Top health care officials are scrambling to bring in oxygen from the mainland after realizing that Hawaii’s hospitals could run short amid a surge in hospitalized COVID-19 patients. A quick fix is not looking promising, however, and hospital officials have already begun canceling nonemergency procedures that involve oxygen in an attempt to conserve supplies.

The state identified oxygen as a potentially strained resource early on in the pandemic as part of its emergency planning, but what was not anticipated was a global shortage in containers that are needed to transport extra oxygen, said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, a trade group for the state’s hospitals and nursing homes.

Raethel said state officials realized the seriousness of the situation Friday and were engaged in meetings throughout the weekend.

“There is a lot of activity to source all possible options for ensuring that we have sufficient oxygen in the state of Hawaii,” he said.

The potential oxygen shortage is the latest hurdle for a health care system that is buckling under a large spike in COVID-19 cases spurred by the highly contagious delta variant of the coronavirus.

On Monday the state Department of Health reported 720 new confirmed and probable coronavirus infections, bringing Hawaii’s total since the start of the pandemic to 62,949 cases. No new deaths were reported Monday, keeping the death toll at 589.

The state’s hospitals also have struggled with a shortage of nurses and intensive care unit beds. Earlier this month the state requested an additional 550 relief health care workers, including critical care nurses and respiratory therapists, from the mainland to help care for COVID-19 patients. Lt. Gov. Josh Green told the Honolulu Star-Advertiser’s Spotlight Hawaii livestream program that the number could rise to 650.

The number of people hospitalized with COVID-19 jumped from 132 on Aug. 1 to 417 as of Monday. The number of people hospitalized with COVID-19 in recent days is about 33% higher than last year’s peak when vaccines were not yet available.

As the number of COVID-19 patients rose this month, the daily consumption statewide for medical-grade oxygen increased by about 250%, according to the Healthcare Association of Hawaii.

Oxygen is used to assist patients with conditions such as emphysema and lung cancer, as well as COVID-19.

“The combined demand has increased to the point where we are concerned about whether we can generate enough oxygen in Hawaii to meet all the needs of our health care facilities,” said Raethel.

Raethel said that there are models predicting when demand might outstrip supply, but he was “very wary of putting out a date” of when that may be.

He said the hospitals are working to conserve supplies so that the state doesn’t reach a critical point.

As part of the conservation effort, Hawaii Pacific Health on Monday told its medical staff that all elective procedures, including those performed in operating rooms and outpatient settings, where oxygen may be needed, will need to be canceled.

“We do not plan to defer any emergency surgery, and we will need to have careful consideration of cases that are urgent but not emergent,” wrote Hawaii Pacific Health President and CEO Ray Vara in a memo to medical staff. “Any cases that can be deferred safely should be deferred until the oxygen supply solutions are clearer. At each HPH facility, surgical and facility leaders will be activating review processes to help with these decisions.”

Hawaii Pacific Health oversees Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Medical Center and Wilcox Health on Kauai.

The state has two liquid oxygen plants, Airgas and Matheson Tri-Gas, both of which are operating at full capacity and have switched to producing medical gas only. Liquid oxygen can be shipped in from the mainland in ISO tanks, but these tanks are in short supply globally due to the pandemic and increased need for oxygen.

Raethel said that orders for tanks are backlogged for months, and the state is currently projecting that it needs two to four tanks a week in order to ensure adequate supply. That would increase capacity by about 15% to 20%.

But the state is still trying to secure the tanks. While three have been identified in Hawaii that could be used, it takes 21 to 30 days for a tank to be shipped to the mainland, where it can be filled, and returned to Hawaii.

Raethel said hospital officials are working with state and federal agencies to find more ISO containers in California that can be sent to Hawaii.