With Utah’s COVID-19 cases staying stuck at high levels and the Intermountain West remaining the nation’s hot spot for the virus, an infectious diseases physician with the region’s largest health care provider warned Friday the state may be in for another tough winter.

“We are not in a good place going into the winter months right now,” Dr. Brandon Webb said during an Intermountain Healthcare virtual news conference, because that’s already when “we expect to have higher rates, and especially going into the holidays, we’re starting out in a place that doesn’t give us a lot of confidence.”

Utah and four other Western states, Montana, Wyoming, Colorado and New Mexico continue to average more than 50 new COVID-19 cases a day per 100,000 residents, according to data collected by the Mayo Clinic. Only three other states nationwide, Alaska, Minnesota and North Dakota are as hard hit.

Mountain West states make up nation’s largest COVID-19 hot spot

Utah’s rate of community transmission of the virus is high but stable, Webb said, in contrast to other states that saw much higher increases, such as Idaho,where a huge spike earlier this fall led to rationed health care. Earlier this week, Gov. Spencer Cox described Idaho’s case counts as “bonkers” compared to Utah’s.

Idaho hospitals saw significant overcrowding, something Webb said Utah has “been fortunate to manage” to some degree because high case counts haven’t fluctuated so dramatically. But the doctor said what’s happening in the region is being monitored closely.

Colorado, he said, is “seeing a significant upswing” and implementing measures to keep that state’s health care system from being overwhelmed, such as going beyond the federal recommendations limiting booster shots of vaccine to allow all adults to get the extra dose.

The dynamics of transmission are difficult to predict, Webb said, “but watching what’s going on in communities with similar vaccination rates, with similar or contrasted types of social precautions and cultural compliance is very helpful to us as we continue to plan our public health response here in Utah.”

Utah’s health care resources are already saturated with COVID-19 patients, Webb said, leaving “no room for error. So we’re grateful we haven’t surged to the great degree that we’ve seen in some other states, but at the same time our steady state right now over the last few weeks is still too high to be comfortable.”

Friday, the Utah Department of Health reported 3,842 new COVID-19 cases and 22 deaths from the virus in the state since Wednesday. The new numbers over the Veterans Day holiday put the rolling seven-day average for cases at 1,568 per day.

That’s affecting the capacity of hospitals in Utah to care for all patients, Webb said, while at the same time, respiratory illnesses like respiratory syncytial virus, or RSV, are showing up sooner than expected, especially among the young.

Admission rates at Intermountain Primary Children’s Hospital are already at peak winter volumes, he said.

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It’s too early to say whether opening up coronavirus vaccinations to children 5 to 11 years old last week will make a difference in Utah’s transmission rates, Webb said, although that’s the expectation. Cases in children 5 to 10 years old are currently higher in Utah than they were during the peak of the pandemic last January.

Curbing that high level of transmission in young children is “incredibly important” in strengthening immunity throughout the population, he said, noting projections from the Centers for Disease Control and Prevention suggest that vaccinating 5- to 11-year-olds could prevent more than 600,000 hospitalizations over the next six months.

The immunity that comes from being infected with COVID-19 is not yet recognized as part of the U.S. public health policy on the virus, Webb said, but may catch up as more is learned. He said Switzerland views immunity from infection as a temporary equivalent to vaccination.

“The science suggests both are important,” Webb said, describing immunity from both an infection and from the vaccine as natural. The people who have the strongest and longest lasting immunity, he said, are those who were vaccinated with at least one dose after having had COVID-19.

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Asked if he was surprised where Utah is as the second winter of the pandemic nears, Webb suggested there may have been too much optimism about wiping out the virus once vaccines became widely available earlier this year.

“I think that we suffered a bit from overenthusiasm when the initial vaccination effectiveness rates were announced. To be honest, those vaccines initially performed so much better than we expected that they would, that we actually shifted the paradigm maybe prematurely to talking about the pandemic being over,” he said.

That led to pulling back on mask mandates and other preventive measures in place to slow the spread of the virus and then, the highly contagious delta variant hit over the summer, sparking the surge in cases that continues today.

“We quickly recognized that while the vaccines are still effective, they do wane. We’ve learned certainly the duration of immunity from vaccination is not as durable as we thought it might be. So I think there’s been widespread disappointment as we’ve had to shift as a community,” the doctor said.

Instead of returning to the belief that “we’re done, we’ve arrived, we’ve made it,” Utahns need to be more realistic, Webb said, as new ways of dealing with the virus emerge, such as antiviral treatments in pill form, including one that could be approved later this month.

Even with new tools to battle COVID-19, Utahns still need to take personal responsibility for not exposing others to the virus, the doctor said. “Our strategy needs to be complimentary, and multi-angled, in order to get us through this winter season into a place where I think we can be more rational about our expectations,” Webb said.