The worst-hit state is North Dakota with 51% of hospitals that reported saying they’re facing shortages; seven states say over 30% of their hospitals are in trouble…

Looking ahead toward the next week, additional hospitals report expecting staffing shortages in 40 states, as well as Puerto Rico. Nebraska, Virginia and Missouri top the list in places that are expected to have the biggest upticks…

In Missouri, Dave Dillion, a spokesperson for the state hospital association, says the fear is that if the surge continues, hospitals will have to begin operating with crisis standards of care, guidelines for prioritizing care when resources run short.

“If this was a regional or a local crisis like we saw early on in New York, nurses would be volunteering to go run to the emergency,” he says. “That isn’t available anymore because this is everywhere.”