The strain of surging COVID-19 cases has reached the point where Gov. David Ige has signed an executive order giving health care institutions immunity from liability if they ration care.

Ige signed Executive Order No.21-06 on Wednesday (808ne.ws/liabilityprotec tion). The new order comes after weeks of warnings from Hawaii health care facilities that their resources were dangerously diminished from the constant onslaught of COVID-19 cases.

Healthcare Association of Hawaii President and CEO Hilton Raethel said the order, which is similar to those used by other states during the pandemic and natural disasters, is a serious first for Hawaii.

Raethel said so far, Hawaii’s health care facilities have not had to use the order, which would mean that Hawaii’s health care providers were too overwhelmed to provide normal care levels. At that point they would have to move to “crisis standards of care,” where some patients get turned away.

“I’m not aware that we have done this before in Hawaii. We are doing everything we can to avoid it. But we do appreciate the governor providing that immunity should that situation arise,” he said.

Raethel said Hawaii’s health care community is working with the Hawaii Emergency Management Agency, the state Department of Health, Federal Emergency Management and other federal agencies to bring in more resources, such as oxygen and staffing.

As of Sunday, he said, 630 clinical staff from the mainland have been brought into Hawaii to support its hospitals. Raethel said, however, that Hawaii’s long-term care facilities still need to staff up by more than 200 so that fewer long-term care patients take up hospital beds while waiting for placement.

“We are preparing, but there is a potential that we could run out of something at some point if these numbers continue,” he said. “We were hoping that when we got through that surge last year that we wouldn’t have to worry about crisis standards of care, but unfortunately, here we are with a much worse situation than what we were in last year.”

State Department of Health officials Sunday reported 10 new coronavirus-­related deaths and 731 new confirmed and probable infections statewide, bringing the state’s totals since the start of the pandemic to 624 fatalities and 67,509 cases.

Health officials also said Sunday that of the state’s total infection count, 11,206 cases were considered active.

Lt. Gov. Josh Green told the Honolulu Star-Advertiser on Sunday, “Our daily cases counts are simply too high to sustain, and our hospital’s intensive care units are full because too many gatherings continue to occur, especially among the unvaccinated members of our state.”

According to the latest information from the department’s Hawaii COVID-19 Data dashboard, 448 patients with the virus were in Hawaii hospitals as of Friday, with 98 in intensive care units and 90 on ventilators.

Raethel said about 85% of the people in the hospital are unvaccinated.

“It’s the unvaccinated individuals in our hospitals who are creating this stress,” he said. “If we did not have all of those unvaccinated people in our hospitals, we wouldn’t be deploying tent systems, we wouldn’t be running short of oxygen, we wouldn’t be needing to bring in all of this staff.”

Green, who is an emergency room physician, had recommended that Ige, state Health Director Dr. Libby Char and state Adjutant General Kenneth Hara consider implementing a 72-hour safer-­at-home order over the Labor Day weekend.

“In the coming two to three weeks, if hospital cases continue to rise toward 500 statewide, or the ICUs remain full, then the governor will have no choice but to restrict gatherings and other activities in Hawaii, just to prevent widespread loss of life from COVID,” he said.

Green said the high number of active cases, 11,206, could translate into 350-400 additional hospitalizations over the next two weeks at a time when Hawaii’s health care teams are already overwhelmed.

“This will also likely mean an additional 100 fatalities will occur in the near future,” he said. “Meanwhile, we can’t treat many other common health conditions like heart attacks and strokes quickly enough with a shortage of ICU beds and fatigued staff. This cycle has to end.”

State Sen. Glenn Wakai (D, Kalihi-Airport-Salt Lake) said what’s happening is unthinkable.

“I just find it astonishing that we didn’t make more drastic decisions a month ago,” Wakai said. “Here we are making decisions that God should be making, not government.”

Dr. DeWolfe Miller, an epidemiologist, UH professor and fellow in the American College of Epidemiology, said infections in the community aren’t abating fast enough.

“If we want to address this, we need to address the classic circumstances under which respiratory diseases spread, and that is: person-to-person gatherings, classrooms, workplaces and places of service,” Miller said. “And, of course, we have to get vaccinated and we have to mask up. It’s just essential to do this now. We are in dire straits.”

Green said Hawaii needs to pause all gatherings and “take this opportunity to do 150,000 vaccinations in the next month to stop the pandemic.”

The latest Hawaii COVID- 19 vaccine summary says 1,882,907 vaccine doses had been administered through state and federal distribution programs as of Friday, up 6,649 from a day earlier. Health officials say 63% of the state’s population is now fully vaccinated, and 72% has received at least one dose.