With Colorado's number of COVID-19 hospitalizations now higher than it was at the peak of the coronavirus pandemic’s first wave in the state in spring 2020, health officials are again urging residents to wear masks in public indoor spaces.

The Nov. 5 announcement was called a statewide “public health advisory,” a term that state health officials appear not to have used before in news releases about the pandemic. The careful language reflected Colorado’s reluctance to again issue a mask mandate for the general public in most settings, a requirement that the state allowed to expire this spring.

“As public health officials, we are issuing this statewide advisory due to steadily increasing cases and a concern for hospital bed capacity,” the metro Denver health officials wrote in a news release.

Colorado and the Denver metro region continue to see steady increases in COVID-19 cases, according to the release. On Nov. 4, Colorado’s rate of daily new cases — 49 per 100,000 people — was the fifth highest in the country and one of the fastest growing, the release said.

The state’s number of hospitalized patients with confirmed COVID-19 was 1,296 as of Nov. 5 — outpacing the 1,277 confirmed and suspected COVID patients on April 9, 2020, the highest recorded number during Colorado’s first wave, according to state data.

Deaths among Coloradans with COVID-19 have routinely reached above 20 per day since late September this year, with 29 deaths occurring on Oct. 17 alone. That’s the highest total since Jan. 10, when the state’s death rate was trending downward after the winter surge.

The advisory was issued by the Metro Denver Partnership for Health, which includes the public health agencies of Boulder, Broomfield, Jefferson and Denver counties as well as Tri-County Health Department, which serves Adams and Arapahoe counties and provides certain public-health services to Douglas County.

Hospitals serving metro Denver are full or nearing capacity due to COVID-19, non-COVID-19 emergencies and other routine visits, with less than 10% of staffed beds available — a trend not seen at any other point in the pandemic, according to the news release. Nearly 40% of hospitals report current or anticipated staff shortages within the next week, the Nov. 5 release said.

While Colorado’s current COVID hospitalizations are about two-thirds of what they were during the state’s winter surge last year, more people are now hospitalized in Colorado for other reasons — car accidents, heart attacks and issues caused by delayed medical care, The Colorado Sun reported. The state’s hospitals have not been more full during the pandemic, the Sun reported.

Gov. Jared Polis has said that if the surge continues, Colorado will need to request medical surge teams from the Federal Emergency Management Agency, or FEMA, and halt elective surgeries, according to the release. “Elective” means a surgery or procedure can be delayed without undue risk to health.

Hospitals may also need to resort to “crisis standards of care,” the release said. Crisis standards of care are guidelines for how the medical community should allocate scarce resources such as ventilators and intensive-care-unit beds in “the extreme case when patient needs exceed the resources available,” according to the state public-health department’s website.

Polis recently issued executive orders that included action to give the state greater authority to direct transfers of patients between hospitals, the Sun reported.

The Colorado Department of Public Health and Environment on Oct. 31 ordered hospitals to suspend cosmetic surgeries in order to free up staff and bed space; some hospitals have already gone further, delaying needed but non-emergency procedures, the Sun reported.

As of Oct. 30, the metro region alone had 581 hospitalizations due to COVID-19 — a number that has been increasing over the past weeks, the release said. A majority of these COVID hospitalizations — about 80% — continue to be among the unvaccinated, the release said.

The news release seemed to signal that more “advisories” — not orders — would be forthcoming if coronavirus trends continue to worsen.

“As public health officials, we will continue to monitor trends in COVID-19, especially as the region moves into flu season and with holidays approaching, and issue advisories as needed,” the release said.

Masks, avoiding indoor gatherings, booster doses urged

The state public-health department and the Metro Denver Partnership for Health urged the following actions and underscored the following information in the health advisory:

• Wear a mask when in crowded public indoor spaces whether vaccinated or not, even in locations where your home county does not already require it. That’s especially important when visiting restaurants, bars, gyms and other crowded places that do not require proof of vaccination for staff and patrons.

• Move public and private gatherings and events outdoors whenever possible to increase ventilation (air circulation).

• Persons at high COVID risk — those who are not fully vaccinated and those with conditions that increase the risk of severe COVID — should consider staying out of public indoor spaces until the case rate has declined.

• Flu season has begun, so Coloradans should get a flu shot, which can be given at the same time as a COVID-19 vaccine.

• All eligible individuals should get vaccinated, including completing both doses of a vaccine if receiving the Pfizer or Moderna vaccines, then get a booster dose after six months for extra protection if you are in a higher-risk group. “Vaccines are the most effective way to prevent COVID-19 infection and hospitalizations,” the release said. Vaccinations continue to be free — no insurance coverage required — and can be obtained in pharmacies and from health-care providers.

• Anyone who is 18 or older who would like a booster dose and is either six months past their initial series of a vaccine or two months past a one-dose Johnson & Johnson (Janssen) vaccination should make a plan to get the booster dose or discuss with their doctor.

(Booster doses are also free and especially recommended for anyone 65 years or older, those living in a long-term care facility and those at high COVID-19 risk based on health conditions or where they live or work, the release said. Anyone who received a one-dose Johnson & Johnson vaccination should also get a booster dose with any of the COVID-19 vaccines. Colorado’s prevalence of COVID-19 makes the state a high-risk area in which to live and work, the release said.)

• The advisory noted that the COVID-19 vaccine for children aged 5-11 is now available, following the federal Food and Drug Administration’s emergency-use authorization of the Pfizer vaccine for that age group and approval by the federal Centers for Disease Control and Prevention. Information for parents and guardians on the vaccine and where to get vaccinated is available here.

• COVID-19 monoclonal antibodies can help prevent severe illness for some people ages 12 years and older who get infected with COVID-19. If you have tested positive for COVID-19 or are not fully vaccinated and have been exposed to COVID-19, and you are at high risk of developing severe COVID-19 due to your age or medical condition, you may be eligible. See information here.

• Get tested if you are experiencing symptoms consistent with COVID-19, and stay home if you are sick or waiting for test results. The news release said employees are entitled to paid sick leave if they have COVID as well as for getting vaccinated for COVID. See test locations here.