It was a brief return to normal times this summer, with no mask mandate for three months.

At the end of June, Gov. Jay Inslee addressed a roomful of local health care providers and politicians in the Riverfront Park Pavilion. No one was wearing a mask. Spokane was reopening. There was cause for celebration.

Just a month and a half later, the tide has turned – drastically.

COVID-19 cases are on an uphill, exponential climb. The Spokane Regional Health District reported 1,911 new cases in the past week alone.

Hospitalizations of COVID-19 patients are the highest they’ve been all pandemic in the state and county.

So what happened? The delta variant arrived.

The delta variant has been compared to chickenpox in terms of its contagiousness. The delta variant is at least two times more transmissible than previous strains of coronavirus. Experts estimate that one person with the delta variant could spread the disease to five to nine people.

Statewide data show this. The state is sequencing some positive COVID-19 samples for variants of concern. In early June 31% of samples sequenced were the delta variant. By the end of July, the delta variant accounted for 95% of the state’s samples.

The delta variant is sending people to the hospital who were not there earlier in the pandemic. The average age of hospitalization has dropped significantly, and local health care providers are seeing patients get seriously ill with the virus even if they have no underlying health conditions.

“What’s been really frightening is when we look at the average age of admitted patients in Spokane – they’re becoming much younger,” Dan Getz, chief medical officer at Providence Health Care in Spokane, said.

The average age of the roughly 100 COVID patients hospitalized in Providence hospitals in the Inland Northwest is below 50 years old.

“They are generally healthy people,” Getz added.

Healthy, but not vaccinated.

More than 90% of patients locally and even statewide who are hospitalized with the virus have not been vaccinated against it. Health care providers are seeing sicker patients and otherwise healthy young people ending up in ICUs on ventilators.

Getz said that even if patients recover from the virus and are discharged from the hospital, they are not healing quickly.

“They are sick for a long time; they could have compromised lung or heart capacity forever as a result of this disease, and these are things that should be statistically unlikely if you have had the full course of vaccine,” Getz said.

In Washington, there are 2 million residents who are eligible to get vaccinated but have not received a single dose. In Spokane County, that number is about 190,000 who are not vaccinated.

These numbers don’t include all of the children under 12 years old who are not eligible to be vaccinated but who are now potentially more vulnerable to getting infected.

In previous COVID-19 waves, kids tested positive, but locally, few got seriously ill . In the current wave, some children and teens testing positive for the virus are requiring hospital-level care.

“Kids are now being admitted to the hospital with the primary diagnosis of COVID – that was not true during the January surge,” said Dr. Mike Barsotti, administrator at the Sacred Heart Children’s Hospital.

Vaccination rates among Spokane County teens, who are eligible, remain extremely low, worrying hospital officials about the coming school year.

As of Aug. 16, 57.1% of eligible residents in Spokane County have gotten at least one dose of a vaccine. Taking into account children who are not eligible to be vaccinated, that percentage of at least partially vaccinated county residents drops to 48.6%.

The younger the person, the less likely they are to be vaccinated in Spokane County. Teens have the lowest vaccination rates among eligible people in the county.

As of Aug. 4, just 32% of 12-17 year-olds in Spokane County were vaccinated. This means that in most high school and middle school classrooms this fall, the unvaccinated likely will make up a majority of students.

Hospital officials are worried for what this low rate and other respiratory viruses like respiratory syncytial virus, called RSV, and influenza along with COVID-19 could mean for pediatric hospitalizations this fall.

Barsotti said this fall and winter, colder weather combined with other respiratory viruses that children are hospitalized for like influenza and RSV create “a potential for a large amount of admissions this winter.”

The fifth wave of cases and subsequent hospitalizations this month led state leaders to install vaccine requirements for workers in several sectors including health care, long-term care, education and state agencies. Employees have until Oct. 4 to finish their vaccination or risk losing their job.

State leaders also reinstated the mask mandate. Beginning Monday, everyone, regardless of vaccination status, is required to wear a face covering in most indoor settings.

When announcing the new mandates, Inslee called the delta variant “a new fight,” and it is now a disease of the unvaccinated.

Hospitals are not overwhelmed yet, but capacity is incredibly tight statewide with elective and nonemergency procedures canceled as well as visitation limited.

The people choosing not to get vaccinated are impacting Washington’s health care system, as patient transfers are becoming incredibly difficult and all of the state’s hospitals are surging together.

“The current situation is really grave,” Cassie Sauer, CEO of Washington State Hospital Association, told reporters on Thursday. “We’re asking for the public’s health and the state’s help.”

Hospitals are canceling surgeries that would require a patient to take up a bed. Patients are being transferred several hours away from home for care, if they can get a bed.

It’s unclear how long this current surge of cases and hospitalizations will last, but locally the surge will likely continue through the month.

“Given the trends we’re seeing, we do expect to continue seeing some cases over the next few weeks,” interim health officer Dr. Francisco Velázquez told reporters this week.

Cases confirmed this week could mean a continued uptick in hospitalizations for the weeks following.

In the meantime, people who are most vulnerable to adverse outcomes from COVID-19 remain at risk, including some of those people who got vaccinated. Immunocompromised individuals are now eligible for a third dose of a mRNA COVID-19 vaccine, and the Centers for Disease Control and Prevention recommends them.

While 90% of people who are hospitalized with the virus are not vaccinated, the other 10% are people who were vaccinated and got a breakthrough case of the virus.

The majority of these patients are older or have underlying health conditions or are immunocompromised.

“These are patients with a history of cancer, leukemia or transplants who did the right thing and got vaccinated but were exposed in the community and are now in the ICU fighting for their lives,” Dr. George Diaz, infectious disease provider at Providence Regional Medical Center in Everett, told reporters last week.

“They were exposed by primarily people who are unvaccinated, and people who are unvaccinated are creating a risk for everyone else,” he added.

Among the vaccine hesitant, many cite the emergency authorization of the three available vaccines as the reason they are holding off, saying they are awaiting full approval by the Food and Drug Administration.

Reporting on Friday indicates the FDA is poised to issue full approval of the Pfizer/BioNTech vaccine as soon as Monday.

Health officials are hoping the current mask mandate and vaccine requirements will be enough to drive case rates down. Ultimately, the virus needs to be contained to prevent unnecessary deaths and keep the state’s hospital system functioning.

State Secretary of Health Dr. Umair Shah asked residents to get vaccinated this week, noting that the mask mandate is just one part of the way to stem the tide of the current surge.

“Masks and vaccines together we know work better,” Shah said.

“We should not fear COVID-19 and the delta variant, instead we should respect COVID-19,” he added. “It does not care who you are; if you let your guard down, it will rear its ugly head.”