ANCHORAGE, Alaska (AP) — A second hospital in Alaska has invoked crisis standards of care, allowing a committee of physicians to determine clinical decisions regarding patient treatment as the state continues to see a spike in COVID-19 cases.

The Yukon Kuskokwim Health Corp. in Bethel announced the activation of the guidelines in a statement posted on its website Wednesday, the same day the facility was operating at capacity. The standards allow overwhelmed hospitals to modify their usual, expected level of care.

Providence Alaska Medical Center in Anchorage, the state’s largest health care facility, earlier invoked the same guidelines.

Health officials at the Bethel hospital said there may be delays transferring people to a referring hospital, along with expanded nurse-patient ratio and longer wait times for elective procedures like colonoscopies and pediatric dental procedures. The decision to continue these types of elective procedures are made on a daily or weekly basis.

“We’re doing the best for every single patient, regardless of what resources are available at any given time. Unfortunately, however, as a result of the current surge in COVID-19 cases requiring hospitalization and limited resources statewide, we are now in a position of making these difficult decisions on a daily basis,” Dr. Ellen Hodges, the hospital’s chief of staff, said in the statement.

The announcement came as Alaska reported 976 new daily cases on Wednesday. As of Tuesday, the state had recorded 8,508 new cases in the past seven days, a 42% increase over the previous week. Almost the entire state is on high alert level because of rising case counts.

Dan Winkelman, the health corporation’s president and CEO, said they have done everything possible to delay activation of these guidelines.

“We urge every resident of the Yukon-Kuskokwim region to get vaccinated, wear a mask in indoor public areas, and social distance. With our hospital and our referral hospitals at capacity, this is our last stand against this virus,” he said.

He said this was a call-to-action to practice stronger mitigation measures to relieve stress, not only on the Bethel hospital, but its referral hospitals in Anchorage to save lives and get back to normal.

“I encourage all tribes and cities to seek legal and financial advice to enact financial incentives for eligible unvaccinated individuals to receive their first shot as President Joe Biden suggested,” he said. “I also encourage all employers and schools to demonstrate leadership to help end this pandemic and develop their own vaccination programs.”