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SALT LAKE CITY — A leading infectious disease expert in Utah said he would recommend a brief closure of schools and businesses as a way to counter the surging number of new COVID-19 cases, which are now at record levels in the state.
Dr. Eddie Stenehjem, an infectious disease physician for Intermountain Healthcare, provided his pitch for a second round of closures during a virtual question-and-answer session hosted by Intermountain on Friday morning.
"We're at a point where we need a big, bold intervention," Stenehjem said. "Us, from the health care, pleading to the public to say 'Look at our ICU, look at our hospitals, look at these suffering patients' has not worked.
"Look at how much national attention we've gotten," Stenehjem continued. "This week we were on ABC, PBS, NBC, CNN — all national news outlets — pointing to Utah as like 'what the hell is happening there? Look at their case counts. What are you going to do?' And yet we haven't seen anything necessarily change."
A spokesperson for Utah Gov. Gary Herbert's office told KSL.com on Monday that Herbert and the state's Unified Response officials view another temporary shutdown as a possibility but there's no indication that it's looming. It's an option "on the table" as it continues to monitor cases, for now.
It's a tactic that leaders of some outside countries recently began revisiting amid spikes of the coronavirus in their respective areas.
A snapshot of Utah's growing cases
Just hours after Intermountain's session ended Friday, the Utah Department of Health released its largest one-day total of new cases at over 2,000 cases. The Utah Department of Health reported Monday there are 117,706 total cases of COVID-19 dating back to March.
Of those cases, 86,269 are estimated as recovered, which is about 73% of all cases to date. The department moves COVID-19 cases from active to recovered after three weeks excluding deaths. That said, the number of active COVID-19 cases are at an all-time high. Utah reached the estimated 30,000 active cases plateau for the first time over the weekend.
To put it into perspective, the state reached a high of 13,022 active cases during its summer spike. The number dropped to below 8,000 by early September before another rise occurred. Active cases reached the 10,000-marker again on Sept. 16 and 20,000 for the first time on Oct. 4, according to health department statistics.
The state also has a running seven-day average of 1,646.9 new cases per day, which is a smidge below the current record set over the weekend. The seven-day running average of test positivity rate is now at an all-time high of 19% through Oct. 27 — about 12.5 percentage points above the national average, according to Johns Hopkins University data.
There are a few states with worse rates. For example, the university notes that South Dakota's rate is at a whopping 50% followed by Wyoming at 43%. Iowa (36%), Idaho and Kansas (each at 34%) rounded out the five states with the highest rates in the U.S. Utah was seventh on that list behind Alabama.
New cases become problematic when they turn into new hospitalizations and sometimes even deaths. Utah still has one of the lowest COVID-19 mortality rates and death rates per capita in the country. But based on the current statistics, Stenehjem explained that every day with large new cases will likely result in dozens of future new hospitalizations and even some deaths within weeks that they are reported. That's why doctors are concerned about new cases.
"What is really kind of frightening is we know hospitalizations are delayed 7-10 days from cases and so the cases we were identifying (Thursday), those people aren't going to hit our hospital for another week to 10 days," he said. "It's at pace for it to be an unsustainable rate for us to handle all of these cases."
Utah's hospitalization levels due to COVID-19 are on the rise. There were 348 active COVID-19 hospitalizations on Sunday, which is the highest the state health department has recorded. Of those, 138 cases involved intensive care unit beds.
Total bed occupation remains at 50%, but health officials said last month that bed space still doesn't account for staff required to handle increases in patients. The state's total ICU beds occupied was 72% on Sunday, which is around the target goal maximum set by the state's Unified Response.
Stenehjem said hospitalization occupancy is up 130% from where it was at the end of October 2019.
As NPR reported last week, Utah's largest hospitals typically treat patients from all over the Intermountain West but backlogs mean doctors in states like Idaho and Montana have had to search for other places to send patients in need.
The rise of hospitalizations is why the Utah Hospital Association met with state officials nearly two weeks ago to discuss Utah's "crisis standards of care" policy should hospitals become overrun with patients — in essence, a plan for determining when some patients might be denied care or moved out of ICU beds to make room for others who might have better outcomes.
