The St. Louis metropolitan area has kept total numbers of coronavirus cases below initial projections, but stay-at-home orders and social distancing are needed for at least another month, the head of the regional pandemic task force said Wednesday.

The 15-county area in Missouri and Illinois covered by the St. Louis metropolitan area could reach 71,000 total infections by the end of April under projections released Wednesday by the St. Louis Metropolitan Pandemic Task Force and its leader, Dr. Alex Garza, chief medical officer of SSM Health.

The task force is a collaboration of the four major hospital systems in St. Louis — Mercy, BJC, SSM and St. Luke’s — and has been providing daily hospital counts for the past two weeks as part of daily task force briefings, with roughly 4,000 positive cases in the area covered by those systems’ hospitals in St. Louis. That’s about half the cases in Missouri right now.

Total hospitalizations have spiked 50 percent in the 10 days that the task force has been conducing the briefings, Garza said. The number of hospitalizations and patients on ventilators have also increased during that time.

Officials expect to hit the peak of cases in the next week or two following an expected surge. It’s difficult to tell because numbers of cases lag a few weeks behind when people are actually infected, Garza said. But the current peak could happen April 25.

“The surge is real, it is continuing and we have to do all that we can to stop the spread,” Garza said, adding, “We can’t let up now.”

With the latest numbers released Wednesday, the four hospital systems in St. Louis had a combined 770 hospitalizations, up from 702 the day before. The number of patients in intensive care went down to 175 from 185 the day before, and the number of patients on ventilators stayed about the same at 149. Hospitals discharged 59 patients on Tuesday, the latest day numbers are available.

But beyond that St. Louis data, the total infection numbers cited by Garza cover all 15 of those Bi-State counties. That could hit a much higher number, with the peak also expected to come about a week from now at current rates. The tens of thousands of expected cases includes people who were never tested or don’t even know they have COVID-19.

An initial projection of the same model found that the area could hit 80,000 total cases by the end of April, but those numbers changed because of stay-at-home orders now in effect in all 15 counties. Illinois came down with a statewide order March 20, closely followed by St. Louis County and St. Louis city, and all of Missouri followed last week. The Illinois order was extended until April 30 and the Missouri order is set to end April 25. The St. Louis ones officially run out April 22, but County Executive Sam Page tweeted Thursday that he would extend his executive order mandating people stay home indefinitely, at least through mid-May.

In order to keep “bending the curve,” Garza said that those stay-at-home orders should stay in place for another month, through at least mid-May.

He also recommended that all social-distancing measures now in place, including handwashing, cleaning surfaces and limiting gatherings, need to continue so that projected cases don’t spike again into a “worst case scenario,” the 80,000 cases of the initial projection.

In good news, the total expected peak of patients using ventilators will be in the low hundreds, far below the 900 ventilators available across the four hospital systems in St. Louis. The region has not had to apply for ventilators from the national stockpile and at current rates has no plans to, Garza said. But the hospitals have not yet taken the step of loaning out ventilators to other areas, either — Garza said that shouldn’t happen until the numbers on the ground bear out that cases will not hit that worst-case scenario.

So far, the largest strain on the healthcare system in St. Louis has been reusing personal protective equipment or PPE while running under crisis mode, Garza said. Nurses and physicians have had to rewash and sanitize protective gear like masks, which would typically never be done.