SALT LAKE CITY — Utahns have enjoyed going shopping, eating out and worshiping together again. Many have returned to the office after months of working at home. Thousands have gathered for concerts or youth sporting events.

But social interaction is coming at a price.

COVID-19 cases and hospitalizations in Utah have surged since May 27, just 12 days after Gov. Gary Herbert moved most of the state to the yellow or low-risk phase from orange or moderate risk.

The alarming spike has prompted state epidemiologist Dr. Angela Dunn to call on government leaders to consider drastic measures.

“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,” she wrote in a June 19 memo.

Medical Reserves Corps Mobile Testing Team administrator Aaron Dayne Smith tests Yareli Bermudez for COVID-19 as she sits on the lap of her mother, Elsa Burmudez, outside of Glendale Middle School in Salt Lake City on Monday, June 22, 2020. | Kristin Murphy, Deseret News

Dunn said Utahns care about the state’s color-coded risk phases and change their actions based on them.

Apparently, though, residents see low risk as no risk.

Efforts to social distance and wear masks seems sporadic at best. Some cities and counties, even small areas within them are vigilant, others are not. Also, politics plays a role as debate rages over the seriousness of the coronavirus pandemic.

“I’m afraid that people when they hear we’re going to yellow or we’re going to green, what people assume is that is less risky. It’s in fact the opposite. The risk increases with the more opening up we have,” said Dr. Sankar Swaminathan, chief of the Division of Infectious Disease at University of Utah Health.

With increased activity and interactions, rather than taking more precautions, people are taking fewer.

“That’s a guaranteed increase in cases,” Swaminathan said.

In her memo, Dunn wrote that if the state does not reach a rolling seven-day average of 200 cases per day by July 1, it needs to move back to orange or moderate risk, which would limit social gatherings to 20 while continuing to call for social distancing and wearing masks in public settings.

“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 wrote.

Dunn also called for government or businesses to mandate wearing masks. She also recommends the state not ease social distancing restrictions anywhere in the state until July 1.

If state leaders don’t find those things “reasonable, we need to be clear with public about why decisions are being made lessening restrictions — economic, not health. Be clear about health risk,” she wrote.

Herbert said in a statement Monday that he shares Dunn’s concerns about the increased spread of the virus. He said her analysis will be “front and center” in state leaders’ discussion this week on how address the surge in cases. 

“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 commonsense guidelines for social distancing, good hand hygiene and especially the use of face coverings,” Herbert said.

Utah again saw a large daily rise in COVID-19 cases Monday, with 444 people testing positive for the virus. The state’s total since the pandemic sits at 17,906 of 299,312 tests given, an overall positive rate of nearly 6%, according to the Utah Department of Health. 

COVID-19 hospitalizations, meanwhile, rose from 90 to 150 in June, Dunn said. If the state continues to confirm an average of 400 new cases per day, about 213 more people will need hospitalization each week based on the state’s 8% hospitalization rate.

For the past week, an average of 471 cases has been reported each day, compared to an average of 327 the previous seven days, state health officials said. While some have questioned whether the rising cases are due to increased testing, testing numbers have actually plateaued, according to Dunn’s memo.

Rachel Black, Salt Lake County Health Department environmental health scientist, collects information from people waiting in their vehicles for drive-thru COVID-19 testing outside of Glendale Middle School in Salt Lake City on Monday, June 22, 2020. | Kristin Murphy, Deseret News

That wasn’t evident Monday outside Glendale Middle School, where a couple hundreds cars lined up at drive-thru testing site, with some people having to wait at least two hours to have their nose swabbed. The west-side neighborhood is grappling with some of the highest rates of the virus statewide.

The push to get businesses up and running again has also contributed to the spike in COVID-19 infections.

A majority of outbreaks — three out of four new cases — have been in the workplace, said Tom Hudachko, Utah Department of Health spokesman.

“That’s an area we need to focus on with education and some prevention efforts,” he said.

To combat the surge, the health department is putting the final touches on a comprehensive guide for employers to safeguard their workers, buildings and offices against the virus. A handbook for employees to keep themselves safe will follow.

“The idea is that whether you run a law firm in a high-rise downtown or a mom-and-pop restaurant somewhere else in the state that this document would be useful to you,” Hudachko said.

As state leaders try to balance shaking the cobwebs from Utah’s once robust economy with keeping sick people from overwhelming hospitals, politics also plays a part in the equation.

“There are, of course, politics at play in how the state is responding to this pandemic. Many elected officials have approached the public with a plan going forward. There were moments when it looked like that plan was doing well, but the problem with that approach is that when things turn, and they have, elected officials need to be careful when they take credit on the way up because they don’t want the blame when it goes back down,” said Jason Perry, director of the University of Utah’s Hinckley Institute of Politics.

Former Utah Gov. Norm Bangerter used to say it’s great to have a highway named after you but don’t forget that people sometimes die on that highway, he said.

“There are political consequences if this response is miscalculated or wrong and people start dying and getting sick at larger rates,” Perry said. “The exposure these politicians get from their approach is connected to the exposure people have to this virus.”

Swaminathan said he didn’t want to name names, but “many, many large stores” he has frequented don’t ask employees or customers to wear masks.

“If they are wearing a mask, they’re often wearing it as some sort of chin adornment. I can’t tell you how many people have a mask just over their mouth or their chin, which essentially does nothing. I think that’s a big problem,” he said.

“To me, it’s not a sustainable situation when you have many large stores where the employees are walking around without masks. What that tells me is that business doesn’t care if I get sick and die.”

If everyone wore face coverings, there would be very little transmission, Swaminathan said.

“Just because you think that you’re invincible doesn’t mean that you should be putting others at risk,” he said.

A Deseret News/Hinckley Institute of Politics poll earlier this month found 42% of Utahns are comfortable going out in public without a mask. Another 10% say it would take a month or so before they would be at ease without one, 12% say two to three months, 10% say three to six months, 12% say more than six months and 4% say never.

The poll also showed that 55% of resident believe the state has the authority to require face coverings, while 70% say businesses should be allowed to decide whether their customers should be required to wear masks.

Intermountain Healthcare and other health systems in Utah plan to hold a press conference Tuesday about the spike in cases, specifically regarding wearing masks.

“We have heard from the (Utah Hospital Association), (University of Utah), and (Intermountain Healthcare) that hospitals are going to exceed their capacity to care for individuals within the next four to eight weeks,” Dunn wrote in the memo.

Even though Utah is known for people looking out for each other, Swaminathan said he doesn’t think residents are fully aware that wearing a face covering does more to protect others than it does to protect themselves.

“It’s a matter of responsibility to your neighbors and your community and society in general for you to do everything you can to prevent spread. It’s not just about whether or not you’re going to get sick,” he said.

“It’s not all or none. Just because you want to go out doesn’t mean you can’t make some sacrifices for the common good.”

Just as politics plays into state leaders’ decisions on dealing with the pandemic, it also enters into some Utahns’ decisions about whether to wear a mask.

“We have high-level Republicans in the state, like the governor, saying everyone should be wearing their mask, but there is a portion of our population that is saying you cannot wear that mask, and they won’t,” he said.

“And that has, whether it’s for actual political reasons or not, become sort of a political statement.”

Those on the far-right say they don’t need to wear a mask and the farther you get to the left, the more likely people will don a face covering and say everyone should be made to put one on, Perry said.

Regardless of the philosophy, he said, it has become a political hot spot.

“I think the important thing to remember is that this is not a political statement,” Swaminathan said. “It doesn’t really matter what anyone thinks. The virus is going to infect people.”

Contributing: Ashley Imlay