lutz said.

The disease burden has led to an increase in hospitalizations in Eastern Washington, which has led to some critical access hospitals taking on COVID-19 patients. In other cases, patients have been transferred to larger hospitals and systems that can treat a patient with complex needs. Recent reports from modelers show hospitalizations increasing in Eastern Washington in all age groups, except for a possible decline in the 40-59 age group.

Eastern Washington’s larger medical hubs in Wenatchee, the Tri-Cities and Spokane are feeling the influx of COVID-19 patients from surrounding counties.

Confluence Health’s Central Washington Hospital in Wenatchee is currently treating 23 COVID-19 patients from five counties in Central Washington. Four hospitals in Benton and Franklin counties are treating 67 COVID-19 patients who make up about 20% of the people hospitalized there. Spokane County has 51 COVID-19 patients, with 36 county residents hospitalized for the virus. Spokane, just like larger hospital systems in Wenatchee and the Tri-Cities, will continue to see patients from other counties that need more intensive treatment for the virus.

More rural counties in Eastern Washington are watching hospitalizations closely.

Four COVID-19 patients are hospitalized in the Northeast Tri-County Health District, which covers Stevens, Ferry and Pend Oreille counties.

Critical access hospitals can take care of some patients with COVID-19, if their staff can handle the care needs and the patients’ need for oxygen or other treatments are not too demanding, Dr. Sam Artzis, health officer at the Northeast Tri-County Health District, said.

Earlier in the pandemic, when there was less disease burden in Eastern Washington, he said there was a lower threshold for hospitals in Spokane to take patients if they needed treatment than now. Now, he said, the criteria for transfers to Spokane have changed.

But treating COVID-19 patients in critical access hospitals can lead to concerns about capacity and personal protective equipment.

“There is concern for capacity to keep those patients and keep them isolated, as well as employees and staff,” Artzis said. “The other consideration we’re forgetting is PPE. We’re not replete with PPE.”

Beyond hospital supplies, transportation can be a challenge in rural regions where volunteers usually staff ambulance transports.

“We’re kind of back in a situation that I won’t say is untenable, but I will say is concerning,” Artzis said.

Beyond Eastern Washington COVID-19 activity, Spokane health officials are also paying attention to what is happening in North Idaho, where case counts and hospitalization numbers have exploded in recent weeks.

Kootenai Health was recently forced to expand its critical care unit. While the expansion was not due only to COVID-19 patients, staffing concerns and the increase in cases led hospital leaders to speak to the Panhandle Health District this week. The Panhandle Health District reported Friday that 31 residents were currently hospitalized with the virus. Kootenai Health officials told the Panhandle Health District’s board on Thursday that its current capacity for COVID-19 patients is 32.

Spokane hospitals continue to have capacity and stand ready to take in patients from the surrounding regions as hospitalizations are expected to continue to rise.

“The blessing and curse of being the regional health care center is we’ll get people from around the area,” Lutz said.