Hospitals in Idaho are so overwhelmed by a surge in COVID-19 cases, that they’ve had to find out-of-state medical providers to help with patient overflow.

“You’re taking seven to eight hours to call a bunch of hospitals to see if one will take your patient who might face a time-sensitive emergency,” Dr. David Pate, a member of Idaho’s coronavirus task force, said to NBC News. “Seven to eight hours might mean that patient won’t survive.”

COVID-19 hospitalizations have increased by 29% in Idaho over the past two weeks, creating a strain on the medical community exacerbated by the distance between healthcare facilities in the mostly rural state. Only 40.36% of Idaho’s population is fully vaccinated, the third lowest rate in the country.

NBC News reports on the extraordinary measures some hospitals are taking to manage the crisis:

Kootenai Health, a hospital in Coeur d’Alene, Idaho, has already converted a conference room into an overflow Covid unit, started paying traveling nurses $250 an hour, brought in a military medical unit and received permission from the state to ration care.

Idaho doctors have asked for help from hospitals “as far south as Texas and as far east as Georgia” according to NBC News, but neighboring Washington has been pressed most often for assistance. At least one Washington hospital, Providence Sacred Heart, has reported longer than normal wait times in emergency rooms as it tries to accommodate Idaho’s surge. The New York Times reports:

The hospital has begun canceling elective procedures and is proceeding only with those that are urgent, Dr. Getz, [the Chief Medical Officer of Providence Sacred Heart], said. Procedures to excise brain tumors and treat orthopedic injuries are among those that have been postponed, he said.

“We are delaying care for people who are in misery,” Dr. Getz said. “It’s agonizing for those patients. This has real impacts on these people who are waiting.”

“It’s become an ethical challenge, as Washington has been aggressive in its Covid safety measures while Idaho’s state leaders have done little to address the latest surge,” explains NBC News. The outlet quotes Dr. Doug White, the director of the University of Pittsburgh’s Program on Ethics and Decision Making in Critical Illness:

“Medical practice is regulated at the state level, public health interventions come at the state level, and so in an emergency like this, I do think that the state lines become very important because what we’re seeing is these very stark differences between how Washington state has responded to the pandemic and how Idaho has responded to the pandemic,” he said, noting that Washington’s aggressive safety measures came at some cost to the state.

The New York Times provides more details:

On the Washington side of the border, residents must wear masks when gathering indoors, students who are exposed to Covid face quarantine requirements, and many workers are under vaccination orders. On the Idaho side, none of those precautions are in place.

“It’s ridiculous,” said Cassie Sauer, the president of the Washington State Hospital Association. “If you have your health care system melting down, the idea that you would not immediately issue a mask mandate is just bizarre. They need to be doing everything they can possibly do.”

Idaho’s governor, Republican Brad Little, has opposed mandating COVID-19 precautions. The Times adds:

He issued a statement on Friday saying he was exploring legal action to halt new mandates from President Biden that will push millions of people to get vaccinated.

“President Biden is out of touch, and his mandates only add to the divisiveness within our country,” Mr. Little said.

Days earlier, reports The Times, Idaho moved “its hospitals in the northern part of the state to crisis standards of care — the threshold at which facilities facing overwhelming caseloads are authorized to ration their resources, perhaps withholding or delaying optimal care for some patients.”

On Thursday, the Idaho Capitol Sun reported that “Idaho has activated the care-rationing protocol for the entire state.”

Meanwhile, in Montana, the Billings Clinic says their ICU is at 150% capacity and the National Guard has been activated to help manage the overflow. The healthcare provider is also preparing to adopt crisis standards of care.

“If it comes to a point where we have to make those incredibly [difficult] life or death situations, we will have an objective team that will be available to provide council and make those decisions,” Laurie Smith, chief nursing officer of the Billings Clinic, told the Billings Gazette.