Revisiting an old solution?
Stenehjem laid out his idea during Friday's session after knocking the state's mask-wearing rate, which he believes is still too low even if two-thirds of Utahns are wearing them. He said the simplest way to handle the uptick is to briefly return to the lockdowns Utahns experienced in March and April.
Schools would move to remote learning with extracurricular activities canceled, businesses would move to work-from-home models, restaurants would only serve to-go options and most people would remain home — for two weeks, at least.
"If everybody stays home for two weeks, what we will see is that curve plummet back down to a level where we can accommodate in our hospitals, in our testing centers (and) in our clinics," he said. "Aside from that, I'm not sure what's going to happen if we continue to go in the course just hoping and praying that things are going to get better."
Herbert instituted the state's first COVID-19 restrictions in mid-March as the number of cases slowly began to climb and medical experts raced to try and figure out the coronavirus. With the state's transmission rate low early on, he began dialing back many restrictions starting in May when the state still implemented a color-coded COVID-19 guidance system.
The time for us to do conservative public health community measures — unfortunately, I think that’s passed. I think we’re going to need a pretty aggressive pause in our life to get that community transmission down, especially as we go into the (Thanksgiving and Christmas) holidays.
–Dr. Eddie Stenehjem, an infectious disease physician for Intermountain Healthcare
The state weathered a summer uptick in cases but hasn't returned to shutdowns since lifting measures. It moved to a new model to handle the pandemic last month at the same time Herbert issued a public health emergency. It's led to more mask requirements and other restrictions but no shutdowns, which are viewed as controversial to some.
As of Monday, officials for the governor's office said it was too soon to make a decision on another lockdown.
The state continues to recommend or require masks in public places. Dr. Deborah Birx and Dr. Robert Redfield, a pair of high-ranking Centers for Disease Control and Prevention leaders, met with Utah leaders and health experts over the weekend. They discussed the importance of mask-wearing to curb COVID-19 cases during the meeting, said Dr. Tom Miller, University of Utah Health's chief medical officer for hospitals and clinics, during an appearance on KSL NewsRadio's "Live Mic" with Lee Lonsberry on Monday.
Miller said he believes masks can still help solve Utah's COVID-19 problem despite the rise in cases but it's something nearly everyone has to do if it's going to bring down rates. On top of that, it would take a few weeks before measures now would begin to fix the problem.
"We know if people do wear those masks at a time that rates are as high as they are and wear them in high percentages — when we're together with families or we're at events, we're at churches, if we're at schools, if we're at businesses and we're inside — they work and they can really cut this down," he said. "But that means 90%-plus of the population needs to be wearing the masks."
Federal and state leaders also talked about new ways of testing to better track who has COVID-19.
While Utah tries to figure out a way to curb its growth of new cases, COVID-19 is rising again in other places around the world as a reminder that the coronavirus pandemic isn't over anywhere.
That is leading to measures similar to what Stenehjem recommended Friday all over Europe. For example, France began another one-month national shutdown on Friday that closed nonessential shops, restaurants and bars. Schools remained open but social gatherings were based, according to the BBC.
- Germany began a partial one-month lockdown Monday that includes closures of theaters, gyms and pools. Restaurants and bars closed for in-person dining but could remain open for food pickups. Schools also remain open.
- Italy closed gyms, pools and theaters, as well as gatherings for weddings and funerals last week. Schools were to remain open and curfews were imposed on restaurants.
- Spain began a nationwide curfew last week and public and private gathering were limited to six people who don't live together.
For experts like Stenehjem, it's the next step in the fight to stop COVID-19 from overwhelming hospitals.
"The time for us to do conservative public health community measures — unfortunately, I think that's passed," he said. "I think we're going to need a pretty aggressive pause in our life to get that community transmission down, especially as we go into the (Thanksgiving and Christmas) holidays."
Contributing: Lee Lonsberry, KSL NewsRadio
