A fall and winter COVID surge is likely on its way to the Pacific Northwest, despite months of relatively low case levels, King County’s top health officer said Thursday.

Recent virus trends in Europe paint a concerning picture of what could be heading to the U.S. in the next month or so, county Health Officer Dr. Jeff Duchin said during a news briefing. He added that no new masking mandates or other public health restrictions were coming at this time for county residents or businesses.

“We’re already seeing increasing COVID-19 activity and hospitalizations in many European countries, even before any of the new variants have become dominant,” Duchin said. “This means that the waning immunity, the increasing gathering, the return to pre-COVID activity is leading to a surge in COVID in Europe. This should be a clear warning for us because in the past, major surges in Europe have been a good predictor of what we can expect to see in the U.S. in about four to six weeks.”

The state’s most populous county is still considered at a low community virus level, per the Centers for Disease Control and Prevention, with a seven-day average of about 96 infections per 100,000 people and 3.1 hospitalizations per 100,000 as of early October, according to county data. The recent numbers reflect a significant decline since early- to mid-July, when the county saw 326.2 cases per 100,000 and seven hospitalizations per 100,000 over a given week.

County numbers are likely an undercount due to the continued popularity of at-home COVID tests, but levels have been trending down.

Washington’s most recent wave led by omicron’s BA.4 and BA.5 subvariants peaked over the summer and began declining between mid-July and August. Since then, county hospitalizations in particular have plateaued at about 10 to 13 per day for the last month and a half, Duchin said.

Deaths have stayed fairly stable at about two deaths per day in the county.

With another potential spike in cases and hospitalization looming, Duchin urged residents to get an updated COVID booster shot as soon as possible. He acknowledged the frustrations his office has heard about challenges securing appointments, pointing to a lack of new federal COVID funding and ongoing staff shortages at drugstores.

“That’s not a good thing. I’m not happy about it,” he said. “… I understand the frustration and I’m sorry it’s occurring, but I can assure you it’s worth the effort.”

In King County and throughout the state, rates for the new, bivalent booster — which protects against severe infection from omicron and its subvariants, as well as the original strain — have been lower than health officials would like, he said.

As of last week, the county reported only about 11.3% of eligible residents had gotten the new shot.

Statewide rates are even lower, with about 10.2% of eligible Washingtonians receiving the updated booster, according to the state data, which was updated Wednesday to include bivalent booster rates.

Washingtonians 65 and older are the most boosted at a rate of about 19.3%, while those 12 to 34 report rates below 5.5%.

White and Asian communities so far have the highest bivalent booster rates at 12.4% and 9.8%, respectively, while American Indian/Alaska Native communities are at about 7%, Black communities are at about 5.4%, Native Hawaiian/Pacific Islander communities are at about 4.7% and Hispanic communities are at about 4.4%, according to the state.

For those struggling to find a booster appointment in King County, Duchin suggested visiting one of the county’s two mass vaccination sites in Auburn and Bellevue.

The Outlet Collection mall in Auburn is open Friday through Monday from 10:30 a.m. to 7 p.m. at 1101 Outlet Collection Way, Suite 1110. The Eastgate Public Health Center in Bellevue is open Monday through Friday from 9:30 a.m. to 4:45 p.m. at 14350 SE Eastgate Way.

Drop-ins are welcome at both sites, though appointments are strongly recommended.

Duchin also reminded residents Thursday that monkeypox continues to circulate in the community, although cases have leveled off in recent months. At one point during the summer, the county counted about 60 cases a week, compared to about 10 or fewer per week recently.

Monkeypox vaccines have also become more available, allowing the county to expand eligibility to anyone who’s had skin-to-skin contact or other close contact with someone with monkeypox; men and trans people who have sex with men or trans people; and anyone who’s engaged in “commercial or transactional sex.”

The monkeypox vaccine still isn’t recommended for members of the general public, he said.

Although October has seen a warm start, cooler weather and more time indoors could lead to a worrisome respiratory virus season, Duchin said.

“We remain vulnerable to what could be a significant fall and winter surge,” he said. “There’s a real possibility we are now in what will turn out to be a lull before the storm.”