SALT LAKE CITY — With another record-shattering day of COVID-19 cases on Thursday, some health experts say it’s crystal clear that Utah’s approach to stemming the pandemic hasn’t been working.

To Dr. Andrew Pavia, chief of pediatric infectious disease at the University of Utah, that reality fits a disturbing definition.

“The definition of insanity is doing the same thing over and over and expecting a different outcome,” Pavia told the Deseret News Thursday, hours before state officials announced a new daily record of 1,501 COVID-19 cases amid a nearly weeklong streak of over 1,000 cases a day.

“It’s clear we are at a point we need to pull out some new tools and do something differently.”

Yet no new tools were presented Thursday as Gov. Gary Herbert addressed Utahns in his weekly coronavirus briefing. Instead, he continued his same old rallying cry for Utahns to decide to “do the right thing” by wearing masks and maintaining social distancing.

He repeated his reluctance to issue a statewide mask mandate, pointing again to Utah’s variety of rural and urban communities, and the aversion some people have to government orders.

That’s all while Utah’s hospital system is on the brink.

A tearful Dr. Emily Spivak, associate professor of infectious disease at University of Utah Health, described how the intensive care unit at University of Utah Hospital was at 95% capacity on Thursday. Hospital doctors and nurses, she said, are being pushed to the point of exhaustion and sharing “heartbreaking” stories of COVID-19’s victims.

“They’re feeling very overwhelmed,” Spivak said, her voice straining with emotion. “We feel supported, we have great leadership, but people are really tired. I don’t know what else to tell you.”

Dr. Emily Spivak, associate professor of infectious disease at University of Utah Health, speaks during a COVID-19 press conference at the Capitol in Salt Lake City on Thursday, Oct. 8, 2020. | Kristin Murphy, Deseret News

‘Stay tuned’

That increase in hospitalizations comes while Utah’s case surge continues, and new infection rates are shifting from the state’s younger population to those who are older — leaving medical experts to predict the increase in hospitalization rates has yet to peak.

“I think we’re all tired,” Herbert said, taking the podium after Spivak walked away from the microphone. He took a somber pause before adding, “It’s like we’re in the third quarter of a very difficult contest, and we’re just kind of going into halftime a little bit tired. We need to have a little modification of our game strategy. We need to have everybody on the team come together and put forth our best efforts. And if we do that, we’ll win. We’ll win this battle, but it’s going to take us all working together to do it.”

But when asked if he’s considering any further restrictions to combat the spike, Herbert said to wait and see.

“We’re going to be meeting with our Unified Command to take a look at what we have in place now, see what’s working and what’s not working and if there’s a change that’s going to be warranted,” Herbert said. “I’ll be meeting next week with our legislative leadership to talk about the same thing. So stay tuned and see.”

When pressed by a Deseret News reporter on whether Utahns can afford to wait any longer for state officials to act when it’s clear that pleading with residents to do the right thing hasn’t been enough to stop the spike, Herbert again put the responsibility onto the shoulders of individual Utahns.

“Well, it’s all about behavior, and so the question really is what’s going to modify my behavior, your behavior,” the governor replied. “Is it somebody’s got to pass a government rule, a law, an ordinance to make you do that? Maybe for some that’s the only way you’ll do that, but for some they’ll rebel even harder against it.”

Herbert said Utahns must “do the right things for the right reasons,” and those decisions should be made at local levels.

“But at the end of the day, heavens, I hope we don’t have to have government tell us what to do to do the right thing,” he said. “That’s probably an indictment upon us as people.

“Again, we’ve seen Utahns rise from times past, whether it be from fires and floods, whether it’s the windstorms we’ve had, whatever the disaster may be,” the governor continued. “Well guess what, we’re being tested today like we’ve never been tested before to see if that same kind of enthusiasm to help our neighbor exists during a pandemic. ... This is a clarion call to let’s double our efforts. Its third quarter time. ... Let’s see what we can all do to do our part.”

