HOLDREGE — Buffalo County recorded its first COVID-19 death Tuesday.

The patient, a man in his 90s, had been hospitalized since late last week. It is the fourth COVID-19 death in the state.

“We send our condolences to the family of this individual,” said Jeremy Eschliman, the health director at Two Rivers Public Health Department.

Several hours earlier, a new case of COVID-19 was announced in Buffalo County, prompting Gov. Pete Ricketts to enact a Directed Health Measure in the Two Rivers area. It includes Buffalo, Dawson, Franklin, Gosper, Harlan, Kearney and Phelps counties.

The DHM went into effect at 10 p.m. Tuesday and remains in effect until May 11.

The new case was acquired by community transmission, Eschliman said. That is when a person has COVID-19, but public health officials are unable to identify how or where that person became infected. No further information was provided.

This newest case is the ninth in the Two Rivers area since March 20. Seven of those are in Buffalo County, including the man who died Tuesday. There is also one case in Dawson County and one in Kearney County. Patients range in age from their 30s to 90s. At least five of those cases are travel-related.

This is the sixth Directed Health Measure enacted in certain regions of Nebraska. A seventh DHM took effect Tuesday night as well in Adams, Clay, Nuckolls and Webster counties.

Directed Health Measures impose enforceable limits on public gatherings. They apply to places such as, but not limited to, theaters, churches, houses of worship, gyms, social clubs, salons and social gatherings, including weddings, funerals, concerts and athletic events. These places are not required to close, but must continue to practice social distancing.

Restaurants and bars are required to close dining areas immediately and move to take out service, delivery, and/or curbside services only, until further notice. Restaurants will play a key part in feeding people throughout the pandemic, Ricketts’ statement said.

Schools are directed to operate without students in the buildings, but school staff may continue working in the building.

These measures do not apply to day care centers, which can stay open, with limitations, including no more than 10 children per classroom.

The Directed Health Measure does not apply to places such as office buildings, grocery stores, pharmacies, hospitals, nursing homes, correctional facilities, courthouses, courtrooms, banks, car dealerships, auto repair shops, nursing homes, long-term care facilities, small shops, golf courses, big box stores, gas stations, convenience stores, shopping malls, manufacturing facilities, packing facilities, construction jobs and other traditional office settings.

Weddings and funerals also are subject to the 10-person limit. Event planners and facilities are encouraged to be flexible with people who are rearranging their plans, Two Rivers said.

Eschliman added, “As our community holds this (grieving) family in our thoughts, we urge everyone to continue to practice social distancing. We knew there would be deaths from COVID-19 in Nebraska, and this underscores the potential seriousness of the disease and the importance of the measures we’re taking as individuals and as a state to help slow the spread of the virus.”