State Epidemiologist: Utah In Acceleration Phase Of Outbreak, ‘Complete Shutdown’ Possible

Jun 22, 2020, 4:09 PM | Updated: Jun 25, 2020, 2:26 pm

SALT LAKE CITY, Utah – State epidemiologist Dr. Angela Dunn said Utah has entered the acceleration phase of the COVID-19 outbreak and state leaders should take certain steps to prevent a “complete shutdown” of the state.

“All of our goals are aligned — keep the economy open and prevent deaths/illnesses,” Dunn said in a memo sent to state leadership before Utah reported over 600 new cases of COVID-19 on Saturday. “We are quickly getting to a point where the only viable option to manage spread and deaths will be a complete shutdown. This might be our last chance for course correction. Contact tracing and testing alone will not control this outbreak.”

Dunn said the rise in cases cannot be explained by a known outbreak that’s driving transmission or a rise in testing.

Numbers from the state health department indicate testing has plateaued in Utah since early May.

COVID-19 testing has plateaued in Utah, according to numbers from the Utah Department of Health. (UDOH)

Dunn said the state has talked with hospital systems across Utah, and the number of COVID-19 patients they are treating has risen from a steady 90 to 150 this month, and that “increase is from the cases that were identified over a week ago.”

Hospitals in eight of 11 Utah counties (73%) have reported increasing ICU utilization over the past three days, and Dunn said that will continue to increase as cases increase.

Non-ICU utilization was up in 17/23 counties (74%) during that time as well.

Between June 17 and 19, the state saw an eight percent jump in total cases.

The above table shows increasing ICU utilization in 8/11 (72.7%) jurisdictions. This will continue to increase as cases increase. (UDOH)

“We have heard from the UHA (Utah Hospital Association), U of U (University of Utah Health) and IHC (Intermountain Healthcare) that hospitals are going to exceed their capacity to care for individuals within the next 4-8 weeks,” Dunn said.

She added around eight percent of cases will be hospitalized one-to-two weeks after diagnosis and about one percent will die around three weeks later.

If current trends hold around 405 new cases per day, Dunn said about 213 people will be hospitalized per week.

“Of those 213, about 85 will be previously healthy working-age people,” she said. “‘Low risk’ — taken from their family and work to fight for their lives in an isolated hospital room. About 17 of the 213 will die — another 11 will die at home or in nursing homes.

“On average, per week, and it’s growing at a rate of 25 percent a week.”

Dunn’s Recommendations

Dunn recommended the state move back to the Orange or moderate-risk category if it doesn’t reach a rolling, seven-day total of 200 cases per day by July 1.

“This will send the message to Utahns that this outbreak continues to be a serious problem, and state leadership is committed to saving lives and preventing a complete economic shutdown,” she said. “We must be clear that the color equates with the economic restrictions in place. And that the risk of COVID-19 spread is higher as the restrictions are lower.

“Utahns care about these colors. They change their actions based on them.”

“Honestly if we continue to see spread like this, it’s going to hurt our economy,” said Jenny Johnson, UDOH public information officer. “You have to have healthy workforce to have a healthy economy. And they go hand in hand. You can’t remove one from the other.”

Aggressive contact tracing, focused outbreak investigations and testing and pointed public messaging can help manage the outbreak at a level of 200 cases per day.

Dunn also said face coverings should be mandated — either by government or business enforcement — and a pause should be put in place to prevent any jurisdiction in Utah from lessening restrictions until July 1.

“If above isn’t reasonable, we need to be clear with the public about why decisions are being made lessening restrictions – economic, not health,” Dunn said. “Be clear about the health risk. Be clear about how these decisions are made and who makes them. This will better equip the public to make informed decisions about how to protect themselves and their health.”

Surge in cases starting May 27, for a total of 17 days of increasing daily incidence. Multiple jurisdictions in Utah moved to yellow on May 27. (UDOH) The map above shows the case rates for the week ending May 15. (UDOH) The map above shows the case rates for the week ending June 18, showing a statewide increase. This indicates widespread transmission. (UDOH) Percent of tests that were positive (%POS), starting on May 26, with a %POS increasing from 4.96% to 9.23% currently, indicating increase spread of COVID-19. (UDOH)

“We really need to have everybody wearing masks to have that be effective,” Johnson said.

Dunn also said steps should be taken to protect those at high risk for severe disease, protect those at high risk for transmission, increase testing and pair policies that limit close contact with contract tracing.

“(Contract tracing) becomes less effective as the number of contacts per case increases, and as the public perceives lower risk and does not adhere to quarantine recommendations,” she said. “Since going to yellow, we have increased our number of contacts/case from approximately five to over 20. For contact tracing to be effective as a tool for stopping the spread of COVID-19, it needs to be paired with policies that limit the number of close contacts per person.

“We are exceeding our capacity to effectively and efficiently conduct contact tracing due to the surge in cases and number of contacts per case.”

Officials noted the upward trend in cases began May 27, just 12 days after most of Utah moved to yellow.

“As we go down in colors, green doesn’t mean go, doesn’t mean we’re good to go,” Johnson said. “The risk of getting COVID-19 right now is actually higher than it was a couple months ago when more people were staying home.”

Gov. Herbert’s Response

Gov. Gary Herbert’s office responded to the memo Friday, saying he appreciated Dunn’s concerns but he has no plans to shut Utah down.

“The governor shares Dr. Angela Dunn’s concern about the increased spread of the virus in our state. Her memo was prepared specifically to help frame key issues for this week’s leadership deliberations about how to address the surge in cases. Dr. Dunn will be a part of those consultations, and her analysis will be front and center in our meetings.

“Governor Herbert emphasized, ‘Our plan will only be as successful as the willingness of people to protect themselves and their loved ones from the spread of the virus by following our common sense guidelines for social distancing, good hand hygiene and especially the use of face coverings.’”

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State Epidemiologist: Utah In Acceleration Phase Of Outbreak, ‘Complete Shutdown’ Possible