Outdoor trick-or-treating has been greenlighted by federal and state health officials this year, a sign that life is starting to get back to normal after soaring COVID-19 cases and hospitalizations this summer spurred heightened restrictions.

Last year the U.S. Centers for Disease Control and Prevention discouraged trick-or-treating, advice echoed by Hawaii’s Department of Health, leaving kids with limited places to show off their Halloween costumes. This year CDC Director Rochelle Walensky endorsed the outdoor activity while urging people to stay in small groups and avoid crowded Halloween parties.

The state Department of Health issued its own Halloween safety guidance Monday, urging revelers to incorporate a cloth or surgical mask into their costumes and provide “low contact, pre-packaged treats” for trick-or-treaters.

State Health Director Dr. Libby Char said in a news release that “outdoor gatherings are safer, and consistent hand washing and mask wearing are recommended.”

The state Health Department also put forth its own ideas for a safer Halloween, including “hosting a scary movie watch party online,” organizing a pumpkin carving contest with neighbors and hosting a virtual Halloween costume contest.

Health officials also reiterated their advice that everyone age 12 and older get vaccinated against COVID- 19. Federal health officials are expected to approve the Pfizer-BioNTech vaccine for children as young as 5 in coming weeks.

State restrictions on the size of social gatherings remain in place, including a maximum 25 people outdoors and 10 people indoors.

Hawaii’s coronavirus cases have fallen steadily since peaking in early September and now average 115 new cases a day statewide. The percentage of COVID-19 tests coming back positive has fallen to an average of 1.7% over the past week. On Monday the Department of Health reported 117 new infections and four new coronavirus- related deaths, bringing the death toll since the start of the pandemic to 876.

The number of people hospitalized with COVID-19 stood at 90 on Monday, according to state data, down from a high of 473 on Sept. 7, with similar declines seen in the number of patients in intensive care units and on ventilators.

Hawaii is now one of seven states that have been downgraded by the CDC to the “substantial” category in regard to community transmission, the second-highest category, which includes states that have reported 50 to 99 new cases per 100,000 people over the past seven days and have a test positivity rate of 8% to 9.99%. Hawaii’s test positivity rate is far lower, at 1.7%, but the state remains in the elevated category because it has recorded 59.8 cases per 100,000 people over the past week.

As in Hawaii, the number of reported cases nationally has fallen sharply since the delta variant caused cases to spike in July.

“The situation has definitely improved, there is very little question of that,” said infectious disease expert Tim Brown on the Honolulu Star-Advertiser’s “Spotlight Hawaii” livestream program on Monday. Brown attributed the decline in cases to the increase in vaccination, continued mask- wearing and the increased levels of natural immunity that have been obtained as the delta variant spread rapidly through the unvaccinated population.

As of Monday, 92% of the eligible population, those 12 and older, had received at least one dose of a vaccine, and 82.2% of that population was fully vaccinated. Nearly all adults 65 and older are fully vaccinated.

Still, Brown, a senior fellow at the East-West Center, said that he thinks the state should be “very, very cautious going forward in lifting our restrictions.”

“The worst thing we could do is just lift all restrictions overnight,” he said.

Brown said he was particularly worried about spread during the holiday season, and said Hawaii could see another surge but that it would likely be more gradual and easier to track. He said the virus can still spread quickly through unvaccinated pockets of the population, and warned that the vaccines’ effectiveness has shown to wane over time.