A growing surge of COVID-19 patients is stressing already packed hospitals and causing more cancellations of elective procedures.

"We have a severe bed shortage crisis," said UMass Memorial Health President Eric Dickson. "The patients are backing up into the emergency department that need to be admitted into the hospital."

The latest coronavirus surge is impacting hospitals across Massachusetts, and hospital officials worry the situation will get worse as the coronavirus spreads over the holiday season. On Thursday, there were 1,238 COVID-19 patients hospitalized in the state, up from 1,026 a week earlier. To make more room for patients as cases swell, the state is recommending hospitals reduce certain elective services and procedures — a strategy some hospitals had already implemented.

Dickson noted the charts showing new cases and hospitalizations look similar to last year at this time. He encourages people to get vaccinations and booster shots, as well as wear masks and keep their distance from crowds. Without those precautions, he expects the situation will worsen.

"And if last year is a predictor of what we're going to see this year, the worst will be somewhere in the first couple of weeks of January, and then we'll start to see some relief," he said. "But that's going to be a rough, rough six to eight weeks, if that's what we have to go through."

Dickson said UMass Memorial Health is seeing roughly twice as many COVID-19 patients as it had a week ago. On top of that, he said patient numbers are up because staffing problems at skilled nursing facilities have made it harder to move patients out of the hospital and into those facilities. And 100 hospital beds at St. Vincent's Hospital are not available because of an ongoing nurses strike.

"It's all adding up to be like the perfect storm for an inpatient bed crisis here in Central Mass.," he said.

Mass General Brigham hospitals had 205 COVID-19 inpatients on Friday, up from 128 three weeks ago.

The Wellforce Healthcare system — which includes Tufts Medical Center, Lowell General and Melrose Wakefield hospitals — has seen a 26 percent increase in COVID-19 patients over just the last week.

"We've been living at or over capacity now for weeks," said Terry Hudson-Jinks, the chief nursing officer at Tufts Medical Center. "And the patients here with COVID equates to about an additional inpatient unit or two of additional patients."

The state Department of Public Health released new guidance to hospitals Friday to reduce certain nonessential elective services and procedures by fifty percent, starting next week. The state also issued an emergency order providing hospitals with some flexibility on nursing staff ratios for ICUs.

“The Commonwealth’s hospitals continue to face significant challenges due to staffing shortages,” Health and Human Services Secretary Marylou Sudders said in a written statement. “Today’s actions will help alleviate pressures by providing hospitals with staffing flexibility in order to reopen inpatient capacity in licensed and alternate space not currently being utilized.”

Some hospitals, including Tufts Medical Center and UMass Memorial Health, have already limited elective procedures beyond the state's new recommendations in an effort to create more capacity as patient numbers swell.

Tufts Medical Center opted to cancel all in-patient elective procedures.

"And that was helpful for the past month," Hudson-Jinks said. "This week, we're finding that that's just not enough space to care for the patients that need our care. So we're beginning to review patients who are on the ambulatory side of elective procedures and canceling or rescheduling those cases so that we can create space to care for additional patients that need our care. We're really in our surge mode — we're surging and looking for space and resources so that we can be larger to care for more sick patients every day. "

Hudson-Jinks said those canceled outpatient procedures include some joint surgery and orthopedic procedures, as well as some minor gastrointestinal procedures. She said they don't take postponing that kind of care lightly, but the decision was necessary to care for patients with immediate and often life-threatening needs.

UMass Memorial Health opted to postpone some, but not all, elective services at this time.

"You can stop doing mammography and redeploy the people for other areas," Dickson said. "But that only means that you're going to see people with later stage breast cancer down the line because you didn't do that early screening."

He said one of the reasons the hospitals were full now, even before the latest COVID surge, is the consequence of important screening and outpatient work that was delayed in the earlier surges.

"I'm not criticizing the decision to to stop doing ambulatory procedures and visits at the time," he said. "But you're just kicking the can down the road and it actually becomes a bigger problem down the line. It doesn't go away."

One difference that will make dealing with the current surge harder, Dickson said, is that this time the state hasn't set up field hospitals to care for the overflow. FEMA assistance for that kind of facility would require a disaster declaration by Gov. Charlie Baker. Baker said earlier this week that there are no plans for now to set up field hospitals, but that he's exploring the idea of bringing in the National Guard to support the state's healthcare system during the surge.

Dickson said he understands Baker has a lot to consider before making a disaster declaration.

"I understand that he's got a very difficult job in terms of understanding the impact it would have elsewhere on the economy within the state," he said. "So for right now, we're going to just have to manage this."