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With Utah’s hospitals maxing out both bed space and options to recruit more physicians and nurses, doctors said Monday that the state’s new mask order and gathering restrictions could not wait another day.
“I would submit we are at the tipping point today,” said Dr. Mark Briesacher, chief physician executive at Intermountain Healthcare. “We are beyond our normal capacity for caring for patients.”
Briesacher and other hospital administrators implored Utahns to heed the orders under the new “state of emergency” Gov. Gary Herbert declared late Sunday as coronavirus cases and hospitalizations break new records with every passing day.
But those figures have been rising dangerously for weeks — despite mask orders and gathering restrictions already in place in all but the state’s most sparsely populated counties. There were 444 Utah coronavirus patients filling hospital beds as of Monday, with nearly 590 Utahns hospitalized for COVID-19 in the past week.
Utah hospitals began opening overflow intensive care units about a month ago, and Herbert said they already have turned away patients from multiple neighboring states. And medical groups have been calling for a statewide mask order for months.
Asked whether the new, more stringent measures and enforcement plans were delayed due to election results — Lt. Gov. Spencer Cox secured victory in his gubernatorial race last week, and President Donald Trump’s defeat was announced Saturday after he for months downplayed the virus’s threat — Herbert said the order “has only to do with data."
“It has absolutely nothing to do with politics,” he said in a Monday news conference, adding that both sides of the political aisle have “used this as a political tool," and the pandemic response may have been better in a nonelection year.
“Politics has gotten in the way. … Politics has a way, unfortunately, of dividing us," he said, later adding he and state lawmakers have been working with a “significant spirit of cooperation.”
Herbert’s declaration of new restrictions followed the state’s most severe week of the pandemic as COVID-19 infections skyrocketed and deaths hit new highs. And the crisis is only worsening; with 2,247 new cases reported Monday, the weeklong case count again broke a new record.
Utah’s death toll from the coronavirus rose to 661 on Monday, with two fatalities reported since Sunday: two men, ages 65 to 84, one from Salt Lake County and one from Washington County.
The new executive orders are in response not only to elevated case counts, Herbert said Monday, but also “the overcrowding of our hospitals. They’re really at the brink of not being able to take people.”
The orders, signed by Herbert and Cox, include a statewide mask order, limit any social gatherings to people in the same households, and place a hold on all school extracurricular activities, including most athletic and intramural events.
These restrictions took effect at 1 p.m. Monday and will end Nov. 23, just a few days before Thanksgiving.
While the new restrictions would not have forced its closure, the Salt Lake City Public Library system said Monday that, in light of rising cases, it had decided to close its in-person Express Services beginning Wednesday. Curbside hold pickup and virtual services will remain available.
The library said it would begin to consider reopening for express in-person services when Utah reaches two weeks with a rolling seven-day average positive test rate below 15%.
At a Utah Hospital Association news conference later Monday, Arlen Jarrett, chief medical officer for Steward Health Care, said he’s grateful for Herbert’s orders “presenting a plan that significantly steps up our game.”
“Science shows us that these measures will work,” said Jarrett, whose system operates five hospitals in Utah. “The experiences of the last two months show us what happens when we don’t follow these measures.”
The majority of cases can be traced back to exposure in the home, Jarrett said, “but it has to get into the home some way.” If Utahns can limit exposure of people “outside our household bubble,” he said, “we should see a significant reset of these cases.”
He added: “The governor has come up with a really good approach right now. ... We might have to do more if we see this is not having the effect.”
Medical staffs are stretched so thin, said Briesacher, that Intermountain has called upon nurses from New York to come back to assist shorthanded crews. New York nurses had visited Utah during the summer, after Utah nurses helped in New York in the spring. It is also adding 200 nurses to its workforce.
“At our biggest hospitals in the Intermountain system, we’re 90% full in our ICUs," Briesacher said. “Having the beds are one thing, but our workforce is affected as much as the public is.”
The rise in cases is having an effect on staffing, which “makes the challenge of caring for our increased number of patients even harder,” said Tracey Nixon, chief nursing officer at University of Utah Health. “Our nurses, all of our health workers, are exhausted, both physically and emotionally.”
The Utah Department of Health’s dashboard lists the number of ICU beds, but Dr. Michael Baumann, at MountainStar Healthcare, said they are working with UDOH to list how many beds have available staff. “There is a difference between capacity and staffed capacity,” Nixon agreed.
Herbert noted in his news conference that 23 counties, covering 90% of the state’s population, had mandatory mask mandates already, but the statewide order was made because “we did think there was a little confusion about who’s in, who’s out.”
“This is less about government mandates and us telling you what to do," Herbert said, “and more about personal responsibility.”
Dr. Thomas Miller, chief medical officer at University of Utah Health, echoed, “It’s very important for our citizens to take up arms and put on masks.” He added: “We need to do our part at home,” particularly when friends and loved ones come to visit, “and to limit gatherings when we can.”
State epidemiologist Dr. Angela Dunn made the same plea during Herbert’s news conference. “For the next two weeks, I urge you to only hang out with those who live in your household,” Dunn said. “This will be the start of us being able to save our health care system.”
The state’s highest infection rates recently have been among the 15-to-24 age group, Herbert said. “Young people don’t have the same reaction that older people do,” Herbert said, but are “vectors of transmission” to older people who are susceptible to more severe reactions to the virus.
Dunn noted that Trump’s coronavirus adviser, Dr. Deborah Birx, and Dr. Richard Redfield, head of the Centers for Disease Control and Prevention, visited Utah the previous weekend, and “they pushed us to increase our rapid testing,” particularly among college students.
For the past week, 21.2% of all tests have come back positive — a record-high rate that indicates a large number of infected people are not being tested, state officials have said.
“There are a lot of cases out there who don’t even know they have COVID,” Dunn said. “We need to identify everybody who has COVID-19, so we can stop the spread of it.”
A surge in testing will find more cases, Dunn said, but ultimately help bring down the rate of positive cases. Utah and Salt Lake counties reported the worst rates of new infections per capita on Monday, with Utah County now exceeding even the highest infection rates in San Juan County when outbreaks at the Navajo Nation peaked in May.
Doctors at the hospitals’ news conference said Utah currently has enough personal protective equipment. And Miller said University Hospital is able to handle elective surgeries — he called them “non-time-sensitive surgeries” — so far.
But hospitals will have to cut back if the COVID-19 numbers keep climbing.
"Non-COVID care will have to be chipped away at to make room for COVID care,” Nixon agreed.
Greg Bell, the president and CEO of the Utah Hospital Association, credited “divine providence” for Utah’s hospitals not hitting their limits yet. “We’ve come so close to overwhelming this or that hospital," Bell said, “but for some reason, we’ve been able to have enough."
Briesacher said doctors are still learning about the long-term effects of COVID-19. The effects "can affect our heart. They can affect your lungs. They can affect how well your kidneys work,” Briesacher said. “We have a lot to learn in this space.”
— Reporters Bethany Rodgers and Taylor Stevens contributed to this report.