Please Note

The Washington Post is providing this important information about the coronavirus for free. For more free coverage of the coronavirus pandemic, sign up for our Coronavirus Updates newsletter where all stories are free to read.

Virginia is recording more coronavirus infections than at any point during the pandemic, creating a new peak in caseloads Monday as numbers rise across the Washington region.

The seven-day average of new cases across Virginia, Maryland and D.C. stands at 2,274, eclipsing a previous record of 2,218 cases that had stood since May 31. Health experts blame colder weather and lax usage of precautions that decrease the virus’s spread, and say the holidays will be a particularly challenging period to wrest control of the pandemic.

The average number of new daily infections across the region has jumped for nine consecutive days, fueled by rises in each jurisdiction. Virginia has hit records for three straight days, while Maryland is about 20 percent below its May peak.

D.C. is recording about half the cases it saw in early May, although the number has more than doubled in the past month.

D.C. Health Director LaQuandra Nesbitt said Monday that the number of new cases in the city is trending in the wrong direction — and that upcoming holiday gatherings could exacerbate that tally. D.C.’s seven-day average stands at 89 cases, up from 36 at the beginning of October.

“Unfortunately, the District of Columbia has not been spared from the rises in the number of covid cases that we are seeing across the country,” Nesbitt said. “We have had concerns about what it would mean for fall and winter season as people have more indoor activity . . . and people may plan to spend more time with their family and friends.”

It’s possible that some of those gatherings took place during Halloween weekend, Nesbitt said. The aftermath of Halloween celebrations could lead to a further rise in cases in the coming weeks, she added, but noted that social distancing, masks and monitoring for symptoms could lessen the impact.

“Being zealous and mindful of what we’re doing as a community can help us keep that curve flattened and not stress our resources, both from a testing perspective as well as our health-care system and hospitalization capacity,” Nesbitt said.

In Maryland, the average daily caseload Monday was 879, up from 530 at the start of October. Officials in Montgomery and Prince George’s counties have recently cited the rising caseloads for keeping their localities at the second phase of recovery.

Montgomery County health officer Travis Gayles said Monday he is “very concerned” about the recent infection surge in neighboring jurisdictions and his suburban county, where new daily infections are the highest since mid-June. The county recently revamped its coronavirus dashboard to better reflect the shift in trends, Gayles said, and is talking to state officials to discuss how to respond to the rise in cases.

Hospitalizations across Maryland have been on the rise for eight consecutive days, reaching a threshold last seen in August. Gov. Larry Hogan (R) said in a Twitter message Wednesday that the state had “concerning trends” and he is speaking with a panel of doctors and public health experts.

Hogan spokesman Michael Ricci said the state has spent several months preparing for another rise in cases. Unlike the initial caseload spike in the spring, he said Maryland has ample testing, existing capacity to care for patients and a contact-tracing operation up and running.

“The governor has said we don’t want to have to revisit the kinds of restrictions we saw in the spring, but much of that is up to each of us and our actions — especially as the holidays near,” Ricci said in an email. “As more activities move indoors, new cases are being driven by small gatherings, and transmission among close contacts and households.”

Hogan has previously said he expected a fall surge but does not intend to reimpose drastic shutdowns to limit its spread.

Virginia’s seven-day average Monday was 1,306 daily cases, up from 747 on Oct. 1. Caseloads in Northern Virginia have risen to their highest level since mid-June, although it remains at about half the May peak. Infections continue to march upward in rural Southwest Virginia, accounting for nearly one-third of all infections in the state.

Virginia Gov. Ralph Northam (D) last week referred to the Southwest as a “hot spot,” saying health officials are working to lower numbers in the region. Northam said Monday he was confident the election could take place safely Tuesday despite the rising trendlines of the coronavirus.

Ballad Health, the largest health system in Southwest Virginia, paused non-emergency elective procedures that require an overnight stay, effective Monday, because of the spike in cases and hospitalizations. Hospital officials said the decision was made because of a lack of medical surgery, intensive care and emergency room nurses available to handle normal patient volumes and a flood of coronavirus patients.

The system, which includes 21 hospitals, has 202 coronavirus patients — 44 of whom are in intensive care, while 24 are on ventilators. Hospital officials said they expect those numbers to rise to 300 patients in the next 10 days, leading to 60 patients in the ICU and 36 on ventilators.

“Our challenge with nursing is probably no different than any other nonurban or rural health system, which came into this pandemic with a shortage of nurses,” said Alan Levine, chief executive of Ballad Health.

Hospital leaders consulted physicians to decide what types of care to defer. Certain hip replacement surgeries and cardiac procedures are among those that have been paused. Sleep studies that require both nurses and respiratory therapists are deferred.

Ballad saw 60 to 70 virus patients during a spike in June. The hospital is gearing up to handle the current spike, as well as an expected influx of flu patients in early December, Levine said.

Hospital officials have begun relocating staff from smaller facilities to larger locations, and have asked Northam to allow paramedics and emergency medical technicians into hospitals to provide support.

The hospital last week announced a 15 percent temporary pay raise for bedside nurses, licensed practical nurses, nursing assistants, respiratory therapists and certain other staff. Levine said it’s unclear how long non-emergency elective procedures will be paused.

The number of coronavirus cases across the greater Washington region is still about half the national average. D.C. is recording an average of 13 new daily infections per 100,000 residents, a number that stands at 25 nationally. North Dakota, with the nation’s highest rate of infection, is recording 148 new infections for each 100,000 residents.

Neil J. Sehgal, assistant professor of health policy and management at the University of Maryland School of Public Health, said the rising caseloads aren’t a surprise to health officials. He said people want a sense of normalcy, which is leading to more behaviors conducive to the virus spreading.

“People have relaxed their vigilance,” he said. “The virus doesn’t relax in the same way we do.”

Sehgal also voiced concerns about family and social gatherings during the holidays, as well as the increase in travel during that period. He said any travel will bring an additional risk of contracting the virus, and urged residents to follow the same basic health precautions in place for months.

“Ten days afterwards, we will know how vigilant people were,” he said.

D.C. health officials on Monday added three states to the city’s list of locations considered “high-risk” for travel because of the pandemic, raising the number of states under the designation to 42.

The growing number of states on the city’s travel advisory means 9 in 10 residents of the country would be required to isolate before nonessential travel in the nation’s capital.

A state is considered high-risk if its seven-day rolling average of new cases is 10 or more per 100,000 people. Under an order from Mayor Muriel E. Bowser (D), anyone who comes to the city from a high-risk state for nonessential reasons must self-isolate for two weeks.

Those who arrive in D.C. from one of the states for essential purposes are asked to monitor for symptoms for two weeks. No states were removed from the list Monday, but California, Oregon and New Jersey were added, while Maryland and Virginia remain exempt from the order.

About 296 million Americans — roughly 90 percent of the population — live in states that are included in the city’s travel advisory. New York is by far the most populous state not included in the advisory.

The greater Washington region Monday recorded seven additional deaths and 1,945 new coronavirus cases — ending a six-day streak with daily caseloads surpassing the 2,000 mark. Virginia added 1,026 cases and three deaths, Maryland added 850 cases and three deaths, and D.C. added 69 cases and one death.

Despite the rise in caseloads, the rate of virus-related deaths has held relatively steady since July. Hospitalizations have ticked upward slightly in recent days.

Rebecca Tan and Gregory S. Schneider contributed to this report.