SALT LAKE CITY — Mark Jorgensen arrived in Utah on a chartered flight from California on Feb. 28 under the care of two paramedics decked out in the medical equivalent of hazmat suits.
The 55-year-old Washington County man spent the previous night in a Folsom, California, hospital where he was an unwanted guest among the city’s residents fearful and angry — at least on social media — about having someone who tested positive for the novel coronavirus in their midst.
Folsom knew he was coming because Jorgensen put it out there to let family and friends know where he was headed. Federal marshals accompanied his ambulance ride from Travis Air Force Base in Fairfield, California.
In Utah, officials were watching the virus spread in other states and were laying the groundwork for a plan to contain it once it inevitably crept in.
Now six months later, COVID-19 is still here and shows little sign of going away soon as Utahns continue to get sick and, in some cases, die.
Here’s the picture in Utah as of Thursday:
- 53,326 cases
- 414 deaths
- 3,153 people hospitalized
- 673,659 people tested
- 0.8% mortality rate (lowest in the nation)
Jorgensen was among hundreds of passengers quarantined aboard the Diamond Princess cruise ship in Japan after an infected passenger spent five days on the ship before disembarking. He learned about his positive result while in isolation at the base.
After touching down at the South Valley Regional Airport in West Jordan, an ambulance with a police escort whisked Jorgensen to Intermountain Medical Center. Reporters and a handful of demonstrators gathered outside the sprawling Murray hospital in anticipation of the first person to be treated for COVID-19 in the state.
Jorgensen, though, couldn’t understand all the commotion. He felt fine.
“I never had any symptoms. That skewed my perception of the whole thing. All through it I was just kind of scratching my head. It kind of seemed like overkill to me because it was all new,” he said in an interview.
“I just kind of thought that it seems every year there’s a new virus that’s going to kill us all. I just thought this was another one of those. I couldn’t figure out why they were just going so all out on it.”
In late February and early March, not much was known about the disease that would disrupt the world, making millions sick and killing hundreds of thousands of people.
Now six months later, health care professionals, politicians and everyone else are still trying to figure how and why the stealthy virus does its dirty work, and the best way stop it.
Gov. Gary Herbert, who has been both praised and criticized for how he has managed the state’s response, used words like difficult, challenging, unique, uncertain and confusing to describe the ongoing pandemic.
“I don’t think we realized how much it was going to permeate our society and how long it would take to get this turned around. That’s been a little bit of a surprise,” he said.
The headline for Utah in 2020, Herbert said, would read: “Not what we expected.”
Like people across the country, Utahns have adapted their lifestyles — sometimes begrudgingly — as public health and government officials deliver changing messages. State leaders have asked generally sociable residents to do hard and sometimes controversial things like wearing face masks and staying away from each other.
“It’s definitely been a bumpy road, but that’s to be expected with a novel virus and a pandemic. But I am really encouraged by how we as a state have really come together to fight this,” said Dr. Angela Dunn, state epidemiologist.
“It’s good to have patience from the public as we tell them new things that might be contradictory, and I think we can expect that moving forward as we learn new things.”
State health officials are carefully watching two events that could dramatically change the equation again in the fall: schools reopening and flu season. And as the weather cools, people will also socialize more indoors, increasing the potential to spread the virus.
“We could have a witch’s brew here,” said Greg Bell, president and CEO of the Utah Hospital Association.
Health care providers have worried about outbreaks on the heels of holidays from Memorial Day to the Fourth of July to Pioneer Day and now Labor Day weekend.
“So far, so good but we’re starting to see a little mini surge,” Bell said.
After weeks of a mostly downward trend that state officials found encouraging, case counts started to rise again last week before dropping again this week, continuing what has become a yo-yo pattern.
“We can’t get tired yet. We’re not out of the woods,” Dunn said. “There are embers everywhere. This could just go to another surge.”
Lives and livelihoods
COVID-19 cases in Utah swelled after Herbert moved most of Utah (not Salt Lake City) to the yellow or “low-risk” phase in May. With quarantine fatigue already setting in, many Utahns treated low risk as no risk. Others argued the move to reopen stores, restaurants and churches came too quickly, and put the economy ahead of people’s health.
Herbert said the state’s plan, headed by Lt. Gov. Spencer Cox, called for a balanced approach to protect lives and livelihoods from the beginning. Protect people’s health and slowing the spread of the virus was first and foremost but state leaders “didn’t want to have a situation where the economy went to zero.”
“We had enough of a free fall as it was, but we did not close our economy like many states did and other countries have done,” he said, adding Utah is considered the fourth least restrictive state in the nation.
“We’re not out of the woods. ... There are embers everywhere. This could just go to another surge.” — Dr. Angela Dunn, state epidemiologist
State and local officials continue to weigh public health against maintaining Utah’s once booming economy. In 42 days, the virus wiped out nearly all of the jobs created the past three years.
