Maryland Gov. Larry Hogan (R) tightened restaurant restrictions Tuesday and urged counties to enforce pandemic rules, as the state department of health announced it is activating plans for hospital surge capacity in response to spiking infections that have topped 1,000 new cases for seven days straight.

“We have now crossed over into the danger zone,” Hogan said.

The new restaurant indoor dining capacity limits will be 50% instead of 75% as of Wednesday at 5 p.m., Hogan said. He said state employees who are approved to telework must do so unless they are essential, and he advised all employers to limit their in-person work or use methods like staggered shifts to reduce risk. Further, he said the Maryland Department of Health will issue new public health advisories: one that warns against indoor gatherings of 25 people or more, and another suggesting that Marylanders avoid travel to states with high spread.

“You should immediately postpone or cancel travel to any of these states with spiking metrics,” Hogan said. “Anyone who has to travel outside the state for an essential reason, upon their return to Maryland, should immediately get tested for COVID-19 and self-quarantine while awaiting the results.”

Maryland’s increase in infections is part of a regional and national trend. Hogan said 761 people were currently hospitalized with COVID, the highest level since mid-June. He said the number of people in intensive care, 136, was the highest since late June. A key indicator, the percent positivity over a seven-day average, was 5.24% on Monday.

Amira Roess, professor of global health and epidemiology at George Mason University, said the threshold of 5% was used to show widespread community transmission.

“We’ve been using 5% positivity as sort of an indicator of how well a state is doing,” she said. “If 5% of the individuals who are getting tested are coming back positive, and that rate just keeps increasing, that is an indication that there is increased cases, there might be transmission going on.”

Another worrying indicator in Maryland is the seven-day moving average of case rates per 100,000 people; on Monday it was nearly 20 and rising. Roess said public health experts aim to keep that rate below 10.

The root cause, Hogan said, was “COVID fatigue,” along with out-of-state travel, house parties, large gatherings, and refusal to wear masks. He said businesses were also failing to comply with regulations, and county authorities were falling short of necessary enforcement. In particular, rules that require restaurant and bar patrons to be seated at tables six feet apart were often ignored.

“Sadly as a result the virus has returned to our state in a big way,” Hogan said. “We absolutely must, and we will, continue to use every tool at our disposal.”

Some in Maryland said Hogan’s measures don’t go far enough. Montgomery County Executive Marc Elrich issued tighter limits Tuesday, including curbing restaurant capacity at 25%, and issuing a similar cap for fitness centers, places of worship and retail businesses.

“Wish [Hogan had] been more aggressive scaling back and used the word ‘must’ rather than ‘should’,” Elrich wrote on Twitter. “Not sure this will push cases down as much as we need to, if at all. Would love to be wrong here.”

Hogan, a Republican, said he had to find a way to let businesses stay open during the pandemic while preventing hospitals from overflowing. However, he said businesses that did not comply with new guidelines could face fines or lose their licenses.

In a sign of the pandemic’s increasing severity, Dr. Theodore Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, said the Maryland Department of Health was issuing an order to expand hospital surge capacity. That includes a protocol for transferring COVID-19 patients to three “specialized care sites” in Baltimore Convention Center Field Hospital, Laurel Hospital, and Adventist Takoma Park Hospital. It also requires hospitals to prepare for a surge of patients, and it makes extra staff available to help handle outbreaks in nursing homes.

Hogan added that the health department is issuing updated guidance for nursing homes, including recommending that all visitors be tested for COVID before arriving at a facility, and he announced that all nursing homes will have to create a stockpile of protective equipment.

In a press conference largely devoted to the coronavirus response, Hogan also addressed his recent comments that repudiated President Donald Trump’s accusations of fraud in the 2020 election.

“It’s really dangerous, I think, in the middle of this pandemic, this economic collapse, people dying across the country, to not know if we’re going to have a transition,” he said. “It’s crazy. We’ve gotta move on.”

Dr. Delbridge urged Marylanders to get a flu shot to decrease their risks this winter and warned that the situation could soon grow dire.

“When we see what the trajectory is now, we are definitely concerned this is a longer-lasting peak and it’s going to go into the winter months,” Delbridge said.

This story was updated to include comment from George Mason University professor of global health and epidemiology Amira Roess, as well as Montgomery County Executive Marc Elrich.