Alaska’s larger, urban hospitals are so crowded with COVID-19 patients that some smaller, outlying facilities are struggling to transfer seriously ill people or scrambling to care for them in place.

Surging COVID-19 cases around the state continued this week with no sign of hitting a peak as the highly infectious delta variant continues to drive new cases and hospitalizations. Hospitals, especially in Anchorage and Mat-Su, describe a crisis-level crush of staffing shortages and complicated coronavirus patient cases.

The state Friday reported two more deaths of people with the virus — an Anchorage woman in her 40s and a Dillingham-area man in his 70s — and hit another new record for COVID-19 hospitalizations, according to the Alaska Department of Health and Social Services dashboard. A total of 444 Alaskans have died with the virus, as well as 14 people from out of state.

Hospitals such as those in Kodiak, Nome and Bethel are encountering unprecedented challenges as coronavirus-related capacity problems down the line ripple into a domino effect of stalled transfer requests.

Nome’s hospital doesn’t even have any COVID-19 patients, but it still faces “a COVID problem,” as Dr. Tim Lemaire, a family practitioner and member of the Norton Sound Health Corp. incident command team, put it. “We don’t have COVID here but we can’t get our regular patients … care because of COVID everywhere else.”

Trying to move patients with heart attacks, strokes or injuries from four-wheeler accidents, Norton Sound Regional Hospital sometimes has to call three or four facilities to find an open bed, at least once moving a patient all the way to Seattle to get them into an ICU.

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Lemaire participates in a new statewide daily morning call that health officials host. Friday’s call was not encouraging, especially the news from Anchorage: full intensive-care units, with COVID-positive patients in half the beds; surgery recovery areas used for COVID patients; patients held in the ER because regular beds were full.

“Man, it’s bleak,” he said.

In Kodiak, hospital officials during a briefing Thursday said they initiated “surge” plans for all patient types in response to continued transfer delays for non-COVID patients and the possible inability to do any transfers in the future. Typically, that can mean bracing to handle complex patients who can’t get care elsewhere.

Bethel’s Yukon-Kuskokwim Delta Regional Hospital has some COVID-19 patients, but providers generally care for them in house, Yukon-Kuskokwim Health Corp. chief of staff Dr. Ellen Hodges said Friday.

It’s the others — cardiac patients, car wreck victims, people with potentially fatal sepsis — who are hard to transfer, Hodges said. For the past few weeks, it’s taken 12 hours, at most 24, to find ICU beds for people in need of critical care because the health organization’s referral hospital, Alaska Native Medical Center, is usually full.

She’s taken to warning friends to stay off bikes unless they wear helmets and put their seat belts on because there’s nowhere for them to go if they get seriously injured.

The only thing that will reduce the pressure on the system is for case counts to go down, Hodges said.

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“It feels like there’s this world inside the hospital and those of us who work in health care of desperation and helplessness,” she said. “And then there’s another world out there of people who maybe don’t understand or realize how dire the situation is.”

State officials say rural hospitals throughout the state are suddenly facing unheard-of medical situations because they’re holding patients they’ve never had to before.

Brian Ritchie, the state’s manager of health emergency response operations, helped a rural hospital find oxygen supplies after COVID-positive patients on high-flow therapy ran through existing cylinders faster than expected.

“It’s a challenge for these small rural communities that have never had to deal with this level of illness before, at this level,” he said.

As of Thursday, there were 208 people hospitalized with the virus in Alaska, a meteoric rise of more than 1,200% since late June, when there were fewer than 20 COVID-positive patients.

Hospitals say those numbers are likely an undercount of the true impact of COVID-19, since they don’t include some long-term COVID-19 patients who no longer test positive but still need hospital care.

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There are also some hospitalizations involving vaccinated people, but those infections tend to be less severe, health officials say. Between January and early September, there were 17 deaths, 105 hospitalizations and 6,378 breakthrough cases among vaccinated Alaskans 12 and over, according to provisional state health data. That’s out of a total of 131 deaths, 894 hospitalizations and 33,039 cases over the same time period.

Unlike the state’s last COVID-19 wave, in which older people proved vulnerable, health care providers say they’re seeing younger, generally healthy and largely unvaccinated people getting sick and dying.

Most of the people hospitalized now are unvaccinated, according to hospital data. A state report in July found unvaccinated Alaskans were 7 1/2 times as likely to be hospitalized as vaccinated people.

The state also reported 702 new cases on Friday, 677 of them residents. Officials have said a backlog in reporting means it’s likely there are more cases than those reported daily.

Alaska in March became the most vaccinated state in the country, thanks to an aggressive tribal health campaign and heavy interest from seniors. But now the state’s vaccination rates have slowed. The Alaska Chamber and state health department last week launched a vaccination sweepstakes to run through October in hopes of increasing rates.

As of Friday, 61.6% of eligible Alaskans had received at least one dose and 56.1% were considered fully vaccinated.

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President Joe Biden’s announcement Thursday calling for coronavirus vaccines or rigorous testing for larger businesses as a way to control the pandemic met with immediate criticism from Alaska Gov. Mike Dunleavy and Anchorage Mayor Dave Bronson.

On Friday, Dunleavy criticized the Biden plan but said the vaccine is the most effective way to fight the pandemic.

“It is clear from the data and empirical evidence over the last year that the vaccine is the most effective way to fight Covid-19,” Dunleavy said in a written statement. “From what we are seeing in our hospitals, the very ill are mostly those who are unvaccinated. As governor, and as someone who had Covid and has been vaccinated, I will continue to recommend that Alaskans speak to their healthcare providers and discuss the merits of the vaccine based on their individual healthcare needs.

“With that said, President Biden’s attempt to force vaccinations is ill conceived, divisive, and un-American. At a time in which we are called to work together, forced medical procedures run counter to our collective sense of fairness and liberty. My administration is aggressively identifying every tool at our disposal to protect the inherent individual rights of all Alaskans.”

The state’s seven-day average test positivity rate — positive tests out of total performed — was 8.98%, a near all-time high. Health officials say anything over 5% indicates the need for more testing.

State health officials this week said they’re talking with providers in other states, including North Idaho, where officials recently issued crisis standards of care to help ration care amid scarce resources.

The fact that those conversations are even happening is shocking, said Jared Kosin, president and CEO of the Alaska State Hospital and Nursing Home Association.

“That should never be discussed in our lifetime, absent for mass casualty events over a short period of time,” Kosin said Friday. “The fact we are contemplating integrating that into our care response is unfathomable. I hope people realize that.”

Reporter Morgan Krakow contributed to this story.