EVERETT, Wash. — The first signs felt eerily familiar.

Getting word that out-of-state travelers may have brought in an extremely contagious virus. Scrambling to notify the public. Tracking exposures. Testing residents. Watching three cases become six, then 10, then 12.

The Snohomish County Health Department had again found itself hustling to save lives and prevent hospitalizations, this time in a race against the spread of measles.

Jae Williams started as a communications coordinator at the health department on Jan. 8, the same day the department learned of measles exposures in the county. So instead of spending the week familiarizing herself with the job and getting to know her team, Williams was calling residents to tell them they might have been exposed to a deadly virus.

She'd made these types of calls before, during the COVID-19 pandemic while living in California.

“Give me a script, and I’m ready to go,” Williams said.

In many ways, the push to curb the spread of measles is reminiscent of the early days of the pandemic that engulfed the country six years ago. The nationwide measles outbreak, now centered in South Carolina, has resulted in thousands of infections over the past year and has put the U.S. on track to lose elimination status after more than two decades. In 2025, three people died from the disease.

But as teams of health experts, nurses, epidemiologists and others have shifted into emergency mode, they remind the public of key differences. Though the measles virus is dangerous and among the most infectious on the planet, this is not like COVID-19.

“This is not a disease we don’t understand,” said Susan Babcock, a public health nurse at the Snohomish County Health Department. “We’ve got good testing for it. We have a good public health response. And we have an effective vaccine.”

Still, even one case can trigger an enormous amount of work for state and local health teams, including those in Snohomish and Clark counties, where outbreaks are ongoing.

Most of this work is invisible to the broader public: making hundreds of contact-tracing calls, coordinating staffing, running tests, compiling data, working with the Centers for Disease Control and Prevention, and sometimes having tough conversations about immunization.

“Right now, it’s hard, some of the politics around vaccine science,” Babcock said. “We just try to be as gentle as possible.”

Over the last two months, dozens of Snohomish County Health Department staffers who normally work in communications, environmental health, substance use, refugee health, emergency response, finance and on other teams have been pulled in to help.

“It’s definitely a team sport,” Babcock said.

Fast break

The rush to respond to Washington’s first outbreak this year began Jan. 7.

The CDC told the state Department of Health that a family from South Carolina had visited while infectious with measles — and exposed people at Seattle-Tacoma International Airport. The following day, South Carolina’s health department learned the family had mostly spent time in Snohomish County.

The state updated Snohomish County health officials later that day.

The first big step was to determine if there are exposures at a location where there’s a record of who was there and when, said Snohomish County health officer Dr. James Lewis. It’s easy to identify and reach people who might have been at a medical clinic, for example, where patient appointments are logged. That becomes much harder at places like a grocery store or restaurant, Lewis said.

In those cases, “then we want to get the word out,” he said.

Everything is time-sensitive. Measles has an incubation period of seven to 21 days, which means it can take up to three weeks for someone to develop symptoms. But the disease is contagious four to five days before the characteristic rash appears, so confirming vaccination records must happen quickly.

People with two doses of the measles vaccine, typically part of combination shots that also protect against mumps and rubella, have about 97% protection against infection. Those who have been exposed but are not vaccinated can receive postexposure protection — a dose of an MMR vaccine — to prevent infection or reduce the severity of the disease, Lewis said. Postexposure prophylaxis for measles is effective within 72 hours of exposure.

That means public health teams generally aim to reach people within three days of exposure, though that’s not always possible, he said.

Meanwhile, a system must be established for quick decisions, clear division of responsibilities and constant communication. One of Jennifer Reid’s main responsibilities is to build an incident management team, much as 911 responders and law enforcement do for an emergency.

“Normally, you have time,” said Reid, the health department's lead emergency specialist. “You have weeks or months to gather information, make a decision and make a change. But sometimes you don’t.”

Reid has spent the last year or so bolstering that emergency response, holding more frequent department trainings, building protocols and running exercises.

When the first three measles cases in the Snohomish County outbreak looked imminent, it was time for Reid’s work to shine, said Carrie Parker, assistant director of prevention services and who acted as incident commander of the emergency team.

“Our phone lines were overwhelmed. Our social media was going insane. We had to pull surge staffing,” Parker said.

On an average day, about four people are tasked with communicable disease response. As the number of infections grew, more than 30 staffers joined in, largely to help call people who might have been exposed and tell them what to do if they got sick. These efforts can help prevent further spread, Lewis said.

