As K-12 and college students and staff return to classrooms across Iowa, the pace of coronavirus cases and hospitalizations has accelerated, prompting alarm among some infectious disease experts.

On Wednesday, the state reported 817 new confirmed coronavirus cases and 13 additional deaths in the past 24 hours. Iowa's death toll stands at 1,061.

The increase appears in part to be due to young adults packing bars in the university cities of Ames and Iowa City in violation of regulations that require social distancing.

The homes to Iowa State University and the University of Iowa saw high daily cases in late June and early July, but those numbers fell when some bars and restaurants closed. Since they reopened and the students returned, the daily case counts have increased and in recent days surpassed a late-June peak.

“I think the situation in Story County and Johnson County is really worrisome,” said Dr. Rossana Rosa, a Des Moines infectious disease specialist. “The way things are looking right now, I don’t know how they get better. I really don’t. Certain places perhaps are going to need to actually shut down to get things under control. It's really looking like that.”

State data shows a sharp increase in the number of daily hospitalizations since late June. The number of people hospitalized has climbed to 313 from just above 100 in late June. There were 201 people in intensive care on Tuesday — the highest number since early June.

While some businesses have implemented mask mandates and are working to keep customers distant, the state has no face mask requirement and there appears to be little enforcement of Gov. Kim Reynolds' July 30 social distancing requirements for bars.

Between July 30 and Aug. 24, the Iowa Alcoholic Beverages Division has conducted 445 inspections and has received 167 complaints.

The agency has seven open cases under investigation but there have been no fines, license suspensions or revocations, despite photos of packed bars in Iowa City, Ames and Des Moines.

“Since the announcement of the increased enforcement efforts through today, ABD has not issued an administrative action regarding the governor’s proclamations,” agency spokesman Jake Holmes wrote in an email.

Reynolds is discussing possible further action with the Iowa Department of Public Health.

“The governor and her team are working with IDPH to assess if additional mitigation efforts are needed,” spokesman Pat Garrett said. She has a press conference scheduled for Thursday.

Rosa said the virus has never been under control in Iowa.

“It’s not even that we had an ember. We just had more of a fire that just kept getting larger," she said. "That’s why the situation is what it is right now.”

University of Iowa President Bruce Harreld has warned he could shift instruction online if students fail to act responsibly.

"The choices you make as an individual will determine the outcome for everyone,” Harreld said.

Iowa's overall positivity rate since March is at 9.5%. The daily rate in recent days has hovering around 10% to 11%, according to state data.

The U.S. Centers for Disease Control and Prevention and the World Health Organization suggests 5% is a safe rate for relaxing mitigation efforts and reopening the economy. State data shows Iowa's rate hasn't been that low since June.

In Story County on Tuesday, 30% of those tested were positive and in Johnson County it was 24%. The rate in Polk County, where Des Moines is located, was 10%,

Those numbers led the White House Coronavirus Task force to recommend Iowa initiate mask requirements in high-spread areas and close bars until virus infections slow. Reynolds has not acted on those recommendations.

On Tuesday, the state approved a plan for the Twin Cedars school district to move to online classes for two weeks after several staff members tested positive. Most of the school's elementary students were exposed and must quarantine for 14 days.

The state has denied waivers from in-person learning for Iowa City, Ames and Des Moines. Iowa City and Des Moines have sued the state and Ames school officials say they plan to soon.

Marion County, which includes Twin Cedars, has reported coronavirus positivity rates exceeding 20% in recent days. The state requires districts show a positivity rate of at least 15% before they seek an exemption to allow remote learning.

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Associated Press writer Ryan J. Foley contributed to this report from Iowa City.