SALT LAKE CITY — Utah leaders and health care experts at the state's largest health care provider made one final plea Wednesday to Utahns to avoid large Thanksgiving gatherings.
Based on what has happened after previous holidays this year and the rate of COVID-19 transmission in recent weeks, they're concerned Thanksgiving has the potential to lead to yet another uptick in COVID-19 cases. An uptick, they warn, will almost certainly lead to more hospitalizations for an already exhausted hospital system.
"This is a time for really getting together with our loved ones that we're used to. Unfortunately, this year is different; this year, we can't do that safely," said Dr. Eddie Stenehjem, an infectious disease physician for Intermountain Healthcare, during a virtual briefing with reporters Wednesday.
"We feel that Thanksgiving might be what we call a superspreader event," he quickly added. "We're going to see many people get together with family and friends, and that will increase our case counts in the next seven to 10 days, which will further drive hospitalizations to a point that we cannot tolerate."
The Utah Department of Health reported 1,781 new COVID-19 cases Wednesday. With that increase, there are now an estimated 62,178 active cases in the state leading into the holiday.
There is some good news ahead of the holiday. For example, both the seven-day running average of new cases and the test positivity rate are both showing signs of going down after all-time highs earlier this month. The health department's epidemiological curve on Wednesday also showed its first incidence decline since mid-August.
Still, that may be short-lived. Stenehjem warned that the community transmission rate and other statistics are too high for multi-household gatherings. After Wednesday's update, the seven-day running average of new cases was 3,112.7 cases per day and the positivity rate was 22%.
It's why health experts and state leaders once again urged Utahns to consider celebrating Thanksgiving only with immediate household members.
Gov. Gary Herbert's state of emergency order on sizes inside private residences expired earlier this week and he emphasized that residents make the decision to have smaller gatherings this week rather than enforce gathering sizes.
"The way we celebrate Thanksgiving this week will have a huge impact on the trajectory on the outbreak of COVID-19 in Utah," he tweeted Wednesday. "The safest celebration is only with those who live under your roof."
Gov.-elect Spencer Cox, also on Wednesday, shared on Twitter a graphic of COVID-19 cases since March. It showed the largest single-incubation period spikes happened after holidays. For example, there was an 83% spike in cases after Memorial Day, which led to the state's first real uptick in COVID-19 cases.
If you are wondering why the experts are so concerned about holiday gatherings, please consider this (and remember most of these were during good weather): pic.twitter.com/OPQNTS3KPh— Spencer Cox (@SpencerJCox) November 25, 2020
There was a smaller, 22% spike after Independence Day and a larger, 88% spike after Labor Day. There was also a 48% spike after Halloween, which started with 15- to 24-year-olds and moved to older individuals recently, Stenehjem added.
None of those previous holidays involved traditional celebrations quite like Thanksgiving, though. The holidays during the pandemic mostly centered on cookouts, trick-or-treating or other outdoor activities. In many ways, Thanksgiving is the first indoor gathering holiday since Utah first experienced a noticeable rise in cases during the summer months.
With cold temperatures forecasted throughout most of Utah Thursday, and also a small chance of precipitation, holding outdoor gatherings might be difficult. That adds to why public health experts are concerned for this week's holiday.
"We know the transmission rate for indoor events is much, much higher for indoor events," Stenehjem said. "This is really our first holiday that we're coming to that doesn't have an outdoor aspect to it. … Thanksgiving is the first one that's predominantly inside and we suspect that we'll continue to see really high rates of transmission within those gatherings of families."
Of course, the overall COVID-19 concern is how new cases will turn into new hospitalizations, and how those turn into either death or long-term complications. That's another fear with Thanksgiving.
Traditional multihousehold gatherings might bring together several generations of people under one roof. It leaves the potential that someone who likely won't suffer serious effects of the coronavirus can spread it to another person with a higher chance of hospitalization.
It's also possible that it will lead to the transmission of the virus to someone who will infect someone else in the community days after the holiday, Stenehjem added.
How it might affect hospitals
The hospitalization concern is larger in Utah right now than many other areas of the U.S. because the resources across the state are already strained.