“At this point, we need to try something new,” said Rep. Suzanne Harrison, a physician and a past president of the Salt Lake County Medical Society. “Having multiple press conferences asking Utahns to ‘do the right thing’ isn’t working.”

Temporary hospital

A spokeswoman for Lt. Gov. Spencer Cox, who is the Republican nominee in the race to become Utah’s next governor and head of the state’s coronavirus task force, said he was not available Tuesday, Wednesday or Thursday to be interviewed for this story. But he issued a written response Thursday night to questions the Deseret News submitted.

Cox called Thursday’s numbers “sobering” and wrote that he’s “sincerely concerned” about the medical system’s capacity to deal with the current spike.

“We have been in contact as recently as today with (chief medical officers) of our hospitals, who are again working around the clock on contingency plans that I pray we will never have to implement,” he said, explaining how the state still has the ability to set up an alternate care site at the Mountain America Expo Center — what he called a “care facility of last resort.”

Asked what more government officials can do to address the spike, Cox again did not deviate from Herbert’s “balancing act” approach.

“The goal is to work with Utahns to keep spread to a minimum, but as the governor has said over and over again, nothing is off the table,” Cox said. “All the tools that government has are up for consideration.”

However, Cox said the governor and his administration need to step carefully.

“Unfortunately many legislators continue to threaten removing the governor’s emergency powers, so it is critical that any additional response has support from legislative leadership,” Cox said.

Utah surpasses Colorado

Utah’s spike in COVID-19 cases has propelled the Beehive State across a concerning milestone. Recently, Utah surpassed Colorado, its more populous neighbor, in the number of confirmed COVID-19 cases. Utah has had 81,947 cases compared to Colorado’s count of 74,922.

And Utah, with a population of over 3.2 million, has about 2.5 million fewer people than Colorado, which has a population of more than 5.7 million.

Colorado has tested nearly 975,000 people, while Utah has tested 892,022, according to each state’s COVID-19 dashboards. Per capita, Utah’s infection rate is higher, with about 2,560 confirmed infections per 100,000, compared to Colorado’s 1,314 confirmed infections per 100,000.

Colorado, however, has seen more hospitalizations and many more deaths — with 7,771 and 2,085 respectively — compared to Utah’s 4,167 hospitalizations and 501 deaths as of Thursday. Per capita, Utah’s hospitalization and death rates are lower than Colorado’s.

Utah’s hospitalization rate is about 130 per 100,000 residents, while Colorado’s is 136 per 100,000. Utah’s death rate is about 15.6 per 100,000, while Colorado’s is 36.5 per 100,000.

While many factors can influence Utah’s lower death rate, medical experts expect a big reason could be Utah’s younger and healthier population compared to other states.

Colorado experienced a spike in April but has not seen daily cases surpass 1,000 like Utah has. Unlike Utah, Colorado has implemented a statewide mask mandate and developed a “dial framework” of five levels, from least to most restrictive. Counties move back and forth between levels, depending on three metrics: the number of new cases, the percent positivity of COVID-19 tests, impact on hospitals, and other local considerations, according to a Colorado Department of Health and Environment spokesperson.

No magic formula

Utah’s state epidemiologist Dr. Angela Dunn said it’s “of course concerning” that Utah’s cases have surpassed Colorado’s, but “we never look at a single metric” to judge Utah’s situation. What’s more concerning, she said, is Utah’s current trajectory in hospitalization and increasing cases among older populations.

So what’s next for Utah to get a handle on the spike?

“When we’re looking at where to go next, we have to put all of the options on the table in terms of what can we do to decrease the spread,” Dunn told the Deseret News.

She noted that Provo and Orem, which recently transitioned to the orange or moderate level of restriction “did a really good job in terms of dropping our cases.” And since its mask mandate was enacted, Utah County has “started to see a turn.”

State epidemiologist Dr. Angela Dunn walks to the podium to speak during a COVID-19 press conference at the Capitol in Salt Lake City on Thursday, Oct. 8, 2020. | Kristin Murphy, Deseret News

Dunn said on a daily basis she’s making recommendations to Herbert and other state leaders for COVID-19 policy based on the state’s data. Asked what her specific recommendations are now, Dunn said “the next level is going to be what policies we can put in place that can have a positive impact.”

