Scott G Winterton, Deseret News

Utah debuts new transmission index system as state reports 987 more COVID-19 cases Tuesday

By Jacob Klopfenstein, KSL.com | Updated - Oct. 13, 2020 at 4:42 p.m. | Posted - Oct. 13, 2020 at 1:02 p.m.


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SALT LAKE CITY — As Utah reported 987 more cases of COVID-19 Tuesday amid an ongoing surge of the disease, state leaders debuted a new system that represents a major shift in the state's approach and response to the pandemic.

No new deaths were reported Tuesday. The Utah Department of Health now estimates there are 22,714 active cases of COVID-19 in Utah, a number that has more than doubled in the past month.

The rolling seven-day average number of positive cases per day is now at 1,182, according to the health department. The positive test rate per day for that time period is now 13.8%.

Tuesday is the second day in a row new cases have been reported at under 1,000, but it's only the third day in October, so far, that has seen fewer than 1,000 new cases, state data shows.

Utah's COVID-19 Transmission Index introduced

To combat the current surge, Utah leaders on Tuesday launched a new transmission index that will be used to assess each Utah county's current COVID-19 situation. It's the biggest policy change of Utah's pandemic so far, replacing the old system state leaders have used for the last seven months and outlining new health guidelines for Utahns to follow.

"We’re having one of the worst outbreaks in the country, and this is unacceptable," Utah Gov. Gary Herbert said. "It’s really time for a new game plan."

The transmission index will now be used in place of the previous color-coded system under the Utah Leads Together plan. Each week, health department officials will look at three key metrics for each county: case rates, percent positivity and statewide intensive care unit usage. Each county will then be automatically categorized as high, moderate or low transmission risk.

Details on the new system can be found at coronavirus.utah.gov/utah-health-guidance-levels. A PDF document addressing frequently asked questions about the new system can be found by clicking this link.

Herbert also announced Utah will transition out of a state of emergency and into a public health emergency designation starting this week. That will allow state leaders to focus on public health aspects of the pandemic, he said.

“We the people can control the outcome of this issue," the governor added.


Utah Gov. Gary Herbert, along with health department interim executive director Rich Saunders, and state epidemiologist Dr. Angela Dunn, provided an update on the new changes at a Tuesday news conference. Watch the replay of the event below.


Transmission index emphasizes casual gatherings

As of Tuesday, the following counties are categorized under the high COVID-19 transmission level: Cache, Garfield, Juab, Salt Lake, Utah and Wasatch.

The following counties are designated as moderate transmission: Box Elder, Carbon, Davis, Grand, Iron, Millard, Morgan, San Juan, Sanpete, Sevier, Summit, Tooele, Uintah, Washington and Weber.

The remaining counties are designated under the low transmission level: Beaver, Daggett, Duchesne, Emery, Kane, Piute, Rich and Wayne.

This graphic, taken from the Utah Department of Health's coronavirus dashboard, shows the state of each Utah county under the new transmission index system as of Tuesday, Oct. 13, 2020. (Photo: Utah Department of Health)

The changes come amid Utah's weeks-long surge in COVID-19 cases and are the result of days of discussions with public health officials and legislators, Herbert said.

The new system places an emphasis on casual social gatherings between family and friends, which are thought to be a major source of COVID-19 spread during Utah's current surge, according to health department interim executive director Rich Saunders.

“The virus doesn’t care how much we love to be around each other," Saunders said.

Casual social gatherings are defined as smaller events between family and friends. They are different from public gatherings, which include settings such as live events, movie theaters, sporting events, weddings, recreation and entertainment. Casual social gatherings also don't include formal religious events or "events with organizational oversight," such as work events, according to the state's guidelines.

Those smaller, casual social gatherings are thought to be responsible for a significant amount of the COVID-19 spread Utah is currently experiencing, so health officials are asking people to change the way they think about such gatherings, Saunders said.

In high transmission level counties, those gatherings will be limited to 10 or fewer people, according to the new guidelines.

A public health directive also extends some requirements to counties considered to be at the moderate transmission level for the next two weeks. Herbert said the two-week extension will allow the state to get a head start on the new system during the transition period.

Under that directive, people in counties categorized under moderate transmission will be permitted to have casual social gatherings of 10 or fewer people. After Oct. 29, that limit will be increased to 25 or fewer people; and those events can exceed 25 people, but only if every participant wears a face mask, the guidelines state.

In low transmission level counties, casual social gatherings are limited to 50 or fewer people. Gatherings can exceed 50 people only if every participant wears a mask.

Statewide mask mandate? Not quite

The new system also emphasizes mask wearing but stops short of requiring masks statewide — a mandate Herbert has repeatedly declined to enact thus far.

Instead, the plan outlines specific scenarios where masks are mandatory.

“It's not really rocket science what we’re asking people to do,” Herbert said. "I’m confident the Utah people will be able to understand this and will act accordingly."

Masks are required for public gatherings — such as live events, movie theaters, sporting events, weddings, recreation and entertainment — for all counties regardless of their transmission level, according to the new guidelines. However, performers at those establishments, such as actors in stage productions, will be exempt from those requirements.

For counties under the high transmission level, masks are further required for public indoor settings, as well as outdoor settings where social distancing isn't possible. For businesses, that includes mask requirements for both employees and patrons.

Under the public health directive, masks are also required in public indoor settings and outdoor settings where social distancing isn't possible for counties considered at a moderate transmission level through Oct. 29. After that date, masks will simply be considered strongly recommended in those settings for moderate transmission level counties.

Masks are also strongly recommended for counties at the low transmission level for COVID-19.

Under the new system, county leaders will still be able to enact blanket mask requirements if they wish. Right now, Salt Lake, Utah, Grand and Summit counties require all people to wear masks while in public in all settings.

