With new coronavirus restrictions set to take effect this week, the Spokane Regional Health District has confirmed 942 new COVID-19 cases in the last three days, including a daily record high of 425 cases on Saturday.

The weekend cases pushed the number of people who have been infected to 13,040 in Spokane County since the pandemic began. The health district estimates that 66% of those cases are recovered.

With case counts escalating statewide, state health officials and Gov. Jay Inslee restricted personal gatherings and closed gyms and indoor dining at restaurants and bars for four weeks in an effort to prevent transmission of the virus in high-risk settings.

There are 106 patients in Spokane hospitals being treated for the virus, including 81 county residents. The Panhandle Health District confirmed 345 cases in the last three days. There are 52 people hospitalized for the virus from the five-county region of North Idaho.

Cases have been reported from every sector, spreading from gatherings in homes to myriad other settings.

After months of studying the novel coronavirus, researchers at the Centers for Disease Control and Prevention have learned more about how the virus spreads. The most common way for COVID-19 to spread is through talking, sneezing, coughing or breathing within six feet of another person, spreading the virus via respiratory droplets.

In certain settings, however, airborne transmission of the virus is also possible as it travels on small droplets and particles that can travel farther than 6 feet and linger in the air. This form of transmission is not as common as close contact transmission, but certain activities create higher risk for spreading COVID-19 by airborne transmission.

Eating and drinking, shouting, breathing heavily while exercising or singing indoors with no facial coverings and poor ventilation can all lead to increased risk for airborne transmission of the virus, according to the CDC.

Virus transmission relies primarily on time and space, according to Dr. Kathy Lofy, Washington’s state health officer.

“The infection risk increases with the duration and the proximity of contact with the infected individual, with certain activities where masks are not worn and where ventilation is not good,” she said.

The limited outbreak data collected in Washington state appears to back this up.

Throughout the pandemic restaurants and the food service industry account for the most outbreaks. There have been 151 outbreaks reported in restaurants thus far in the pandemic in Washington. Agriculture and produce packing plants make up the second-highest outbreak category, with 110 outbreaks, according to the Department of Health.

Dining in restaurants is also associated with a higher risk for contracting COVID-19. A July CDC study found that study participants who contracted COVID-19 were approximately twice as likely than control participants to have dined in a restaurant in the two weeks before getting sick.

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” according to the CDC report.

The Washington outbreak list is nowhere near complete, Lofy warned on Sunday, due to difficulties with contact tracing and determining where exactly a person was in the time before their symptoms appeared.

“These identified outbreaks likely only represent a portion of transmission occurring in the community,” she said. “And we are likely only detecting a fraction of these outbreaks.”

In Spokane County, there have been outbreaks confirmed at both restaurants and gyms during the pandemic, according the health district; however officials did not make those numbers available Monday evening.

While not as many recent outbreaks have been traced directly to restaurants and gyms, that does not mean they aren’t occurring, said Mark Springer, an epidemiologist at the health district. Epidemiologists have been focused on settings like schools, workplaces and day cares where lists of close contacts are easier to access and track, he said.

“It’s not unreasonable to look at those activities as being higher risk even though we don’t have the documentation of Restaurant A, B and C,” Springer said.

In mid-October, on a webinar hosted by the University of Washington Medical School, then-Health Officer Dr. Bob Lutz mentioned an outbreak at a local spin class in Spokane County. He said that despite a distance of 16 feet between individuals, the class still led to an outbreak due to the environment with an individual shouting and everyone else breathing heavily while on spin bikes.

The Gonzaga Bulletin reported an outbreak in mid-October at a Union Studios spin class that had just 13 people in attendance and led to some Gonzaga students contracting the virus.

The Washington outbreak data does not list “gym” as an outbreak setting category, and the Department of Health did not respond to requests for the statewide number of outbreaks in gyms or fitness facilities by press time.

Springer said outbreaks have been reported in several athletic settings, including in youth sports programs where masking is not used. Higher respiratory activities, like intense exercising, means a person can potentially project respiratory droplets 12 to 15 feet, Springer said, which is why they advised college fitness centers to separate machines 17 feet or more apart earlier this year and face machines towards the walls.

There might not be as much data supporting restaurant and gym closures as community members want, Springer acknowledged, but he asked them to consider being prudent.

He compared going to high-risk settings for COVID transmission to making the choice to wear a seat belt or drink and drive.

“You won’t always get burned on it, but it is more risky,” he said.

Inslee’s new restrictions ask people to stop gathering indoors with anyone not in their immediate household.

Springer said many local outbreaks are connecting to gatherings with family members, friends or extended family clusters, often gathering without masks.

Even if people continue to gather indoors, with closed restaurants and gyms, more potential transmission can be avoided.

“We can impact people’s connections out in the community, and some of those high-risk connections are in fitness (centers) and restaurants when people aren’t wearing masks and physical distancing is really poor,” he said.

Current guidance for students in lower grades attending school in-person has not changed with Inslee’s directive, and thus far, children from the ages of 0 to 9 years old make up only 4.4% of confirmed cases in Spokane County.

While local school districts have confirmed several cases and asked many other students to quarantine, precautionary measures appear to be working to keep the virus from spreading inside schools.

Plans for older grade levels to return to in-person learning are on pause in Spokane County, however, until transmission is under better control, according to the health district.