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MANSFIELD -- Richland County worsened to "red," or level three, Thursday in the state's four-tiered, color-coded COVID-19 ratings, according to the Ohio Department of Health website.

If the local situation doesn't improve, Richland County could become the state's first "purple," or level four, county since the Public Health Advisory System was implemented in July.

Ashland County remained "red" again this week. Crawford County was "orange" and Knox County was again "yellow."

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Eleven counties were "red" this week around the state, though Richland County is the only one placed on the state's "watch" list in danger of becoming purple.

"Richland County meets six of seven indicators this week and is on the watch list," Gov. Mike DeWine said during his Thursday press conference.

"The county has more than doubled their increase in new cases, growing from 4.1 average new cases per day on Sept. 19 to 9.1 average new cases per day on Sept. 25. The county added 95 new cases during the past two weeks.

"These case numbers exclude incarcerated individuals," DeWine said. "The county also has sustained increases in healthcare utilization, including outpatient and emergency department visits and hospital admissions," DeWine said.

"Local health department officials report community spread and outbreaks at correctional centers and a long-term care facility. They also report that families continue to plan events and that there are parts of the county where there is little mask wearing, which can lead to additional spread," DeWine said.

Richland County, which was "yellow," or level one, during a month-long period in late summer, has been impacted by a recent COVID-19 outbreak at the Richland Correctional Institution.

According to the Ohio Department of Rehabilitation and Correction website, updated Thursday, Richland Correctional Institution had 71 inmates currently testing positive and 56 staff members. More than two dozen inmates had been hospitalized earlier this week.

The county's numbers do include RICI prison staff members, since they are in the community when they are not working.

According to the ODH website, three local long-term care facilities each had one new positive test.

This week, Richland County triggered six of the state's seven indicators, meaning it will remain at level three for one week. If six to seven indicators are also triggered next week, the county will move to level four, according to Richland Public Health educator Reed Richmond.

At level four, Richland County would have "severe exposure and spread" and stay-at-home orders would be issued, Richmond said.

Richland Public Health Commissioner Sarah Humphrey said the question county residents need to be asking is what they can do to slow the spread of coronavirus.

“What can I do to help reduce the spread of COVID-19 virus, to help businesses, schools, athletics, and everyday life from being disrupted further, and to simply keep those who may not be as healthy as themselves not end up sick, hospitalized, or worse?” Humphrey said.

“It is going to take our community, working together, to change the trajectory of COVID-19 in Richland County,” Humphrey said.

“This includes wearing masks when necessary, social distancing, staying home when sick, and not to hold unnecessary family and social get-togethers. Right now, a common focus is to keep children in the schools safely, in an environment where we know they thrive. In order to do this, we all need to recognize the role we play in keeping others healthy and simply do our part," Humphrey said.

Richmond said the level three designation this week means there is "very high exposure and spread" of COVID-19 in Richland County. He said county residents are encouraged to limit activities as much as possible and to follow all current health orders.

The ratings system was launched by Gov. Mike DeWine in July to measure the virus spread in each of Ohio's 88 counties. A county meeting 0-1 indicators is yellow; 2-3 is orange; 4-5 is red; and 6-7 are purple.

The six indicators triggered in Richland were:

-- new cases per capita (78.4 cases per 100,000 residents.

-- sustained increase in new cases (4.1 cases on 9/19 to 9.1 on 9/25).

-- proportion of cases not in a congregate setting.

-- sustained increase in emergency department visits (3.3 average visits on 9/24 to 7.7 on 9/29)

-- sustained increase in outpatient visits (11.4 average visits on 9/9 to 23.4 on 9/14)

-- sustained increase in hospital admissions (0 average visits on 9/19 to 4.0 on 9/28)

The only indicator not triggered by Richland County was intensive care unit (ICU) bed occupancy.

Richmond said the facial coverings mandate remains in place. This includes when in any indoor location that is not a residence; outdoors and unable to consistently maintain a distance of six feet or more from individuals who are not members of their household; waiting for, riding, driving or operating public transportation, a taxi, a private car service or ride sharing vehicle.

For more information about the Ohio Public Health Advisory System, visit http://coronavirus.ohio.gov.

For more information about the coronavirus situation in Richland County, visit https://www.richlandhealth.org/ and follow the coronavirus links in the sliders at the top of the page.

If you have questions, call the Ohio Department of Health COVID-19 Call Line 1-833-427-5634. The call line is open from 9:00 a.m. to 8:00 p.m. each day, including weekends.

City editor. 30-year plus journalist. Husband. Father of 3 grown sons and also a proud grandpa. Prior military journalist in U.S. Navy, Ohio Air National Guard. -- Favorite quote: "Where were you when the page was blank?"