“In the absence of a declaration or a plan, doctors and nurses, on their own, are the only ones left to make these gut-wrenching decisions,” Toner says

Everything should be done to avoid moving to crisis standards, says Toner, but he worries that many places right now are in “chaos,” struggling to do the kind of coordination necessary to keep this worst-case scenario at bay,

“We have individual doctors calling other hospitals, even out of state, trying to transfer patients — that should not be happening,” he says. “We’re not balancing patients enough between hospitals. We’re not sharing resources as well as we should.”

In New Mexico, the surge has led to ICU waiting lists and state health officials have warned they might have to employ crisis standards of care soon if the trajectory of infections simply stays the same, let alone rises.