NASHVILLE, Tenn. (WKRN) — The latest report from the White House Coronavirus Task Force says the spread of COVID-19 in Tennessee over the last month “has become deeper and unyielding,” citing Halloween and “related activities” as contributors.

The information was included in a document, dated Nov. 15, obtained by ABC News. The report, which is provided to governors across the United States, suggests 47 states and the District of Columbia are in the “red zone” for coronavirus cases, including Tennessee.

The “red zone” indicates states with more than 100 new cases per 100,000 residents for the previous week. 18 states were on this list in July, while the number jumped to 38, as of Nov. 1.

Tennessee is currently ranked number 20 on the list with 400 new cases per 100,000 residents, compared to the national average of 294 per 100,000. The list is topped by states including North Dakota, South Dakota and Iowa.

The report indicates 81 of Tennessee’s 95 counties are in the “red zone.” The five counties topping the list, in order, are Rutherford, Knox, Hamilton, Williamson and Sumner.

During the time period of Nov. 7 through Nov. 13, the report states, on average, 221 patients with confirmed COVID-19, and 121 patients with a suspected case of the virus, were reported as newly admitted each day to hospitals in Tennessee.

The White House Coronavirus Task Force wrote in the report, “over the past month, the spread in Tennessee has become deeper and unyielding. Week over week increases in hospitalizations, reported limited bed availability, and increasing deaths correlate with Halloween and related activities.”

The report continued, “with Thanksgiving and upcoming holidays, Tennesseans must understand the COVID-19 situation statewide. Serious messaging and action is needed from state leadership; recommending Tennesseans wear masks in public settings communicates the current risk level and identify actions all Tennesseans need to take.”

The task force added, “effective practices to decrease transmission in public spaces include limiting restaurant indoor capacity to less than 25% and limiting bar hours until cases and test positivity decrease to the yellow zone.”

Only three states are not in the “red zone,” according to the White House Coronavirus Task Force — Maine, Vermont and Hawaii.