The Queen’s Health Systems declared an “internal state of emergency” Friday as an influx of COVID-19 patients at its West Oahu hospital outstripped available beds and the ability of staff to care for them.

“That means that all hands are on deck,” said Jason Chang, chief operating officer of The Queen’s Health Systems and president of The Queen’s Medical Center.

Chang said that at one point 63 patients showed up at the emergency department at The Queen’s Medical Center-West Oahu, 26 of whom believed they were sick with COVID-19.

“That’s a crisis because that emergency department has 24 beds, and 63 makes it very tough for us to provide the right amount of care,” he said.

All of the 104 beds at the West Oahu hospital are full, and as many patients as possible are being transferred to The Queen’s Medical Center in downtown Honolulu and potentially the neighbor islands, said Chang.

But that too is a challenge, as those hospitals are also struggling to take care of the increase in patients as COVID-19 cases soar throughout the islands.

Earlier this week Chang said the hospital system had run out of available intensive care beds, was canceling elective surgeries and procedures, and postponing more serious surgeries when possible.

He said city officials are helping set up a triage tent outside the West Oahu hospital with about two dozen cots. The National Guard also may be called in to help.

“It’s really a crisis out there,” he said. “The number of new COVID cases is just increasingly high.”

Chang said area residents should still go to the West Oahu hospital if they have an emergency, such as a heart attack or stroke.

The emergency declaration applies to all of Queen’s health care facilities. Queen’s is expecting 74 relief nurses from the Federal Emergency Management Agency to arrive Monday. Overall, the state is expecting more than 500 health care workers to arrive in Hawaii to assist with the surge in cases.

“It’s overwhelming our system,” said Chang, who urged residents to get vaccinated and stay home from social events. He also advised residents to call the Queen’s COVID hotline at 691-2619 if they are worried about symptoms and need health care advice.

Meanwhile, top state and county officials are debating various new restrictions to help curtail the spread of the coronavirus. On Friday state officials reported 845 new COVID-19 cases and four more deaths. The state is averaging 661 new cases a day.

Lt. Gov. Josh Green said the state is considering a vaccination verification program, similar to San Francisco and New York City, which would require people to show proof of vaccination against COVID-19 in order to enter restaurants, bars, gyms and other indoor establishments.

He said such a policy could be two to three weeks away.

“We are working up that policy and giving it as an option to the governor,” Green told Spotlight Hawaii, the Honolulu Star-Advertiser’s livestream program, on Friday.

A vaccine verification program for businesses is among a number of options Green said the governor and county mayors are considering as the highly contagious delta variant causes COVID-19 cases to surge throughout the islands and an influx of patients strains hospitals. Green said imposing a curfew to relieve pressure on emergency rooms is one idea, but he doubts it will happen.

While a portion of the public is pushing for more stringent measures to control the spread of the virus, Green said the policy decisions are complicated.

“I know there are people out there who say, ‘Look, just shut it all down,’” said Green. “But that’s a pretty difficult thing to do when suddenly a family who got vaccinated won’t be able to pay their rent, won’t be able to pay their mortgage, won’t be able to pay for groceries for their children, may not have extra unemployment protection.”

Green said it’s difficult to punish everyone because 17% of residents who are eligible to get the COVID-19 vaccine still haven’t gotten it. But if case numbers can’t be controlled or there are outbreaks in schools, Green said, the state will likely have to look at shutdowns.

As of Friday morning there were 381 people hospitalized with COVID-19 throughout the state, 90% of whom are unvaccinated, said Green. On July 1, before the delta variant of the coronavirus caused a spike in cases, there were just 40 people hospitalized with the virus, according to state data.

Green said there are 3,200 hospital beds throughout the state, about 2,200 of which are currently staffed. The state is in the midst of bringing in more than 500 relief workers, including critical care nurses and respiratory technicians, which is expected to help the hospitals open up more beds.

Green said the state also has a variety of options to increase capacity, including turning hotels into makeshift hospitals, using the National Guard to set up portable hospitals and using the Hawai‘i Convention Center for patients.

On the more extreme end of options is building a new facility, which would cost about $300 million. “That would be if we had months and months of high levels in the hospital and our hospital facilities couldn’t survive,” he said.