Salt Lake Chamber President Derek Miller said it was like cruising along in the car and getting T-boned out of nowhere. Despite the crash, the same business-friendly principles that made Utah’s economy strong — solid workforce, low taxes, reasonable regulation — remain in place, he said.
Joblessness has continued to decline, with unemployment now at a lowest-in-the-nation 4.5%, according the U.S. Department of Labor. The national average is 10.2%.
“It certainly doesn’t mean that we can claim victory. The fight is far from over,” Miller said.
There are still about 100,000 people looking for jobs who can’t find them, the same number of Utahns out of work during the 2009 recession. Back then, the state launched an effort to create 100,000 jobs in 1,000 days.
“I think we need something like that now. We need a goal that we can look toward and it ought to be a goal facing toward helping people find the jobs that they need,” Miller said. “When we talk about jobs, what we’re really talking about is people.”
Utah can keep its economy — 90% of which is small businesses — going with three simple things: hand-washing, social distancing and mask-wearing, he said.
“Seldom in business or even life is the most important thing we can do also the easiest thing we can do,” Miller said. “That is good news for all of us that that is true in fighting the coronavirus.”
Despite mixed messages on the efficacy of wearing face coverings early on, state officials ultimately strongly urged Utahns to put them on in public, though Herbert stopped short of issuing a mandate as some Utah cities and counties did.
Wearing masks has perhaps been the source of the most controversy during the pandemic.
“If you don’t want to wear a mask, fine, just don’t go out and see people,” Herbert said, comparing it to laws that protect people from secondhand cigarette smoke.
Herbert said one his biggest frustrations is people not relying on accurate information. He said he read an article recently saying conspiracy theories are growing faster than the virus itself.
“There’s a lot of people that are loud and never in doubt about their points of view, but they’re very seldom correct. That confuses the issue,” he said.
In the fishbowl
No one in the state who tested positive received the kind of treatment that Jorgensen did.
Doctors placed him in Intermountain’s emergency preparedness unit, a building constructed to treat emerging infectious diseases. It’s comparable to the National Institute of Health’s bio-containment centers, of which few exist in the country.
Jorgensen was the first patient to be cared for in the specially designed facility. His room had three glass walls.
“I felt like a goldfish in there,” he said.
Doctors and nurses came in geared up like characters in the 1995 movie “Outbreak” to check his vitals. They entered through one door to see him and exited another to decontaminate. The room had a door through which meals were passed.
Jorgensen just sat there. He felt fine.
Meanwhile, his wife, Jerri, was in a hospital in Japan without any symptoms. The couple talked on the phone, “wondering together what this was all about,” he said.
Jorgensen learned that others who tested positive on the ship were allowed to quarantine at home. He wondered why he couldn’t do the same. It wasn’t practical or even contemplated that every positive case would be handled like his. The hospital didn’t have the capacity and ultimately infected people would have to quarantine at home
After talking with his doctor, Jorgensen was released from the hospital. An ambulance — again with federal marshals in tow — drove Jorgensen home to southern Utah in the middle of the night on March 6.
As Jorgensen settled into his basement isolation on that day, Herbert declared a state of emergency and the Davis County Health Department confirmed the first active case of COVID-19 in Utah. The patient, a woman older than 60, was exposed to the virus while on the Grand Princess cruise ship.
Though Dunn said it did not represent the first case of community spread in the state, Utah could expect more people to get sick.
To date, COVID-19 has infected 53,326 Utahns. The number of cases for July and to date in September have more than doubled the total for March through June.
Herbert renewed the state of emergency on Aug. 20, without the blessing of the Utah Legislature. State lawmakers earlier this year gave themselves the power to extend, modify or repeal such orders.
School bells ringing
Bell recalled muttering under his breath “no we’re not” when a state legislator insisted in a meeting that schools would reopen this fall.
“This thing is going to get away from us,” he remembers thinking.
So far, 40 of the state’s 41 school districts have opened their doors to students, with everyone in the building required to make masks as part of their daily attire, per a mandate Herbert issued on July 9. College students have also returned to campuses around the state.
Already one school, American Preparatory Academy’s Draper 1 location, shut down on-campus learning Tuesday after 15 positive cases of COVID-19 were reported.
Pleasant Grove High School closed for two days this week because of a cluster of positive tests. The school reopened Thursday on a modified schedule combining in-person and online learning.
In March, schools didn’t know enough about how to mitigate or react to the virus so they all shifted into emergency learning mode.
“In the spring, the only way we knew to be safe was just to close everything and stay away from each other,” said Sydnee Dickson, state superintendent of public instruction.
