After Nebraska’s reopening led to record COVID-19 cases and hospitalizations, the state is changing course in hopes that renewed public health restrictions will stanch the infections.

Gov. Pete Ricketts continues to lean on personal responsibility to make the difference in the pandemic. In his announcement Friday, the governor also emphasized a new public service message urging people to avoid problem situations to help slow the virus.

But the strategy shift that Ricketts announced Friday recognizes the limits of personal responsibility, addressing Nebraska’s growing public health emergency.

The World-Herald interviewed health officials and experts around Nebraska on how the state needs to move forward. Officials asked for more from the governor and state government and said they see room for improvement in fundamental strategies to rein in the uncontrolled coronavirus pandemic.

Nebraska’s centerpiece testing system, TestNebraska, has been returning recent results in an average of 4.3 days — meaning some sick and worried patients have been waiting the length of a workweek without an answer.

One source said local health departments are overwhelmed with contact tracing, even as Ricketts says the state has untapped tracers awaiting work.

Major differences also remain over how forceful Nebraska’s response should be.

Ricketts continues to reject calls for a statewide mask mandate — even though 11 states without one are among the U.S. leaders in new cases, according to Covid Act Now. In asking people to make better choices on physical distancing and gatherings, the governor urged last week, “Please, folks.”

In an interview with The World-Herald, Ricketts said he is trying to have “as light a touch as possible” to preserve the state’s hospital capacity.

“We can’t do this just with mandates,” he said.

Others want stronger public health restrictions, and it’s clear the changes announced Friday are in many ways a modest turn back. The biggest change could happen at bars, where patrons will need to be seated — no standing crowds allowed. Ricketts noted that “standing room only” won’t be allowed for those gathering at bars to watch the Huskers’ season opener against Ohio State on Saturday.

Mask mandates are in place in Omaha and Lincoln, and at least a few other Nebraska communities want to pursue the option, too. The health director from the Kearney area said he wants to mandate masks locally because of sparse mask-wearing, but the state won’t authorize it.

Some local health districts also are asking for leeway to set their own regulations.

Last week, 100 local leaders in the Grand Island area held a video meeting to discuss extra measures their communities need going forward, said Teresa Anderson, director at the Central District Health Department.

Grand Island suffered with high case numbers and deaths in the pandemic’s first wave, and Anderson said she intended to submit a plan to Ricketts.

Anderson said she asked Ricketts last week for approval to mandate masks locally through a health measure, but the governor declined.

Said Anderson, “I think people are starting to say, ‘Wait a minute — we’re not going to go back to April and May.’ ”

Two weeks ago, leaders from the University of Nebraska Medical Center warned of a “potential perfect storm” striking Nebraska. Dr. James Lawler, a director at UNMC’s Global Center for Health Security, stepped away from support for Nebraska’s phased reopening — a response that the university helped develop.

Back in April, Ricketts and Lawler joined together to show support for Nebraska’s unique pandemic regulations: tailored restrictions, carried out by regional health districts, without a uniform lockdown.

At phase four of Nebraska’s reopening, the state had rolled back most of its public health restrictions — only to find record numbers of cases from the novel coronavirus (1,286 new infections reported on Friday alone), an all-time high in COVID-19 hospitalizations (322 and rising) and 547 Nebraskans dead.

Lawler said those phases were helpful early in the pandemic. But he said officials have learned about how the virus behaves in communities, and current conditions do not call for businesses and schools to open fully and community activities to continue as normal.

Lawler told The World-Herald last week that the state needs to again use what public health officials call “non-pharmaceutical interventions.”

“What we are seeing is a complete lack of personal responsibility,” he said, “and a complete lack of collective responsibility in the community to band in and protect each other.”

Still, Lawler said the choice is not to lock down fully or open fully.

On Friday, Lawler stood with Ricketts in announcing Nebraska’s change.

“It’s really important for all of us to buckle down at this point, to take action to reduce transmission in the community,” he said.

UNMC’s Dr. Ali Khan also has presented an eight-week coronavirus response plan to the Nebraska Department of Health and Human Services, according to the university.

Khan, the dean of the College of Public Health, declined to be interviewed by The World-Herald before the governor could respond to the plan.

Khan, speaking at an Omaha City Council meeting earlier this month, described a plan to get kids in schools, fans in stadiums and people back to work.

Khan said containing and controlling the virus is “pretty straightforward” through a three-pronged approach: leadership, decreasing transmission through testing-tracing-isolating, and community engagement around masking, social distancing and hand-washing.

“We have the power to affect the trajectory of this outbreak today, right now, before a vaccine ever shows up,” Khan said.