In one case, a person knew they were sick and tried to recover at home, but ultimately needed medical care. Instead of just showing up at a clinic, they called ahead, had a virtual appointment, then drove to the clinic, where staff wearing protective gear asked questions and performed a swab test outside, avoiding exposure in the clinic, Lewis said.

“That’s a perfect example of how this messaging can work and be effective,” Lewis said.

When it was clear that two schools in Everett and Edmonds had been exposed, health workers made about 300 contact-tracing calls and both schools closed for a couple of days. Because the schools had fairly high MMR vaccination rates, Lewis said, the exposures didn’t lead to any staff or student infections.

The state Department of Health laboratories have run more than 80 measles tests this year. During the first two months of 2025, in comparison, the state labs tested nine samples.

“It’s hard to quantify the immense amount of work that public health has to put forward to investigate even one case,” said Katie Curtis, Snohomish County public health’s director of prevention services.

Walking a tightrope

Many parts of a measles response are logistical and data-driven, but sometimes the approach needs to be more personal.

The measles vaccine has been available in the U.S. for more than six decades and is considered the best tool to prevent serious disease. But after years of misinformation campaigns and, more recently, conflicting messaging from the federal government about the vaccine's safety and efficacy, a growing number of families are hesitant to trust the shots.

“Our whole team has a lot of empathy for that population, because they just don't really know and they're scared, and, of course, they're going to feel terrible that their kid is sick,” said Sarah Legat, a Snohomish County public health nurse.

When she talks with families who are wary of vaccines and choose not to immunize their children or to delay vaccination, she doesn’t hide the science. But if a family has already been exposed to measles, her main goal is often to provide and collect necessary information, not change minds or place blame.

She hears from many young mothers in particular, who might not consider themselves “anti-vaccine,” but maybe haven’t made up their minds yet. Then after being inundated with online vaccine misinformation, they “get freaked out,” Legat said.

As a younger mom herself, Legat understands how ending up on the wrong social media algorithm can “just attack you.”

Sometimes if you have a lot of questions about something" Legat said, "it’s easier to not take action than to do something you’re not certain about.”

This kind of thinking is also strategic; after someone’s already exposed to measles, making them feel bad that they aren’t vaccinated isn’t going to do any good, Babcock added. It might just alienate them.

“And we need them to cooperate up to a point,” Babcock said.

Instead, public health teams emphasize the need to quarantine, and prioritize finding out where that person went during their exposure period and who else is in their household.

In the current outbreak, all the Snohomish County cases so far have been among unvaccinated children, mostly siblings. All have been linked to the South Carolina travelers in some way, either through direct contact or through exposures at a Mukilteo church, where the family visited during their trip.

Public health teams realized early on that, because of church members’ religious beliefs, pushing vaccination efforts there was “probably just going to cause tension and make risk-reduction efforts more difficult,” Lewis said.

The health department worked to communicate with the families and church members in their preferred languages, provided translated recommendations to stay home to minimize transmission, and shared materials that removed references to vaccines to better “meet folks where they were,” he said.

“They put up all our posters in the church,” Lewis said. “They put posts up on the church Facebook page. And as a result of all this, I really think we’ve had way fewer cases than we would have had otherwise.”

As of this week, the county has counted 14 cases in its outbreak.

“I thought we would have been lucky to get away with 20 cases,” Lewis said. “So given the situation and the extent of the exposure we saw, that is a huge win.”

The next countdown

Over the last few weeks, Snohomish County’s outbreak response has quieted, in a way. Additional cases have occurred only within the families already quarantining, and there have not been new public exposures.

The health department has taken a breath, transitioning from an all-hands-on-deck response to a “new normal,” said Parker, the outbreak response’s incident commander.

In other parts of the state, cases continue to pop up. In the last two months, there have been eight in Clark County, three in Stevens County and one in Kittitas County.

Dr. George Diaz, medical director of infectious disease at Providence Regional Medical Center Everett, credited Snohomish County’s relatively low number of cases so far to local public health’s quick response and the county’s MMR rates. A Providence Swedish clinic in Everett also became an exposure site in January, but every staffer was immunized against measles and no additional cases were linked to the clinic, he said.

"There's other counties in Washington that have much lower vaccination rates,” Diaz said. “And those are areas where an outbreak could be devastating.

In total, Washington has counted 26 cases this year.

“There is a chance that there’s unrecognized transmission going on in the community,” Lewis reminded. Still, our numbers are far from those in other parts of the country.

Per public health guidance, outbreaks are considered over once two incubation periods, or 42 days, have passed since the last case was no longer contagious. As of now, that date would be April 4.

“Watch that 42 days for us,” Parker said. “The countdown has begun.”

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