As Denver metro counties continue to inch closer to local stay-at-home orders under Colorado's system of coronavirus-related restrictions, the state announced a new level of rules that prohibits indoor dining and personal gatherings — a change that applies to the majority of the Denver metro area and many counties in other regions.

The state's COVID-19 dial, which has been in effect since September, is the set of different levels of restrictions that each county is required to follow based on the severity of a county's local virus spread. The dial grew out of the state's safer-at-home order — the policy that came after the statewide stay-at-home order this spring and allowed numerous types of businesses to reopen.

The state recently switched to color identifiers — levels blue, yellow and orange rather than numbered levels — to avoid confusion. Until Nov. 17, level red meant a stay-at-home order. Now, level red — "severe risk" — is the second-highest level to the purple level, deemed "extreme risk," amounting to a stay-at-home order.

The new level red, announced by the Colorado Department of Public Health and Environment on Nov. 17, encompasses the vast majority of the metro area. The new level takes effect in counties with severe enough virus spread on Nov. 20, according to the department.

The counties moving to the new level red on Nov. 20 are Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson in the metro area. Other counties moving to the new level that day are Clear Creek, La Plata, Logan, Mesa, Morgan, Routt, Summit and Washington counties.

"If we are not careful now, we risk plunging into the deep end of the dial, where hospitals are not able to serve everyone who needs care, whether they are COVID-19 patients or other types of patients," Jill Hunsaker Ryan, executive director of the CDPHE, said in a news release. "It’s up to all Coloradans to help our essential health care workers save lives.”

Some of the key changes that come with counties moving from orange to red:

• Personal gatherings of two or more people — whether in public or private — are prohibited. Nothing in the updated public health order prohibits gatherings of people who live in the same residence.

• Restaurants are closed for indoor dining. Takeout, curbside and delivery are allowed. Dining in outdoor spaces with members of a person's own household is allowed.

• Indoor events, both seated and unseated, are closed.

• Outdoor events, both seated and unseated, are now allowed to be attended only by groups that consist of people from the same households. Outdoor events may operate at 25% capacity or up to 75 people excluding staff, whichever is less.

More counties qualify

A spokesperson for the State Joint Information Center, which takes questions for the state public-health department, provided the new thresholds of virus spread that would trigger a county to move from orange to the new level red. Similar to a threshold for the old level red, the line a county would have to cross is 350 new cases per 100,000 people over a two-week period — a metric known as a county's "incidence rate."

Based on that standard, in roughly 50 of Colorado's 64 counties, the rates of new cases cross the line for the new level red based on the state's data as of Nov. 18, but many appear likely not to move to that level for at least a few weeks, if at all. More than a dozen of those counties sat in levels lower than orange as of Nov. 18.

For example, Costilla, Custer, Lake, Montezuma, Pitkin and San Juan counties are moving to level orange on Nov. 20. Those counties' incidence rates exceed the limit of 350 aside from San Juan, whose data appears to be evaulated differently due to its small population.

In recent months, the state public-health department has allowed counties a period as long as several weeks to attempt to reverse their trends of local COVID-19 spread before formally moving to a stricter level on the dial.

Elbert County was in level orange as of Nov. 18, but its incidence rate sat at 570 — well above the threshold of 350 for level red. Other counties fared much worse: Adams County's rate was 1,300 as of Nov. 18.

'Cautiously optimistic' about new level

Last spring as the pandemic emerged, health officials thought “we need to throw the kitchen sink at it” because there was no time to spare and less was known about the virus, said John Douglas, head of Tri-County Health Department.

Now that Colorado is trying a new set of coronavirus-related restrictions that still stops short of a stay-at-home order, Douglas says he's hopeful that the current measures can stop the state's steep spike in COVID-19 cases and hospitalizations.

“I am cautiously optimistic that if we can get as many counties as possible to move to this level of reduced community capacity, we have a pretty good chance at turning the curve on community transmission,” Douglas said, referring to the tighter limits under Colorado's new level red.

It's a “kind of halfway step” between level orange and a stay-at-home order, said Douglas, whose department serves Adams, Arapahoe and Douglas counties.

The new level still allows retail at a “reasonably high level” of capacity and lets personal services — such as hairstyling, massage therapy and dog grooming — stay open at the same capacity as in level orange, Douglas said. He thinks that's “probably reasonable” as long as people wear masks.

Places of worship didn't change capacity between level orange and the new level red, and “I'm a little concerned about that,” Douglas said. Actions such as shaking hands, hugging and singing hymns will increase spread, Douglas added.

“Houses of worship were early places that were identified as sources of transmission,” Douglas said. “I think it all depends on how the faith leader runs things.”

Path to stay-at-home orders less clear

Several public-health agency directors signed a Nov. 5 letter to the state public-health department, urging the state to speed up the process of moving counties to tighter restrictions on the dial.

The letter included signatures from health agency leaders from Denver, Jefferson, Broomfield, Boulder, Lincoln, Prowers and Kiowa counties, along with Tri-County Health.

“Paradoxically, the ultimate outcome of these delays could be a greater likelihood of moving to the stay-at-home level that we all want to avoid and/or a greater length of time required in stay-at-home to reverse the dramatic rates of growth,” the letter says.

Earlier in November — before the new level red was announced — Douglas, the health chief, told Colorado Community Media it's hard to predict when Adams and Arapahoe counties would move to stay-at-home orders.

But those counties have seen increases in their restrictions roughly every couple of weeks since mid-October. Tri-County Health issued a public health order for Arapahoe on Oct. 16 that moved up the last call for alcohol and tightened limits on personal gatherings, and Arapahoe moved to level yellow on Oct. 28. It moved to level orange Nov. 11.

Whether counties in level red will move to level purple — the new label for local stay-at-home orders — now depends on whether hospital capacity risks being breached, according to the state's updated public health order for the COVID-19 dial. It's not entirely clear when that might happen.

State health officials recently estimated that point might be reached in late December, Douglas noted.

"We are hoping the significant restrictions in the red level will help slow disease transmission, but if any county gets to a place at any time where lives are at risk due to hospitals being at capacity, they could move to the purple level," a State Joint Information Center spokesperson said in a statement.

Curfew under the scope

Adams County on Nov. 7 was put under a curfew — essentially a nighttime stay-at-home order — to keep people in their homes from 10 p.m. until 5 a.m., with an exception for those working “critical” jobs or people with an urgent reason to be out. The public health order for Adams includes language akin to the statewide stay-at-home order Colorado saw this spring. The curfew order was set to expire 30 days after Nov. 7 unless Tri-County extends it.

Denver enacted a similar nighttime order effective Nov. 8.

When asked if the curfew order for Adams would be extended, Douglas, the health chief, said Tri-County Health was evaluating that decision and planned to look at what impact the curfew has had on virus spread.

Asked if a curfew is possible in Arapahoe and Douglas counties, he said Tri-County wouldn't take that step "at this point," noting those counties' lower rates of virus spread.

"I think we’ll be slower to look at ideas like that for them," Douglas said.