Dr. Joann Schaefer, Nebraska’s former chief medical officer, said one key issue going forward is expanding and improving the state’s testing capacity — including finding a good use for antigen testing for a rapid diagnosis.

“When people are sick or mildly symptomatic, they want to know right now if they have it,” Schaefer said.

The White House Coronavirus Task Force also has recommended the state step up its restrictions — with regulations Nebraska has declined to implement.

According to an August report from the task force, obtained by the Center for Public Integrity, Nebraska should: implement a mask mandate in counties with 20 or more cases, close bars, restrict indoor dining and limit social gatherings to 10 or fewer people in areas with the most cases.

Nebraska HHS declined a request from The World-Herald for more recent reports.

Ricketts said he has recognized the rise in hospitalizations, some 40% higher than Nebraska’s earlier peak in May. He said he’s particularly seen the rapid increase in the last three weeks, and continuing issues at long-term care facilities around the state.

On Friday, the state also announced $40 million in funding to boost staffing at 21 hospitals around the state. Ricketts said that plan has been in the works for a couple of weeks, as has the shift in the state’s directed health measures.

Ricketts continues to oppose any state mask mandate or other a local mandate from local health officials. When asked if he would consider requiring masks in specific settings, Ricketts said no.

The governor said his goal is to educate people about the use of masks and why it’s important for protecting hospital capacity. He wants voluntary compliance.

With a vaccine still down the road, Ricketts said the state will need to manage the virus for the months ahead. He acknowledged the state might need to make more changes to its directed health measures in the future.

On testing, Ricketts said the state has helped TestNebraska’s lab catch up, and by Tuesday it was turning around results within 48 hours on 84% of its tests. But he said that’s an issue the state will continue to manage.

Asked if Nebraska’s approach will be enough to control the pandemic, Ricketts said: “I believe it will because Nebraskans do the right things when you ask them to do it.”

Many health officials also acknowledge a lot of recent cases stem from small gatherings of family and friends — placing public health issues squarely in the privacy of someone’s home.

When The World-Herald asked Douglas County Health Director Adi Pour what more should be done to address the pandemic, she said, “This is all about personal responsibility. We have put everything in place we can.”

But Dr. Bob Rauner, president of Partnership for a Healthy Lincoln and a Lincoln School Board member, said asking people nicely won’t get the public response needed to manage the pandemic.

Rauner said he sees no consistency in the state’s message, although he was encouraged Ricketts brought in Lawler for Friday’s announcement. “It’s a public health response,” he said in his 43rd community coronavirus update, “which means our politicians and leaders need to get on top of this.”

Lancaster County is Nebraska’s lone county with stricter pandemic restrictions than the state authorizes, allowed because of an exception provided to the community in state health statutes. Even with the state’s changes announced Friday, Lancaster’s restrictions will remain stronger.

The county’s directed health measure sets restrictions on gatherings, restaurants, bars, salons, child care centers and gyms.

Officials there credit the measure — which includes an indoor mask mandate — with helping keep control of the virus. According to the Lincoln-Lancaster County Health Department, it has not had clusters traced to salons or restaurants, and they say the rules have substantially limited spread in child care settings.

Health department officials from around Nebraska held a conference call last week with the governor to discuss stepping up the public health response. Several health districts want the state to authorize their own local directed health measures.

Early in the pandemic, a few health departments — including Douglas County and Two Rivers Public Health Department in Kearney — took that step. But the state later said any local measure needed authorization from the state’s chief medical officer, officials say.

Jeremy Eschliman, director of the Two Rivers department, said he would mandate masks through a local directed health measure, and he believes that step has support in the community. But he said the state will not approve.

Eschliman said conferences are still meeting in Kearney — and many people do not wear masks. If masks aren’t required, he said, too many people decide the guidance isn’t for them.

“Without additional restrictions at this point, it’s going to be challenging, quite honestly,” he said.

Susan Bockrath, executive director of the Nebraska Association of Local Health Directors, said many health departments feel that the pandemic strategy across the state has largely forgotten prevention.

“We are fully in response mode,” Bockrath said early in the week.

Bockrath said the time and effort to track growing crowds of infected people and their contacts is overwhelming the health departments. She said departments are asking: “How do we make it so people don’t have to be contacted?” — by preventing the cases from happening in the first place.

Out of that, the association last week started a public service campaign around avoiding the “Three C’s” — crowded places, close contact and confined spaces.

A flyer that has started circulating offers simple advice: Avoid gathering in groups when you can’t keep 6 feet of distance, wear a mask when with people you don’t live with and avoid enclosed spaces with poor ventilation.

On Friday, the Governor’s Office publicly endorsed the effort and held it out as key to the state’s response.

Said Ricketts, “This is vital for us to be able to preserve our hospital system.”

Photos: Our best staff images of October 2020

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