After seeing a surge of coronavirus cases, Summit County has issued an order for all residents to not leave their homes unless necessary — amid calls for the state and other counties to take similar action.

The shelter-in-place restriction, which is the first in Utah, will start Friday at midnight. It will be in place until May 1 throughout the county, a hotspot for skiing and tourism, and all visitors have been asked to leave “as safely and quickly as possible.”

“With the virus, per capita, we are similar to Italy. We are similar to New York City,” said Rich Bullough, the county’s health director. “And we are the most heavily hit in the state of Utah.”

Summit County had 97 confirmed cases of the coronavirus on Wednesday, when it issued the order — up seven from the previous day and including eight visitors. That’s the most visitor cases in any county in Utah.

Overall, the Utah Department of Health reported that another 48 people had tested positive, bringing the state’s total to 346 cases. The lone fatality statewide is a Davis County man who died Sunday.

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Meanwhile, Salt Lake County’s total — the highest for any county in the state — rose to 154. Summit, though, has 41,000 residents compared to the 1.1 million people living in Salt Lake County. That makes the infection rate in Summit about 1 per 400 individuals.

“The situation is urgent,” Bullough said. “If the rates continue to rise and the rate of hospitalization rises, our medical system will be at capacity very soon.”

The health director declined to say how many intensive care beds the county has and how many are full. But he noted some of the coronavirus patients there have been hospitalized.

To slow the rate of infection, residents are ordered to not leave their home except for necessities, such as food or doctor appointments. They can also go outside to exercise, but are asked to maintain social distancing of 6 feet.

Essential services will be allowed to continue. Those include health care facilities, banks, hardware shops, utilities, transportation services, farming, post offices and grocery stores. Restaurants can also stay open in accordance with the state’s orders requiring that no customers dine in. And the state liquor store in Park City will remain open on a limited basis.

Nonessential travel is prohibited. Those with secondary houses in the county are asked not to stay there for the duration of the order. The county created a “community concerns line” at 435-333-0050 for people who have questions.

Anyone who violates the order can be charged with a Class B misdemeanor. In Utah, that is punishable by up to six months in jail and a fine of up to $1,000.

Previous health orders — including measures in Salt Lake, Utah and Summit counties — limit groups to no more than 10 people. Bullough said that while those orders have come under fire by Utah Gov. Gary Herbert for including similar criminal penalties, the health director believes the shelter-in-place charges “are not in conflict with the intent of the governor’s office.”

He said discretion will be used in enforcing it with the focus on “egregious and aggressive acts.”

No state order, for now

The governor’s spokeswoman, Anna Lehnardt, confirmed: “We were notified of Summit County’s decision this afternoon. Given the infection rate in that area of the state, we understand and support their decision to issue this order at this time.”

Herbert has said that, at least for now, he does not intend to issue a statewide shelter-in-place requirement — despite pleas for him to do so from some doctors, lawmakers and city and county council members across Utah, and decisions made in nearby states, including Idaho and California, to do so.

An economic plan released Tuesday by the governor instead emphasized continued social distancing until virus transmission rates come down. And earlier Wednesday, the state’s lead epidemiologist said Utah’s efforts to reduce the spread of the virus were showing some signs of success, although she cautioned that residents need to continue to stay home when possible.

Only 5% of COVID-19 tests in Utah are positives, said Angela Dunn, the state epidemiologist. That’s a smaller percentage than some states with wider outbreaks, such as New York, she said.

And Utah has recorded a 16% increase in coronavirus cases in each of the past two days, according to data from the Utah Department of Health. That’s less of an increase than in some early days of the outbreak.

“I think we can be confident that we are bending the curve here in Utah with our social distancing method,” Dunn said.

During a streamed conversation later in the day, Dunn said the state health department is working with communities as they make their own decisions, based on public health realities. She expressed support for Summit County’s order during the discussion with Silicon Slopes Executive Director Clint Betts, also a member of The Salt Lake Tribune’s board of directors.

“Given their spread and given their tight knit community, I think it is a very prudent step to ensure that people’s lives are saved,” she said, noting that the state is “constantly reevaluating” whether to issue a similar order.

Bullough said he appreciates the state’s efforts. But “we couldn’t wait any longer for a sweeping recommendation," he added. "So we’ve chosen to act.”

