BOISE, Idaho (AP) — Idaho Gov. Brad Little on Monday ordered a return to some restrictions to slow the spread of the coronavirus as intertwined health care systems across the state showed early signs of buckling.

The Republican governor returned the state to stage 3 of his four-stage reopening plan and said indoor gatherings will be limited to 50 people or fewer, and outdoor gatherings will be limited to 25% of capacity.

“Idaho is at a critical juncture,” Little declared during the Statehouse news conference with a heavy police presence as protestors could be heard shouting in the hallway. “This is unacceptable and we must do more.”

Little, who wears a mask in public and encourages others to do so also, didn’t order a statewide mask mandate, something many health care professionals have sought. But many residents in red-state Idaho oppose such a mandate.

State officials continue reporting surging infections daily, with 650 more on Sunday for a total approaching 60,000 along with 573 deaths.

The state’s positivity test rate is fourth-worst in the nation, according to The COVID Tracking Project.

The restrictions announced Monday also include a mask mandate for all long-term care facilities and physical distancing for gatherings of all types. Employers should continue allowing teleworking for at-risk workers or make special accommodations in the workplace.

St. Luke’s, with hospitals in southwestern and central Idaho, is reporting that 20% of hospitalized patients are suffering from COVID-19. Its hospital in Twin Falls is postponing elective surgeries and sending children in need of medical care to Boise. On Monday, St. Luke’s told people to stop coming to its emergency rooms for COVID-19 testing.

Dr. Joshua Kern, vice president of medical affairs for St. Luke’s Magic Valley and Jerome, said the surge of patients in that area is approaching a level the hospital might not be able to handle, meaning deciding who gets treatment.

“That's not good for our staff, having to decide who lives and dies, and it's not good for the patients,” he said. “The natural outcome of not controlling the virus will be unnecessary deaths.”

State epidemiologist Dr. Christine Hahn said some hospitals are in what's called a contingency stage, one step below moving into a crisis stage that could lead to the scenario described by Kern.

Primary Health Medical Group, the largest independent medical group in Idaho, has had to close two of its 19 urgent care clinics in southwestern Idaho because of sick or quarantined staff. The clinics are a buffer keeping hospital emergency rooms in the region from getting clogged with patients not needing emergency-level care.

“This surge, this disease today, right now is out of control,” said Dr. David Peterman, a pediatrician and the CEO of Primary Health Medical Group.

The group reports that the positivity rate is up to nearly 7% among 5- to 12- year-olds, and nearly 11% for teenagers. Peterman said it’s not clear if a return to school for teenagers is causing a surge of infections in local communities or if the surge in local communities is causing more teens to become sick.

In northern Idaho, Kootenai Health in Coeur d’Alene said it is near capacity due to the coronavirus.

And a coronavirus outbreak has also occurred at the Boise VA Medical Center, which cares for veterans, said Dr. Andrew Wilper, chief of staff at the facility. He urged the wearing of masks, saying that inconvenience shouldn't be mistaken for oppression.

“We live in a country where you can choose whether to wear a mask because someone was willing to die for you to have that freedom,” he said.

Little issued a statewide stay-at-home order due to the coronavirus in March that ended on April 30 with the start of his economic recovery plan called Idaho Rebounds. The state advanced successfully through two-week reopening intervals to stage 4 that had no statewide restrictions. The state has now fallen back to stage 3.

Local entities are allowed to make restrictions, and 11 counties and nine cities have mask mandates. Ada County moved back into stage 3 restrictions last summer.

Idaho unemployment rose to about 12% following the stay-at-home order but rebounded to 4.2% in August. But the September unemployment numbers jumped to 6.1%. State officials attributed the increase to record growth in the labor force.

“I’m hopeful that the citizenry of Idaho will recognize the magnitude of this problem,” Little said, asking Idaho residents again to wear a mask and do “the patriotic right thing and doing a little bit of a sacrifice to get us through this winter until such time as that vaccine arrives.”