The rate of COVID-19 outbreaks in Colorado child care centers more than tripled in October, prompting reminders from the state about key health and safety precautions.

State officials tallied around three dozen outbreaks in child care programs in October, compared with 10 in September. There were a dozen outbreaks Denver, with smaller numbers in Adams, Boulder, Jefferson, and El Paso counties. Colorado has about 4,500 licensed child care providers serving children ages 0-5 and school-age children.

An outbreak is defined as two or more cases in which public health officials believe transmission occurred within a particular facility.

Unlike schools, many child care centers have been open during most or all of the pandemic. The first child care outbreaks occurred in May in two suburban Denver centers, and there have been periodic outbreaks since. However, October saw a notable increase in the number of outbreaks.

The jump coincides with rising community spread in metro Denver over the past several weeks. State officials have now classified both Denver and Adams County in the second-highest of five risk categories, called “Safer Level 3.” Most other nearby counties fall into the middle category, “Safer Level 2.”

Around 40 K-12 schools also had COVID-19 outbreaks in October, with nine in Adams County, seven in El Paso County, six in Denver, and five each in Arapahoe, Douglas, and Jefferson counties. That compares with 18 outbreaks in September. Colorado has more than 1,900 K-12 schools.

In most of the child care outbreaks, only a small number of staff and students tested positive for COVID-19, typically two to four per center. In a few cases, the numbers were eight to 10. In about one-third of the outbreaks, additional staff members or students were considered “probable” coronavirus cases, but didn’t have lab-confirmed results. No deaths were associated with any of the child care center outbreaks.

Child care providers are required to follow a host of health precautions to prevent the spread of coronavirus, including conducting health screenings when children arrive, keeping children in the same groups all day, and frequently sanitizing classroom surfaces. Children over 3 years old must also wear masks, except when eating or napping.