Even though masks aren't being mandated statewide, Utah leaders are still asking people to wear them while in public and to implement them whenever possible, Saunders said.

“If you take the politics out and you look at the science, masks just work,” he said.

3 key metrics

There are three key statistics health officials will look at to determine a Utah county's transmission level and decide when a county can move to a different categorization.

Each week, state health officials will assess every county's seven-day average positive test percentage and 14-day case rate per 100,000 people, as well as statewide ICU usage, according to the new guidelines. Counties are rated at the high, moderate or low level if two out of the three metrics fall under the criteria for a certain level.

Counties can be considered at the high transmission level if the seven-day positivity is 13% or more. They can be considered at the moderate level for a seven-day positivity of 6-12.9%, and can be rated as a low transmission level county if the seven-day positivity is below 6%.

Richard Saunders, acting director of the Utah Department of Health, speaks as he joins with Gov. Gary Herbert, and state epidemiologist Dr. Angela Dunn in announcing major changes to Utahâ??s COVID-19 guidance system, at a press conference at the Capitol in Salt Lake City on Tuesday, Oct. 13, 2020. (Photo: Scott G Winterton, Deseret News)

If that statistic is above 10% positivity for a given area, it indicates that there are not enough tests being conducted, and health officials are likely missing people who have COVID-19 due to the lack of testing, according to the health department guidelines. If the 14-day positivity is under 5% for an area, that means health officials are probably capturing most people who have the disease in that area.

Counties can meet the high transmission level criteria if they have a 14-day case incidence rate of 325 or more per 100,000 people. Counties can be assessed at the moderate transmission level if their incidence rate is 101-324 per 100,000 people, and they can be considered at the low transmission level if the incidence rate is 100 or less per 100,000 people, according to the guidelines.

The case incidence rate helps health officials determine how quickly COVID-19 is spreading in a given area, according to the health department's guidelines. Looking at the case incidence rate per 100,000 people helps compare different areas as if they had the same population.

This graphic, taken from the Utah Department of Health's coronavirus dashboard, shows three key metrics health officials will consider under the state's new COVID-19 transmission index, which debuted Tuesday, October 13, 2020. (Photo: Utah Department of Health)

The third metric considers ICU usage across the state. Counties can be rated at the high transmission level if 72% or more of the state's total ICU beds are being used and if 15% of those are being used by COVID-19 patients. Counties can be rated at the moderate level if the statewide ICU usage falls between 69-72% and if 6-15% of those beds are occupied by COVID-19 patients.

The low transmission level criteria is statewide ICU usage below 69% with 6% or less of those beds being occupied by COVID-19 patients.

Health officials are considering statewide ICU numbers instead of local usage because some rural areas don't have any ICU beds, the state's guidelines indicate. Patients from those areas who need an ICU bed might be transferred to another area that has available resources.

As of Tuesday, about 65% of all ICU beds in Utah were occupied, state data shows. About 15.8% of those beds are being filled by COVID-19 patients statewide, Herbert said. But some health systems are experiencing occupancy rates far exceeding that, such as the University of Utah Health system, which is currently at 95% of its ICU capacity, Herbert said.

Utah health officials are keeping a close eye on these metrics to ensure that healthcare systems across the state don't become overwhelmed any further, Herbert said. But they're already starting to feel the strain, and the health department, along with the Utah National Guard, is standing by in case the state needs to mobilize a field hospital at the Mountain America Expo Center in Sandy, the governor added.

“Our hospitals are getting overwhelmed," Herbert said.

New COVID-19 cases

Tuesday's new numbers indicate a 1.1% increase in positive cases since Monday. Of the 931,732 people tested for COVID-19 in Utah so far, 9.5% have tested positive for the disease. The health department reported an increase of 8,801 tests conducted as of Tuesday.

A total of 249 COVID-19 patients are currently hospitalized in Utah Tuesday, including 90 in intensive care unit beds, according to the health department. That is the same number of current hospitalizations as Monday. About 65% of all ICU beds in Utah are occupied as of Tuesday, while about 49% of non-ICU beds are filled, state data shows.

Tuesday's totals give Utah 87,819 total confirmed cases, with 4,383 total hospitalizations and 522 total deaths from the disease. A total of 64,583 Utah COVID-19 cases are now considered recovered, according to the health department.

Herbert acknowledged that the last seven months of the pandemic have been exhausting. But he encouraged Utahns to continue fighting the spread of COVID-19 and to change their behavior to do so.

“I like you, am tired of 2020," Herbert said. “Frankly, it doesn’t matter how tired we are. We must, in fact, win this fight.”

Methodology:

Test results now include data from PCR tests and antigen tests. Positive COVID-19 test results are reported to the health department immediately after they are confirmed, but negative test results may not be reported for 24 to 72 hours.

The total number of cases reported by the Utah Department of Health each day includes all cases of COVID-19 since Utah's outbreak began, including those who are currently infected, those who have recovered from the disease, and those who have died.

Recovered cases are defined as anyone who was diagnosed with COVID-19 three or more weeks ago and has not died.

Deaths reported by the state typically occurred two to seven days prior to when they are reported, according to the health department. Some deaths may be from even further back, especially if the person is from Utah but has died in another state.

The health department reports both confirmed and probable COVID-19 case deaths per the case definition outlined by the Council of State and Territorial Epidemiologists. The death counts are subject to change as case investigations are completed.

Data included in this story primarily reflects the state of Utah as a whole. For more localized data, visit your local health district's website.

Information is from the Utah Department of Health and coronavirus.utah.gov/case-counts. For more information on how the Utah Department of Health compiles and reports COVID-19 data, visit coronavirus.utah.gov/case-counts and scroll down to the "Data Notes" section at the bottom of the page.

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