Since then, education officials have followed the science on how the virus spreads such as through close contact or respiratory droplets. They have adapted schools in an attempt to make them safe for students and teachers, who are more vulnerable to sickness.
Despite the strange, new environment, Dickson said school leaders have reported one of the best starts in many years.
“Let’s think about that in context,” she said. “Kids haven’t been in school for five or six months, so they’ve missed their friends, they’ve missed the rituals of school, they’ve missed their teachers.”
Dickson said teachers are also saying that students are more kind, respectful, engaged and focused on school. And though they find masks annoying, they are wearing them, she said.
One superintendent told her even if schools close after two weeks, getting back is good because kids have been away for so long.
Dunn said it’s difficult to predict what might happen in schools largely because they haven’t been in session since March.
“That’s something we’re going to keep our eye on, be very vigilant until we get a vaccine,” she said. “We want to keep kids in school, want teachers, staff, parents, students to feel safe and be safe.”
Dickson said changing information about the virus has been frustrating for educators.
“But I think we’re at a place now where we’re just going to play this out and hope that as we get into the fall that we can keep kids in school and prevent illness,” she said.
What’s the spread?
Infectious disease doctors know a lot about the virus now that they didn’t know in March, Dunn said.
There wasn’t much evidence of presymptomatic or asymptomatic transmission six months ago. Evidence from other countries experiencing outbreaks showed that it mostly spread from people coughing, sneezing or being very sick.
There weren’t a lot of measures in place to detect asymptomatic or presymptomatic spread because doctors thought it was mostly transmitted when people had symptoms, Dunn said. While that’s still probably the case, there is evidence that the disease spreads without symptoms.
“It isn’t driving the outbreak. That’s not how most people get it. But it is possible so we of course have instituted face masks,” she said.
Among the known contact point, 59% of Utahns contracted the disease in their own homes, while 17% became sick through a social interaction and just under 8% at work, according to the Utah Department of Health.
Early on, the scientific community looked at the flu as a possible example of how to treat COVID-19, thinking that face coverings wouldn’t be useful.
“Now, here we are trying to mandate face masks,” Dunn said. Some Utah cities and counties require masks in public places, while the state requires them in schools and in state buildings. “It’s seen as a key prevention measure.”
People’s frustrations are understandable when the public health message makes a 180-degree turn, Dunn said.
“Some people see that as they don’t know what they’re talking about and so it’s been very, very challenging,” she said. “Again, we just discovered this virus in December. We’re not even a year into it.”
At the beginning, health workers were expecting that a lot of transmission would come from touching surfaces contaminated with the virus, but it’s mostly transmitted through actual droplets, Dunn said. She still recommends good hand-washing and cleaning surfaces regularly.
Anticipation that hot weather would quell the virus like it does the flu also didn’t turn out to be correct. Utah saw its biggest spike in cases during record summer heat. Sweltering Arizona had the highest per capita rate of COVID-19 cases in the country in early July.
From the beginning, state officials knew testing would be critical to slowing the spread of COVID-19. But because the Food and Drug Administration initially fell behind in approving tests and with a lack of testing capacity in the state for the novel coronavirus, the effort started slowly.
Early on, the state lab only conducted 80 to 100 tests per day, partly because it had to manually extract the genetic material needed to determine a positive or negative result. At one point, the lab had almost no extraction kits because of breakdowns in the supply chain. Scouring the state for the other testing options yielded a box of the kits in a lab that wasn’t doing COVID-19 testing.
“That extended us out a couple more days,” said the state health department’s Nate Checketts, who is serving as testing director with the state’s Unified Command.
Since then the state lab, Intermountain Healthcare and ARUP have expanded their testing capacity at least tenfold. Manufacturers have caught up with a variety of tests that can be done quicker, though turnaround times have still sometimes lagged.
In early August, legislative auditors found testing turnaround times in Utah ranged widely across providers from just over 24 hours to more than 72 hours. Auditors called for more transparency from providers and efforts to shorten the times as the state scrambles to keep new cases down as children return to school.
Utah was conducting 4,000 to 5,000 tests a day from April through June. Daily COVID-19 testing peaked on July 13 when 8,161 Utahns had swabs shoved up their noses, with 749 coming back positive.
“The number of symptomatic people was just flooding the system,” Checketts said. “The testing was just through the roof up to that point.”
Testing numbers have declined overall the past six weeks. Checketts attributes the drop to fewer people having symptoms. Public health officials, he said, have looked at a variety of other possible explanations but don’t see anything else contributing to the change.
As of Thursday, 673,659 Utahns have been tested, which accounts for about 21% of the state’s 3.2 million people.
Through May, the positivity rate was about 3% to 5%. But during the midsummer surge, it ballooned to 10%, which the federal government considers a serious hot spot. The average for the length of the ongoing pandemic is 8% to 9%.
