Alaska is seeing a serious COVID-19 surge. Where are people getting it? Just about everywhere people mix.

As COVID-19 surges across Alaska, health officials said Thursday that new cases mostly emerged from one scenario: anywhere people mix.

Alaska is dealing with an unprecedented level of COVID-19 cases statewide, and public health officials say even those higher numbers may be an undercount of current cases as test results stack up in a data backlog. Nonetheless, recent numbers show that the virus has spread to all regions of the state, and it’s putting pressure on an already-stretched health care system.

COVID-19 is spreading anywhere people mingle together in Alaska, state epidemiologist Joe McLaughlin said during a call with reporters on Thursday. To be sure, there are outbreaks in communal living settings like nursing homes and jails, he said, “but the vast majority of transmission is just happening among people as they mix.”

Whether it’s at a store, bar, restaurant or sporting event, COVID-19 transmission is happening, he said. It’s like flu season — early on, transmission is sporadic before becoming widespread. And once it hits that point, it’s possible to get the flu at work, with friends or at a house party. The same thing is happening with COVID-19, he said.

[Gov. Dunleavy deems virus escalation an ‘imminent threat’ as Alaska reports 478 new COVID-19 cases]

One of the highest-risk situations, McLaughlin said, is living with someone who has tested positive for COVID-19.

A lot of transmission is happening among people who live together, said Louisa Castrodale, an epidemiologist with the state.

“One person might become sick in that household, and then all of a sudden it blows through the entire family,” she said.

One case can quickly become six as the virus makes its way to all members of the household. And it’s really challenging, especially given how many people have young children and cannot isolate from others.

“Wearing a mask, keeping our distance, avoiding others is going to be the single best way that we can preserve our hospital capacity,” said Dr. Anne Zink, the state’s chief medical officer.

In Anchorage — which, as the state’s largest city, can drive trends in statewide virus numbers — officials recently shrank gathering size limits and broadened an emergency order on mask-wearing in response to rising cases across the community.

“This virus can only replicate if it has your cells to replicate in,” Zink said. “It needs humans to live. But if we spread ourselves apart, and don’t give it more humans to live in, it can’t keep moving.”

Smaller social gatherings are now increasingly associated with new virus cases nationwide, The Washington Post reported this week. That’s in contrast to early in the pandemic, when many cases were reported at long-term care facilities or crowded clubs, the Post reported.

Public health officials have cited masks as an important tool in limiting the spread of the virus. This week, the federal Centers for Disease Control and Prevention published more guidance on the importance of wearing masks, including evidence that masks have been shown to protect the wearer.

“So not only can you protect others, but it can help you,” Zink said on the call.

While Alaska Gov. Mike Dunleavy has so far refrained from issuing a statewide mask mandate, Zink said slowing the spread of COVID-19 comes down to the individual. She said the state is trying to give Alaskans the knowledge they need and emphasized that officials want people wearing masks.

“This virus does not care if you believe that the mask will work or not,” Zink said. “It does not care what you think about the media’s reporting of it. It does not care if the governor says it or I say it. It cares that it has a human to live in.”