Where are hospitals at before Thanksgiving? The health department reported Wednesday 570 people are currently hospitalized due to COVID-19, a tick below a record 573 reported Tuesday.
Intensive care units at the state's largest hospitals were reported to be 87% full, while the ICU beds statewide were 82% full as of Wednesday. That's taking into account ICU beds for both COVID-19 and non-coronavirus reasons.
The state's ICU utilization threshold is 85%. The hospitals best equipped for ICU patients have exceeded that number nearly every day since Nov. 10, with a high of 96% last week. If they reach max capacity, they may not be able to accept new ICU patients, whether that be someone with severe COVID-19 complications or other dire needs, such as a stroke, heart attack or accident victim.
Since a hospitalization related to COVID-19 typically occurs one to two weeks after a person tests positive, public health experts expect that hospitalizations will continue to remain high for at least the next few weeks even if new coronavirus cases this week is lower than what has been reported this month. If there is another big uptick in new COVID-19 cases from Thanksgiving gatherings, it's likely the strain on hospitals will linger into Christmas and into the start of 2021.
Due to the crunch already in existence, Stenehjem explained that Intermountain Healthcare hospitals across the state have activated surging plans. They've found ways to increase ICU space by converting other parts of hospitals that typically aren't used for ICU space.
It helps with bed space, but it doesn't address the glaring issue. An ICU bed is only as useful as a staff member to tend to a patient in it. Dealing with a fatigued staff stretched thin, some hospitals have even brought in staff from other states to try to fix this issue.
"Beds don't care for people, caregivers care for people," he said, "and that's what's being stressed even more so than our capacity issues right now in our hospitals."
Handling mental health
It's not just COVID-19 that health care professionals are worried about as the calendar moves toward the big holiday season. During Wednesday's briefing, experts also focused on mental health concerns.
Dr. Travis Mickelson, a psychiatrist and associate medical director of mental health integration at Intermountain Healthcare, said recent surveys have suggested that upward of 50% of adults have dealt with depression or anxiety. On top of that, about 25% of 16-to 25-year-olds surveyed reported they had serious thoughts of suicide.
Thankfully, the state hasn't experienced an increase in suicide attempts. That's due in large part to the support Utahns have provided to one another during a stressful year, he added.
He urged that parents take care of themselves so they can take care of other family members, and for people to reach out to friends, loved ones or colleagues that might be struggling. He added that teenagers and young adults are among the most vulnerable, while men are typically less likely to seek out help as a result of perceived stigma against it.
"It's very important for us to appreciate if we're not doing well, that we are confident and able to ask for help, and if we see anyone in our family circle or a friend circle or colleagues, teammates who aren't doing very well, it's going to be very important for us to reach out to them," Mickelson said. "Let them know that you notice that things don't seem to be going well for them and ask them if there's anything to do to help, and follow up with them."
Mickelson said there isn't any evidence at this point to show that in-person or online learning has resulted in additional mental health issues. In fact, he even said children's ability to adjust to wearing masks and other guidelines have shown that they are "great role models" for adults.
To combat mental health problems during the pandemic, Intermountain launched an emotional health relief hotline earlier this year. It provides anyone in the state access to a person from 10 a.m. to 10 p.m. daily who can guide them to the best resources for their needs. The number is 833-442-2211. The National Suicide Prevention Lifeline, which provides are similar service, is 1-800-273-8255.
But there's a toll that goes beyond the general public. The hospitalization surge can and has impacted the mental health of caregivers. Mickelson said the health care provider is working to ensure employees are given the best mental care to deal with the heavy caseloads and deaths they've witnessed.
Stenehjem also provided his view on what it's been like inside a hospital over the past few weeks. He added that it's not just physically and mentally exhausting to deal with so many patients, but it's also been frustrating to see people ignore public health guidelines.
"Our caregivers are tired and many times they're incredibly frustrated and sometimes downright angry when we go out, we are in public … and we see people not abiding by the public health measures," he said. "We know those activities that we are witnesses are leading to increased deaths within our communities. … It's really hard for us as caregivers to see that.
"We come to work every day and we have more and more patients and we have more and more patients die and we see misinformation on social media and our immediate circles that is devastating to us," he added. "We care so deeply for this community and will care for this community … like they're our parents but we need our community to help us."