Following warnings Monday from Gov. Tom Wolf's administration, Butler County added another 15 confirmed cases to its total.

On Monday, Secretary of Health Dr. Rachel Levine warned of a growing trend that people ages 19 to 45 were being infected at a much higher rate, which could lead to higher infections among those age 65 and older.

Older individuals are at a higher risk of developing severe symptoms of COVID-19, which can be fatal.

According to the Pennsylvania Department of Health's report Tuesday, Butler County now has a total of 404 confirmed cases of COVID-19 since the beginning of the pandemic. The report also listed 40 probable cases, which await testing results. The county's death toll remains at 13.

Butler County was one of a handful of counties that almost saw further COVID-19 restrictions, which were expected to have included the closure of dine-in services at restaurants and bars.

County Commissioner Leslie Osche on Tuesday said Butler County remains subject to decisions made by the state Department of Health, unlike neighboring Allegheny County, which has its own public health department.

“To be clear, the commissioners do not have the authority to close businesses, nor would we if we had the option, at least not under these circumstances,” Osche said.

In a news conference Monday, Levine addressed the confusion surrounding southwestern Pennsylvania.

“We are looking at all of our case counts very carefully throughout the state. We do not plan at this time to use those dramatic statewide measures,” she said.

Levine said she and her department contacted county commissioners to discuss their latest statistics and the possibility of imposing restrictions.

“We had a robust discussion, but none of that really influenced our decision, and we decided to hold for the present time,” Levine said.

Osche said the restrictions would have ordered bars and restaurants to close indoor dining and would have limited gatherings to 25 people or less.

She said the commissioners asked for data that linked higher COVID-19 statistics to usage of bars and restaurants. She said the department of health could not supply that data.

“There remains always a risk that they can make these decisions at any time,” Osche said.

In the meantime, Osche said the county commissioners have worked with Butler Health System for a localized look at virus management strategies.

Currently, Butler Memorial Hospital is not considering reducing its services and capacity as they had early in the pandemic, according to Dr. John Love, the health system's medical director of infectious disease.

“I think we would have to look very carefully for the reasoning the state may move a county backward,” Love said.

Love said the hospitals in its system, Butler Memorial and Clarion, both have a low number of patients hospitalized for the virus.

“We may have to go back to not allowing visitors and things like that just to prevent infected people from coming into the building,” he said.

Love said the system continues to watch the numbers of positive cases attributed to Butler County from the state as it provides a better look at localized infections as opposed to results from their testing site, which includes many people who come from outside the county to get tested.

Love said the bigger concern locally for BHS is the rising backlog at Quest Diagnostics.

BHS has used the third-party testing laboratory throughout the pandemic with varying degrees of backlog. Love said results using Quest have returned to the seven- to 10-day range. At its best, the facility returned results within two to three days.

Love said contact tracing from the Department of Health doesn't begin until a positive result is found.

“They're waiting a week or more to find out what the answer is,” he said. “It's the dominant problem that impedes us from understanding what's going on in our community.”

While there is a level of uncertainty, one aspect that is certain are the protocols that keep people safe.

Hand washing, mask wearing and social distancing prevents the spread of COVID-19, according to Love and other medical experts across the country.

“As much as our efforts are about laws and mandates and requirements, they're actually mostly about your choices,” Levine said. “In Pennsylvania, we're all in the green phase. We've been able to return to work, but our actions as a community will continue to impact whether we can stay at work.”

The following numbers on the coronavirus pandemic were compiled from regular news releases from the state Department of Health.Tuesday’s COVID-19 statistics:Butler CountyConfirmed cases: 404Probable cases: 40Negative tests: 8,928Deaths: 13PennsylvaniaNew cases: 929Total cases: 96,671New deaths: 20Total deaths: 6,931Recovered: 76 percentSurrounding CountiesAllegheny: 5,364 confirmed cases; 78,994 negative; and 199 deathsArmstrong: 88 confirmed; 2,715negative; and 6 deathsBeaver: 843 confirmed; 8,138 negative; and 79 deathsClarion: 64 confirmed; 1,341 negative; and 2 deathsLawrence: 175 confirmed; 3,702 negative; and 9 deathsMercer: 163 confirmed; 5,574 negative; and 6 deathsVenango: 32 confirmed and 1,849 negativeWestmoreland: 1,004 confirmed; 22,606 negative; and 39 deaths.