Coronavirus infections on Lanai have swelled to 65, up from four cases just three days ago, prompting a stay-at-home order that is expected to take effect on Tuesday.

Maui Mayor Michael Victorino has sent the lockdown request to Gov. David Ige for approval.

“I always go back to thinking what if it’s been here longer than we think and it’s gone around and infiltrated our community deeper than we think? We’re not isolated, there’s still quite a bit of construction and people coming in and out,” said Jason Allen, 48, owner of Fish-N-Chips Sportfishing in Lanai City, who’s lived on the island since 2002. “Lanai has historically been the place where you don’t want to get sick. The medical facilities here aren’t the same as they are on Oahu and Maui.”

So far, none of the island cases are serious enough to require hospitalization, Maui hospital officials said at a virtual community town hall meeting Friday.

Maui Health, which operates the 219-bed Maui Memorial Medical Center, the county’s only acute-care hospital also serving Lanai’s 3,100 residents, said it is currently running at 78% occupancy, with 10 ICU beds available for any serious COVID-19 cases that arise on the rural island that is struggling to contain a rapidly growing outbreak linked to a couple of “large social gatherings” and household transmission. There are just two ventilators on Lanai, but about 70 on Maui, none of which are currently being used for coronavirus patients, hospital officials said.

Maui Memorial is prepared to expand its capacity if there is an influx of infections, said hospital CEO Mike Rembis.

“We’ve gone through two surges as most of the country has. We’re no different than the rest of the nation. We are ready and we can expand from 219 today to almost to 300 if we needed to, but we all pray and hope we don’t have to face those kinds of surges.”

Any COVID-infected patient that becomes critically ill on Lanai will be air lifted to Maui for specialized care, said Tracy Dallarda, spokeswoman for Maui Health.

“Thus far, the positive COVID individuals are not exhibiting any critical symptoms, but if they were to, plans are in place to care for them,” she said.

The Queen’s Medical Center said it is prepared to care for a surge in cases from the island. The Oahu hospital is currently treating about 30 COVID-19 patients, compared to more than 90 patients per day in August.

“The Queen’s Health Systems is aware of the number of new cases on Lanai and has offered our support. The number of COVID patients in our inpatient units is currently at the lowest point in four months, so we are confident that we can help with any new cases that need hospitalization, including critical care,” said Jason Chang, chief operating officer at the Queen’s Health Systems.

Hawaii Pacific Health, which operates a Straub clinic on Lanai, said it too is ready to care for Lanai residents who may need to be hospitalized.

“We have been in close contact with our team there to ensure they have all the resources they need to respond to the community’s needs,” said spokeswoman Kristen Bonilla. “We are also sending Straub staff from Oahu to Lanai to assist with the testing efforts this weekend.”

Mass testing will begin on Saturday at the Old Dole Administration Building in Lanai City from 7 a.m. to 1 p.m.

“I think it’s going to blow up. We have families that are living in real small houses (because) housing here is very limited,” said Allen, who took his first customers since March out fishing on Friday. “I’m now geared up, got everything ready to go again, put money into the operation to take passengers out … and now we’re going to get shut down again. I have trips on the books, but I’m sure I’m going to get calls cancelling them. With each day it’s just another cut. It’s the death of a thousand cuts.”

Hospitals on other islands are preparing to take Lanai residents because Lanai Community Hospital, which has 45 employees, is a critical access facility with just four patient beds, three emergency room beds and 10 long-term care beds.

The facility, which typically treats three to six patients a day in the emergency department, has set up a triage tent outside the emergency department to prevent spread into the hospital, but said so far there has been no increase in volume. In fact, there were zero emergency room visits on Thursday, according to Maui Health, which said it has the capacity to conduct more than 1,000 tests daily if need be and can react quickly “at the very first sign of any kind of COVID surge.”

“We are prepared here on Maui as we are in Lanai to practice safe medicine,” said Dr. Vijak Ayasanonda, an ER physician at Maui Memorial. “We are worried that there always will be that next surge. We know what could come so it’s better to be over prepared.”

Hawaii health officials reported three new coronavirus deaths on Oahu — two men and one woman, all of whom were older than 80 with underlying medical conditions — and 131 new infections statewide, bringing the totals since the start of the pandemic to 209 deaths and 14,464 cases. There are 2,963 active infections statewide and 11,292 patients now considered recovered, or 78% of those infected.

Lanai residents for the most part have been “very cautious,” practicing safe distancing for months now, Allen said.

“It has already turned from a community that was real close-knit to … you just don’t see people anymore,” he said. “If you’re living on Lanai you surely know some of the kupuna. I can’t imagine the feeling of isolation that has to be going on here.”