BOISE, Idaho — In another ominous sign about the spread of the delta variant, Idaho public health leaders on Thursday expanded health care rationing statewide and individual hospital systems in Alaska and Montana have enacted similar crisis standards amid a spike in the number of unvaccinated COVID-19 patients requiring hospitalization.

The decisions marked an escalation of the pandemic in several Western states struggling to convince skeptical people to get vaccinated.

The Idaho Department of Health and Welfare made the announcement after St. Luke’s Health System, Idaho’s largest hospital network, asked state health leaders to allow “crisis standards of care” because the increase in COVID-19 patients has exhausted the state’s medical resources.

Idaho is one of the least vaccinated U.S. states, with only about 40 percent of its residents fully vaccinated against COVID-19.

Crisis care standards mean that scarce resources such as ICU beds will be allotted to the patients most likely to survive. Other patients will be treated with less effective methods or, in dire cases, given pain relief and other palliative care.

A hospital in Helena, Montana, was also forced to implement crisis standards of care amid a surge in COVID-19 patients. Critical care resources are at maximum capacity at St. Peter’s Health hospital, officials said Thursday.

And earlier this week Providence Alaska Medical Center, Alaska’s largest hospital, also started prioritizing resources.

Thursday’s move in Idaho came a week after state officials started allowing health care rationing at hospitals in northern parts of the state.

“The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” Idaho Department of Welfare Director Dave Jeppesen said in statement.

He urged people to get vaccinated and wear masks indoors and in crowded outdoor settings.

“Our hospitals and health care systems need our help,” Jeppesen said.

One in every 201 Idaho residents tested positive for COVID-19 over the past week, according to a tally by Johns Hopkins University. The mostly rural state ranks 12th in the U.S. for newly confirmed cases per capita. More than 1,300 new coronavirus cases were reported to the state on Wednesday, according to the Idaho Department of Health and Welfare.

Hospitalizations have skyrocketed. On Monday, the most recent data available from the state showed that 678 people were hospitalized statewide with coronavirus.

Meanwhile, the number of COVID-19 patients in intensive care unit beds has stayed mostly flat for the last two weeks at 70 people each day – suggesting the state may have reached the limit of its ability to treat ICU patients.

Though all of the state’s hospitals can now ration health care resources as needed, some might not need to take that step. Each hospital will decide how to implement the crisis standards of care in its own facility, public health officials said.

Kootenai Health in the city of Coeur d’Alene was the first hospital in the state to officially enter crisis standards of care last week.

At the time, Chief of Staff Dr. Robert Scoggins said some patients were being treated in a conference center that had been converted into a field hospital. Others received treatment in hallways or in converted emergency room lobbies. Urgent and elective surgeries are on hold across much of the state.

On Wednesday, nearly 92 percent of all of the COVID-19 patients in St. Luke’s hospitals were unvaccinated. Sixty-one of the hospital’s 78 ICU patients had COVID-19. St. Luke’s physicians have pleaded with Idaho residents for months to get vaccinated and take steps to slow the spread of coronavirus, warning that hospitals beds were quickly running out.

Public health officials have warned Idaho residents for weeks to take extra care to ensure they don’t end up in hospitals. Last week, Jeppesen said residents should take their medications as prescribed, wear seat belts and reconsider participating in any activities such as cycling that could lead to injuries.

The health care crisis isn’t just impacting hospitals – primary care physicians and medical equipment suppliers are also struggling to cope with the crush of coronavirus-related demand.

One major medical supplier, Norco Medical, said demand for oxygen tanks and related equipment has increased, sometimes forcing the company to send patients home with fewer cylinders than they would normally provide. High-flow oxygen equipment – normally used in hospital or hospice care settings – is also being more frequently requested for at-home patients, said Norco President Elias Margonis.

“It seems like they’re discharging aggressively to free up beds for new patients coming into the hospitals,” Margonis said.

Margonis spent much of his morning on the phone with public health leaders and hospitals, trying to determine how the crisis standards of care will change the way patients are discharged from hospitals. Already, the company has seen an increase in customers seeking specialty oxygen equipment that flows at a rate of 8, 12 or 20 liters per minute rather than the standard 4 or 5 liters per minute, he said.

“When someone goes home, we bring their bed, we bring their wheelchair, we bring their cannula, their oxygen,” Margonis said. “This is where we’re saying, it’s important that you can’t just discharge the problem, even if the patient is on the mend and on the way to getting healthy. To recover, they need the right support.”

Primary Health Medical Group, Idaho’s largest independent primary care and urgent care system, late last month was forced to shorten operating hours because its waiting rooms were so packed with patients that staffers were staying hours past closing in order to see them all. Meanwhile, the company was dealing with higher-than-normal numbers of staffers out sick because they had been exposed to coronavirus in the community or had symptoms and were awaiting tests.

As case numbers continued to increase, three of Primary Health Medical Group’s 21 clinics in southwestern Idaho have had to stop operating on weekends, said CEO Dr. David Peterman.

Now the medical group is also preparing to monitor its patients who are released earlier than they normally would be from the hospital after emergencies, Peterman said.

“We will see more visits with patients that are avoiding the emergency room and patients who are sicker and need more care,” Peterman said.

Resources have been exhausted across the medical system, Peterman said.

“This is heart-wrenching. I’ve practiced medicine in southwest Idaho for 40 years and I have never seen anything like this,” he said.