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.

Eastern Idaho regional health officials on Thursday held off on tweaking or repealing its mask mandate and large event ban for Teton County, leaving the legal order in place while they tweak the regional pandemic response plan.

Teton's cases have significantly decreased since the board issued the legal order two weeks ago. However, local officials say testing is still delayed there, hampering their understanding of how many coronavirus cases are active in Teton.

"We're doing a lot less testing because of the delay associated with using our external labs who are testing because, if it takes 10 days (to get results back), it's not really worth the test," Teton Valley Health CEO Keith Gnagey told the board. He said he supports keeping the mask mandate.

Teton's representative on the health district board, Bill Leake, said elected officials in Teton — where Driggs and Victor have their own mandates that were superseded, but not repealed, by the health district board's mandates — also support keeping the mask mandate.

"All indications are we’re in a good place, and we want to stay here," Leake said. "I think it’s essential that we keep the mask mandate."

In addition to Teton's testing issues, board members also decided to delay any vote on its legal order for the county because the regional pandemic response plan isn't clear about how an area would move down to a lower risk level.

The plan outlines clear metrics to rise in risk level, based on the rate of active cases per 10,000 people and hospital capacity; the board moved both Teton and Bonneville up to moderate risk from minimal risk, where the region remains, because of case spikes. The plan also says after 14 days the board will reevaluate legal orders, but it doesn't offer criteria to move an area back down.

Board members agreed they'd look to modify the plan at their next meeting, and would hold off on taking any action on Teton's mandates. Before that discussion, board chairman Bryon Reed said he thinks Teton's low case numbers now mean "we're seeing the results" of mask mandates by the health district board and cities within Teton.

"I personally believe we need to follow our plan," Reed said, opening talks on Teton's mandates. "I think leaving it in place does lean to be an arbitrary (move) on our part because our plan says if they're below a certain metric, we'll consider it. We used that metric to move them to yellow. I believe with all counties we should use that metric too."

After the meeting ended, Reed told the Post Register in an interview that "I'm not for moving us away from face masks, I just want to follow the plan." During the meeting, Reed said he "accepted the mask order and the mitigation efforts that we've put on because I don't want to close any businesses," which he said is "where I draw my line."

In recent weeks, eastern Idaho has seen a surge of new COVID-19 cases and hospitalizations, data and hospital officials say, during a busier-than-average time period. Active cases and COVID-19 hospitalizations during July in the region have risen fourfold.

Bonneville County's spike has been the starkest. Nearly 250 new cases have been reported in Bonneville since July 18, when the county first reported an active case rate of of more than 10 per 10,000 people. On Thursday afternoon, the health district reported Bonneville had an active case rate of 14.3 per 10,000, with 170 active cases and 568 total cases.

The state reported 83 new cases Wednesday in Bonneville, according to the Idaho Statesman, while the health district reported 49 new cases for Bonneville. Health district administrator James Corbett said that's because the state reports positive test results as they come in, and the health district only reports cases once they can confirm the person lives within a given county.

More tests are being administered here, but health officials say test results are still taking three days or more to come back. The region's positive test rate continues to hover around 10%, according to limited data from the health district, well above the maximum 5% positivity rate experts say indicates testing is catching most cases.

Corbett said "testing has slowly increased" as local testing sites are getting more supplies, but "we're not out of the woods by any means."

"Our ability to manage cases right now is not in a good position," health district Director Geri Rackow said about delays in test processing. She also said that although testing isn't one of the metrics that triggers a shift in the plan's risk levels, it is mentioned as something the board should consider in any decision it makes.

At next Thursday's meeting, the board has busy plans. It hopes to amend the pandemic response plan to specify how counties will transition to lower risk levels, look to modify its ban for gatherings of over 150 people in the moderate risk level, talk with child health experts and school administrators on and potentially decide how to tailor pandemic response measures ahead of the school year's start and reassess each of the legal orders mandating masks and banning large events in Teton and Bonneville counties.

Going forward, the board could tweak metrics it uses to determine an area's risk level. Its case count metrics depend on active cases, which refer to cases that are still infectious, rather than total cases, which include people who have recovered. When testing is delayed, people sometimes are no longer infectious by the time their case is reported by the health district. That's happened several times this week.

"I'm not sure that's a valid parameter anymore because of that," said Jefferson County Commissioner Shayne Young.

Editor's note: This article has been updated to correct information about when Bonneville's rate of active COVID-19 cases over time.

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.