Iowa Gov. Kim Reynolds’ system for determining when to issue a statewide coronavirus shelter-in-place order or other restrictions is based on a 12-point scale that weighs age, hospitalization, population and long-term care outbreaks, according to documents obtained Wednesday.

Each category has a maximum of three points. The proportion of cases requiring hospitalization, for example, must reach 15% before the maximum points are assessed in that category.

A shelter-in-place order would require Iowa reach at least 10 points, according to the document, which the governor's office publicly released Thursday morning in response to media inquiries.

Thirty-eight states have issued shelter-in-place or stay-at-home orders, considered to be among the strictest directives to keep people home. Iowa has yet to issue such an order.

► More:The latest on the coronavirus outbreak in Iowa

So far, Reynolds has resisted calls from mayors, members of Congress and others to issue such an order, saying she wants to use data-specific metrics to make the decision as a way to avoid additional undue hardships or panic.

Reynolds has ordered many businesses to close, and recommended schools close. She has also limited gatherings to 10 people or fewer, and asked businesses to let employees work from home when possible.

Reynolds and officials from the Iowa Department of Public Health have previously outlined the general criteria they were using to make their determinations on mitigation strategies. But for more than a week, they've avoided providing the specific metrics associated with the assessment.

►More: Data begins to offer clues on how many COVID-19 cases could appear in Iowa — and how many deaths​​​​​​​

The metrics generate criticism

The document, first obtained by the Iowa City Press-Citizen, looks at the following metrics:

Percentage of population greater than 65 years of age

Percent of identified cases requiring hospitalization

Infection rate per 100,000 population in the past 14 days

Number of outbreaks in long-term care facilities

The document has already generated criticism.

"When I look at it, we'd be almost to Armageddon before she would issue (a shelter-in-place order)," Johnson County Board of Supervisor Chair Rod Sullivan said.

► Monday:Johnson County Supervisors ask Gov. Reynolds to issue shelter-in-place order

The model weighs heavily on crisis moments, such as outbreaks within long-term care facilities, or for hospitalization percentages to climb rather than measures of infection across the population, said Eli Perencevich, a professor of medicine at the University of Iowa Carver College of Medicine.

As of Thursday,74 people had been hospitalized with the virus and 11 people had died with it in Iowa. Several Iowa nursing homes also reported virus outbreaks.

► More:Updated COVID-19 maps and charts track cases and data in Iowa and across the U.S.

"Instead of tracking the spread of disease to protect older Iowans, we are using them like a canary in the coal mine to determine how bad things are,” Perencevich said. “(With this tool,) we have to wait for older people to die before implementing maximum protective measures."

As she has before, Reynolds maintained Thursday that Iowa did not need a shelter-in-place order, saying she has already enacted many of the measures associated with a shelter-in-place order but has "just done it in a incremental fashion."

"So my challenge, I guess, to individuals out there that think I haven't done enough: I would ask them to go and take a look at other states and recommendations that they put in in their stay-at-home (order) — I don't care what you call it; I'm basing it on data," she said.

► Last week:Gov. Kim Reynolds: Iowa is already under 'equivalent' of stay-at-home order to fight coronavirus

On Thursday, state officials released a map that breaks the state into six regions, along ratings that listed the regions from a high of seven to a low of five. The map included a link to an explanation that ratings from zero to three would dictate "Preparation and Awareness"; four to nine would dictate "Social Distancing and Mitigation Strategies"; and a ten and above would require "Shelter-in-place."

Officials in the governor's office and those in public health did not provide a breakdown of the map by county, making it difficult to accurately differentiate between the different regions. Nor did officials provide an explanation for how the map was drawn up.

"The map was developed from health care data and is based on health care utilization patterns," said Amy McCoy, a spokeswoman for the Iowa Department of Public Health.

McCoy, when asked for the map broken down by county, said she did not have one immediately available.

At her news conference on Wednesday, Reynolds had indicated she was open to issuing more stringent mitigation restrictions to certain areas of Iowa instead of statewide. Linn, Polk and Johnson counties have the most known cases of the virus in the state.

"There are different variations of the impact across the state, and so that's why we're going to make the decisions based on the data that we have and we're going to try to identify where some of the hot spots are," she told reporters. "We'll continue to work with them, see if there's additional directives that we need to put in place that could help mitigate what we're starting to see there. But we start every day reviewing the data and we end every day reviewing the data."

The governor's staff did not respond to questions from the Register Thursday about who developed the 12-point system or about the underlying science. Several Register reporters attended Reynolds' Thursday news conference through a telephone conference line but were not selected by her staff to ask questions.

State officials consulted with at least five Johnson County-area hospitals and some health and emergency departments about the metrics, but it is unclear how the specific criteria were decided, said Sam Jarvis, the community health division manager at Johnson County Public Health Department.

"There are quite a few things we can quantify and count, but is there something that helps pull the trigger, so to speak," Jarvis said. "A lot of thought was put into those conversations."

► ​​​​​​​More:Iowa Gov. Reynolds: 'I can't lock the state down' over coronavirus concerns

Zachary Oren Smith writes about government, growth and development for the Press-Citizen. Reach him at zsmith@press-citizen.com or 319 -339-7354, and follow him on Twitter via @zacharyos.

Jason Clayworth is an investigative reporter at the Des Moines Register. He can be reached at 515-699-7058 or jclayworth@dmreg.com.

Barbara Rodriguez covers health care and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 515-284-8011. Follow her on Twitter @bcrodriguez.