Visitors wear masks as they walk in downtown Idaho Falls on Thursday, August 6, 2020.

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As regional health officials continue to issue county mask mandates, they raised the threshold at which they would consider slightly more stringent event bans, requiring that any move to a high-risk level would have to be done at a higher caseload.

Eastern Idaho Public Health's board of county representatives on Thursday removed from their pandemic plan the case threshold of 20 active cases per 10,000 residents to move an area to high-risk level. In its place, board members unanimously approved a new districtwide threshold of 50 active cases per 10,000 residents. Health officials said the original case rate wouldn't stress hospital capacity.

The change follows Bonneville County nearly breaching the original caseload limit this week.

Since late June, eastern Idaho's total coronavirus cases have increased nearly tenfold: From roughly 200 to around 2,000. Hospitalizations for COVID-19 in the region have also increased sharply since then: From around a dozen cumulative hospitalizations to at least 70.

Health officials have focused on preserving hospital capacity. During summertime, hospitals usually see an influx of trauma patients. Nearby hospitals also treat patients from across the region and even parts of neighboring states. Tack on COVID-19, and resources can stretch thin.

"We are not concerned solely about COVID hospitalizations," health district Director Geri Rackow said. "That’s one piece of the hospital patients that are served."

Capacity is not yet threatened, hospital officials say. The health district reports about 70% of Intensive Care Unit beds here are used, and about 50% of all hospital beds are occupied.

Eastern Idaho has 44 staffed ICU beds, according to the health district. Dr. Tim Ballard, chief medical officer for Eastern Idaho Regional Medical Center, the region's largest hospital which handles the brunt of trauma cases, said its ICU is routinely at capacity.

"At least as of last week, our ICU was essentially full for several days in a row," Ballard said. For "quite a few days this month, we went on divert," which means they had to send some patients to other hospitals to manage capacity.

Eastern Idaho health board's plan uses active case rates to project how many COVID-19 patients will become hospitalized to preserve hospital capacity. They estimate 1.5% of COVID-19 cases end up needing ICU care, based on previous state reporting. Rackow said that rate has proved true here.

The moderate risk threshold, of 10 active cases per 10,000 residents that the board uses for most nearby counties, is projected to lead to 4 ICU admissions over 10 days. 

The previous high-risk threshold, officials said, of 20 active case rate per 10,000 would lead to seven ICU admissions over 10 days; the new rate of 50 active cases is projected to lead to 12 ICU admissions over 10 days.

"As we’re planning for the unknown, we found out that we’re a little overly aggressive in our thinking as far as planning for what is coming," said Casey Jackman, CEO of Idaho Falls Community Hospital. Both he and Ballard supported the new, higher metrics for the high-risk level.

Board chairman Bryon Reed said "We've said from the beginning of this" that the regional plan is flexible, and "as we learn more and we understand our ... situation, we need to adapt."

The only additional restrictions that the pandemic plan calls for at the high-risk level is a ban on events with more than 50 people. Ada County has had a similar ban, along with a mask mandate, for nearly two months as its caseload skyrocketed. The regional health board there this week ramped up Ada's event ban to gatherings over 10 people, the Idaho Press reported.

Eastern Idaho Public Health's board on Thursday also issued new county restrictions for two rural counties, Lemhi and Clark. Lemhi's began immediately. The mandate for Clark, Idaho's least populated county, takes effect Sunday.

A total of six of eight eastern Idaho counties are at the moderate-risk level: Bonneville, Fremont, Jefferson, Teton, Lemhi and Clark. For each county that's reached that level, the health board has, in unanimous votes, mandated masks and capped event attendance based on venue size. Custer and Madison counties are the only two in eastern Idaho without heightened restrictions from the regional health board.

The board re-evaluates whether a county should continue the mandates after 14 days. Before removing mandates, the pandemic plan says a county's active case rate must fall below the threshold that pushed it to a higher risk level for the past week.

The mask mandates carry misdemeanor charges for violators, with up to $300 in fines, 6 months in jail, or both, but law enforcement across Idaho have generally said they'd avoid enforcing public health orders and, instead, educate people.

Lemhi breached the threshold for the moderate-risk level starting Aug. 8 . The standard for bringing a county to a higher risk level is if it surpasses an established daily active case rate for three consecutive days.

All but three counties are evaluated under the threshold of 10 active cases per 10,000 people to be determined at moderate risk. Lemhi and Custer are under a higher threshold of 15 active cases per 10,000 people due to their small populations. Clark, with an estimated 900 residents, is evaluated on a case-by-case basis.

Some experts are also concerned about testing. Rackow said generally only symptomatic patients are being tested. The district's rate of tests that return positive hit a high of 18%, drastically over the 5% that health experts say indicates most coronavirus cases are being reported. Test turnaround time is around four days here, officials say.

"Our testing rate is not where it needs to be," said Dr. Kenneth Krell, who leads EIRMC's ICU.

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.