Public health experts, including US Surgeon General Dr. Jerome Adams, have warned the US could “become Italy,” where doctors in hospitals filled with Covid-19 patients have been forced to ration care and choose who gets a ventilator.But the US may already be seeing the beginnings of this in some areas, marking a new stage of the nation’s outbreak.

The reality is that what we’re seeing right now in our emergency rooms is dire,” said Dr. Craig Spencer, director of global health in emergency medicine at NewYork-Presbyterian/Columbia University Medical Center in New York City.”Last week when I went to work, we talked about the one or two patients amongst the dozens of others that might have been a Covid or coronavirus patient,” Spencer told CNN’s Anderson Cooper Tuesday. “In my shift yesterday, nearly every single patient that I took care of was coronavirus, and many of them extremely severe. Many were put on breathing tubes. Many decompensated quite quickly.”There is a very different air this week than there was last week.

Officials in New York state are pushing hospitals across the state to increase capacity. The state is home to more than 6% of the world’s confirmed cases so far — and roughly half of all US cases.In New York City, plans are also underway to build emergency hospitals and backfill other hospitals with 1,000 beds in the Javits Center, according to New York Gov. Andrew Cuomo. In addition, thousands of doctors and nurses, who are either retired or no longer see patients, have signed up as a “surge health care force,” Cuomo said Wednesday.There are simultaneous effort to procure ventilators for the most severe patients. According to Cuomo, New York has procured 7,000 ventilators in addition to 4,000 already on hand, and the White House said Tuesday that the state would receive two shipments of 2,000 machines this week from the national stockpile. But the state needs 30,000, Cuomo said.The Strategic National Stockpile said Wednesday that it held approximately 16,660 ventilators before the coronavirus response, and ventilators have been deployed over the past few days

An outbreak, a pandemic like this could overwhelm any system in the world,” warned Dr. Anthony Fauci, the United States’ top infectious disease expert. Without enough ventilators, “that’s when you’re going to have to make some very tough decisions.”Cuomo also described the extreme measures hospitals are planning to take to increase their capacity for patients who need intensive care.”We’re going so far as to trying an experimental procedure where we split the ventilator,” Cuomo said Tuesday. “We use one ventilator for two patients. It’s difficult to perform, it’s experimental, but at this point we have no alternative.”