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DES MOINES, Iowa (AP) — Iowa has among the nation’s highest coronavirus death and infection rates and residents should avoid gatherings in most counties to fight the virus, federal experts said this week.

The virus infected and killed about twice as many people per capita in Iowa as the national average between Oct. 10 and Oct. 16, the White House Coronavirus Task Force reported. That included a 33% weekly increase in deaths.

The number of new cases increased, even after climbing for weeks, as did the state’s test positivity rate, the panel said in an Oct. 18 report released Friday by the Iowa Department of Public Health.

The grim statistics came as Iowa’s hospitals faced a surge of coronavirus patients. The number hospitalized hit a record 536 according to data released Thursday evening.

In all, 90% of Iowa counties are experiencing high or moderate levels of virus transmission, the report found. In those areas, “both public and private gatherings should be as small as possible and optimally not extend beyond immediate family,” the report said.

“Mitigation efforts must be strengthened in areas with increasing cases and test positivity,” the report said. “These should including mask wearing, physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and ensuring flu immunizations.”

Iowa does not have a statewide mask mandate or any limits on the size of public or private gatherings. Instead, organizers of events are supposed to ensure that those participating are 6 feet apart — a rule that appears to be rarely enforced.

Despite the public health crisis, Republican Gov. Kim Reynolds has not held a televised news conference on the subject for more than two weeks. She routinely says residents need to “learn how to live with” the virus and that stricter public health measures would harm the economy.

She told the Sioux City Journal on Thursday that she doesn’t plan to change her approach.

“Right now, I don’t anticipate doing anything, but it’s not to say that I wouldn’t in the future if I needed to,” she said. “It just would be very, very targeted and mitigated, because we know how to do that with the data that we have.”

Her spokesman Pat Garrett said Friday that residents, “especially vulnerable Iowans, need to continue to take the necessary precautions to avoid exposure.” He said hospitals report having enough resources to handle the surge in patients.

The governor attended a crowded rally last week for President Donald Trump’s reelection campaign at the Des Moines airport, which critics said flouted her own social distancing rule and risked becoming a superspreader event. She has been campaigning this week for Sen. Joni Ernst, who is in a tight race for reelection.

Last week, Reynolds told the Des Moines Register that she objected to the task force’s Oct. 4 report warning that the state was seeing “many preventable deaths” from the virus. Reynolds told the newspaper that she discussed the issue with task force member Health and Human Services Secretary Alex Azar during his visit to Iowa last week.

The report did not use that language this week but pointed to months of national data to observe that “partial or incomplete mitigation leads to prolonged community spread and increased fatalities.”

Iowa had 238 new cases and 2.8 deaths per 100,000 population last week, which were both about double the national average and ranked the state 8th in cases and 6th in deaths.

Deaths have risen even faster this week, now reaching 1,617 since the beginning of the pandemic. The state reported a one-day record of 31 new deaths on Wednesday, and 38 more in the two days since then.

Iowa Department of Public Health spokeswoman Amy McCoy said the state was in touch with hospitals “to ensure resource capacity and offer assistance” and would continue to enforce rules requiring groups to be seated and 6 feet apart at restaurants and bars.

McCoy also pointed to one bright spot in the weekly report, that Iowa had conducted more lab tests than the national average. She said the state would continue to take steps to expand its testing capacity.