Soon after the initial shock of the pandemic began to wear off in the late spring, local health officials started warning about what might happen this winter.

Many of the remedies they suggested to slow the spread of COVID-19, like social distancing and moving activities outside, are harder in the winter. But the real fear has been about what happens when the annual seasonal influenza surge is layered atop the hospital demands from the pandemic.

Hospitals in the state are filling even as cold weather has only recently hit, and Summit County Health Director Rich Bullough used stark terms to describe the local COVID situation.

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“To me it means — and I’ll just be blunt about this — it means unless behaviors change, we’re in trouble,” Bullough said Thursday. “I grew up in Utah, I grew up loving winter. This is the only winter in my life I’m not looking forward to, because I’m very concerned about the direction we’re heading right now.”

Bullough said that wearing masks, maintaining social distance, limiting gatherings to 10 people or fewer and washing hands consistently are keys to keeping the virus at bay. He has also stressed the importance of getting a flu shot.

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Around 14% of COVID-19 tests in Summit County are coming back positive in a rolling seven-day average, Bullough said, and the virus is hitting the East Side just as hard as the Snyderville Basin when the case numbers are adjusted for population.

“The hot spot related to current cases and increase in cases is in the Kamas Valley,” Bullough said. “This is not (only) a western Summit County issue.”

He said there had been 189 new cases in western Summit County over the past two weeks, and 66 in eastern Summit County. On a per capita basis, 47% of new cases are occurring on the East Side.

The South Summit School District is currently the hardest hit school district, he added. According to the state Department of Health, there were eight active cases in the district as of Thursday.

The Park City Hospital retains capacity to treat patients, its medical director Wing Province said. The facility is accepting non-COVID, non-critically ill patients from other Intermountain hospitals to create more room to treat COVID patients at the five Intermountain hospitals that have been designated for that purpose.

The Intermountain system has 23 hospitals, Province said, five of which have been designated to receive the most seriously ill COVID patients.

While the Intermountain system retains capacity to treat patients, a state briefing Thursday indicated how quickly that could change if trends aren’t reversed.

“We warned the governor last week that in view of the increase in cases — from 800 to 900, now to 1,200s, 1,500s, today a rolling average of about 1,600 over the last seven days and a daily rate approaching 2,000 — we know that in about seven to 10 days, two weeks, cases will end up in our hospital,” said Greg Bell, the president and CEO of the Utah Hospital Association. He went on to say that hospitals may soon implement the crisis standards of care that have been designed to ensure that finite supplies like drugs and hospital beds are allocated equitably in response to an emergency like a severe earthquake, mass shooting or pandemic.

That could mean medical teams deciding which patients will receive care based on factors like age and case severity because there aren’t resources to treat them all.

Bell warned that normal medical events will continue to happen even amid the pandemic, the accidents, heart attacks and strokes that in normal times make up approximately 70% to 75% of patients seeking medical care.

Dr. Mark Shah, an Intermountain Healthcare emergency physician, discussed steps health care providers have taken to lessen the strain on hospital systems, like expanding at-home care, moving patients to create room in COVID-specific hospitals and mandatory overtime for some caregivers.

“Despite those best efforts, health care is still finite. These contingency efforts may fall short. They may not meet the demand of patients if this community spread goes unchecked,” Shah said. “… Let’s be frank about what that means. That means that patients — COVID and non-COVID patients — may not have access to the care they normally would because there is simply not enough of it and that means outcomes that we try our hardest to avoid.”

Shah said that about 5% of COVID patients typically require hospitalization, and of that cohort, about 20% to 30% require intensive care. As new case numbers spike, health care officials cautioned that means an influx of patients requiring hospitalization in one to two weeks even as the system is rapidly filling now.

Shah said the crisis care protocols have been designed with an eye toward equity, so that someone’s race, location or socioeconomic status wouldn’t affect the level of care they receive.

In Park City, there have been recent changes to the COVID-19 testing process. Instead of a nasal swab that can cause discomfort as it reaches back into the sinus cavity, tests are now conducted using saliva. And rather than a drive-up clinic, people seeking tests at Park City Hospital are now asked to create an appointment at intermountain.com/covidtesting.

Tests are available for people who have one symptom of the disease or who have been exposed to a person who has COVID-19.

Symptoms of COVID-19 include fever, cough, difficulty breathing, muscle aches and pains, diarrhea, decrease in sense of smell or taste or a sore throat, according to an Intermountain official.

Gov. Gary Herbert indicated at the press conference he would attempt to work with the state Legislature to increase testing availability and do away with barriers to testing like symptom requirements.

The conference included some of the most dire warnings state officials have offered yet and came on the brink of the holiday season when families traditionally gather indoors in larger groups with people of many ages.

In an interview, Province urged restraint this year.

“Parties of more than 10 people are a great way to spread COVID, so we are strongly urging people not to have (holiday) parties,” Province said. “… Folks flying in from all over the country – you’re exposing yourself to a lot of potential COVID. … We’re really worried about the holidays causing a lot of spread of this virus.”

Bullough is eyeing the upcoming holiday season with trepidation. He said his own family has decided not to gather for Thanksgiving and was considering the same for Christmas.

As for Halloween, he advised parents to quarantine candy for 24 to 48 hours before family members eat it and to avoid large gatherings like parties. The actual act of trick-or-treating, however, appears to be relatively safe, he said, as it is outside and costumes make it easy to wear masks.

He advised enabling trick-or-treaters to get candy without a large group of people reaching into the same bowl or touching many pieces.

The guidance to limit gatherings to 10 people or fewer, Bullough said, is designed to aid contact-tracing efforts and to allow families or close friend groups to continue to gather without large parties that might mix the smaller, more closely related groups of people.

But with the holidays approaching, the pandemic entering its eighth month and fatigue growing among the public and health care workers alike, Bullough sounded words of caution.

“I think the picture is grim for this winter,” Bullough said. “… For me, I’m genuinely concerned. I don’t want to blow this out of proportion. We need to change our behaviors. We need to take this seriously.”