Nez Perce County is Idaho’s ninth-most populous county, with just more than 40,000 people, but it has reported the state’s highest number of fatalities from COVID-19.

Of the 63 confirmed and nine probable COVID-19 cases reported in the county as of Friday, 18 residents have died. That works out to a mortality rate of about 24 percent – eight times Idaho’s average mortality rate of about 3 percent.

The reason such a high percentage of county residents who test positive for the virus die from it likely derives from the advanced age of the relatively few county residents who have been tested.

Everyone who has died in Nez Perce County from COVID-19 was older than 70.

A large share of those who have died from the disease were residents of a single nursing home operated by Life Care Centers of America in Lewiston, the county’s largest city.

Since the virus was first confirmed at that facility on March 25, 17 residents have died. Of those residents, eight tested positive for COVID-19. The other nine were never tested, although the Lewiston Tribune reported the families of three of those untested residents believed they had the disease.

Life Care Centers of America operates more than 200 nursing home facilities in 28 states, according to the company’s website. This includes a facility in the Seattle suburb of Kirkland that was an early epicenter for the coronavirus in the U.S. At least 37 people associated with the Life Care Center of Kirkland died from complications of COVID-19.

All residents of Life Care Center of Lewiston have been tested for the virus, said Leigh Atherton, a spokesperson for the Tennessee-based company, with 39 residents testing positive for the virus and 29 testing negative. Fourteen residents are considered recovered.

Fourteen of the facility’s 125 employees tested positive for the virus, with five having returned to work after recovering, the statement said.

“We’ll continue to provide regular updates to state and local officials, as well as to family members who are concerned about the health and safety of their loved ones,” Atherton’s statement said. “The family members and Lewiston community have been so supportive, and we extend our sincere thanks for all the random acts of kindness that have been shown to us as we battle this challenging virus.”

Atherton said the Lewiston facility will work closely with the Idaho Department of Health and Welfare and the local health district to ensure the correct steps are taken moving forward.

A spokesperson for Idaho Public Health’s North Central District, which covers Nez Perce, Latah, Clearwater, Lewis and Idaho counties, could not be reached for comment about the Life Care Center outbreak despite repeated attempts.

Just eight other cases have been confirmed elsewhere in the district – three in Idaho County and five in Latah – with no fatalities.

Two cases of COVID-19 were reported among tribal members on the Nez Perce Reservation, part of which is in Nez Perce County, late Friday night. On Saturday, the tribe reported 10 more cases.

Contact tracing for the two cases identified Friday was underway Saturday by the North Central public health district and Nimiipuu Health.

In a Saturday news release, the tribe said, “It is believed that all positive cases of COVID-19 are related, and at this time there is no implication of community spread of the COVID-19 virus.”

The Nez Perce Reservation has been under a stay-home order since March 17.

Nez Perce Tribe spokesperson Kayeloni Scott said residents, mostly living in rural, remote areas, have largely complied with the order, but trips to regional centers such as Lewiston may be necessary for essential supplies.

Carol Maurer, spokesperson for the city of Lewiston, said she was not aware of any other outbreaks linked to specific locations within the city.

The city’s responsibility is largely to disseminate information and educate residents on how to stay safe and healthy, Maurer said. While the local public health district handles much of the coordinated response to the pandemic, Maurer said the city has been in “constant communication” with other towns in the county to ensure information is uniformly distributed and guidelines for reducing risks are met.

Lewiston is directly across the Washington border from the city of Clarkston, with large amounts of travel among residents from either side. The cities have been coordinating as much as possible to avoid logistical issues between the two states, according to Maurer.

As the region’s main population center, Maurer said Lewiston authorities are aware of the risks and are moving forward accordingly.

“It’s everything to do with population size,” Maurer said. “Our numbers aren’t big-city numbers, but ideally we don’t want any. So the most important thing for Lewiston now is just not going backward.”