ANCHORAGE, Alaska (AP) — Alaska’s largest hospital has begun rationing care, saying it has been overwhelmed by COVID-19 patients.

Providence Alaska Medical Center said Tuesday it will prioritize resources and treatment to those patients who have the potential to benefit the most.

Dr. Kristen Solana Walkinshaw is chief of staff at the hospital and says that, “We are no longer able to provide the standard of care to each and every patient who needs our help,”

Alaska, like other places, has seen a surge in COVID-19 cases driven by the delta variant of the coronavirus.

Providence is one of only three hospitals in Anchorage, a city of 300,000 people. Walkinshaw says Providence’s emergency room is overflowing and patients have to wait for hours in their cars to see a doctor for emergency care.

Cases back to last winter’s levels

The number of COVID-19 deaths and cases in the U.S. have returned to levels reached last winter, potentially bolstering President Joe Biden’s argument for sweeping new vaccination requirements.

The U.S. is averaging more than 1,800 COVID-19 deaths and 170,000 new cases per day. That’s still well below the peak of about 3,400 deaths and 250,000 cases per day in January. But it’s frustrating health care leaders, nine months into the nation’s vaccination drive, who are watching hospitals fill up with unvaccinated patients.

While hot spots such as Florida and Louisiana are improving, infection rates are soaring in Kentucky, Georgia and Tennessee, fueled by children back in school, loose mask requirements and low vaccination rates.

The cases, driven by the delta variant and resistance among some Americans to get vaccinated, are concentrated mostly in the South.

“Now in Kentucky, one-third of new cases are under age 18,” says Dr. Ryan Stanton, an emergency room physician in Lexington. He says some children brought it home from summer camp and spread it to the rest of the family, and “between day care and schools and school activities, and friends getting together, there are just so many exposures.”

Other states facing crises as well

Public health officials in Idaho say crisis standards of care are imminent for the state’s most populated region as hospitals continue to be overrun with unvaccinated COVID-19 patients.

Dave Jeppesen, the director of the Idaho Department of Health and Welfare, says southern Idaho, including the Boise metropolitan area, could join northern Idaho in rationing health care at any moment.

Last week, the state formally enacted “crisis standards of care” in northern Idaho, giving overwhelmed hospitals permission to direct scarce resources like intensive care unit beds to the patients most likely to survive. At Kootenai Health in Coeur d’Alene, some COVID-19 patients are being treated in a field hospital at a conference center.

In North Dakota, an executive at the largest health care system in the state says its hospitals in Fargo could use up to 300 additional nurses to handle COVID-19 cases and is bumping up incentives to fill the void.

“We really are in crisis,” said Dr. Doug Griffin, Sanford Health vice president and medical officer in Fargo, which serves a metropolitan area of about 250,000 people in North Dakota and Minnesota.

Hospitals across the region are filling up with both COVID-19 and non-COVID-19 patients, Griffin said. Fargo Sanford is about two to three weeks from reaching its peak hospitalization capacity.

Besides nurses, the system is short-staffed for inpatient services, respiratory therapy and even “people who draw blood,” Griffin said.

In Montana, 17 National Guard soldiers have volunteered to keep helping the state with its COVID-19 response.

Gov. Greg Gianforte says 10 soldiers will be assisting Billings Clinic while another seven will help the state lab in Helena.

Over the past 18 months, Montana National Guard members have aided with COVID-19 response at nursing homes and by testing visitors arriving at airports.

Montana reported another 1,249 confirmed cases on Tuesday, with 362 people hospitalized. At least 1,847 residents have died of COVID-19 in the past 18 months, with cases steadily rising since mid-July. The health department reported 47 deaths in the first two weeks of September.

More than 474,000 residents, 51% of the eligible population, are fully vaccinated.