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As several rural counties in Utah move to the state’s “Green” or “normal risk” phase of coronavirus precautions, Cache County will remain in the modified-Yellow phase.

The Cache County Council requested on June 9 that the governor move the county to Green, as well, but Cache was not among 10 counties listed as Green in an executive order from Gov. Gary Herbert on Friday.

State Epidemiologist Angela Dunn said Friday that when it came to moving the Bear River Health District and much of the rest of the state to Green, the Utah Health Department recommended caution to National Guard Maj. Gen. Jeff Burton and subsequently to the governor’s office.

“When we look at the Bear River area in general, there still is an increase daily in cases while testing is still going on,” Dunn said. “We’re not finding increasing cases because we’re doing more testing, you know, we’ve been doing testing for a while there and are just finding more cases. And the percent-positivity is around 9 or 10 percent in that area, as well.”

BRHD reported 76 new lab-confirmed cases of COVID-19 in the district on Friday, bringing its cumulative total to 1,305 cases. At least 279 of those cases are considered “recovered.” BRHD had been following the CDC’s criteria for recovered cases of being at least 3 days without symptoms and 10 days since symptoms first appeared, but according to spokesperson Josh Greer, that criteria has been very difficult to keep up with since the spike hit Cache County. BRHD will be switching to align with Utah’s reporting criteria: If a patient tested positive for COVID-19 three weeks ago and has not died since, they will be counted as recovered. Greer said residents can expect recovery numbers to rise very rapidly in the next few days.

Since May 27, Cache County has been reporting an average of 35 new cases per day, not including June 5-6, when results from a clinic testing all workers at JBS Hyrum boosted numbers to nearly 200 new cases for each of those days. There were 49 new cases in the county reported Thursday and 69 reported Friday.

BRHD reports only three people currently hospitalized among district residents. Hospitalizations have been low despite the spike, Dunn believes, because most COVID-19 cases in the district are in the 18-60 age range and seniors are among the people most likely to develop serious symptoms. Of BRHD’s roughly 1,300 cases, 112 are among minors and 92 are among seniors.

Box Elder and Rich, the other two counties in the Bear River Health District, are not going Green, either, despite reporting much lower numbers than Cache. While Box Elder’s numbers have also been increasing along with the Cache County spike, it’s seen an average of fewer than 3 new cases a day since May 27. Rich County reported its first case on June 12. Since then, its count has increased to three confirmed cases.

Dunn said a county’s neighboring communities also play a role in UDOH’s restriction recommendations.

“We look at it from a public health perspective in terms of how many cases the jurisdiction has,” Dunn said, including “what their hospitalizations look like, what their testing looks like — and we also look at the surrounding communities, because we know the virus doesn’t stop at the border of communities — to understand kind of what the risk is with decreasing restrictions within that community.”

The counties transitioning to Green are: Beaver, Daggett, Duchesne, Emery, Garfield, Kane, Millard, Piute, Uintah and Wayne. Salt Lake County will stay in the Orange level, and Utah’s remaining 18 counties will remain in Yellow.

While it’s unlikely that Cache County will be moving to Green for the time being, it’s also unlikely to move back to Orange.

Dunn said that there have been examples of some places around the world increasing restrictions again in response to a rise in numbers, but that could be difficult here.

“It can be really hard for the public, and politically, to move back to more restriction, and I think that’s what we’re facing here in Utah right now.”

That drop in health officials’ political sway means that Cache County residents and businesses were subject to precautionary restrictions before the first wave really hit locally. But now that the first wave is here, restrictions are loosening and health officials are saying it’s up to individuals to slow the spread.

“We are relying, right now, on individuals taking the necessary precautions to limit the spread of COVID-19,” Dunn said. “We’re working really closely with policymakers to try to figure out what’s feasible from the policy front, but until that happens, we need individuals to limit their number of close contacts by physically distancing, wear face masks, wash their hands and stay home when they’re ill.”

The County Council defended its vote to request the governor set Cache to Green in a Facebook post three days after its vote.

“We support the Utah State Senate Public Health and Economic Emergency Task Force’s recommendation for Utah to move to Green—with precautions,” the council stated. “We want to make clear that our request to move to Green was not an endorsement of reckless behavior nor do we believe COVID-19 is not a serious issue within our community.”

In the council meeting and in interviews with the media, council members listed several economic and health impacts it believes other officials have not taken into consideration, including millions of dollars in lost economic activity.

“It was heartbreaking to learn that three of our residents felt it necessary to take their own lives in relation to the Covid-19 isolation measures,” the council stated in its Facebook release.

Citing disagreements among experts on some of the particulars of virus precautions as well as differing opinions among the lay populace, the County Council stated it wants to let individuals, not leaders, decide what precautions, if any, they should take to keep the virus from spreading.

“Our decision was to trust our fellow citizens with liberty and responsibility,” the release states.

In response, Dunn said health officials have been doing their best to take broader health impacts into consideration, but there’s not enough data yet to say whether COVID-19 has directly caused a significant increase in deaths by suicide.

“We do have a little bit of evidence that there has been an increase in mental health crises,” Dunn said. “It’s really hard at this point to tie them directly to COVID, to give you any kind of exact causal or significant relationship. But no doubt that kind of anecdote happens, and there are likely some out there that are related to COVID-19. But in terms of statewide trends, we just don’t have enough data on that.”

From 2016 to 2018, the Bear River Health District had an average of about 30 deaths by suicide annually, for an annual rate of 18.5 per 100,000 residents. That rate is below the state’s rate of 22.2 but above the U.S. rate of 13.6, according to UDOH. Whether 2020 sees a significant increase in suicide attributable to COVID-19 remains to be seen, as does the complex matter of whether COVID-19 precautions did more harm to Americans physically, mentally and economically than the virus might have caused without them.

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