Data from local health departments indicate that the coronavirus is spreading in the D.C. region at levels similar to what it saw in late spring, when stay-at-home orders were still in effect. Now, as the numbers rise, local officials are weighing whether and how to reimpose restrictions to limit the spread of the virus.

In D.C., where the health department is reporting its highest levels of community spread since late May, Mayor Muriel Bowser has not imposed new restrictions or rolled back the city’s reopening process. At a press conference Thursday, Bowser said the city “may” need to impose new restrictions if cases continue to rise heading into the winter.

“We’re watching our metrics and our experience with the virus very closely in the District,” said Bowser.

In Maryland, Gov. Larry Hogan tightened restrictions on indoor dining capacity on Tuesday, and the state health department activated plans for hospital surge capacity. The move was a response to seven straight days where the state saw 1,000 or more new daily coronavirus cases. Montgomery, Prince George’s, and Anne Arundel counties have all added new restrictions of their own in recent days. At a press conference Thursday afternoon Hogan  announced additional investments and initiatives to protect Marylanders against the virus.

On Thursday the Virginia Department of Health reported the seven-day average number of daily new cases was 1,546, the highest that metric has reached since the pandemic began. Gov. Ralph Northam (D) has not announced new restrictions. He announced expanded testing and wrote on Twitter that it was “time to double down” on physical distancing, mask wearing, and other measures to curb the spread.

In an email to DCist/WAMU, Northam spokesperson Alena Yarmosky wrote that beyond the expansion of public testing, “the Governor is actively consulting with health experts at the state and local level, and is considering a number of mitigation strategies.”

For months, public health experts have warned that the fall and winter months could bring a rise in infections as the weather gets colder and people are forced inside more. They are particularly concerned about the change in season colliding with “pandemic fatigue,” as people tire of adhering to social distancing guidelines and continue to host and attend gatherings.

“My biggest concern is that at a time when we’re all tired is the exact same time that we have to double our efforts,” Dr. David Marcozzi, an associate professor of emergency medicine at the University of Maryland School of Medicine, told DCist/WAMU.

D.C. announced 128 new coronavirus cases on Thursday. On Wednesday, the city recorded its highest daily case count since late May, with 206 new cases. There have been several days over the past month where the daily count of new cases topped 100 — and case counts have been trending upwards since September — but according to DC Health, this week’s numbers now indicate “substantial community spread” of the virus.

The city’s community spread metric has been rising since September, but the city has not categorized community spread as “substantial” since May, before the city began its gradual reopening process. During the coronavirus surge in the spring, this metric of cases per 100,000 residents reached an all-time high on May 5, when the average daily case rate was 27.56. That number dropped to a low of 4.54 in early July. Now, as of this week, the seven-day average daily case rate in D.C. has risen to 15.8 cases per 100,000 residents.

D.C. Health Director Dr. LaQuandra Nesbitt attributed some of the recent rise to people “letting their guard down” during small, private social gatherings where people report not wearing masks and adhering to other public health guidelines.

Nesbitt said 45% of new cases in the past two days in D.C. were among people between the ages of 25 and 40, an indicator that younger people may be taking more risks in terms of virus exposure.

“It’s critically important that young people do not underestimate what it means for them to be the primary transmitters of virus in this country,” Nesbitt said.

Maryland and Virginia have also seen some of their highest numbers since late May. On Wednesday, Maryland recorded 1,714 new cases. The state had not seen a daily case count that high since May 19.

And Virginia saw a record 2,103 new coronavirus cases on Saturday, Nov. 7. In recent weeks, it has had more cases per capita than neighboring Maryland, which has a smaller population. Over the past seven days, an average of 6.5% of coronavirus tests in Virginia have come back positive, which means that the state is above the 5% threshold recommended by the World Health Organization for reopening.

The majority of Virginia’s increased cases are in the southwestern part of the state, but the D.C. suburbs are also seeing a gradual uptick in cases. Fairfax County’s positivity rate is 6.2%, and the county announced last week that cases were increasing, but not surging. Epidemiologist Barbara Downes with the county’s health department said in a statement the rise was due to people dropping precautions as well as exposure at work.

“We’re seeing increases associated with almost every type of workplace — daycares, landscaping businesses, restaurants, construction companies,” Downes said.

