Doctors in Grand Island, alarmed over the growing cluster of coronavirus cases there, are asking Nebraska Gov. Pete Ricketts to implement even stricter measures to force more people to stay home and slow the spread of the virus in their community.

Forty-five doctors from the Grand Island area signed a letter asking for more help from state officials and warning that the number of cases in the community could be much higher than what has been reported because of a lack of testing.

The letter was written by Dr. Libby Crockett, an OB-GYN at the Grand Island Clinic, and Dr. Rebecca Steinke, a family physician at Family Practice of Grand Island and the medical director of the Central District Health Department, which covers Hall, Merrick and Hamilton Counties.

Taylor Gage, a spokesman for Ricketts, said the Governor’s Office has been in contact with Grand Island’s mayor, the public health department there, the hospitals and officials at the JBS USA beef plant, where 10 workers tested positive for the coronavirus.

“We are reaching out to the doctors to set up a meeting with them,” he said.

In Hall County, where Grand Island is located, the first two confirmed cases of COVID-19, the disease caused by the novel coronavirus, were announced March 26. A little more than a week later, the doctors said, the area overseen by the Central District Health Department had 47 confirmed cases, including one death.

Those who have tested positive include health care workers at the Grand Island Clinic and three nursing and rehabilitation facilities.

“COVID-19’s arrival has been much swifter than we ever imagined,” the letter says. “And, we know from very clear data from other places throughout the world, that the incidence is going to increase dramatically in the next two weeks if nothing further is done to mitigate the spread in our community.”

Hall County, population 61,000, is second only to much-larger Douglas County when it comes to confirmed coronavirus cases in Nebraska.

Because coronavirus testing supplies are limited, Grand Island doctors say those numbers “do not even begin to show the full picture of what is happening here.”

Doctors have seen dozens of patients with COVID-19 symptoms who do not meet the criteria for testing, the doctors said. Current guidelines prioritize testing for patients who are already hospitalized, health care workers, first responders and people with underlying health conditions.

Crockett and Steinke project that there could be several thousand more infected, including many who may not be showing symptoms.

Directed health measures ordered by Ricketts, now in place across all of Nebraska, have closed schools and dine-in areas at restaurants and restricted gatherings to 10 people.

The doctors said that is not enough to truly contain the virus and asked Ricketts to implement even more restrictions. Grand Island is home to several manufacturing and meat-processing facilities, including the JBS beef plant, McCain Foods, Case New Holland and the Hornady ammunition plant.

“There are too many people still working outside the home,” Crockett and Steinke wrote. “Many of these individuals are working in close quarters. ... To make matters worse, many of those workers live in large, multi-generational households where access to health information is limited, which will facilitate the spread of the virus to the most vulnerable populations, and quickly.”

Ricketts has said he has implemented targeted containment measures for Nebraska counties in consultation with state health officials and experts from the University of Nebraska Medical Center.

Some have urged Nebraska to impose stay-at-home orders, but Ricketts and local health officials say those are not necessary here at this point. Across the country, states are increasingly taking that step, ordering people to stay at home or shelter in place.