BOISE, Idaho (AP) — Idaho is seeing its largest coronavirus spike since the pandemic began, with new cases increasing by 46.5% percent over the past two weeks. That trend has some health care experts urging Gov. Brad Little to take additional action to slow the spread.

“As a health system, we're all very concerned,” said Dr. Bart Hill, the vice president and chief quality officer of St. Luke's Health System, the largest health system in the state. “It's indicative of anticipating we're going to see more hospitalizations affecting an older population in the next two, three, four weeks.”

Idaho is currently sixth in the nation for new cases per capita, with a positivity rate of just over 15% -- one of the highest in the nation. Still, Little has declined to take additional statewide steps like requiring masks to slow the virus.

“Idaho is an expansive state, and communities and their needs vary greatly across the state,” Little's spokeswoman, Marissa Morrison, wrote in an email to The Associated Press on Tuesday. “Governor Little remains committed to working closely with public health districts and mayors, and he supports the decisions of local officials in slowing the spread of COVID-19 in communities experiencing high virus activity.”

Little has repeatedly said that the responsibility to slow the coronavirus falls on individuals, urging people to wear masks, practice social distancing and practice good hygiene.

“Our personal actions work better to slow the spread of coronavirus than anything else,” Little said Thursday when he announced Idaho would remain in Stage 4 of his reopening plan for the 18th week in a row. “This is about personal responsibility, something Idaho is all about.”

A significant portion of Idaho residents, however, don’t seem to be taking Little’s message to heart. Photos of a volleyball game in the southern Idaho town of Twin Falls area posted to social media on Monday showed mask-less people sitting hip-to-hip in a packed school gym. St. Luke's hospitals in the region, meanwhile, are now postponing elective surgeries to ensure there is room for an expected influx of COVID-19 patients in the coming days.

Hill said health care providers knew that the pandemic would ebb and flow over time, and the temporary statewide shutdown that Little ordered back in March gave medical facilities time to prepare for spikes like the one Idaho is currently experiencing. St. Luke’s Health System still has adequate capacity for now, he said.

“I know (St. Luke's) leadership is having conversations with the governor today and tomorrow expressing our concerns that doing the same of what we have been doing is not likely to change our trajectory,” he said. “The direction we’re heading is one that it looks real problematic.”

Hill said he's not advocating steps that would hurt the economy, but rather targeted interventions like information campaigns aimed at teens and young adults who are more likely to spread the virus to older and more at-risk Idahoans. Hill also said the state needs to improve testing capacity so anyone can get a test and quick results if they are concerned they have been exposed to the virus.

“I’m not a fan of shutting down businesses, but we also have to be smart,” Hill said. “So I support the football games where we’re not having fans in the stadium.”

Morrison, Little's spokeswoman, said the governor hasn't ruled out “further action from the state if healthcare capacity statewide or in certain parts of the state experience alarming shortages.”

Morrison declined to say exactly what metrics would trigger further action, however.

Local health departments have required masks in several eastern Idaho counties, but health department leaders have not yet made the same decision in southern Idaho. In the Boise region, masks are required, but that requirement is seldom enforced.

School districts in the Boise region are holding in-person classes, despite the regional health department placing Ada County being in the “red” category, indicating the highest risk level of coronavirus transmission.

On Tuesday, the Idaho Education Association announced a new hotline that educators can call to anonymously report any coronavirus-related safety and health concerns at their schools.

“Since school buildings reopened, we have heard reports from educators in many areas of the state about breakdowns in safety protocols and COVID-19 transparency,” Idaho Education Association President Layne McInelly said in a statement Tuesday.

McInelly said the reports would give the teachers' union a more accurate picture of the situation in Idaho’s schools, and that the data would be shared, when appropriate, with public education decision-makers.

The announcement came after hundreds of educators in the West Ada School District called in sick for the second day in a row in protest of how the West Ada School Board has been handling coronavirus protocols and decisions. The “sick-out” forced the district to cancel classes on Monday and Tuesday this week.

McInelly criticized what he said was “a vacuum of rules from the state,” forcing local districts to figure out the best approach for themselves.

“These West Ada teachers want to be in classrooms with their students but are unable to do so because of mismanagement of safety protocols and lack of transparency in reporting of COVID-19 cases by the district," he said. "They are unable to achieve proper physical distancing because of large class sizes and inadequate facilities.”

Morrison said the state has provided school districts with a framework to follow as they make pandemic-related decisions at the local level, and noted that the state has directed “unprecedented amounts of money to public schools for the safe reopening and to minimize budget impacts due to COVID-19.”

Idaho first entered Stage 4 back in June, allowing all types of businesses to open and very large gatherings to be held as long as social distancing protocols are followed. At the time, Idaho had just 3,260 confirmed cases, according to a tally by Johns Hopkins University.

On Tuesday, Idaho had 873 new cases, for a total of 54,663 confirmed COVID-19 cases statewide. So far, 535 Idaho residents have died because of COVID-19.