WASHINGTON POST, GREGORY S. SCHNEIDER, OVETTA WIGGINS, LAURA VOZZELLA, and KYLE SWENSON

Virginia closed all schools for the rest of the academic year and Maryland ordered all nonessential businesses to shut their doors as the coronavirus continued to spread Monday, with health care workers sounding the alarm about dwindling supplies of protective gear.

The number of cases announced in the region had reached 684 as of Monday evening. Virginia Gov. Ralph Northam (D) said the state was “moving into a period of sacrifice” and canceled the remainder of the school year — becoming the second state to do so, after Kansas.

Northam also ordered restaurants to stop serving sit-down diners and directed a list of recreational and entertainment businesses to close, including theaters, fitness centers, barber shops and bowling alleys. Maryland Gov. Larry Hogan (R) went further — closing anything deemed nonessential — but stopped short of joining New York, California, West Virginia and other states in ordering all residents to shelter in place.

Closing the businesses where people might gather is a “better, smarter action for us,” Hogan said. “Unless you have an essential reason, then you should stay in your home.”

D.C. Mayor Muriel E. Bowser (D) announced no new restrictions Monday, despite calls for tougher measures after weekend crowds ignored no-gathering orders and flocked to see the cherry blossoms in full flower. Bowser said restrictions already in place have “basically closed down the District.”

Bowser, Hogan and Northam spoke by phone Monday afternoon and agreed to push to expand testing and business assistance in the region and to “advocate for more resources and leadership from the federal government to meet immediate needs.”

“Our actions promote the health and safety of more than 360,000 federal workers,” the leaders said in a joint statement. “We call on the federal government to provide additional financial support to help our jurisdictions maintain the health and safety of the region and the federal workers who serve the American people.”

As the number of patients continued to grow, doctors and other health workers expressed rising concern about the lack of personal protective equipment, or PPE, and businesses raced to manufacture more in the face of exploding international demand.

Hundreds of doctors and health care providers from around Virginia have signed a petition asking Northam for emergency action.

“We beg you to use your exceptional powers immediately — literally TODAY — to solve the desperate medical supply shortage that is thwarting our efforts to control this pandemic before it reaches the point of no return,” the doctors wrote in an online plea that began Saturday in the Charlottesville area and has drawn hundreds of signatures from across the state.

So far, the Trump administration has not opted to enact the full force of the Defense Production Act, a law that would enlist manufacturers to help in the production of materials critical for slowing the pandemic.

Rep. Abigail Spanberger (D-Va.) on Monday helped introduce a bipartisan resolution to pressure Trump to use the act. “A doctor called our office and left a message, sobbing, saying people are going to die and they don’t have what they need. That is not okay,” Spanberger said.

Bruno Petinaux, chief medical officer at George Washington University Hospital in the District, said a task force is discussing options, including 3-D printing for surgical masks and using new processes such as ultraviolent lights and hydrogen peroxide vaporizers to clean equipment.

Hospital staff are storing used but unsoiled N95 masks in brown paper lunch bags, with their names written on them, so the masks can be reused or cleaned later, Petinaux said.

City officials are looking to boost bed space at hospitals and other locations, including setting up a floor just for covid-19 patients at United Medical Center, the District’s only public hospital. The effort could include using unlicensed spaces such as hallways and scouting locations that could be reconfigured, such as furloughed nursing homes or unused hotels, said Christopher Rodriguez, the city’s top homeland security official.

Rodriguez said hospitals have already begun discharging non-acute patients and canceling elective surgeries to free up beds for virus patients.

In Maryland, Hogan said Laurel Regional Hospital in Prince George’s County — which recently was downsized to a medical center that primarily provides outpatient services — will reopen as a 135-bed hospital “in short order” to accommodate virus patients.

Plans are also underway to set up a “field hospital” at the Baltimore Convention Center and an “alternate care site” at the Hilton Hotel in downtown Baltimore, part of the state’s effort to add 6,000 more hospital beds.

Hogan said the Federal Emergency Management Agency is delivering 250 hospital bed packages for the field hospital, which will be operated by the University of Maryland Medical Systems and Johns Hopkins Hospital. He also said health care providers will stop doing elective surgeries to free up hospital beds.

Amy Goodwin, a spokeswoman for the Maryland Hospital Association, said there is not currently a shortage of personal protective equipment across Maryland’s four dozen hospitals.

But some physicians are worried. William Zirkin, an emergency medicine doctor at Greater Baltimore Medical Center, said doctors and nurses have been going to Home Depot and looking on Amazon for supplies including masks and goggles.

“You want to do right,” he said. “But at the end of the day you are not a martyr.”

The Virginia Department of Health recently received a shipment of personal protective equipment from the Strategic National Stockpile to shore up hospitals, nursing homes and emergency medical squads in the fight against the spread of the coronavirus.

The supply of M95 respirators, regular surgical masks, face shields, gowns and gloves arrived in the state more than a week ago, said R.P. “Bob” Mauskapf, director of the Office of Emergency Preparedness at the Virginia Department of Health. Maryland also received a shipment.

Mauskapf said the National Guard helped distribute the equipment to providers around Virginia.

But the delivery was not enough for the hundreds of health workers who began petitioning Northam over the weekend about the need for items including surgical masks, N95 masks, masks with face shields, disposable gowns, protective gloves and hand sanitizer — as well as testing kits and related supplies.

Northam said he and his staff have been calling companies around the state seeking help with production and distribution.

In his Monday briefing, Northam tightened his ban on gatherings of more than 10 people, making it mandatory and applying it even to gatherings in private homes. The ban does not apply to hospitals and certain employment settings.

Businesses that remain open must limit patrons to 10 at a time. Northam said the state will be posting guidance online for what is considered essential and nonessential, a list that he said is likely to change.

He said he knew the steps would cause pain, noting that roughly 40,000 Virginians filed for unemployment last week. “That number will, unfortunately, go up,” he said.

In Maryland, Hogan acknowledged the increasing burden of trying to solve the public health crisis without killing the economy. “We don’t want our businesses to die, and we don’t want people to lose their jobs, but we also don’t want to lose the lives of so many people,” he said.

His order to close all nonessential businesses had a list of exclusions such as law and accounting firms, banks and grocery stores. He said the latest action was due to “irresponsible and reckless behavior” by some residents who have defied previous orders of social distancing.

Maryland is launching several programs to help small businesses stay afloat, Hogan said, including a $175 million business relief program and a $5 million “layoff aversion” fund: “We will have your backs in the weeks ahead and do everything we can to get you back on your feet to help you recover.”

Maryland officials said Monday morning that the number of known coronavirus cases increased by 44 since Sunday. According to a Washington Post analysis, 289 cases — and three deaths — have been reported in the state.

Virginia health officials announced three virus-linked deaths late Sunday, for a total of six deaths in the state. Virginia Department of Health officials said two of the people had previously tested positive for the virus and the third person was a “newly positive case.”

All three were women in their 80s who had been hospitalized. One of the women was a resident of a long-term care facility. Officials said the three patients were from Newport News, Williamsburg and James City County.

The Post analysis showed 254 cases reported in Virginia.

The District announced 21 new cases Monday, bringing the city’s total in The Post’s analysis to 141. D.C. Fire and Emergency Medical Services officials said an assistant fire chief had tested positive.