Idaho public health leaders announced Tuesday that they activated “crisis standards of care” allowing health care rationing for the state’s northern hospitals because there are more coronavirus patients than the institutions can handle.

The Idaho Department of Health and Welfare quietly enacted the move Monday and publicly announced it in a statement Tuesday morning — warning residents that they may not get the care they would normally expect if they need to be hospitalized.

The move came as the state’s confirmed coronavirus cases skyrocketed in recent weeks. Idaho has one of the lowest vaccination rates in the U.S.

The state health agency cited “a severe shortage of staffing and available beds in the northern area of the state caused by a massive increase in patients with COVID-19 who require hospitalization.”

The designation includes 10 hospitals and healthcare systems in the Idaho panhandle and in north-central Idaho. The agency said its goal is to extend care to as many patients as possible and to save as many lives as possible.

The move allows hospitals to allot scarce resources like intensive care unit rooms to patients most likely to survive and make other dramatic changes to the way they treat patients. Other patients will still receive care, but they may be placed in hospital classrooms or conference rooms rather than traditional hospital rooms or go without some life-saving medical equipment.

At Kootenai Health — the largest hospital in northern Idaho — some patients are waiting for long periods for beds to open up in the full intensive care unit, said Dr. Robert Scoggins, the chief of staff. Inside the ICU, one critical care nurse might be supervising up to six patients with the help of two other non-critical care nurses. That’s a big departure from the usual one ICU nurse for one ICU patient ratio, he said.

On Monday, the Coeur d’Alene hospital started moving some coronavirus patients into its nearby conference center. A large classroom in the center was converted into a COVID-19 ward, with temporary dividers separating the beds. Some emergency room patients are being treated in a converted portion of the emergency room lobby, and the hospital’s entire third floor has also been designated for coronavirus patients.

Urgent and elective surgeries are on hold, Scoggins said, and Kootenai Health is struggling to accept any of the high-level trauma patients that would normally be transferred from the smaller hospitals in the region.

Other states are preparing to take similar measures if needed. Hawaii Gov. David Ige quietly signed an order last week releasing hospitals and health care workers from liability if they have to ration health care.

The unfolding crush of patients to Idaho hospitals has been anticipated with dread by the state’s heath care providers. Medical experts have said that Idaho could have as many as 30,000 new coronavirus cases a week by mid-September if the current rate of infections lasts.

“Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect,” Idaho Department of Health and Welfare Director Dave Jeppesen said in a statement.

He added: “This is a decision I was fervently hoping to avoid. The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places. Please choose to get vaccinated as soon as possible – it is your very best protection against being hospitalized from COVID-19.”

The designation will remain in effect until there are enough resources — including staffing, hospital beds and equipment or a drop in the number of patients — to provide normal levels of treatment to all.

More than 500 people were hospitalized statewide with COVID-19 on Sept. 1 and more than a third of them were in intensive care unit beds.

Idaho’s hospitals have struggled to fill empty nursing, housekeeping and other health care positions, in part because some staffers have left because they are burned out by the strain of the pandemic and because others have been quarantined because they were exposed to COVID-19.

Late last month, Little called in 220 medical workers available through federal programs and mobilized 150 Idaho National Guard soldiers to help hospitals cope with the surge.

Two hundred of the federal workers are medical and administrative staffers available through a contract with the U.S. General Services Administration. The U.S. Department of Defense agreed to send a 20-person medical response team to northern Idaho. The Idaho National Guard soldiers will help with logistical support such as screenings and lab work.

On Tuesday, the governor called the move to limit care “an unprecedented and unwanted point in the history of our state” and urged residents to get vaccinated against coronavirus.

Data from the U.S. Centers for Disease Control and Prevention shows that full vaccination with any of the currently available coronavirus vaccines dramatically reduces the risk of requiring hospitalization for a coronavirus infection.

“More Idahoans need to choose to receive the vaccine so we can minimize the spread of the disease and reduce the number of COVID-19 hospitalizations, many of which involve younger Idahoans and are preventable with safe and effective vaccines,” said Little, who is a Republican.

When the pandemic first came to Idaho at the start of 2020, Little ordered a partial shutdown of the state — ordering some businesses to temporarily close or shift to take-out style services, banning some large gatherings and asking residents to stay home as much as possible.

The move was aimed at ensuring that hospitals wouldn’t become overwhelmed by patients. Idaho was on the verge of enacting crisis standards of care during a major coronavirus surge last winter, but narrowly avoided doing so — making this the first time the state has taken the drastic measure.

Little reopened the state in stages over a period of several months and has not reimposed restrictions limiting gatherings. Businesses are mostly operating as normal.

The state’s crisis guidelines are complex, and give hospitals a legal and ethical template to use while rationing care.

Under the guidelines, patients are given priority scores based on a number of factors that impact their likelihood of surviving a health crisis.

Those deemed in most in need of care and most likely to benefit from it are put on priority lists for scarce resources like ICU beds.

Others in dire need but with lower chances of surviving will be given “comfort care” to help keep them pain-free whether they succumb to their illnesses or recover.

Other patients with serious but not life-threatening medical problems will face delays in receiving care until resources are available.

“I hope that your takeaway from this is that the vaccines work. They are the best tool by far that we have,” to keep people from getting seriously sick from the coronavirus, said Jeppesen, the state health department director.

The demand on hospitals is likely to increase in coming weeks as case numbers continue to climb, Jeppesen said, so everyone should take steps to avoid needing any emergency care if possible by wearing seatbelts, taking medication as prescribed and reconsidering activities like riding bikes that can lead to accidents.

“Just be a little more careful,” he said.