Editor’s note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

With Utah reporting 1,837 new coronavirus cases and hospitalizations nearly reaching a new record high Thursday, Gov. Gary Herbert declared that “the time for talk is over — it’s time for action.”

But that action isn’t coming from the Utah Capitol. Herbert said local governments will have to decide whether to enforce the mask orders and gathering restrictions that are in effect in almost every county — rules that many Utahns have defied or ignored.

“This is not an easy thing to enforce," Herbert said at his weekly news briefing on COVID-19, after again asking Utahns to change their behavior. He did not announce any new restrictions or initiatives.

Doctors and health care administrators reiterated Thursday that Utah’s hospitals are on the brink of rationing care, with 317 Utahns hospitalized for coronavirus on Thursday — a new record in daily reports. (However, the state has updated its coronavirus dashboard to show 318 hospitalizations on Wednesday, rather than the 299 originally reported.)

And, for the second day in a row, the state reported 10 new deaths from coronavirus.

Hospitals have alerted Herbert they soon will need to shift to “crisis standards of care" — protocols used to decide which patients will receive which level of care when the system is overcrowded.

To avoid putting those standards in place, said Dr. Mark Shah, an emergency physician with Intermountain Healthcare, “We cannot continue to argue about masking. We cannot continue to argue about whether this pandemic is real or made up. And we cannot continue to argue that health care will continue to be fine.”

For the past week, the state has averaged 1,578 new positive test results a day, continuing a streak of new record highs, the Utah Department of Health said.

Utah’s death toll from the coronavirus stood at 598 on Thursday, with fatalities in the double digits for the second day in a row:

• Four Salt Lake County men, one age 25 to 44. Two were 45 to 64, and one was 65 to 84.

• Two women from Beaver and Piute counties and two men from Emery and San Juan counties, all age 65 to 84.

• A Utah County woman and a Washington County man, both older than 85.

For the past week, 18.1% of all tests have come back positive — a record-high average rate that indicates a large number of infected people are not being tested, state officials have said. And in individual counties, as many as 30% of tests are coming back positive, according to state figures released Thursday.

State officials will review policies around testing, Herbert said. “We think more testing is going to help us,” he said.

There were 11,232 new test results reported on Thursday, above the weeklong average of about 8,400 new tests per day.

Greg Bell, president of the Utah Hospital Association, said hospitals and the state “don’t exactly know” when crisis standards will have to be implemented, explaining that admissions are a “lagging indicator.”

When the state reports a daily average of cases approaching 1,600 a day, Bell said, “we know that in seven to 10 days, two weeks, those cases will end up in our hospitals.”

“We’re just issuing a warning,” Bell said. “We don’t know yet, but there is a foul wind, and we need to take every precaution to avoid a worst case.”

Switching to crisis standards, Shah said, will mean a “a gradual degradation” of services, “not an on-off.” He said that patients — both with COVID-19 and without — may see delays in care, or postpone surgery, or be transferred away from their nearest hospital.

“The guidelines are focused on individual patient assessment, based on short-term outcome,” Shah said. That means patients are given an objective score, based on such factors as how much their organs are failing.

The score is also weighted by an “individual assessment based on capacity,” he said.

“We’ve moved away from more blanket categorizations of who would not qualify for ICU care,” Shah said. According to the guidelines, a patient’s age is not part of that score, but it could be used as a tiebreaker if two patients otherwise have similar conditions.

State-mandated restrictions rose in two counties — Uintah and Duchesne, in eastern Utah — after positivity rates there increased this week, bumping them from the “moderate” transmission category to the “high” category.

That means 23 of Utah’s 29 counties are at the highest transmission levels. Under guidelines the state adopted this month, those counties are under a mask order and must limit private gatherings to 10 people.

The only counties not included in those restrictions are Iron, which reported “moderate” transmission levels; and Daggett, Kane, Piute, Rich, and Wayne counties, which remained at the lowest level for the third week.

For the past week, Wasatch County reported the highest number of new cases per capita, followed closely by Utah County. But other data show the crisis worsening in other areas, too.

San Juan County, which reported the most hospitalizations per capita in the past week, also showed one of Utah’s highest rates of tests coming back positive, at 27.9%. And the towns of Blanding and Monticello reported more cases per capita in the past two weeks than all but three of the 98 Utah “small areas” that health officials use to track local health data.

Piute County — whose small population has prompted state officials to keep it at the “low” transmission level, despite case numbers and testing data above the state’s thresholds for high restrictions — reported the state’s highest percent positivity, at 30%.

And the county is one of the six covered by the Central Utah Health Department, which reported the state’s second-highest number of hospitalizations per capita in the past week.

Salt Lake County reported the state’s third-highest number of cases and hospitalizations per capita in the past week. Infection rates were highest in Salt Lake City’s Glendale neighborhood and downtown, as well as Kearns, the eastern neighborhoods inside West Valley City, and Midvale.

A small number of anti-mask protesters gathered at the home of state epidemiologist Dr. Angela Dunn Thursday morning and again late Thursday afternoon after her address was posted online.

“It’s scary, and wrong that someone would feel comfortable sharing my personal information,” Dunn said at the news conference. “It’s scary that people think it’s OK to harass civil servants.”

“Protesting at Dr. Dunn’s home is not the best use of people’s time,” Herbert said, adding that the taxpayer-owned governor’s mansion has also been the site of anti-mask protests.

He later issued a statement urging organizers to cancel their protests, and saying law enforcement has been working for weeks to protect public health officials.

“It’s one thing to protest an elected official like myself, but it is completely out of bounds to protest at a state employee’s home,” Herbert said. " ... Dr. Dunn has been and continues to be a critical leader in Utah’s pandemic response."

The Utah Medical Association had earlier condemned the gathering in a statement, saying that harassing a public health official “will in no way change the minds of anyone who respects real science, reason and even common sense, when it comes to the proven methods of fighting a pandemic virus that has killed more than a million across the globe and nearly 600 here in Utah.”

Several neighbors came out to support Dunn during the small evening protest. Brandon Peterson hung a sign in his window that read “We (heart) you Dr. Dunn.” Peterson said he is grateful to Dunn for her work and doesn’t think anyone should be harassed at their family home.

Neighbor Laura Hopkins said it is “shameful” that people would intimidate someone who is working hard on behalf of the state. Hopkins said she believes the only way to reopen the economy is for people to wear masks.

The protesters left Dunn’s home when two masked people, who declined to give their names, started arguing with them about mask use.

— Reporter Sara Tabin contributed to this story.