The state of Iowa is not establishing new COVID-19 precautions even as the head of the Centers for Disease Control points to evidence that people with no symptoms can spread the virus.

The CDC director said in a recent interview with an NPR affiliate that up to 25 percent of infected people may be asymptomatic, and that COVID-19 appears to be about three times as infectious as the flu.

State officials have been encouraging all Iowans to stay home as much as possible, but Gov. Kim Reynolds has largely focused on asking people who feel sick to stay home.

IPR asked Reynolds Tuesday if it’s time for more aggressive messaging on social distancing for everyone.

Reynolds said she thinks the state has been aggressive in its messaging. She said Iowans should only go out for essentials, and should “be conscientious” and stay at least six feet away from others.

“I can’t lock the state down,” Reynolds said. “I can’t lock everybody in their home. We have to make sure that the supply chain is up and going. We have an essential workforce that has to be available.”

As of Tuesday, Iowa was one of about 17 states that did not have a statewide stay-at-home order. And Reynolds has not given local governments the authority to issue their own orders.

Dr. Megan Srinivas, an infectious disease doctor in Fort Dodge, said public messaging about social distancing has been confusing at all levels of government, and she sees that reflected in her community.

“One of the statements I always hear is that they thought that they only needed to stay home if they’re sick, which is not true at all,” Dr. Srinivas said. “The message that we’ve been pushing for weeks from infectious disease world and from the public health world really is that you need to stay home, period, because social distancing is the only way we can ensure that transmission is not occurring.”

She said the state needs a formal stay-at-home order so it can enforce closures of non-essential businesses, and to give local law enforcement authority to disband groups of people.

“The fact that we’re still increasing exponentially in the number of cases, the fact that the death count is increasing as well, all point to the fact that we’re still on a rising trajectory,” Dr. Srinivas said. “That coupled with the fact that we’re not actually enforcing that people need to socially distance in the way we can with shelter-in-place, only exacerbates that problem.”

In the past few weeks, Reynolds has ordered schools, restaurant dining rooms, bars, clothing stores, gyms, and other kinds of businesses to close.

But she has repeatedly said the state’s internal data does not point to a need for a formal stay-at-home order. State officials have declined to provide many details about the data beyond describing what metrics they are looking at.

At a recent news conference, Iowa Department of Public Health Deputy Director Sarah Reisetter listed metrics she said the department is using to make recommendations to the governor.

“The percent of our population that is 65 or older…the percent of identified cases requiring hospitalization…the rate of infection per 100,000 Iowans in the past 14 days…the number of outbreaks in settings like long-term care facilities where our older populations and Iowans with underlying health conditions live…we look at all four of these factors in addition to information about the experiences of other states,” Reisetter said.

Dr. Srinivas said she has been wondering what data Reynolds has that leads to the conclusion Iowa should not have a stay-at-home order. She said all the models she and other infectious disease doctors are looking at point to a need for stricter measures right now.

Dr. Srinivas pointed to a model from the University of Washington that, assuming social distancing measures are in place through the end of May, predicted Wednesday 1,367 Iowans will die of COVID-19 by mid-June.

“If there’s other data that we’re not aware of, that’s great,” Dr. Srinivas said. “But I’m just curious where that data is coming from.”