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Staff at Saint Alphonsus Meridian Health Plaza collect patient information and conduct health screening before administering tests for COVID-19 and other respiratory diseases on Wednesday, July 8, 2020, in Meridian.

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BOISE — Of all 50 states, Idaho has the second-highest positivity testing rate for COVID-19, according to Johns Hopkins University.

Idaho’s positivity rate for COVID-19 testing is 23.22%, the university’s data shows. That means for every 100 tests administered, over 23 of them come back positive.

Idaho’s rate is 4.6 times higher than the World Health Organization’s advised reopening positivity rate of 5%, and trails only South Dakota, which has a positivity rate of 23.64%. The state had no stay-at-home orders or business shutdowns.

Dr. David Pate, former president and CEO of St. Luke’s Health System in Boise, said positivity rate isn’t the only way to gauge the spread of COVID-19. One should also take into account case numbers, he said; Idaho’s case numbers are on the rise after seeing a dip in early September.

“We’ve got a lot of community spread and we probably need more people to get tested,” Pate said in a phone interview Tuesday.

He said the highest positive testing percentage he’d seen across the country was in the high 20s or low 30s.

“What are the new daily cases and what is that positivity rate, and they should be moving in the same direction,” Pate said. “… They have trended together (in Idaho) so we haven’t had any issues.”

Idaho in total has reported 45,082 confirmed and probable cases of COVID-19, including 660 new cases reported Tuesday; 492 people have died.

The state’s average daily incidence rate hit a high this summer and then dropped until mid-September, when it started to rise again. On Tuesday, the rate reached a seven-day moving average of 26.2 new daily cases per 100,000 people. That compares to a peak of 31.2 per 100,000 on July 16 and a low of 13.2 per 100,000 on Sept. 7 and 13.

The rise in cases could force Ada County school children back to distance learning, according to Central District Health spokesman Brandon Atkins.

“It certainly does appear that our school categorization level in Ada may adjust in the near future unless we see a shift in the number of cases occurring,” Atkins wrote in an email, adding that CDH officials would meet with school administrators later in the week to determine what that change might look like going forward.

According to CDH’s dashboard, Ada County has a two-week average daily case rate of 17.1 per 100,000 population as of Sept. 27, which sets it in the yellow school reopening category. If that number reaches 20 per 100,000 population, school districts will be pushed into the red school reopening category, where they were at the beginning of the school year.