Maryland Gov. Larry Hogan on Tuesday announced the tightening of coronavirus regulations for businesses, hospitals, and nursing homes throughout the state.

“This is not just the flu,” Hogan said. “More people have died from COVID19 than from annual car accidents, gun violence, and the flu combined.”

The governor rolled back Phase Three regulations across the state, announcing that all bars, restaurants, clubs, and establishments that sell food and alcohol must close by 10 p.m. Hogan said establishments statewide have failed to maintain social distancing protocols and urged counties to monitor establishments for COVID-19 code violations. All retail businesses, houses of worship, and gyms will revert back to Phase Two 50% capacity restrictions. Hogan also announced that fans will no longer be allowed at stadiums and horse racing tracks. All of these regulations go into effect Friday at 5 p.m..

Dr. Eric Toner with the Johns Hopkins University’s Bloomberg School of Public Health said it may take a few weeks to see if these regulations will help flatten the curve.

“I think this is a prudent move, but he needs to keep evaluating it on a daily basis,” Toner said.

Last week Montgomery, Prince George’s and Anne Arundel counties already tightened restrictions from where they were in Phase Two (the counties were lagging behind the state in reopening due to elevated COVID numbers). Montgomery County councilmembers floated the idea of another shutdown while encouraging Hogan to take additional action. However, Toner said a shutdown should not be needed.

“We had to do that in the spring because we had very limited testing. We didn’t know how many cases there were. We didn’t know where they were,” Toner said. “Now we have a lot more information. We should be able to be more surgical and precise in our interventions and not have to close down the entire economy.”

The additional restrictions come after Hogan announced limits on restaurants and gatherings a week ago and the number of cases continues to spike in the state. The state’s 7-day rolling average positivity rate is about 6.9% with 13 days straight of new cases above a thousand, according to state public health data. Just three days ago, there were more than 2,300 new cases in one day. That number set a record, surpassing the previous highest number of cases on May 19, when there were 1,782.

Hospitals are also facing new restrictions, Hogan announced: Many state hospitals have moved to a red status, and the department of health has activated the next level of the state’s hospital surge plan which restricts visitations except for compassionate care, parents of minors, and assistance for those with disabilities. The department is also suggesting that hospitals limit elective procedures that are not urgent or life saving.

“Our highest priority right now is preserving capacity at our hospitals so that doctors and nurses can do their jobs and make sure that people get the right critical life saving treatment,” Hogan said.

Hogan said that in western Maryland and other rural areas of the state, some hospitals are reaching their full capacity. The department of health is also issuing an emergency order and developing a plan that will allow hospitals that are either full or near capacity limits to transfer patients to hospitals that are equipped and able to provide them with care they need.

Toner said this is meant to head off a problem evident nationwide, where many rural hospitals are unable to meet COVID-19 surge needs.

“Even on good days they tend to transfer intensive care patients out and certainly in this situation they may have a dire need to transfer patients,” Toner said.

Dr. Thomas Scalea, a physician-in-chief of shock trauma with the University of Maryland Medical Center, who spoke alongside Hogan Tuesday, said Maryland is already a model for the nation in its ability to transfer patients from hospitals for trauma informed care.

“This program is both wise and timely,” Scalea said. “Organizing time sensitive care is what the Maryland Institute for Emergency Medical Service System [MIEMSS] does best.”

The medical service system will allow physicians across the state to see where acute and intensive care beds are available for COVID patients and transfer patients as needed.

Hogan also announced additional protocols at nursing homes. Indoor visitations at the state’s nursing homes are being limited to compassionate care visits only. All visitors will need to provide proof of a negative test result within 72 hours prior to their visit.

“I realize this is very difficult especially at this time of year to be unable to see your grandparents or your loved ones, but please know that by refraining from visits at this time you are helping save lives and the lives of our most vulnerable,” Hogan said.

The health department is also mandating twice weekly COVID-19 testing for nursing home staff and weekly testing for nursing home residents. That mandate goes into effect this Friday, Nov. 20.

Hogan said he met yesterday with Vice President Mike Pence’s coronavirus task force, and he expects to meet with the National Governors’ Association and President-elect Joe Biden’s coronavirus transition team on Thursday.

“I’m very concerned that we’re in the middle of this battle with people dying and hospitals overflowing in every state in the country and we have to make sure that there is a smooth handoff,” Hogan said referring to the issue of the Trump administration’s refusal to provide briefing materials to Biden’s transition team.