INDIANAPOLIS (AP) — Indiana health officials confirmed 28 more COVID-19 deaths on Thursday, and the state’s seven-day rolling average of new cases of the respiratory disease has doubled in three weeks.

The Health Department’s daily update showed Indiana’s seven-day rolling average of newly confirmed COVID-19 infections reached 1,653 as of Wednesday. That number, up from 825 new cases on Sept. 24, is the highest level the state has seen during the pandemic.

While Republican Gov. Eric Holcomb announced Wednesday he would extend his statewide mask order for another month, he decided against reinstating tougher restrictions at the statewide level.

Instead, Dr. Lindsay Weaver, chief medical officer for the Indiana State Department of Health, outlined “very clear guidance and expectations” regarding actions that should occur within each county based on its rating in the state’s color-coded rating system for coronavirus risks, though none of the recommendations come with guaranteed restrictions or specific enforcement mechanisms.

State metrics released Wednesday indicate an increase in counties moving into the orange rating – up to 21 from eight last week. Weaver said state health officials will convene local officials in these counties to discuss necessary restrictions and ways of monitoring social distancing requirements.

For counties in red — indicating the most severe level of COVID-19 spread — Weaver said state health officials could take such actions as limiting the size of social gatherings and restricting capacity inside businesses. No guidance was provided, however, for changes to in-person classes or the need for school closures.

Western Indiana’s Fountain County, the only currently rated red, has traced many COVID-19 cases in its recent surge back to group gatherings and poor compliance with safety protocols, including wearing masks, said Dr. Sean Sharma, health officer for the Fountain and Warren County Health Department.

To help curb the spread, the local health department is now recommending schools temporarily move classes online and cancel extracurricular activities. There are no enforceable restrictions yet, but Sharma said that could be a next step if the rate of virus spread doesn’t improve.

Still, Holcomb’s Democratic challenger in the November election, Dr. Woody Myers, a former state health commissioner, said that Weaver’s outlined recommendations “are good ideas,” but lack “teeth” — such as fines for residents who refuse to wear masks in public.

“What we need to do is go back towards where we were earlier, in order to minimize the spread of the virus,” Myers said during a news briefing Thursday. “If we see positive results, great. If we don’t, we continue down that pathway until we get what we need.”

Although Holcomb took decisive action earlier in the pandemic, including a partial shutdown of the state’s economy and forced school closures, he said a “blanket response” won’t help address current spikes.

“Every one of these cases is a extremely localized occurrence. Every single one of them,” Holcomb said during a news conference Wednesday. “For us to continue to balance our lives and our livelihoods ... We don’t get to say we’ll shut everything down to zero, pull our kids out of school and figure out a way later to care for all those in need.”

Holcomb said the state is now offering to help individual counties seeing spikes access medical resources and complete contact tracing, and to educate local communities about personal responsibility in response to the virus.

Ohio said people traveling from Indiana are being asked to quarantine for 14 days. Chicago is requiring a quarantine.

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Casey Smith is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.