The number of people hospitalized with COVID-19 jumped to 437 on Tuesday, a nearly 5% increase from the previous day, further straining the resources of Hawaii’s hospitals, which have had to set up overflow tents and bring in nurses and other medical staff from the mainland to help care for the influx of patients. This week, hospitals also have had to begin conserving oxygen supplies.

By comparison, there were just 40 people hospitalized with COVID-19 in Hawaii on July 1, before the highly transmissible delta variant of the coronavirus sent case counts soaring.

The increase in COVID-19 patients, about 88% of whom are unvaccinated, is increasing the likelihood that the state will need to take more aggressive action to alleviate the pressure on the state’s health care facilities.

Lt. Gov. Josh Green has said that if the state approaches 500 patients hospitalized with COVID-19, then he would recommend potential shutdowns.

The numbers “must drop because we can only get up to about 500 people in the hospital with COVID and continue to know that we have enough ICU beds and give comprehensive care,” he told the Honolulu Star-­Advertiser’s Spotlight Hawaii livestream program Monday. “If we exceed that, then you start wondering do we have to ration care in some other way.”

Green said a survey of the hospitals found that the state potentially could accommodate 710 COVID-19 patients in its approximately 2,200 hospital beds. Still, resources are being stretched thin.

“If we get anywhere near 500, you are going to have to take very strong action, life-preserving action, and that would likely come in the form of at least a temporary shutdown based on some standards,” said Green.

Gov. David Ige, who ultimately makes the decisions about COVID-19-related restrictions, has not provided a similar benchmark, but has urged residents and travelers to change their behavior to help reduce cases. He also limited social gatherings to no more than 10 people indoors and 25 people outdoors Aug. 10.

He also sought to quell rumors over the weekend that the state was heading toward a four-week shutdown.

“I want to clear the record that there are currently no plans to shut down,” he tweeted Sunday. “All posts on social media and being distributed by other means are not true.”

Ige later clarified that he was still urging people to halt travel. “Visitors — you are still being asked to postpone your travel to Hawaii,” he tweeted. “Residents are also being asked to halt non-essential travel.”

Green said that the rampant rumors over the weekend about a shutdown were starting to lead to a run on grocery stores.

County officials are also scrambling to control the surge in hospitalizations. On Hawaii island, Hilo Medical Center is operating at 120% capacity, the Hawaii Tribune-Herald reported Tuesday.

Hawaii County Civil Defense warned Tuesday that the high number of cases is affecting critical medical services, and urged residents to limit public activity to only essential needs.

Statewide, 100 ICU beds are in use for COVID-19 patients, according to state data, bringing the number of ICU beds in use for all patients to 258. There are 84 ICU beds available statewide.

The state has averaged 877 new cases a day over the past two weeks, though health officials say that is just an indicator of the level of infection spreading throughout the islands and that the actual case count is surely much higher.

On Tuesday the state Department of Health reported 553 new confirmed and probable coronavirus infections, bringing the state’s total since the start of the pandemic to 63,502 cases.

The case count includes 430 new cases on Oahu, 37 on Maui, 65 on Hawaii island, 13 on Kauai and eight Hawaii residents diagnosed outside the state.

No new virus-related fatalities were reported, so the statewide COVID-19 death toll remained 589.

The state’s official coronavirus-related death toll includes 455 fatalities on Oahu, 68 on Maui, 59 on Hawaii island, three on Kauai, one on Molokai and three Hawaii residents who died outside the state.