BOISE, Idaho (AP) — Idaho Gov. Brad Little warned residents that car crash victims could be treated in hospital conference rooms and diabetics with infections could be denied beds if hospitals continue to fill and the state has to initiate crisis standards of care.

The dire warning came Thursday, roughly an hour after the state's public health agency announced that COVID-19 is now the leading cause of death in Idaho.

Still, the Republican governor said he wouldn't order a statewide mask mandate — something health care leaders have requested to slow the virus' spread — or enact additional restrictions at this time. Instead, Little opted to keep Idaho in stage two of his “Idaho Rebounds” plan, restricting group sizes to 10 people or fewer, except for religious or political gatherings.

The Idaho Department of Health and Welfare said COVID-19 was the state's leading cause of death in November. The illness killed 247 people last month, and over 1,100 residents to date, making it the third leading cause of death in Idaho for the year.

That’s about four to five times the number of annual deaths from flu and pneumonia. More than 116,000 residents have been infected. A northern Idaho doctor who took part in the news conference said some of them could face lasting lung damage from the disease.

“This is not like any virus I’ve ever seen,” said Robert Scoggins, a doctor at Kootenai Health in Coeur d’Alene who specializes in pulmonary diseases and critical care medicine.

Stage two of the Idaho Rebounds plan also requires masks at long-term care facilities, recommends that at-risk residents self-isolate, and encourages businesses to allow employees to work from home. Bars, nightclubs and restaurants can remain open but patrons must be seated.

Little was among the first governors last spring to publicly wear a mask and has encouraged others to do so. However, anti-maskers say wearing a mask is an infringement of their freedom, mandate or not, and despite rising infections and deaths.

Idaho has a projected $630 million budget surplus despite the pandemic, and Little has floated plans for unspecified tax cuts as well as investments in education and roads. But the state’s budget has been buoyed by federal coronavirus relief money that’s now drying up, including unemployment assistance at the end of the month.

“I have got to get these numbers under control,” Little said. “I’ve got to get better compliance. I’ve got to get people choosing to do the right thing so that we can go back and take advantage of this economic prosperity instead of having it diminished by us having to spend extra money on health care, businesses slowing down, and kids being out of school.”

Little has left it up to regional health districts to decide whether to issue mask mandates in their own communities. The health districts are led by board members, most of whom are not medical professionals and who often face heavy pressure from community members who oppose mask mandates. Some regional health boards have asked Little to order a statewide mandate, citing the local pressures they face, to no avail.

Recent Central District Health board meetings have been disrupted by protest, forcing board members to delay votes on a proposed regional mask order.

During the press conference Thursday, Little repeatedly declined to say whether he believes issuing a statewide mask mandate would do more harm than allowing the current trajectory of coronavirus spread to continue. Hospital leaders with Saint Alphonsus Health System and St. Luke's Health System have both said that they expect the state to reach “crisis standards of care” levels — where health care providers must choose which patients get access to limited life-saving treatment based on who is most likely to survive — as soon as the end of December or the start of January.

“If we can’t slow the spread, this situation will affect you personally, whether you have COVID or not,” Little said. Heart attack or car-crash victims, for example, might not get treatment.

Little said he had metrics that would help him decide if and when to issue a mask mandate or other restrictions, but declined to elaborate.

Little said that besides the surge of patients, hospital workers are getting sick, also potentially limiting how many people can receive treatment.

Idaho’s largest hospital system, St. Luke’s Health System, announced Thursday it would hold an urgent, drive-thru career fair next week in hopes of recruiting additional staffers to help care for COVID-19 patients.

The hospital system is trying to hire housekeepers, food service workers and laundry technicians as well as staffers to help transport patients and customer service workers to help refer patients to clinics.

Scoggins, the doctor at Kootenai Health, said he’s concerned his facility won’t be able to treat patients, and there won’t be anywhere to send them. He’s also concerned about the hospital’s workers, who have been fighting the disease since spring.

“Our staff is becoming fatigued and burned out,” he said.