As the number of individuals hospitalized with COVID-19 continues to spike, Austin Public Health officials moved the community into Stage 5, its highest stage of COVID-19 risk, Dec. 23.

Under the Stage 5 guidelines, all individuals should avoid gatherings outside of the household and avoid dining or shopping except as essential. Businesses should also scale back only to contactless options, such as curbside or delivery service for restaurants.

Since the beginning of December, the seven-day moving average of new COVID-19 hospitalizations spiked from 81.33%, from 30 to 54.4. As of Dec. 23, the positivity rate in the area was 9.9%, three times the target for the community.

As of Dec. 18, according to a joint statement from Ascension Seton, Baylor Scott & White and St. David's HealthCare, the Austin area's staffed hospital beds were 82% occupied and its Intensive Care Unit beds were 80% occupied.

"If you wait to pull the alarm until the hospitals are already full, that surge will continue until the hospitals and the morgues are overwhelmed, and we simply cannot afford that in Austin and Travis County," Austin-Travis County Interim Health Authority Mark Escott said.

Previously, Escott had said a curfew for certain businesses could be part of the move to Stage 5. However, APH officials are not yet recommending a curfew as of Dec. 23 and said they will continue to monitor numbers over the next few days and weeks.

"We'll need to see some changes relatively quickly. We have a significant concern about New Year's [Eve] and the gatherings that normally happen during that time period," Escott said.

Stage 5 recommendations also include stopping extracurricular activities at schools where masking and distancing are not possible. Escott said he recognizes some activities, such as high school football playoffs, present challenges to suspend completely, so he is asking school districts to limit activities as much as possible.

Escott also said he has warned local superintendents that if COVID-19 numbers continue trending in the wrong direction into January, he will recommend virtual education only following the break. Those recommendations may not be uniform for all grade levels, he said.

"We will try to preserve elementary education as much as we can. Those are the students that most benefit from in-person [instruction]," Escott said.

Some districts, including Austin ISD, went all-virtual for a week following the Thanksgiving holiday break in order to prevent spread after some families had traveled.

In addition to groups gathering together for the holidays, Escott said bars operating as restaurants and not enforcing social distancing or mask requirements remain a cause for concern. On Dec. 22, he presented a list to county commissioners of 27 bars that have been fined for violating the state's COVID-19 guidelines, including some that have received multiple fines.

Under state and local COVID-19 guidelines, businesses that do not comply with government safety orders are subject to a misdemeanor charge and a fine of up to $1,000.

"Unfortunately we have many bars that have not behaved well and are contributing to these cases. So if we could close one thing, that thing would be bars," Escott told commissioners Dec. 23.

As the spread of the virus worsens locally, healthcare workers are in the process of receiving the vaccine in order to stay on the front lines of fighting the outbreak. The state has sent two shipments of vaccines to pharmacies, clinics and hospitals across the state.

Austin facilities have received 42,000 doses of the vaccine since Dec. 14 for health care workers and nursing home residents.

"This may be our last hard time now that the vaccine is coming and beginning to be distributed," Mayor Steve Adler said. "We need people to hold on just a little bit longer."