State College’s ordinance requiring masks to be worn in businesses and other places open to the public will remain in place as COVID-19 cases in the region and throughout the state continue to surge to record levels.

Based on a recommendation from the borough’s Board of Health, borough council on Monday night unanimously approved an amendment extending the ordinance until the COVID-19 transmission rate in Centre County drops below the Centers for Disease Control’s “substantial” level, which is defined as fewer than 50 new weekly cases per 100,000 residents.

The CDC scale rates community transmission at four levels: low, moderate, substantial, and high. At the substantial and high (100 new cases per 100,000 people over seven days), the CDC recommends all people, regardless of vaccination status, wear masks in public indoor settings.

Council voted 6-0 to extend the ordinance based on transmission level. Councilwoman Janet Engeman was absent. Prior to Monday, the ordinance had been scheduled to expire at the end of January.

“This is really in the line of the very least we can do,” council President Jesse Barlow said of the ordinance.

The ordinance requires anyone over the age of 2 inside any building open to the public to wear masks, with some exceptions. Businesses and organizations are required to post notice of the mask requirement at all public entrances.

Individuals and businesses found to have violated the ordinance can be found guilty of a civil infraction and fined $300, but Borough Manager Tom Fountaine said previously that has not been enforced. State College police have not issued any citations since the ordinance was originally enacted in September and have instead focused on education, a department spokesperson said.

State College is the only municipality in Centre County with a current mask mandate. Penn State has an indoor mask requirement for all campus buildings, and Patton Township is considering its own ordinance, but Fountaine said he has heard no indication that any other Centre Region township is considering such a requirement.

Centre County has been at the highest level of community transmission since August 27 and sees no sign of abating soon as the highly contagious omicron variant drives spread. The county had 3,264 new cases in December, its highest monthly total of the pandemic.

In the first 10 days of January, the county has recorded four of its five largest daily case increases since the start of the pandemic and with 2,239 infections this month has already surpassed the total of 2,045 for the entire month of January 2021.

Statewide, Pennsylvania has shattered its monthly and daily COVID-19 case increases, with the commonwealth’s 13 highest single-day increases occurring in the last 13 days.

Pennsylvania hospitals have seen a corresponding spike in COVID-19 inpatients, with a record number of hospitalizations for the virus each of the past five days.

Locally, Mount Nittany Medical Center continues to see an elevated number of COVID-19 inpatients, though the daily census has moderated since reaching a pandemic high of 76 on December 14. Centre County’s only hospital had 47 COVID-positive inpatients ranging in age from 12 to 93 on Monday and has had a daily census between 44 and 48 COVID inpatients since the start of the year.

About 74% of Mount Nittany’s COVID inpatients on Monday were not vaccinated, in line with the approximately 70% of unvaccinated COVID inpatients the medical center has had since hospitalizations began to rise in September.

The surge of cases and hospitalizations has had a well-documented impact on Mount Nittany’s services. After weeks of postponements, the medical center on Monday resumed elective surgeries requiring an overnight stay on a limited basis, and emergency department wait times have been longer than usual. In early December, Mount Nittany took the extraordinary measure of diverting ambulances for about 12 hours because the ER was so overwhelmed.

“This is having a direct impact on people, on businesses and clearly on the health care system,” Tom Charles, executive vice president of system development, said during an update to council at the start of Monday’s meeting.

“Other services that we normally provide are being affected because we have to direct resources to the care of covid patients and also patients who we are unable to discharge because of staffing issues in area nursing homes.”

The omicron variant, he noted, is much easier to contract and spread and that immunity is lower without a booster shot.

“Even though we’ve had a portion of the population that’s been fully vaccinated — meaning two doses of Pfizer or Moderna or one of Johnson & Johnson — we have a lower proportion that’s actually received booster shots, and what we know from experience is that the protection against omicron is significantly reduced without being boosted,” Charles said.

Cases are rising at a much faster rate than hospitalizations during the current wave, but, Charles said, the sheer volume could create a challenge.

“On a per-capita basis, the number of hospitalizations may not be as great in this wave. The challenge is so many more people are getting COVID that even if on a per capita basis the number is lower, so many people are getting it that it’s going to drive the number of hospitalizations up over time and that’s a concern,” he said. “Overall I would say we’re not seeing a significant sustained spike in ICU utilization and ventilator and oxygen utilization. That’s tended to be more intermittent in this wave.”

He added that masking and avoiding large gatherings, even if vaccinated, remain critical.

“We’re really doing the best that we can but the underlying thing that will make our situation get better is to see some relief in the spread of COVID in the community, the ability to get patients out of the hospital and discharged to nursing homes and allow us to return to somewhat more normal operations,” Charles said.

“We are a long way from where we normally are and even a long way from where we were in some respects a year ago.”