Gov. Tim Walz has ordered hospitals to postpone elective surgeries because of the COVID-19 pandemic emergency, a move that is designed to conserve resources as well as protect patients and caregivers.

Some health care systems, including the four largest in the state, have already begun pulling back on elective surgeries. Earlier this week, the Minnesota Hospital Association asked the governor to issue an order to make the practice standard across the state.

"We want to make sure that everybody that uses masks and gloves and personal protective equipment takes action now in a coordinated manner," said Dr. Rahul Koranne, chief executive of the hospital group. "This is something that needed to be done."

The move comes as 12 more cases of COVID-19 were confirmed by laboratory tests and announced Thursday, bringing the total number of known cases in the state to 89.

Although four people are hospitalized, including one in critical condition, 24 people have recovered, according to the Minnesota Department of Health (MDH).

There were also more people who made a trip to the doctor last week with symptoms of fever and upper respiratory illness, a possible sign that COVID-19 concerns are affecting clinics more, according to indicators that the Health Department uses to track the seasonal flu.

"We really believe that there is widespread community transmission of COVID throughout the state," said Kris Ehresmann, MDH infectious disease director, including cases that have not been confirmed by a test.

With the new coronavirus circulating, hospital officials say they want to prepare for a possible surge of COVID-19 patients.

At Allina Health, nearly 50% to 70% of surgeries could be considered elective, depending on the hospital and the time of year. Postponing surgeries will make more hospital rooms available.

"We just like to make sure that we have all the right resources available should the pandemic worsen and should we have a lot of COVID-19 patients to take care of," said Dr. Robert Quickel, a general surgeon and a vice president overseeing surgical procedures.

"There is disruption for sure, but we are really doing this in a careful way," he said. "We are finding actually that a lot of patients had already started to think about it and in some cases had canceled their own procedures."

Surgeries or procedures should be delayed unless doing so would have negative consequences for the patient, including a threat to life, permanent disability or progression of cancers, according to the order.

"The greatest risk we face during the COVID-19 pandemic is overwhelming our health care systems and limiting their ability to respond to emerging cases," Walz said in a statement.

Sen. Michelle Benson, R-Ham Lake, a leader of a key health committee, supported the governor's action.

"I know the Executive Order today will impact hospital services not related to COVID, but it is necessary to make staff and supplies available to keep our health care system stable if predictions about the COVID spread are accurate," she said in a statement.

While hospitals and surgical centers will make decisions on a case-by-case basis, procedures such as joint replacements, eye surgeries and cosmetic surgeries are likely to be delayed.

"We are focusing on not delaying anyone's cancer care or any other care that might cause them any harm by canceling," said Quickel.

The move is also designed to minimize the spread of COVID-19 by limiting visits to the hospital.

"We are focusing on keeping people safe, but really we don't want anyone gathering and going places where they don't have to go," he said. "It is about keeping patients safe and keeping our providers safe."

Since COVID-19 hit Minnesota, seven cases have required hospitalization, including the critical care patient whose case was first disclosed by health officials on March 10.

But based on what is happening in other states and globally, the number of patients needing hospital care can increase quickly. Although there have been no COVID-19 deaths in Minnesota, so far there have been about 150 deaths nationwide.

With 222,000 cases identified worldwide and growing, the resources to conduct COVID-19 tests are stretched thin. That's why the MDH testing laboratory has changed its guidelines to prioritize tests for hospitalized patients, health care workers and those who live in nursing homes and other facilities that house groups of people.

Still, MDH conducted nearly 400 tests on Wednesday and has done tests for 3,100 patients since mid-March.

Ehresmann added that testing for COVID-19 in people who have mild symptoms, which occur in about 80% of the infections, is not necessary because there is no treatment for this new coronavirus. Instead, people who are sick should stay home.

People with more serious symptoms, including fever and shortness of breath, should contact a doctor before going to a clinic.

Some private medical laboratories are testing, and so far 19 of the state's 89 cases have been discovered by them. The Mayo Clinic lab alone has discovered 14 of the 19. It said Wednesday that it has purchased equipment that will allow for expanded testing.

Private labs are not restricted by the state's testing policy. Generally, a physician will not order a test if a patient does not have symptoms, which take two to 14 days to develop. The test is unlikely to detect the virus before that happens.

As the pandemic continues, Ehresmann said some public attitudes, including panic and denial, are starting to take shape and it was her hope that more people "move to the middle."

"While we want people to take this seriously … we don't want people to feel panicked," Ehresmann said. "We are concerned about people's mental health.

"At the other end of the spectrum, we are hearing about people who don't think that this is a real problem. It is incredibly important that they stay home if they are sick."

Staff writers Jeremy Olson and Christopher Snowbeck contributed to this report.