“We’d like to get down to a lower positivity rate,” Checketts said.
And with school starting along with the coming flu season, “we’ll see,” he said.
“We’re all preparing for the best, hoping for the best and trying to figure what we’ll do if it doesn’t work out,” Checketts said.
State officials continue to advise Utahns who have any symptom associated with COVID-19 to get tested. Checketts said the guidelines could change if there is another uptick with the virus.
Distinguishing between the flu and COVID-19 also will be key in the next few months. Some manufacturers are working on a combination influenza A, influenza B and COVID-19 test or ABC test.
“If that can get out in the market that would be great,” Checketts said.
The disease can’t be stopped if public health officials don’t know where it is. Testing is the key to controlling the pandemic and keeping the economy open, he said.
Sick and dying
To date, 3,153 Utahns have been hospitalized with COVID-19. The single-day total for the past six months peaked on July 23 when 225 people were in the hospital, including 97 in intensive care units.
Utah hospitals, including University of Utah Health and Intermountain Healthcare, have a total of 457 ICU beds, and they nearly reached capacity in the summer when 77% of them were occupied, with COVID patients accounting for 22% on July 18. Eighty percent is considered full capacity given staffing and other needs.
“The U., in fact, maxed out a time or two and got really goosey nervous,” Bell said.
Although computer modeling projected Utah hospitals would be overrun in August, the number of patients has gradually ticked downward, though there were a couple of spikes the past month.
Hospitals know how to treat COVID-19 patients much better than they did six months ago, Bell said. Doctors don’t go to ventilators as early or as often. Also, many people are now treated in critical care units instead of ICUs. They’re also not as nervous about surface transmission.
“Consequently, we’ve learned that our hospitals are one of the safest places in the world,” Bell said, noting the health care worker infection rate is very low. “We just learned how to handle this bug pretty well.”
But that doesn’t mean the nasty virus isn’t still spreading and killing people.
To date, COVID-19 has claimed 414 Utahns. They were mothers and fathers, brothers and sisters. Most were old, a few were young. Some died surrounded by family. Others succumbed alone. The state’s rate of about 13 deaths per 100,000 residents is among the lowest in the country.
Though Utahns age 25 to 44 account for the most cases in the state, they are less likely to develop severe disease that results in a hospital stay or death. Conversely, people older than 64 have seen the fewest cases but are among those with more serious disease, including hospitalization and death.
“The fact that fewer people in these age groups are becoming infected in the first place likely is a major contributor to Utah’s low case fatality rate,” according to Tom Hudachko, Utah Department of Health spokesman.
The health department reports that while Hispanics and Latinos make up just 14.2% of the state’s population, they account for more than 36% of the total cases of COVID-19 in the state. More than 19,200 cases have been reported among Hispanics and Latinos.
The highest death rate in Utah falls among people with Hawaiian and Pacific Islander backgrounds, according to the health department. Native Hawaiian and Pacific Islanders make up 1.6% of Utah’s population, but account for 4.3% of all cases and 5% of all deaths.
The Navajo Nation, a portion of which lies in southeastern Utah, has been hit particularly hard.
Hudachko said health officials don’t have a great answer for why the virus has taken a proportionally greater toll on minority populations.
“But we know that health disparities have existed among racial and ethnic minorities, and the pandemic has unfortunately shone a spotlight on that,” he said.
The reasons behind those disparities are complex and cut across social, economic, cultural and educational boundaries, he said. The health department has focused a lot of resources into better understanding the conditions that lead to those disparities so it can address them in its pandemic response.
Herbert said the state’s plan has succeeded in keeping the hospitals from being overwhelmed, protecting people’s health and livelihoods and having a low mortality rate.
“We are in a very good place,” he said. “It’s not time to spike the football, but on balance we’ve done a pretty darn good job.”
The governor said he hopes the state’s overall response ends in him handing Utah over to his successor in “full blown recovery mode and kind of have blue sky and smooth sailing.”
“We’ve gone through the rough waters and we’re still in some of the rough waters, but I think we can turn this around and give it to the next person to occupy this office in much better condition,” he said. “His spring will be much better than my spring.”
As for Jorgensen, he still feels fine. His life didn’t change much after the health department cleared him once his 10-day quarantine ended.
He went back to riding his mountain bike and running Desert Solace, an addiction treatment center in St. George that he and his wife founded. His doors have stayed open but the phones went quiet for a couple of months. He obtained a Paycheck Protection Program loan to keep it going.
In hindsight, he still wonders if his treatment was excessive, though he said he’s more understanding now that doctors didn’t know much about COVID-19 six months ago.
“I don’t blame anybody,” Jorgensen said. “I know that it was an unknown and they didn’t know what they were dealing with.”