OLYMPIA – Masks are back for everyone at large outdoor gatherings.

Starting Monday, everyone in the state – regardless of vaccination status – will be required to wear a mask at outdoor gatherings of 500 people or more, Gov. Jay Inslee announced Thursday. The requirement will affect sporting events, fairs, concerts and other large gatherings.

“The outdoors remains the safest place for people to be,” Inslee told reporters. “But when people are packed tightly together, we’re getting transmission and ultimately, hospitalizations and death.”

In the last six weeks, five outdoor events have turned into superspreader events, or large events that resulted in a significant COVID-19 spread, Secretary of Health Dr. Umair Shah said. Those are the Watershed Music Festival, Omak Stampede, Bass Canyon Music Festival, Whatcom County Fair and Grant County Fair.

The delta variant has continued to bring a new surge of COVID-19 cases statewide. Cases are now at their highest since the pandemic began. Last month, the state reinstated a mask mandate indoors for everyone, vaccinated or not.

“When you combine large crowds with the delta variant without any mitigation measures in place, we’re going to keep seeing these superspreader events,” Inslee said.

King and Pierce counties implemented similar outdoor mask requirements last week. The move dovetails with the sweeping announcement by President Joe Biden urging private businesses to require vaccination or testing as a condition of employment.

The biggest concern right now in Washington is COVID-19 hospitalizations, currently at an all-time high.

There are 1,767 people hospitalized with COVID-19 in Washington hospitals as of Wednesday, and in Spokane County alone there are 221 COVID patients hospitalized.

Shah said the trajectory is starting to slow, but it does not change the fact that the state is seeing “extremely high” case rates and hospitalization numbers.

Last week, Idaho enacted crisis standards of care, a set of guidelines used by hospitals when they are unable to operate at normal levels or in a normal setting, in North Idaho . Kootenai Health had recently converted a resource center to a COVID treatment unit to care for lower-level COVID patients.

Crisis standards of care mean patients might be treated in nontraditional settings, or certain equipment or treatments may not be available. In the most extreme circumstances within crisis standards, care is actually rationed based on stretched supplies or resources.

Washington’s hospital system is not at a point where it needs to use crisis standards of care, Shah said. “And we certainly don’t ever want to get there,” he said.

Most, if not all, acute care hospitals in the state are operating under contingency capacity, meaning that resources or staffing, and care, are not typical at the hospital compared with pre-COVID times. Transferring patients is taking much longer than normal, leading to adverse outcomes, and patients are waiting in hallways for emergency department beds.

“Health care is not an unlimited resource,” Peg Currie, chief operating officer at Providence hospitals in Spokane, told reporters Monday. “Staffing has been problematic across the state.”

Inslee called on the Idaho government to do more to prevent the spread of COVID-19, such as adopting masking requirements.

“Their medical crisis is becoming our problem,” Inslee said, as some Idaho patients have now had to come to Washington’s already stretched hospitals.

Shah said the number of Idaho patients coming to Washington is not currently impacting the state’s hospital system significantly. However, if it does begin to, Shah said the state may need to take additional steps and turn those patients away.

Some Washington hospitals are already starting to make changes to prepare for a surge, such as adjusting staffing ratios or canceling elective surgeries. Elective surgeries have been canceled or postponed in Spokane County for nearly two weeks.

The Department of Health has been working with state agencies and local health care partners to prepare, Shah said. He pointed to the Washington Medical Coordination Center, which is tasked with handling transfer requests of patients when hospitals can’t treat them.

Inslee said the state is already looking for assistance for hospitals that are short-staffed, such as using contracted workers or calling in the National Guard.

For now, the state has the resources to handle what’s happening in the hospital system, Shah said, but “at some point, it could break, and we want to do everything we can to prevent it.”

“Our health care system will be strained and stretched unless we do the right thing,” Shah said.

Here’s a look at local numbersThe Spokane Regional Health District reported 440 new COVID-19 cases on Thursday and seven additional deaths.

There have been 778 deaths due to COVID-19 in Spokane County residents.

There are 221 people hospitalized with the virus.

The Panhandle Health District reported 321 new cases on Thursday.

There are 116 Panhandle residents hospitalized with the virus.