O'FALLON, Mo. (AP) — With the number of new COVID-19 cases soaring and hospitals nearing capacity, St. Louis County's executive, Dr. Sam Page, on Friday announced strict new regulations that seek to slow the spread of the disease.

For four weeks starting Tuesday, St. Louis County residents are being told to stay home except to go to work or school, shop, exercise or get medical care. Residents were advised to establish social groups of 10 or fewer relatives and/or friends. The four-week period includes Thanksgiving but ends before Christmas.

Also, in-person service at bars and restaurants will be shut down, though carry-out and outside dining will be allowed. Businesses, gyms and places of worship will be reduced to 25% capacity, down from 50%. Those inside must wear masks.

“This won’t be easy and this won’t be fun,” Page, a Democrat, said.

The city of St. Louis, which is not part of the county, separately issued an order late Thursday prohibiting gatherings of more than 10 people, effective Saturday. The order placed no new restrictions on in-person dining or additional capacity limits.

Other U.S. cities are taking steps to try and bring the virus under control. Chicago on Thursday issued new restrictions limiting social gatherings to 10 people, starting Monday. Mayor Lori Lightfoot also urged people to stay home whenever possible.

Missouri's health department on Friday cited 4,005 new cases and 20 more deaths, which brought its totals since the pandemic started to 229,376 confirmed cases and 3,359 deaths.

The state’s COVID-19 dashboard lists 2,328 hospitalizations across the state, which is more than six times the number in July, shortly after Republican Gov. Mike Parson allowed the state to reopen for business. Hospitalizations have doubled in the past month, and the Friday total was a new record that topped the mark set Thursday by 171.

Space to care for the most critically ill patients is also shrinking quickly. The state dashboard shows that there are no intensive care unit beds available in northeastern Missouri, and just 19% of such beds are available in Kansas City. In St. Louis, some hospitals are being forced to turn away transfer patients from rural areas because of a lack of available beds.

“We can’t possibly, responsibly wait any longer to take the steps that are needed to get the spread of this virus in check in our community,” said Page, who is also a physician.

In a separate news conference, St. Louis Metropolitan Pandemic Task Force Director Dr. Alex Garza made an emotional plea for Parson to issue a statewide mask mandate. His voice breaking, Garza said St. Louis-area hospitals will soon run out of bed space and staffing to treat not only COVID-19 patients, but people with other illnesses.

“I’m not a dramatic guy,” Garza said. “This scares me.”

Dr. Shane Wilson, who works at the 25-bed Scotland County Hospital in Memphis, Missouri, echoed the call for a statewide mask mandate. Wilson said the hospital is full and understaffed because so many workers have the virus or are in quarantine. They're sending patients to hospitals up to two hours away, and that's only when they can find one accepting transfers.

“I’m telling you right now, we’re run over — we’re right on the verge or being run over,” Wilson said.

It seems unlikely that Parson will budge. His spokeswoman, Kelli Jones, said in a statement that Parson “has led with a balanced approach since day one of this pandemic and will continue to do so.” She said his administration works with the Missouri Hospital Association and a panel of infectious disease doctors to monitor health care capacity.

“Governor Parson has been very clear and consistent about his support for local control. Every individual MUST take action to minimize the spread of COVID-19,” Jones said.

Page's orders drew immediate criticism from Republican St. Louis County Councilman Tim Fitch. He said the root of the virus spread in the St. Louis region is from outlying counties that have avoided mask mandates and other restrictions.

“It’s absolutely the wrong strategy,” Fitch said of Page’s plan. “You don’t punish your residents and businesses to try and make a point with surrounding jurisdictions.”

But Page has cited ample evidence that many in St. Louis County also are becoming lax. Earlier this week, he noted that up to 200 people attended a Halloween party at the home of a high school student. At least five people who were at the party have since tested positive.

Page acknowledged that there is “no way” all of the rules can be enforced, but he expects most residents and business operators to understand why they are necessary and to comply. When severe restrictions were in place in the spring, the county sent cease and desist letters to businesses in violation. The county also sued two fitness centers that opened at a time when they weren’t allowed to do so.