Hawaii announced its first death from the coronavirus Monday night after earlier in the day declaring it had its largest single-day increase in cases.

There were 21 new infections reported Monday for a total of 77, as state officials grapple with how to avoid overwhelming the fragile health care system.

The DOH reported 12 new positive tests on Oahu and another two each on Maui and Hawaii island. Kauai reported no new cases Monday. On Sunday the state reported eight people had contracted the disease.

The 21 included one individual who has been admitted to a hospital for treatment, bringing the total number of hospitalized patients with COVID-19 to four. Most of the cases are on Oahu and are related to travel by returning residents, the DOH said.

“It does indicate the virus is still a significant threat to Hawaii,” said state Health Director Bruce Anderson, adding that it is critical not to allow the disease to spread because of the state’s limited health care resources. “We urge that everyone be very vigilant about maintaining social distancing. Take it seriously. People are literally dying because they can’t get the health services they need.”

Gov. David Ige on Monday ordered the entire state, except for essential workers, to stay at home and work from home beginning Wednesday through April 30 to prevent widespread community transmission. That followed Honolulu Mayor Kirk Caldwell’s emergency order the day before requiring everyone except essential workers to shelter in place from 4:30 p.m. Monday through at least April 30. Ige earlier ordered visitors and residents returning to the islands to undergo a 14-day quarantine starting Thursday.

Meanwhile, President Donald Trump said at a news conference Monday that he is considering opening up the United States in a matter of weeks as Americans struggle to make ends meet.

“I think that’s wishful thinking on his part. As we watch this epidemic travel through other countries, it’s taken months before we start to see any decrease in the number of cases. We would expect the same thing to happen here in the United States,” Anderson said. “We’re looking at a period of many months, not a few weeks, before this epidemic is likely to turn (and) we can be relaxing our actions to prevent the spread.”

Hawaii could see 40,000 to 45,000 cases by the end of April if drastic action isn’t taken, Caldwell said. With fewer than 300 intensive care units in the state, projections indicate that Hawaii could exceed its capacity of ICU beds by April 25.

Honolulu’s emergency medical services is already being strained with dozens of COVID-19-related calls daily that most of the time are not life-threatening, said spokeswoman Shayne Enright. There were roughly 300 suspected coronavirus calls to EMS since Thursday, averaging about 70 a day, she said.

“We wanted to alert people that the system could get overwhelmed. We need people to utilize other services instead of EMS. Every time we go on one of these calls, we have to put on PPEs,” personal protective equipment that is in short supply, Enright said. “A lot of these are turning out to be non-life-threatening medical emergencies, where we could have avoided using these PPEs.”

Enright suggested people call their doctors, hospital hotlines or 211, as well as go to drive-thru clinics.

“EMS is for medical emergencies, so with flu-like symptoms your life is not at risk if you’re experiencing a fever,” she said. “Stay home for us so we can be there for you.”

Hospitals are also worried about global shortages of personal protective gear that keeps medical workers safe from infectious diseases.

The Queen’s Medical Center, which has more than two weeks’ worth of N95 masks and at least a month’s worth of personal protective equipment, said it has ordered more N95 masks, goggles, gowns and face shields and continues to get weekly shipments. Queen’s and Hawaii Pacific Health, parent company of Kapiolani Medical Center for Women &Children, Straub Medical Center, Pali Momi Medical Center and Wilcox Health on Kauai, have postponed elective and non-urgent surgeries to preserve medical supplies.

The Hawaii Healthcare Emergency Management Coalition, commissioned to maintain essential medical services in the case of chemical and biological emergencies, has assembled stockpiles of emergency supplies, including 179,000 masks, as well as other equipment. The Healthcare Association of Hawaii is working to expand areas in the hospital that can be used for patient care and establish temporary hospitals in the worst-case scenario.

Ige said the state is also considering converting cruise ships for non-ICU patients, and working with federal authorities on establishing mobile hospitals “should we not be successful in bending the curve.”

“We all need to be committed to doing our part to fight COVID-19, making sure we don’t see exponential spikes and overrun facilities,” Ige said.