EVERETT — Unvaccinated people not wearing masks, a return to pre-pandemic life and a variant that’s at least twice as contagious as the original virus.

Combine the three and you get a fifth wave of COVID-19 transmission.

Across the state, virus cases are rising, with the vast majority coming from unvaccinated Washingtonians, as the delta variant takes root. Now, health experts are asking everyone to wear a mask in crowded indoor spaces, and pleading with the unvaccinated to get their shots.

“I think we all wanted to be further down the road and more immune to this kind of bounce back so quickly, and yet, here we are,” Snohomish Health District health officer Dr. Chris Spitters said. “With this strain circulating, and the reduced level of prevention measures, it’s just not good enough. That’s what nature is telling us.”

In Snohomish County, the latest two-week case rate shows 139 new infections per 100,000 residents — up from the previous count of 109.

For the most part, though, counties with lower vaccination rates are seeing the largest spikes in cases.

In Franklin County, about 41% of eligible residents are fully vaccinated. The latest two-week case rate, ending in mid-July, showed 490 new cases per 100,000 people, according to state data. That’s the highest in the state.

Of the counties with the 15 highest case counts in the state during that span, none have full vaccination rates of 60% or higher, state data shows.

Earlier last week, Spitters, alongside public health officials from other western Washington counties, called on everyone to consider masking up in crowded indoor spaces. They also asked businesses, like grocery stores and retail shops, to reinstate mask requirements.

“The best way to make sure everyone who is unvaccinated wears a mask is just for everyone to wear a mask,” Spitters said. “The sign at the front door saying ‘If you’re unvaccinated please wear a mask,’ while well intended, is just not effective.”

A few days later, Gov. Jay Inslee and state Secretary of Health Dr. Umair Shah did the same.

Inslee said he’ll be making decisions in the next few weeks that will increase the state’s vaccination rate. That could include requiring state employees to get their shots.

In Edmonds, the city is again requiring all employees who work indoors to wear masks, regardless of vaccination status. Additionally, all visitors to city buildings must mask up when indoors, except when attending a public meeting.

Countywide, if the situation continues to worsen, it’s “certainly conceivable” that a masking order may be needed to stem the spread of the variant, Spitters said.

“It’s not very difficult, it’s not expensive and it works,” he said.

He’d yield such a decision to the governor, but “something more than a please may be necessary.”

Breakthrough cases

Breakthrough cases occur when someone who is fully vaccinated contracts COVID.

Everyone’s heard about one, Spitters said.

“They’re a small minority of cases,” he added. “That’s just something we have to live with. Don’t let anecdotes or data about ongoing breakthrough cases break our spirits or dissuade us from appreciating the effectiveness of these vaccines.”

More than 4.4 million Washingtonians are fully vaccinated. And so far, 4,241 breakthrough cases have been reported statewide, according to Department of Health data. Of those, 259 were hospitalized, and 52 people died.

“It’s not a reason to say vaccines don’t work,” Spitters said.

No vaccine is perfect, he added. As more people get vaccinated, there will be more breakthrough cases. However, getting more of the population protected means fewer hospitalizations and deaths.

One area of concern for Spitters, he said, is the delta variant, which according to the federal Centers for Disease Control, is as contagious as chickenpox.

The variant has become the state’s dominant strain, which will likely lead to more breakthrough cases.

New federal data also shows that people experiencing breakthrough cases can transmit the virus.

Yet, fully vaccinated people need to be infected to spread COVID. And getting your shots make you at least three times less likely to contract COVID, and at least 10 times less likely to be hospitalized or die, the CDC said.

As of Wednesday, 96% of people hospitalized in Washington due to COVID were unvaccinated, state officials said.

The geography of vaccinations

Vaccines are still the best protection against COVID, experts agree.

In Snohomish County, 62% of the eligible population is fully vaccinated. That’s the fifth-highest rate in the state.

Of counties with more than 100,000 people, Snohomish ranks third among all counties in fully vaccinated residents.

But there are still 240,000 eligible residents who have yet to get a shot, Spitters said. And another 125,000 children under 12 aren’t yet eligible for vaccines.

Rural areas of the county, such as Darrington, Sultan, Granite Falls, Arlington and Gold Bar have the lowest vaccination rates, according to data from the Snohomish Health District.

In those cities, the percentage of eligible residents with at least one shot ranges between 47% to 52%.

Cities along the I-5 corridor, including Edmonds, Mill Creek, Bothell, Mountlake Terrace and Lynnwood, are among the top. The percentage of eligible residents with at least one shot is between 66% to 77%.

The city of Lake Stevens has the highest vaccination rate in the county, with 81% of residents having received at least one dose.

“That was great to see,” Spitters said.

And the city of Everett is lagging behind other urban areas. In total, 58% of the city’s eligible population has gotten at least one shot. South Everett has the lowest rate, at 53%.

That was surprising, Spitters said, given Everett’s central location and proximity to mass vaccination sites, as well as hospitals and clinics that provide shots.

Meanwhile, racial and ethnic analysis shows the county’s white and Hispanic populations are trailing others in getting shots.

“It’s kind of the million-dollar question,” Spitters said. “How to help people who have not yet gotten vaccinated — those who are open to it or want it — how to help them get across the line and get it done, and then what, if anything, to do about those who are strongly fixed against getting vaccinated.”

In Olympia, Inslee and state leaders hope a new program that relies on primary care doctors to dispel vaccine misinformation will lead to more shots.

Locally, the county is still using mobile vaccine clinics to reach communities with less access to shots.

However, Spitters said he’s less optimistic than he previously was when it comes to convincing people who are firmly against vaccinations.

“Maybe recent events will be a motivator for some folks,” he said.

Joey Thompson: 425-339-3449; jthompson@heraldnet.com. Twitter: @byjoeythompson.