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Good news: Vaccines are on the horizon.

Clinic director for Eastern Idaho Public Health, Amy Gammet, relayed developments to regional officials Thursday that two vaccine candidates are showing early promise. Health care workers could receive the roughly 50,000 doses Idaho hopes to receive as soon as December, according to the state Coronavirus Vaccine Advisory Committee which met Friday. Widespread distribution could come next summer or later.

Bad news: Local hospitals are issuing a united plea as the holiday season approaches. Be safe, they warn, or else overwhelmed medical staff may not be able to provide you the care you need.

1. November already worse

At the end of October, the director of eastern Idaho's largest intensive care unit said that month was "the worst we've ever seen." Multiple times, ICUs at Eastern Idaho Regional Medical Center and Idaho Falls Community Hospital temporarily went on divert because they couldn't handle more patients.

Now, the region, state and nation are in worse positions that leave them less able to deal with a post-holiday surge, according to experts, medical leaders and public officials.

"It's going to get worse," Idaho Falls infectious disease doctor Richard Nathan told the Post Register in a text on Friday.

"There's a lot of anti-maskers and people opposed to the rational restrictions that are suggested," Nathan said . "We should probably have a big bump in cases in a month" following Thanksgiving. "Forget even a month. In a few weeks."

Deaths are up. A lot. Last week, the region tacked on another 17 deaths, bringing the total death toll to 90. In the first 20 days of November, 35 deaths were reported. Only 28 were reported in October.

Bonneville County, the largest in eastern Idaho, on Thursday became the fourth of eight counties in eastern Idaho to reach the critical-risk level for coronavirus spread; the other three counties are Lemhi, Madison and Teton.

Lemhi County's spread has slowed significantly. If that continues, by early next week the county could drop to the high-risk level, where Fremont and Jefferson counties sit. Custer County is at the moderate-risk level, while Clark County is at the minimal-risk level.

Seven of eight counties in Eastern Idaho Public Health District are under mask mandates.

By Thursday, eastern Idaho had added 220 cases daily over the past week, on average. That number's been skyrocketing steadily, the Post Register's tracking shows. On Nov. 1, for instance, the rolling 7-day case average was 133.4. Before then, on Oct. 1, that figure was 116.1 In October, it peaked at 181.1 on Oct. 24.

"I think as it stands, the hospitals are mostly at capacity. And there's a strain on the underlying health care system. And it's just going to get worse," Nathan said.

2. Testing shifts

Testing data has been spotty due to inconsistent reporting by medical providers, health district spokeswoman Mimi Taylor told the Post Register on Nov. 13. However, public data by the state health department show diagnostic PCR testing declined drastically in eastern Idaho this month, compared to October.

Some of that gap has been filled with rapid, less accurate antigen tests, but the region's decline in PCR testing puts it well behind most other public health districts in the state, including Southeastern Idaho Public Health.

Between Nov. 1 and 14, for instance, 4,375 PCR tests were reportedly conducted in eastern Idaho. That's slightly more than the number of PCR tests run in the first week of October — in other words, PCR tests have been cut in half even as cases have spiked. Before October, only 311 antigen tests were reportedly run in eastern Idaho. Since late October, though, there hasn't been a week where less than 400 antigen tests were run.

One threshold epidemiologists monitor as a sign of strength in an area's testing is the rate of tests that return positive. And in eastern Idaho, that's consistently been the highest of all seven public health districts in Idaho.

Last week's reporting showed some improvements in the rate — dropping from 26% to 21.6% — but it's still far above the 5% rate recommended by national health experts and the low-single-digit rates that have been achieved in some areas.

In other news, Eastern Idaho Public Health director Geri Rackow announced Thursday that the health district is preparing to roll out a new online data dashboard displaying COVID-19 infection data. She said in an email after the health board meeting: "We hope to have it rolled out by December 1 at the latest."

3. Outbreaks metastasized this month

A state report released Friday showed at least 124 new coronavirus cases and three new deaths were reported in eastern Idaho long-term care centers in the past two weeks. Two new facilities have reported outbreaks. At least 411 coronavirus cases and 12 deaths from COVID-19 are linked with 27 long-term care facilities in eastern Idaho.

Long-term care facilities often house people who are at high risk for severe complications from COVID-19. Statewide, long-term care centers are linked to 376 of Idaho’s more than 800 deaths tied to COVID-19, as of Friday. The report says long-term care centers are linked with 5,138 cases in Idaho.

Idaho’s Department of Health and Welfare says a facility has an active outbreak if there has been a confirmed or probable case among staff or residents in the past 28 days.

Eight outbreaks that were linked with 77 cases and seven deaths are resolved, meaning no cases were reported in those outbreaks in the past 28 days.

Since March, more than 13,600 eastern Idahoans have contracted the coronavirus and more than 480 have been hospitalized with the virus. Eastern Idaho hospitals were treating 62 COVID-19 patients on Thursday evening, according to the health district; 53 were eastern Idahoans.

Just 5,028 total cases and 25 total deaths were reported here at the end of September.

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.