SACRAMENTO, Calif. (AP) — California Gov. Gavin Newsom relaxed his stay-at-home order on Wednesday to let hospitals resume elective surgeries, a move that will send many thousands of idled health care employees back to work as the state takes a cautious first step toward restarting the world's fifth-largest economy.

While only a narrow opening, it was a significant milestone because just three weeks earlier Newsom had the same hospitals preparing for a worst-case scenario that could see them overwhelmed to the point that tens of thousands of additional beds would be needed to handle the overflow of patients.

Cases continue to grow in California. But it's at a manageable pace as the state's 40 million residents live under a stay-at-home order that has closed schools, beaches, parks and most businesses while canceling things like concerts and sporting events to prevent the spread of the disease.

Newsom's order took effect immediately and left it up to local governments and individual hospitals to determine how and how soon to resume elective surgeries for heart and cancer patients, among others.

A day earlier, New York Gov. Andrew Cuomo said some hospitals there could resume elective outpatient treatments next week if they meet certain requirements for space and number of virus cases. And in Washington, which along with Oregon is coordinating with California on issues for reopening, Gov. Jay Inslee said he was hopeful elective surgeries could resume soon.

Newsom said decisions on when to more broadly reopen California will be based “first and foremost” on public health.

“I wish I can prescribe a specific date to say, ‘Well, we can turn on the light switch and go back to normalcy,’ ” Newsom said. “We have tried to make it crystal clear that there is no light switch and there is no date in terms of our capacity to provide the kind of clarity that I know so many of you demand and deserve.”

Most people in the state have followed the stay-at-home order, but there are signs of unrest. On Monday, hundreds of people protested business closures at the state Capitol, and on Wednesday there was a small but boisterous protest at City Hall in Los Angeles.

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Republican state Sen. Brian Dahle said Newsom’s plan for reopening needs to be “accelerated for rural communities where the impact is not proportional to the number of reported infections.”

“The timeline for Los Angeles is not our timeline,” said Dahle, who represents 11 counties in the northeast corner of the state.

But even in Los Angeles County, the nation’s largest with 10 million residents and the epicenter for California's virus outbreak, there are hopeful signs that have officials considering reopening golf courses and florist shops, and perhaps resuming thoroughbred racing — without fans — at Santa Anita Racetrack.

“I can’t play God and say yes or no,” Board of Supervisors Chairwoman Kathryn Barger told The Associated Press. The county must “weigh all the facts surrounding each business and determine whether or not it’s going to compromise where we are in terms of slowing the spread” of the virus.

California has more than 35,900 coronavirus cases and 1,350 deaths, according to data complied by Johns Hopkins University. The number of infections is thought to be far higher because many people have not been tested, and studies suggest people can be infected with the virus without feeling sick.

For most people, the virus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness and death.

Coronavirus hospitalizations statewide — the most important statistic to California officials because it signals how many doctors and nurses and medical equipment is needed — slightly declined on Tuesday, continuing an encouraging trend.

With hospitals well below capacity, Newsom said they could start scheduling procedures like heart valve replacements, tumor removals and preventative services such as colonoscopies. The change does not include purely cosmetic procedures.

“These are the scheduled surgeries we think are foundational to people’s health," Newsom said.

They also are a revenue lifeblood for hospitals, many of which have lost substantial sums. Tens of thousands of health care workers were idled as elective procedures were postponed.

Beth LaBouyer, executive director of the California Ambulatory Surgery Association, said most of the state’s more than 700 surgery centers have either closed or were working minimal hours. “It’s been a tremendous impact on the medical system,” she said.

While Newsom's order is immediate, it will take time for hospitals to resume those operations.

“This process will balance the needs of those who have been waiting patiently for necessary medical care with public health concerns about a second wave of COVID-19,” said Carmela Coyle, president and CEO of the California Hospital Association.

Surgeries will likely resume slowly, with changes for patients, such as limiting visitors and purging waiting rooms of magazines and toys. said David Ford, vice president of the California Medical Association. Densely populated areas like Los Angeles County will likely be slower to resume surgeries than more rural counties where there are far fewer cases, he said.

How quickly other areas of California's economy return to life is dependent on how much the state can ramp up testing for the virus and track down others who have been in contact with infected people to see if they also test positive.

Newsom announced that Trump said the federal government would provide 100,000 swabs needed for tests this week, 250,000 next week and even more a third week. He also said Abbott Laboratories is going to have 1.5 million antibody tests to survey communities to find out who was previously infected to help authorities better determine the prevalence.

California now is testing about 16,000 people per day with a goal of 25,000 by May and ultimately 60,000 and 80,000 per day, Newsom said.

When testing reaches the much higher number, health officials expect to find 2,000 to 3,000 new cases a day and will have to track down between 30,000 and 35,000 of those people’s contacts.

The governor said the state has experience tracking down infected people, noting it has done so with tuberculosis, measles and HIV.

“We’re not starting our tracing program from scratch,” Newsom said. “The question that’s asked of us now is to do it at a scale that we have not seen.”