She said her team is “regularly” looking at other states for possible solutions, but none have presented a silver bullet. Short of a vaccine, “we’re all doing the same thing in terms of encouraging” mask wearing and social distancing.

Herbert noted Utah isn’t the only state experiencing COVID-19 spikes — and so far, no state has found “a magic formula to solve the problem.”

“They’re all trying different approaches from government mandates to freewheeling, letting it go where it goes, to everywhere in between,” Herbert said. “We’ve tried to have an optimal approach in the middle.”

Herbert said spikes have been happening in states with or without shutdowns or mandates, “so if we think that’s somehow a silver bullet, that probably is not what we’re observing across the country.”

“I do believe there are differences in states, differences in our cultures, differences in our politics, and so, you know, the one-size-fits-all doesn’t work,” the governor said. “We’re trying to find our unique Utah solution to address our unique Utah needs.”

Cox also noted “every state has experienced surges, and the response to those surges have also been different.”

“It’s almost impossible to judge a response by just one indicator,” Cox said in a statement. “A spike in case counts clearly concerns us, but we have to look at many factors — the Unified Command is constantly reviewing the best data and insights available to us to make the best possible recommendations.”

‘Moment of reckoning’

Utah has been using a color-coded system of red, orange, yellow and green to indicate levels of restrictions. Local requests to transfer to different colors must be fielded and approved by the governor.

Early on in the state’s pandemic response, state officials designed the system to indicate levels of risk, but since then Herbert has said the state may have made mistakes in its color-coded guidance system, misinforming people about actual risk. Going from red (high risk) to orange (moderate risk), and then to yellow (low risk), Herbert said people thought they didn’t have to take as many precautions.

Pavia said the “intention” of Utah’s color-coded system perhaps started out as one that would be dial-like, but it turns out to not have worked that way.

“There’s a difference between the concept of a dial and the concept of light that are really these big steps that you take up or down,” Pavia said.

Harrison, D-Draper, said it’s time for “the governor to step up and take action.” If not a statewide mask mandate to send a clear message about the situation the state is now in, perhaps moving away from the color coded system to better communicate the need to continue taking COVID-19 seriously, no matter the level of restrictions.

“My concern from the very beginning is that I think it was confusing that some parts of the state were in different colors and it gave the impression things were safe rather than we need to still maintain our vigilance in wearing masks and washing hands and so forth.”

Harrison added: “We have to try something new, and we need elected leaders with the political courage to follow the recommendations of medical experts and get us back on track, because the current trajectory is unsustainable. Our ICU doctors and nurses are at a breaking point.”

Pavia, too, said something needs to change. If not a statewide mask mandate — which he said is “absolutely necessary” — government leaders need to do something, and now.

“It’s time for a moment of reckoning,” Pavia said. “We are in a very dangerous spot. We have to take some very bold steps.”

Pavia said medical experts know hospitalizations lag behind spikes in COVID-19 cases, and the streak of over 1,000 daily cases means “hospitalizations have not yet hit their peak.”

“So yes, things will get worse even if we put the brakes on really effectively today,” Pavia said. “We have to do it now.”

Dr. Angela Dunn, state epidemiologist, left, listens as Dr. Andrew Pavia, chief of the Division of Pediatric Infectious Diseases at University of Utah Health, speaks about new developments with the novel coronavirus COVID-19 and how the state’s health systems and hospitals are working together to prepare for possible community spread of the illness during a press conference at the Utah Department of Health in Salt Lake City on Thursday, Feb. 27, 2020.
Dr. Angela Dunn, state epidemiologist, left, listens as Dr. Andrew Pavia, chief of the Division of Pediatric Infectious Diseases at University of Utah Health, speaks about new developments with the novel coronavirus during a press conference at the Utah Department of Health in Salt Lake City on Feb. 27, 2020. | Laura Seitz, Deseret News