LANSING, Mich. (AP) — Gov. Gretchen Whitmer on Tuesday urged Michigan residents to get the flu vaccine to ease the load on the health system if there is a surge of coronavirus cases during the fall and winter influenza season, announcing the state wants at least 1 million more people vaccinated.

She received a flu shot during a news conference to “show how easy it is.”

More than 3.2 million of Michigan’s 10 million residents were vaccinated against the flu last season. The state’s goal is to increase that number by a third, to 4.3 million. It announced an advertising campaign that will begin next week, and hospitals and community health centers said they will boost their own efforts to encourage flu vaccinations.

“When we all get our flu vaccine, we can help keep thousands of patients out of the hospital and prevent overcrowding,” Whitmer said.

Influenza, a contagious respiratory illness, can cause mild to severe illness — including hospitalization or death. Older adults, young children and people with chronic health conditions are at high risk of serious complications.

“The flu vaccine prevents anywhere from 40 to 60% of cases of the flu every year,” said Dr. Joneigh Khaldun, the state’s chief medical executive. People who get the flu despite having been immunized tend to face less severe symptoms, she said.

The state health department on Tuesday reported 20 additional COVID-19 deaths, including six that occurred days or weeks earlier, bringing the total number of confirmed or probable deaths to nearly 6,700.

The seven-day average of new cases statewide was 705 as of Monday and had stayed mostly constant over the previous two weeks, ranking lower than all but 12 other states on a per-capita basis.

Khaldun said the Detroit region had the highest daily case rate per million residents (69) as of last Friday, followed by the Upper Peninsula and Saginaw regions (57), then the Kalamazoo (53), Grand Rapids (40) and Traverse City (32) regions. The Jackson and Lansing regions had the lowest rates (25).

Whitmer, a Democrat, did not make any announcements on reopening gyms, movie theaters, bowling alleys and other businesses that remain closed under her order except in much of northern Michigan. She has said she will talk more about the issue this week amid pressure from industry groups that say Michigan is among a handful of states that have not let those types of operations reopen statewide with capacity restrictions.

The governor reiterated that Michigan is “faring a lot better than a lot of other states are right now” because “we took aggressive action early on to fight this virus.” She said she will not be “bullied” to let the businesses open after five-plus months of closure.

“It is something that we are continuing to scrutinize and determine if it’s safe to move forward,” Whitmer said.

Local health departments last week identified 70 outbreaks, which are defined as two or more non-household cases with a link by place and time indicating a shared exposure. None appeared to be associated with gyms, theaters or bowling alleys in northern counties. The state’s website said the list was not complete due to the underreporting of outbreaks and the difficulty of doing effective contact tracing.

Whitmer said some gyms outside northern Michigan “are flouting the law and have seen outbreaks, and they’ve closed within days of when they open.”

Of 292 new or previously identified outbreaks or clusters of cases, 92 were in nursing homes or other long-term care settings. Thirty-five were tied to social gatherings, 25 to offices, and 22 each to manufacturing/construction and agriculture. Three were associated with personal care services, which can include hair salons, spas, gyms or similar businesses.

Tori Sachs, executive director of the conservative political group Michigan Rising Action, said Whitmer allowed Detroit casinos to open in early August “and can’t explain why small and family-run businesses aren’t able to also be given a fair shot at reopening safely.”