He anticipates the economy in Summit County will suffer for some time, but he hopes the order will “shorten the duration of the impact.” It will be reviewed in two weeks.

The county, he noted, is unique in Utah because it’s a ski resort destination where many people vacation and support businesses. But that’s also what he points to as the cause for the local spread of the virus. The first case in Summit was a visitor and it later spread to a restaurant worker, Bullough said.

“Absolutely, it is related to tourism,” he said. “But I anticipate we won’t be the only county in Utah to take this action.”

(Leah Hogsten | The Salt Lake Tribune) A family loads a cart full of groceries into their car outside of Walmart in Park City, March 25, 2020. Summit County issued a stay at home order on Wednesday, which goes into effect on Friday and lasts until at least May 1. The order, which is the first of its kind in Utah, asks residents to stop nonessential travel and orders nonessential businesses to close.

Will Salt Lake County be next?

Salt Lake County Mayor Jenny Wilson said she continues to evaluate what steps are necessary and may issue an order. But any decision, she said, should be based on data. And she hasn’t seen the numbers that she believes are necessary to put in place strict restrictions.

“We need to know to what degree social distancing and other measures have been effective,” she said in a statement Wednesday.

Some Salt Lake County Council members, though, have taken a stronger stance. As some in the state have raised concerns that a shelter-in-place order would further disrupt the economy, Councilwoman Shireen Ghorbani argued at a meeting this week that such a measure would actually be better in the long term.

“Whatever we are doing to limit the interactions that we’re having in public and really get people to take that seriously, the sooner that we do that, that is the economic answer,” she said. "If we’re able to move back to business as normal, it’s going to be with drastic measures taken upfront to stop the spread of this virus.”

Taking “a bunch of half measures,” she argued, will only draw out the impact of the coronavirus.

Meanwhile, Salt Lake County District Attorney Sim Gill said law enforcement in the county will enforce the health department order for large groups to remain under 10 people. Even though Herbert challenged that, saying there would be no “Gestapo” for gatherings, Gill said it’s within state law for violators to be prosecuted.

Those efforts, Gill noted, will be focused on rare cases when people persistently break the rules.

“We can’t ignore the reality of what is happening,” he said. “This disease is spreading very rapidly. The goal is not to prosecute people or hold them criminally liable. The goal is to mitigate the transmission and educate the public.”

Statewide concerns from doctors

But rather than having a piecemeal system of city and county orders, the Utah Academy of Family Physicians and other health care providers have begun calling on Herbert to issue a statewide shelter-in-place — which he has, so far, called “draconian.”

Kristin Francis, an inpatient physician at University of Utah Hospital, said she believes an order — rather than encouragement — to stay home could reduce the state’s death toll by thousands, to about 1,000. “The predictions are that we could save almost 50,000 lives if we put these measures in place,” she said.

Lily Everett, a physician’s assistant in Salt Lake City, started a petition Sunday after the first COVID-19 death in Utah, calling for a statewide mandate requiring people to stay home. Already, more than 5,000 individuals have signed, mostly doctors.

She said it’s not too late to implement a stay-at-home restriction and see the benefits. “It needs to be an order that’s enforced, though,” she said.

Some political leaders are making the same request. Salt Lake City Democratic Sen. Luz Escamilla, the first member of the Utah Legislature to test positive for COVID-19, called for the governor to issue an order during a previous streamed Silicon Slopes conversation.

“To me, the time is right to do that,” she said. “I think we want to be ahead of the curve.”

State Sen. Derek Kitchen, D-Salt Lake City, said Wednesday that circumstances might be different if Utah had been able to conduct COVID-19 testing on a mass scale earlier. But now, he said, there are likely residents with mild or no symptoms inadvertently exposing others.

“If we don’t do something, it’s going to be out of control,” Kitchen said.

But Senate President Stuart Adams, in Wednesday’s Silicon Slopes town hall, said he sees a shelter in place order as a “last resort," citing potential damage to the economy and the consequences to Utahns as a result, which he said could include “psychological, emotional, even suicides.”

“I think we ought to do everything we can do to keep our economy going and actually keep people safe,” he said. “Keeping people safe is obviously one of the biggest items we have to deal with. But that, I think, has a lot broader connotation than just shelter in place.”

— Tribune reporters Taylor Stevens, Nate Carlisle and Benjamin Wood contributed to this story.