Natalie Talis, Population Health Manager with the Alexandria Health Department, said that cases, hospitalizations, and ventilator use are all up in Alexandria. Talis wrote in an email to WAMU/DCist that transmission in the city “is likely happening within households, at the workplace, and at social gatherings,” based on the health department’s analysis.

Alexandria will not impose additional restrictions, but “AHD and the City are ramping up educational efforts around how to reduce the spread in these key settings, increasing free testing availability, and encouraging people to avoid travel and gatherings during Thanksgiving.”

Ryan Hudson, a spokesperson for Arlington County’s Public Health Division, wrote to DCist/WAMU that the county’s seven-day average of daily new cases is 41, the highest count since May. He did not mention new restrictions, but said the county “continues to implore all Arlingtonians” to avoid large gatherings, wear face masks, maintain physical distance and wash hands.

In response to rising numbers, Prince George’s County and Anne Arundel County announced additional restrictions on Thursday morning.

“It is time to hunker down. We are in the midst of another surge,” Prince George’s County Executive Angela Alsobrooks said at a press conference on Thursday morning.

Effective 5 p.m. Sunday, Prince George’s County will limit indoor gatherings to no more than 10 people, and limit outdoor gatherings to 25. Indoor restaurant capacity will decrease from 50% to 25%, retail businesses will have to decrease capacity from 75% to 50%, and places of worship will have to decrease capacity from 50% to 25%. Fitness centers will remain open at 25% capacity and bowling alleys will remain open with 25% capacity, or 50 people. The county will continue to require masks in all public spaces (unless outside and engaged in rigorous physical activity).

“These are the guidelines that have been implemented, and please note — they have not been implemented arbitrarily,” Alsobrooks said.

Alsobrooks says the county will be stepping up enforcement on restaurants and big box stores that are not following the COVID guidelines — and asked county residents to call 311 if they see businesses or restaurants not following the guidelines.

As of last week, county health data in Prince George’s County show a test positivity rate of 6.4%, above the 5% threshold recommended by WHO. Last week, the county reported 69 hospitalizations due to the virus — which county health director Dr. Ernest Carter said was the county’s highest average since June.

“Just in the last two days, we’ve seen a 27-bed increase in hospitalizations,” Carter said. “Thankfully our hospital capacity remains very strong … however, we absolutely have to get it under control because if we don’t, there will be a rapid rise in our intensive care units and we’ll have to do further things to make sure we have that capacity.”

On Thursday, Anne Arundel County Executive Steuart Pittman also announced rolling restrictions that will go into effect between Friday and Nov. 20.

Starting Friday at 5 p.m., the county will ban indoor gatherings of more than 10 people and outdoor gatherings of more than 25 people. Starting Monday at 8 a.m., the county will suspend youth athletics at all county fields and facilities. And on Friday, Nov. 20 at 5 p.m., maximum capacity at restaurants, bars, and all food service establishments will be reduced from 50% to 25%.

Pittman said waiting on Maryland Gov. Larry Hogan to announce additional restrictions “is not an option.”

“Like our neighboring jurisdictions, we are acting now to slow the spread that will inevitably lead to a hospitalization surge at a time when our hospitals are operating near capacity. This is a more dangerous moment than we faced in the spring, so there is no question that we must take action,” Pittman said at a press conference Thursday morning.

On Tuesday the new case rate, or the number of cases per 100,000 Anne Arundel County residents, spiked to the highest it’s ever been: 23.5 cases per 100,000 people, according to county health data.

“We’re hitting a new case rate high each day,” said Dr. Nilesh Kalyanaraman with Anne Arundel County’s health department. “We know what we need to do to control this surge.”

Earlier this week, the Montgomery County Council approved new restrictions on businesses and restaurants that have already gone into effect — and similarly to those in Prince George’s County and Anne Arundel County, they were more strict than the new restrictions imposed by the governor. Montgomery County Executive Marc Elrich wrote on Twitter that he wished Hogan had “been more aggressive scaling back” the reopening of certain businesses and activities.

This story was updated to correct a COVID data metric from average per 10,000 residents to average per 100,000 residents, to include more details about the role of young people in D.C.’s spread, additional information from Alexandria and Arlington, comment from the office of Virginia Governor Ralph Northam, and to reflect what Governor Hogan announced on Thursday.