The intensive care facilities at Straub Hospital in downtown Honolulu are operating beyond their capacity as COVID-19 cases surge, requiring staff for the first time to execute disaster plans put in place early in the pandemic in order to handle all of the patients.

“We’re there. We’re at the end of what we can handle,” said Dr. Jonathan Paladino, an intensive care unit physician at Straub and director of critical care medicine for Hawaii Pacific Health, during a Wednesday morning news conference outside of Straub’s emergency room. He urged all Hawaii residents “to exercise their aloha, to do the right thing, become vaccinated.”

Paladino said that the ICU is operating at up to 125% of its capacity and is currently at stage five of a seven-stage protocol that was modeled off of military disaster planning.

“We are sitting right there on the bubble of normal operations, but we’re having to stretch ourselves, we’re having to come up with new staffing models, we’re having to come up with new treatment areas to be able to accommodate the patients that are here,” he said.

The hospital has set up a triage tent outside the emergency room and is working to covert space to care for sicker patients.

Hospitals throughout the state have been reporting a shortage of staff and ICU beds in recent days with the number of COVID-19 cases far surpassing the peak last year when vaccines weren’t yet available. While about 70% of Hawaii residents have now received at least one shot of a vaccine, and 61.5% are fully vaccinated, the highly-contagious delta variant of the virus has quickly spread through the remainder of the population that is unvaccinated.

Hawaii is one of seven states that has surpassed its previous peak in COVID-19 hospitalizations per capita, the New York Times reported this week. Other states include Florida, Louisiana, Mississippi, Arkansas, Oregon and Washington.

Earlier this week, The Queen’s Health Systems said it had run out of intensive care beds, had started canceling elective surgeries and procedures and had to divert patients with emergency health needs to other hospitals. Hospitals on Hawaii island and Maui are experiencing similar strains.

Lt. Gov. Josh Green said that about 90% of the 336 COVID-19 patients currently hospitalized are unvaccinated. While the delta variant has shown to infect vaccinated people at higher rates than the original virus, the vaccines are still fulfilling their primary purpose of protecting people from serious illness and death, health officials say.

There is a glimmer of good news, said Green, in that case numbers in recent days appear to have plateaued. The percentage of COVID-19 tests coming back positive has remained at about 7.5% in recent days. Currently, the state is averaging about 680 new cases a day, according to state data. But Green warned that case numbers need to come down from that level.

“People can go from 12-hour shifts to slightly longer. Sometimes they can go to 24-hour shifts. But eventually, you reach a wall, a hard stop,” said Green. “We are not there, but we will get there if we continue to have six hundred or more cases a day.”

The case numbers have skyrocketed among younger people with lower vaccination rates. During the first week of July, there was an average of 35 new cases for every 100,000 residents between the ages of 18 to 44. That figure jumped to 353 new cases during the week beginning Aug. 8. Cases have also surged among children, with an average of 239 new cases per 100,000 residents for the week starting Aug. 8, up from 22 cases in early July.

Green said that more children are coming into the hospitals and some have needed critical care.

“We are seeing the initial number of cases in the ICU for children. I do not believe that any child has been put on a ventilator yet,” he said.

COVID-19 pediatric ICU patients are being cared for at Kapiolani Medical Center for Women and Children, which is part of Hawaii Pacific Health’s network of hospitals. A spokeswoman for the health care system declined to say how many children with COVID are in the ICU, citing patient privacy issues.

Paladino said that overall children who contract the virus are still faring well.

“Our children are very resilient and deal with viruses just as part of their maturation process,” he said.

Still, more than 370 children nationally have died from COVID-19, according to a recent report from the American Academy of Pediatrics and the Children’s Hospital Association. Children who contract the virus may also have so-called long haul symptoms that can last for months.

Paladino said that children are often contracting the virus from their unvaccinated parents.

“Is that a gamble that you want to take? Is that where you want to risk it all for the health and safety of your children?” he said. “That is a deeply personal question that everyone is going to have to ask themselves.”