Communities in Eastern Washington, including Spokane, must take seriously directives to wear face coverings, to physically distance in public and to limit gatherings , state health officials warned on Tuesday.

If not, counties could stall in Phase 2 of the state’s reopening or even move back to Phase 1, said David Postman, chief of staff for Gov. Jay Inslee.

Lacy Fehrenbach, deputy secretary of health for the state’s COVID-19 response cited a study done by the Yakima Health District, which found that about 35% of residents were wearing masks.

She said that is “far lower than what we would want to see.”

“We have to keep reminding people that going back to normal does not mean letting go of nonpharmaceutical interventions,” Fehrenbach said.

Spokane County added 18 new confirmed cases on Tuesday, with no new deaths reported but three new hospitalizations for people suffering from the disease.

There are now 12 residents receiving treatment in Spokane hospitals . Spokane County Health Officer Dr. Bob Lutz said Monday that many of those people who are hospitalized are in the intensive care unit.

The county had 860 confirmed cases total as of Tuesday.

A new report, with models from the Institute for Disease Management, projects increases in coronavirus cases and deaths in Yakima, the Tri-Cities and Spokane this summer, if additional interventions are not put in place.

“However, in all three areas, if intervention and substantial physical distancing reduce the transmission rate, the epidemic can be curtailed, emphasizing that future COVID-19 burden depends entirely on societal behavior,” the report says.

Postman, Inslee’s chief of staff, said that, while officials can’t go door to door to enforce public health directives and recommendations, people need to take them seriously.

“If we could get people to take seriously what’s in place now, we might be able to start to restrict the spread a bit,” he said, noting that the IDM report was “sobering” for the governor’s office.

Postman said that in counties that have advanced in Inslee’s phases of reopening might “find themselves moving back” if there are spikes in cases, noting the Department of Health could re-institute restrictions if necessary.

The state health department is helping to support local health districts in Eastern Washington with contact tracing, case management and ensuring local residents can find places to isolate if need be.

The uptick in cases in the most populous parts of Eastern Washington are concerning to officials because “we might not see the lull we thought we could get,” Postman said, referencing the much hoped-for idea that summer would bring less cases of the virus.

With COVID-19 transmission rates are increasing in Eastern Washington, Inslee and State Secretary of Health John Wiesman were in Yakima County Tuesday, where more than 5,700 residents have tested positive, 50 people are in the hospital and 111 residents have died from the virus. The county has one of the highest rates of positive testsin the state at 26%, while the state average hovers at 5.5%.

In the Tri-Cities, hospitalizations due to COVID-19 have increased substantially in the last month, with 70 people in local hospitals receiving treatment for COVID-19. There are 2,226 confirmed cases with 94 deaths in Benton and Franklin counties. The region applied to go to Phase 2 of the governor’s reopening plan, but Fehrenbach said that application is on pause, due to the report released last weekend from the Institute for Disease Modeling. Franklin County has an even higher rate of positive cases than Yakima County.