INDIANAPOLIS (AP) — The Indiana State Department of Health on Wednesday again increased the number of counties designated as higher-risk locations for coronavirus spread as the state continues to record sharp increases in hospitalizations and new infections.

Fifty-three of Indiana’s 92 counties were placed in orange or red levels under the agency’s color-coded weekly tracking map update, compared to 40 counties that were at those levels last week.

While one less county is listed under the most severe level compared to last week, more than half of the counties across the state are designated as higher-risk — the most since the state implemented the rating system in September.

“We’re seeing COVID-19 spread in virtually every county,” Republican Gov. Eric Holcomb said during a news conference Wednesday. “Our hospitals are under a tremendous amount of pressure."

More than 100 people a day are being admitted to Indiana hospitals with COVID-19 symptoms, said Dr. Kristina Box, Indiana’s health commissioner. Almost 70% of those hospitalized with the coronavirus in Indiana are age 60 or older, she continued, lending to a new statewide effort focused on protecting venerable populations in long-term care settings, like nursing homes and assisted living facilities.

To slow the spread of the virus, more than 1,300 members of Indiana's National Guard are being deployed to the 133 hardest hit long-term care centers on Nov. 3, assisting with infection control practices like improved COVID-19 testing for facility residents and employees. That support will then expand to all 534 nursing homes in Indiana over the next three weeks, Adjutant General, Brig. Gen. Dale Lyles said Wednesday. The extra help will be available until Dec. 31.

Holcomb decided a month ago to lift nearly all of Indiana’s restrictions while extending the statewide mask mandate. He announced Oct. 14 another month-long renewal of the mask order until at least Nov. 14.

The governor, up for reelection next week, doubled down on the importance of mask-wearing, which he called “a small price to pay” in order to bring COVID-19 case numbers down, as well as for keeping schools and businesses open.

“We can control only what we can control... Our whole posture is, ‘Let’s be proactive, not reactive,’” Holcomb said Wednesday. “We need individuals to understand that their actions have consequences or their inactions have consequences.”

Indiana's highest-risk counties are now in the eastern region of the state, including hotspots in Fayette, Dearborn and Ohio counties. Box said the state has recommended that local officials in those counties take steps to control the size of events and establish other "guardrails” to help reduce virus transmission.

The state’s remaining 39 counties received yellow or blue ratings based on the number of new cases per 100,000 residents and the percentage of tests confirming COVID-19 infections.

Still, Box noted ongoing “challenges” with contact-tracing that could be worsening the statewide spread of COVID-19. The state is seeing an uptick in people who are refusing to answer questions or comply with contact tracers, Box said, as well as families that are neglecting to test multiple people in their homes to avoid quarantines.

“We are seeing an increasing number of people who are just like ‘We’re not going to help you, not going to give you information, not going to quarantine, not going to isolate, we’re just not going to do it,’” Box said. “But it is worth it, and it’s part of what we can do as Hoosiers to try and protect other Hoosiers.”

The state health department’s daily update of its coronavirus dashboard showed 1,679 Hoosiers are currently hospitalized with the coronavirus, the highest since Mid-April. Of those, 470 are in intensive care. Such hospitalizations have grown by more than 69% since Sept. 22 — the day before Holcomb announced the changes.

Now, the state’s availability of open ICU beds has dropped below 30% for the first time since health officials started tracking the metric.

State officials also added 14 more coronavirus deaths on Wednesday to raise the state’s death toll to 4,227, including confirmed and presumed coronavirus cases. That’s an increase of 204 deaths in the past week.

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Casey Smith is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.