— North Carolina hospital executives asked Gov. Roy Cooper on Monday to "issue an immediate order to shelter in place," and take the state's response on the coronavirus outbreak up another notch.

Governors in 16 U.S. states have already issued "shelter in place" orders impacting 142 million people. Officials said about 43% of the nation is under a stay at home order, and other states, including Hawaii, are expected to do the same.

Just what that would mean in practice remains to be seen, but similar orders in other states closed a broad swath of businesses and essentially told people to stay home, with a significant list of exceptions.

Among those exceptions: Grocery shopping, caring for elderly family members and outdoor exercise. The goal of these orders is to limit people from congregating and potentially spreading the virus.

Cooper and his team have been asked repeatedly about taking this step, and they've said for days that everything's on the table, but that a full shutdown wasn't imminent. The governor reiterated much of this Monday afternoon when he announced plans to order new closings, hitting barber shops, nail salons and gyms, and capping gatherings at 50 people.

His latest order also extended school closures though May 15.

Cooper spokeswoman Sadie Weiner said Monday evening that the governor appreciates the hospitals' input and that "we will continue to work closely with the hospitals and prepare for every scenario."

The North Carolina Healthcare Association said in a statement that the governor's latest moves were positive, "but not enough to tamp down the surge we anticipate is coming to hospitals in the near future." The association's shelter-in-place letter said hospital leaders from around the state spoke to each other Monday and that "it’s clear that the cases are increasing at a rapid rate."

Association President Steve Lawler, who signed the letter, told WRAL News Monday evening that it's time to take the state's measures "to that next level."

"The states and the countries that have done the best in bending the curve ... are the ones that took these kinds of actions sooner rather than later," Lawler said.

Hospitals fear a surge in sick patients that will overwhelm their resources – the limited bed space, ventilators and personal protective equipment needed to treat patients and protect health care workers in a system not built for what a pandemic could bring.

“This is really an investment in time,” Lawler said. “It’s an investment in helping hospitals and health systems better prepare and actually have more time before there’s an influx of patients.”

Limited testing supplies and the fact that COVID-19, the illness associated with the new coronavirus, can apparently be spread by people not showing symptoms complicate things, and health care workers, elected officials and others have repeatedly asked people to stay away from each other as much as possible to slow the spread of this virus and give the system a chance to prepare.

Not everyone is taking that seriously enough, the association said Monday.

"It is imperative that we move quickly, as it will take at least two weeks after a shelter in place order is issued before we see a change in the trajectory of cases,'" the association's letter states. "Hospitals and physicians throughout the state believe this is the only resort left to immediately impact the growth and spread of the virus."

The letter went to the governor with copies for the lieutenant governor and other statewide elected officials. This group – North Carolina's Council of State – meets Tuesday morning via conference call.

Meanwhile, the North Carolina Chamber said a shelter in place order should be a "last resort" because of the economic impact that would result. Some industries are asking the governor to declare them critical businesses so their work can go on regardless.

A construction trade group, Associated Builders and Contractors of the Carolinas, wrote Cooper Monday, in a letter first reported by the NC Insider.

"With the high level of importance of construction within our state, the low risk nature of construction related to the virus and a long-standing heavy emphasis and professional experience implementing health and safety protections for workers and the public, we urge you to recognize construction as essential services that should be continued during this time," the letter states.

"Shelter in place" isn't a legally defined term – at least not in North Carolina law. California's shelter in place order included a long list of exempt businesses that could stay open, including hospitals, gas stations, pharmacies and cannabis shops, grocery stores, farmers markets, food banks, convenience stores, take-out and delivery restaurants, banks, laundromats and the media.

California's order also had exemptions for school feeding locations and day cares, though only for parents working in essential business sectors allowed to operate. Outdoor trails and parks also remain open under California's order.

Cooper has issued a number of closure orders over the last week, and Monday's was the broadest yet. By 5 p.m. Wednesday, a wide range of entertainment venues, including bowling alleys and sweepstakes parlors, indoor exercise businesses, barber shops, nail salons, massage therapy businesses and tattoo parlors are supposed to close.

The governor already had ordered restaurants and bars closed to in-house seating, though delivery is allowed.

As of Monday morning, the state had seen more than 100,000 new unemployment applications due to COVID-19.