In early May 2020, the Queen’s Medical Center took down its disaster tent outside the ambulance bay, ending an anxious seven-week period during which people undergoing COVID-19 testing were separated from the rest of the hospital population — and signaling hope that the virus was no longer circulating widely here.

Now, with the highly contagious delta variant ripping through unvaccinated residents, a triage tent is again standing at Queen’s Punchbowl Street site. And another is set up at Queen’s Medical Center West Oahu, where an “internal state of emergency” was declared last month as an influx of COVID-19 patients outstripped available beds and the ability of staff to care for them.

It should be obvious to Hawaii residents that community spread is surging at an alarming pace. Short of another lockdown, vaccination rates need to pick up and more vigilance imposed to maintain strict mask mandates and physical-distancing directives. And to maintain the integrity of the health care system, hard choices may be required.

In response to these and other red flags, Gov. David Ige last week signed an executive order giving health care institutions immunity from liability if they ration care. The order, which is similar to those used by other states during the pandemic and natural disasters, serves as a sobering first for Hawaii in that it creates potential continuum-of-care problems for many patient types — not just those with COVID-19 infection.

Idaho this week activated “crisis standards of care,” which allows rationing for some hospitals due to a crush of coronavirus patients. The move greenlights hospitals to assign scarce resources, like intensive care unit rooms, to patients most likely to survive. Other patients would still receive care, but they may be placed in areas other than traditional hospital rooms, or go without some life-saving medical equipment.

Simply put, this tactic — the dreaded consequence of pandemic-related strains on facilities and staffing, along with vaccination rates increasing in slow steps — means many patients may not get the care they would normally expect if they need to be hospitalized. Additionally, already at some facilities, such as Kaiser Permanente in Hawaii, surgeries for patients in need of non-urgent operations are being postponed.

The pushed-back appointments are surely touching off anxiety among patients awaiting procedures and screenings that could reveal health concerns requiring prompt follow-up attention. And it’s clear that more COVID-19 vaccine shots in arms could go a long way to easing this predicament.

The high count of unvaccinated patients in hospitals is forcing Hawaii’s health care institutions — working in tandem with state and federal agencies — to bring in more staffing and scramble to secure other vital resources, such as medical-grade oxygen, in an effort to fend off crisis standards of care.

Healthcare Association of Hawaii President and CEO Hilton Raethel had rightly pointed out that in the absence of unvaccinated patients, “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.” There are some 620 health care workers from the mainland assisting local frontline caregivers for up to a few months. Hawaii must get caseloads under control while this safety net is in place.

While nearly 64.5% of the state’s total population is fully vaccinated, the delta variant has bumped up the rate needed for herd immunity protection — to a near-universal level, possibly — because its median viral load is much higher than original COVID-19 strains, making it far more transmissible than the virus that drove last year’s case counts.

Yes, pandemic fatigue is now palpable — but it’s also dangerous, given the prognosis that Hawaii’s health care system is in dire straits. Now more than ever, we need to make every effort to protect ourselves and one another.