There were 174 people who tested positive for COVID-19 over the weekend in Spokane County.

On Monday, health officials confirmed 36 more.

There are 73 people hospitalized and receiving treatment for COVID-19, including 49 Spokane County residents. Six county residents died from the virus over the weekend. Since the start of the pandemic, COVID-19 has killed 85 people here.

The numbers follow a week of decisions by school districts regarding whether to resume in-person learning.

School districts do not have to follow the recommendations of local health officials who are recommending districts conduct only distance learning in Spokane County this fall.

Yet many are following those guidelines, including in Spokane County, where local health officer Dr. Bob Lutz issued a warning regarding students returning to school buildings for in-person learning.

“Allowing children to come back to school full time when we have high rates of disease in our community will be challenging going forward,” Lutz said on Monday.

Lutz’s recommendation is based on state health officials’ risk assessment levels, released last week. For counties with more than 75 COVID-19 cases per 100,000 in the last two weeks, state health officials strongly recommend distance learning, with only certain carve-outs for students with the highest learning needs.

Spokane County has an incidence rate of 213 cases per 100,000 residents from July 22 to August 4. The majority of counties in Washington have incidence rates higher than 75 cases per 100,000 residents.

Lutz said he does not expect the infection rates to drop quickly.

“I think for the foreseeable future, and the foreseeable future for me is months, I do not see us getting to below 25 (cases per 100,000),” Lutz said on Monday. “And I question how quickly we’ll get to that below 25 per 100,000 mark in 2020, let alone in 2021.”

This is how pandemic curves work, Lutz said, the virus spread quickly and the case rates rose rapidly. Transitioning to a period of plateauing numbers and then a gradual descent from the peak will take time, he said.

Spokane County is in its plateau stage at the moment. Lutz said the county’s reproductive number for the virus, meaning the number of people infected for each confirmed case, is below one, like the rest of Eastern Washington.

While the health district does not have jurisdiction over how school districts choose to reopen, health officials will get involved if there are confirmed COVID-19 cases in schools.

The Washington Department of Health considers an outbreak at a school when two people, who do not share a household, have epidemiologically linked cases within a two-week period. When there is an outbreak, the entire classroom where the students were linked is sent home to quarantine for two weeks. Schools will need to close if more than 10% of classrooms have been dismissed due to outbreaks.

While Spokane Public Schools announced it will begin the 2020 school year with distance learning, other districts in Spokane County have announced hybrid models, where students will come to school for a certain number of days per week. Lutz does not recommend these models, and he said he expects to see students and staff become infected with the coronavirus at these schools.

“I fully expect to see cases and, very likely, outbreaks in schools,” he said.

If a child displays any symptoms consistent with COVID-19, they have to be sent home for at least 10 days or until they test negative for the virus, which will likely cause disruptions in the learning process, Lutz said.

He reiterated the guidance is based on what state health officials looked at internationally with schools reopening in other countries, since there is no data available in the United States about reopening schools with COVID-19 circulating in the communities. Other countries had low incidence rates for COVID-19 when they reopened schools. In Belgium when schools reopened in May, the country had an incidence rate of 35 cases per 100,000 residents in the last two weeks. In Washington state, the incidence rate is currently 127 cases per 100,000 residents in the last two weeks.

If Spokane County gets down to the state’s second risk assessment level for reopening schools, 25 to 75 cases per 100,000 residents, Lutz said he would entertain recommendations for some in-person instruction in certain situations.