NEW ORLEANS (AP) — Efforts to mitigate COVID-19 at large New Orleans events — including mask mandates or requirements attendees be vaccinated or have a negative test — will likely continue into the fall because of low state vaccination rates and the spread of dangerous variants, the city’s health director said Tuesday.

Dr. Jennifer Avegno’s remarks came at a news conference focusing on the city’s efforts to encourage vaccinations in a state that has one of the nation’s lowest vaccination rates. Louisiana health officials on Tuesday said COVID-19 cases are surging, largely among non-vaccinated people, as the more easily transmissible Delta variants spread in the state.

Avegno’s remarks come as the city looks to a new NFL and college football season, and the return of major entertainment events such as the New Orleans Jazz and Heritage Festival, which was postponed form its usual spring dates.

The city currently allows major events to have full capacity if there is a mask requirement or if attendees are required to have either a vaccination or a negative COVID test.

“I think folks should expect that that might the case in the fall,” Avegno said. “We would all love to have large events that did not require some degree of mitigation. And before Delta I was maybe a little more confident that we would get there.”

Mayor LaToya Cantrell’s spokesman, Beau Tidwell, said nearly 64% of the city’s adult population has had at least one shot of vaccine, much higher than the state’s overall rate of less than 40 percent of the total population.

But Avegno said she’s seeing signs of a rising infection rate in the city and an increase in the percentage of positive tests. And she said she’s concerned about infected people from other areas spreading the virus when they visit.

Statewide, 454 people were reported hospitalized with COVID-19 Tuesday — up from 251 less than two weeks ago.