After months of resisting a requirement for Iowans to wear masks, Gov. Kim Reynolds on Monday night announced the state’s strictest mitigation efforts yet – including a face-covering mandate in some situations – as she warned that Iowa’s healthcare system is being pushed to the brink.

“Right now, the pandemic in Iowa is worse than it has ever been,” Reynolds said in a 10-minute livestreamed address, noting that in the past two weeks 52,000 new virus cases have been diagnosed, the same number that were diagnosed between March and mid-August.

Daily new hospitalization rates have more than doubled from 100 a day in late October to more than 200 a day, which Reynolds said “is not sustainable.”

Her press conference came after a week where Iowa COVID-19 cases jumped 203%, and the White House coronavirus task force called for “immediate action.” In a report dated Nov. 8, the task force called on Iowans to wear masks in public and to avoid gatherings with anyone outside their immediate household until positivity rates fall significantly. Iowa was third in the rankings for the highest per capita rate of positive COVID-19 cases in the nation over the past seven days as of Tuesday morning. Positivity rates for people tested in Clinton and Jackson counties were 29.3% and 31.7% respectively, among the highest in the state.

Reynolds said she was afraid the mild cases experienced by many people who have had COVID-19 have made Iowans “complacent.”

 “The number of Iowans in the hospital with COVID-19 has doubled to the point that one out of every four hospital patients has the virus. As cases continue to climb, hospitalizations will also grow at a similar pace,” she said.

“If our healthcare system exceeds capacity it’s not just COVID-19 we’ll be fighting. Every Iowan who needs medical care will be put at risk,” she said.

Ambulances transferring a COVID-19 patient may not be available to respond to an accident on a rural county road. Family members who suffer a heart attack or stroke may have to be transported many miles away to receive treatment, she said in explaining her decision to put stronger measures in place.

The mandates that began at midnight Monday include:

 nMasks are required to be worn by people in indoor public spaces and unable to social distance for 15-minutes or longer, including visitors and employees inside state buildings.

nIndoor social, community, business and leisure gatherings are limited to 15 people. Outdoor gatherings are limited to 30. This includes wedding and funeral receptions, family gatherings and conventions. It does not restrict gatherings that occur in normal daily business or government operations.

nWith the exception of high school, collegiate and professional sports, all organized youth or adult sports activities are suspended, including basketball, wrestling, gymnastics, swimming and dance. At high school sports and extra-curricular activities, spectators are limited to two people per student and are required to wear masks.

nRestaurants and bars must close at 10 p.m. and cannot host private gatherings of more than 15 people. Masks must be worn by staff who have direct contact with customers and by customers when they are not seated at a table.

nInpatient, elective procedures will be reduced by 50%.

The restrictions will be reassessed in a week. Additional measures might be added based on hospital capacity, Reynolds said.

“This isn’t about mandates; this isn’t about government. There isn’t enough law enforcement in the country to make sure that every Iowan is wearing a mask when they should. There aren’t enough sheriffs in Iowa’s 99 counties to shut down every noncompliant bar,” she said. “If Iowans don’t buy into this, we lose. Businesses will close once again. More schools will be forced to go online, and our health care system will fail. The cost in human life will be high.”

Iowa Democrats issued a statement calling Reynold’s actions “too little, too late,” saying her “half-measured attempt” at a mask mandate will not be enough to slow the spread of the virus.

Eli Perencevich, an epidemiologist at the University of Iowa Hospitals and Clinics, tweeted that Reynolds’ new mask requirements do not go far enough.

“Ask yourself this: 1) does the virus only spread after 10 p.m. 2) if you don’t need to wear a mask unless you will be next to someone for 15 minutes, will you ever need to wear a mask? The answer to both of these questions is no,” his tweet read.