District Director Geri Rackow listens to attorney Michael Kane during a Board of Health meeting at the Eastern Idaho Public Health building on Thursday, July 9.

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Stepping away from pandemic-related restrictions as infections rise but hospital capacity remains stable, the Eastern Idaho Public Health board on Thursday revamped its plan and signaled it would rely on people to choose whether to adhere to pandemic precautions.

"My plea is that people understand that we're not out of this pandemic yet," health district Director Geri Rackow said.

As she introduced a revised version of the plan removing most language about mandates, Rackow said "continuing to issue public health orders is no longer justified."

It does not mean people should stop following precautions, officials urged. "We can all choose to do those things that we know," Rackow said.

But local doctors warned the move comes too soon and risks the region's recovery.

In undefined, extreme situations, the board's new plan says it can issue mandates.

"We continue to educate very single day," said Rackow, referencing the agency's daily Facebook posts. "... I would say that people have become tone deaf to the information that we're sharing."

Three counties — Bonneville, Fremont and Jefferson — were poised for new mandates before the board overhauled its plan. Likewise, the health board voted to expire mask mandates in Madison and Teton counties in two weeks, on March 18.

The end for most mask mandates mandates comes as coronavirus cases resurge in eastern Idaho. Last week, two counties here topped state charts for highest infection rates.

Regional daily infection rates began rising in mid-February, climbing over an average of 70 each day by Wednesday night. The rising case rates have translated this week into a rise of new COVID-19 hospitalizations — from 20 local patients with the virus Feb. 24 to 28 patients Wednesday. Hospital representatives told the board that the rise has not threatened their ability to provide routine health care, unlike a rise late last fall that nearly triggered a statewide hospital resource crisis.

In ending its approach of issuing, lifting and re-issuing mandates in counties as infection rates fluctuate, the regional health board shifted toward a strategy of "personal responsibility" that restriction-weary officials across the state have urged.

Health board chairman Bryon Reed maintained that the board's plan was always focused on preventing hospitals from being overwhelmed.

"I just feel strongly that to issue a public health order to an entire county, each and every citizen in the county, that takes somewhat of a critical need to justify that course of action from a public agency," Reed said. "That need was there. I firmly believe in my heart that we had that need late last summer and throughout the fall," when hospitals were nearly overrun with COVID-19 patients. "But at this time, I do not sense that there is a critical need to justify that." Cities and schools can make their own decisions, he said.

He also claimed "we have a lot of immunity now," citing the state's vaccine rollout that has made frontline workers in hospitals and schools eligible and new state figures that say half of around 291,000 Idahoans age 65 and up have been vaccinated.

Medical experts, meanwhile, warn that it's too early to end restrictions — with just a fraction of the population vaccinated and more infectious coronavirus variants emerging.

All eight county representatives from the largely rural area of the state supported the plan overhaul and votes to expire mandates. The only doctor who serves on the board, Dr. Barbara Nelson, opposed the vote, citing the emergence of new variants and other risk factors.

"I think rescinding a mask mandate is being done prematurely," Nelson said. She noted that cases rose two weeks after the health board lifted Bonneville County's mask mandate and that "we don't have a significant amount of the population vaccinated."

"We're talking human lives here and disability, and I think we've seen that compliance is worse without a mandate," Nelson said.

Dr. Kenneth Krell, intensive care unit Director at Eastern Idaho Regional Medical Center, told the Post Register in a text message during the meeting that the health board should've reinstated Bonneville County's mandate for the next month.

"We're seeing some uptick in cases and need the next month to see trends in variants and more vaccine. We know the mandate made a difference in compliance," Krell wrote. He said "it's just too early and EIPH guidance has made a difference. We risk our recovery by eliminating mandates too early."

Before the votes, Teton County representative Bill Leake asked for Teton's mandate to remain in place until late March or mid-April. He said time to educate people on the decision was needed. 

Leake said mandates weren't being enforced in Teton County. Authorities in Bonneville County weren't enforcing the order from the health district, which itself has no enforcement power and relies on local law enforcement.

Earlier, Rackow said evidence was unclear on whether mandates change people's decisions to wear masks. She said infections have risen in Idaho counties with or without mandates. A Center for Disease Control and Prevention report in November found that Kansas counties that opted into a state-issued mask mandates saw their infection rates fall while counties without mandates saw their infection rates continue to rise.

People aren't listening

On why infections are rising now, Rackow referenced news reports on athletic games where attendees ignored state-issued guideline as evidence that "not everyone is continuing to heed the recommendations and physically distancing and wearing face coverings when they're gathering with others."

Health district epidemiologist James Corbett said many people he talks to for case investigations tell them they aren't isolating at home after getting tested — only when they receive positive COVID-19 test results, which can take multiple days for non-rapid tests.

"You mix all those things together and you can see why we are seeing an increase in cases," Rackow said. "We know that we were never going to be able to eliminate the virus completely and we know that we'll continue to see cases. But as we've heard from our hospitals, they are in a much better position."

Reporter Kyle Pfannenstiel can be reached at 208-542-6754. Follow him on Twitter: @pfannyyy. He is a corps member with Report for America, a national service program that places journalists into local newsrooms.