AUSTIN (KXAN) — A possible surge of COVID-19 cases projected to be worse than the June/July peak could threaten holiday season activities, health leaders say.

On Tuesday, Austin-Travis County Interim Health Authority Dr. Mark Escott warned Travis County commissioners that if cases continue to worsen, we could be back in Stage 4 by Nov. 4 according to University of Texas COVID-19 projections.

Escott says those UT projections don’t take into account Monday’s new hospitalization admissions, which were down somewhat, but moving back into Stage 4 of COVID-19 restrictions is still possible.

“Right now, the projections for Thanksgiving are bleak,” Escott told commissioners.

While the moving average of new cases has seen some flattening in the past week, there has still been a consistent increase in hospital bed usage overall in the past three weeks, Escott said.

On top of that, ICU bed usage also increased in about the same three-week time frame. By the third week in November, the UT projections say Austin and Travis County could be looking at significant hospital bed usage, according to Escott.

Two age groups seeing increased hospitalizations in the past week include the 60-69 and the 80+ age range, with 80+ experiencing a big jump in percent positive, according to Escott. The 10-19 age group has seen a decrease in hospitalizations in the past week.

He says he doesn’t want to experience the same reality El Paso is facing right now. El Paso recently reported a nearly 300% increase in COVID-19 hospitalizations since the start of the month, which is straining area hospitals.

“We are very concerned about what’s happening in El Paso and Dallas and San Antonio, other jurisdictions,” Escott said. “We’re also very concerned that we’ve got Halloween coming up this weekend, and the potential for that to lead to an even worsening of the projections for the subsequent weeks.”

Escott says according to current projections, if the transmission rate doesn’t change, Austin and Travis County could face as many as 700 people in the hospital with COVID-19 by the third week of November. He says more than 200 of those would be in the ICU.

Comparitavely, 114 people were in the hospital for COVID-19 in the Austin area Monday, and 43 of them were in the ICU.

“That’s terrifying,” said Travis County Commissioner Brigid Shea when she heard the projections Tuesday. “And if that’s what we’re looking at, that sounds to me like an El Paso-style level of outbreak.”

Escott is concerned about holidays, because family gatherings are when health leaders are seeing transmission taking place. He says they’re not really seeing the virus being spread in grocery stores or offices, where strict guidelines are in place, but rather the transmissions are happening when people, who are asymptomatic or displaying mild symptoms, gather with family and friends.

Escott says only then do people realize they have COVID-19, when they’ve already spread it to their loved ones.

“If disease transmission is increasing, which it appears that it has been, then things get ugly very quickly,” he said. “Back in June, we saw in a similar stage to where we are now, and three weeks later—we were in crisis.”

The UT projections are predicting the possible second surge to be worse than the June/July peak. If it is, it’ll take longer to flatten the curve again, according to Escott. It won’t be over by Christmas.

“We all have to do our part and ensure that we are acting safely, so that we don’t have a miserable Thanksgiving and Christmas,” Escott said.