The Alaska Department of Health and Social Services (DHSS) on Saturday activated crisis standards of care for 20 hospitals in the state as it struggles with the latest surge in COVID-19 cases, with some hospitals resorting to having to ration health care.

"Today’s action recognizes that Alaska has an interconnected and interdependent health care system, requiring the need for activation of the State’s decision-making framework. That framework includes a progression of conventional, contingency and crisis standards of care identifying strategies to be used depending on the situation and types of resource shortfalls being experienced," the state health department said in its announcement.

Crisis standards of care are guidelines that can be used by health care providers during a disaster or public emergency when not enough resources are available to provide the normal standard.

According to DHSS, the decision to activate crisis standards of care was made by Alaska's volunteer Crisis Care Committee. The crises that hospitals in Alaska are experiencing include: limited renal replacement therapy, limited oxygen supplies, limited hospital staff and difficulty in transferring patients from rural communities to hospitals.

“This activation was requested by the Crisis Care Committee so our health care providers could continue to provide the best medical care possible for Alaskans under good faith immunity,” DHSS commissioner Adam Crum said. "I want to stress that our health care facilities in Alaska remain open and able to care for patients."

"Crisis standards of care will remain in effect until there are sufficient resources to provide the usual standard of care to all patients," the department said.

Last month, the department enabled crisis standards of care throughout the state by adding an addendum to the state's existing Public Health Emergency Order. At the time, Crum specified that the addendum was not a "disaster declaration" or a "mandate," but an effort to "provide support and guidance to our state’s health care providers as they continue to care for Alaskans during these unprecedented times."

According to the Johns Hopkins University COVID-19 tracker, Alaska has a seven-day moving average of 578 daily cases, around half of the average that was seen in September. So far, Alaska has confirmed 115,000 COVID-19 cases and 578 related deaths.