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The spike of new coronavirus cases in Madison County that's been driven by young people, between 18 and 29 years old — which elevated eastern Idaho's unprecedented surge status last month, and made the Rexburg area a state hotspot and national hotspot — hasn't strained health care capacity as much as outbreaks elsewhere in the region, health officials say.

That's because while Eastern Idaho Public Health's estimate that 4% of all reported coronavirus cases result in hospitalization has proven true mostly, only 1% of people contracting the virus in Madison County are being hospitalized.

Each risk level of eastern Idaho's four-tiered pandemic response plan uses an active case rate to assume how many people with the virus will become hospitalized in the coming weeks after an outbreak.

Madison's outbreak of mostly young people drove the health district's hospitalization rate down to 3.1% in October, health district epidemiologist James Corbett said Nov. 5. But it may not last.

Corbett said the concern is that other, more vulnerable people may become infected in Madison County at high rates, which would compound concerns of limited health care capacity at local hospitals.

Cases have somewhat slowed in Madison County, but it's not in the clear yet.

"While the rate may come down, it's still appropriate to take precautions with individuals because if the hospitalization rate goes up, that also could lead to increased hospitalizations," Corbett.

Despite Madison's lower hospitalization rates, large and small eastern Idaho hospitals report that more and more people are being hospitalized with COVID-19, stressing but not overwhelming their staff resources.

1) Did the spike slow?

The jury is still out on why cases began to decline in late October, Corbett and health district Director Geri Rackow said Thursday morning. However, state health department data released that evening show that testing drastically declined during the last two weeks of October in eastern Idaho. Only 4,799 test results were reportedly received for eastern Idahoans between Oct. 18 and Oct. 31.

The last week of October showed the sharpest decline in testing. Just 1,782 tests were reportedly performed in eastern Idaho then, the state says, which is the lowest number of tests processed in a single week since early September.

In two recent local testing news firsts, eastern Idaho's testing positivity declined by multiple percentage points, and its positivity rate is just barely under the state's highest. The state says 23.3% of coronavirus tests in the Eastern Idaho Public Health District returned positive in the last week of October, down from 25.7% the week before. That was a peak as the region's positivity rate climbed steadily since late September.

The only other health district with a higher rate for the last week of October, which is the latest reporting period, is South Central Public Health District, home to the Magic Valley, where a large hospital is transferring some patients to Boise because it can't take care of them. South Central's positivity rate is 24%.

2) Fewer results, tests

Corbett said Thursday that the health district discovered it had not contacted some people who test positive. He said that's because "we found out we never received a positive" test notification from medical providers who administered the test. "With increased testing there are some challenges," he said. "Providers have to report in a proper way," but this is new territory.

Rackow said fewer people have sought testing recently, which data during the last two weeks of October confirm. "I don't know what to attribute to that. We are still certainly seeing sickness circulate in our community," Rackow said, but "people are not wanting to seek testing."

3) Another death in a nearby long-term care facility

A state report released Friday showed at least 34 new coronavirus cases and one new death was reported in eastern Idaho long-term care centers last week. Two new facilities have reported outbreaks. At least 253 coronavirus cases and nine deaths from COVID-19 are linked with 25 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 322 of Idaho’s more than 670 deaths tied to COVID-19, as of Friday. The report says long-term care centers are linked with 4,119 cases in Idaho, a rise of 304 cases since last week.

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.

At least 19 facility outbreaks in eastern Idaho are active, accounting for 210 total cases. 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 10,500 eastern Idahoans have contracted the coronavirus; roughly 400 have been hospitalized with the virus; and at least 65 have died. The region's coronavirus case totals and death counts both nearly doubled last month. Eastern Idaho hospitals were treating 58 COVID-19 patients on Thursday evening, according to the health district; 50 were eastern Idahoans.

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.