SIREN, WIS. – As he sat down to a margarita on the sunny patio of Adventures restaurant Wednesday, Jeff Wostrel was comforted to see staff wearing masks, sanitizing surfaces and keeping tables spaced apart and booths separated by plexiglass in an effort to curb COVID-19.

Many other establishments in this woodsy northwest corner of the state haven’t been as careful.

But a feeling of safety in remoteness is quickly fading after a surge in COVID-19 across Wisconsin has turned it into one of the nation’s top coronavirus hot spots. The spike so alarmed health officials that the state issued a new order this week to limit the size of public indoor gatherings and is making plans for the opening of a field hospital near Milwaukee to handle an anticipated rise in hospitalizations.

“It’s like everywhere else ... it’s taken hold here,” Wostrel said of his home community in cabin country of Burnett County. “Can’t put your head in the sand anymore.”

Wisconsin recently climbed to third in the nation in new COVID-19 cases per capita over the past seven days with 294 cases per 100,000 people, according to data collected by the New York Times. Only North and South Dakota had higher rates.

Eight of the country’s top 20 metro area hot spots are  in Wisconsin, including several in the northeast part of the state.

While Wisconsin’s Burnett County was one of the last in the state to get a single case of COVID in the spring, state health officials now have marked it as having “very high” case activity.

As cold autumn weather moves in and winter looms — taking away outdoor seating at restaurants — limiting public indoor gatherings to 25% of room or building capacity for the next month has locals worried about losing struggling businesses.

Adventures owner Gary Kannenberg, who opened the place almost 21 years ago, said he feels like he has constantly shifted his business model with government orders that often come with little warning.

He put more tables outside this summer and recently added heaters to his patio, while cutting seating inside almost in half. He also added a takeout window and plans to extend the season for the restaurant’s food truck.

“People know that we’re trying, and we have a pretty good reputation,” he said. “They feel safest here.”

His business didn’t fall off too much over the summer, and he thinks he can survive at 25% capacity until the order is set to expire Nov. 6. But he and many others worry about what will happen over the winter if those restrictions are extended.

“I don’t think many businesses will survive if it holds on,” he said, so he expects many bars and restaurants simply won’t adhere to it.

Health experts have attributed the state’s spike to the reopening of colleges and K-12 schools as well as general fatigue over wearing masks and social distancing.

The new restrictions, from Gov. Tony Evers’ Health Services secretary, restrict gatherings in indoor spaces without an occupancy limit to 10 people. The measure does not apply to some places, including colleges, schools, churches, polling locations, political rallies and outdoor venues.

As the order was issued Tuesday, a state judge was considering a lawsuit seeking to strike down the governor’s mandate that masks be worn in enclosed public spaces. In announcing the field hospital opening, Evers said Wednesday that officials hoped that day wouldn’t come “but unfortunately, Wisconsin is in a much different, more dire place today and our health care systems are beginning to become overwhelmed by the surge of COVID-19 cases.”

Only 16% of the state’s 11,452 hospital beds were available as of Tuesday afternoon, according to state health officials. The number of hospitalized COVID-19 patients had grown to 853, its highest during the pandemic according to the COVID Tracking Project, with 216 in intensive care.

In River Falls, Wis., a college town about a half-hour east of the Twin Cities, Roy Garcia, part owner of BX Mexican Cuisine & Bar, said the new restrictions are “going to be a nightmare.” His business was shut down for three months beginning in March and has slowly been regaining its footing since June.

“The numbers are still in the red and we’ve had to take money out of our own pockets,” he said. Being forced to cut back to 25% capacity isn’t going to help matters, he added.

“But there’s not much you can do,” Garcia said.

Over at the Nutty Squirrel Sports Saloon, Daniel Hull looked around at a nearly empty establishment. If not for COVID-19, the business would be bustling, with students working on laptops, golfers stopping after playing a round and a group of moms stealing away for an afternoon get-together.

“[COVID] has made it hard to understand where life is going,” said Hull, vice president of operations for JAMA Investments, which owns five other bars and restaurants in Wisconsin.

“I just feel lost, confused, sad,” Hull said.

Katie Erickson, a senior at the University of Wisconsin-River Falls, said the rise in cases is concerning and “people aren’t taking it as seriously as they should be.” While she is careful to avoid crowds, she said, most students seem annoyed with precautions.

Students recently returned to in-person classes after a spike in cases last month forced the campus to switch to online learning for two weeks.

“Most students see the virus as a nuisance,” Erickson said. “They don’t want their college life to be impeded.”

Boyd Davis, owner of Peek-A-Boo Boxing Gym, is determined not to contribute to the spread. Customers have their temperatures taken when they enter and are required to wear masks. Davis tracks everyone who comes into the gym to make contact tracing easier should a customer later test positive for COVID-19.

“You have to do everything you can because you don’t know where people have been,” he said. “People aren’t doing what they’re supposed to be doing. … Yeah, I’m worried.”

Back in Siren, at Tavern on Main, a small bar with just 44 stools amid pool tables and other games, bartender Phil Ambelang lamented the slowdown in business. He said daily happy hours used to draw about 30 customers, but the numbers have thinned the past few weeks with COVID cases rising.

“We felt like we were immune,” he said. Now he worries the restrictions on capacity might discourage so many people from going out that they won’t fill to even 25%, forcing businesses to close.

“We all love this community,” he said. “What’s going to happen, I don’t know.”

The Associated  Press contributed to this report.