David Spillers sees the images from New York and New Orleans, of hospitals crumbling under the weight of a patient load they can’t carry, and wonders if he’s looking at the future.

He is the CEO of Huntsville Hospital, which he touts as treating more patients in a year than any other in Alabama. His job, amid the throes of the deadly novel coronavirus pandemic, is to prepare, to think of every variable and develop a solution.

It's the same as those hospital leaders elsewhere in the country whose hospitals are now suffocating.

Spillers maintains Huntsville Hospital and it's 11-hospital system across north Alabama is, at this moment, ready.

But what does ready really mean?

"I'm scared to death when I see what's going on in New York and New Orleans and some of these other places about that happening here," Spillers said Monday.

Related: See AL.com’s coronavirus coverage.

As Spillers is asked question after question about the ready status of Huntsville Hospital, answer after answer comes with a disclaimer.

March 23: "How are our supplies right now? Right now, we have adequate supplies on hand."

March 29: "Our supplies are in good shape. As we look out two weeks, based upon the current patients were treating, we're in good shape."

March 31: "Our supplies continue to look good based upon where we stand currently. All that could change very quickly if we get a large influx of inpatients."

But what does ready mean?

Spillers said Huntsville Hospital has discharged patients with the objective of creating more bed space capacity for COVID-19 patients. That purge has happened more quickly in hospitals throughout the system, he said, than at the main campus in downtown Huntsville.

But inpatient capacity seems, for now, ready. Spillers said the hospital could create 500 (or possibly even more) beds beyond what Huntsville Hospital already has.

Still, having hundreds of vacant beds across the system reveals yet another issue.

"At some point, beds aren't the limiting factor," Spillers said. "Supplies and staff are the limiting factor. How do we staff all these additional beds if we ever need them?

"You don’t just put somebody in a bed. You've got to care for somebody you put in a bed. There's a lot more to it than just creating bed space."

Huntsville Hospital CEO David Spillers talks to reporters at a day coronavirus briefing held in Alabama. Spillers is seated at the City Council's meeting chairs with other offiicals, but they are demonstrating social distance to protect from the disease.

And the relentlessness of COVID-19 goes on.

"COVID-19 patients consume an enormous amount of resources," Spillers said. "Probably use 10 times as much resources as a regular patient so about every 10 COVID patients could be the equivalent of 100 normal patients. They also stay in the hospital 10 to 12 days so that's why hospitals can fill up very quickly when we start having inpatients that have COVID-19."

As far as equipment, Spillers said the hospital has fared well in collecting what is needed. A shipment of surgical masks was received last week. A shipment of N95 masks are expected later this week. The hospital system, as of a week ago, had about 300 ventilators – a healthy stockpile that allowed Huntsville to loan some machines to East Alabama Medical Center in Opelika.

"We want to stock up but we don't want to hoard," Spillers said. "That's a delicate balance. You don’t want to take supplies from places like Birmingham and New Orleans where they've got to have them right now. But you want to have an adequate supply for our community when the time comes."

That's the backdrop by which everything is being done by hospitals: "When the time comes."

And that's the nightmare, that spike of serious cases that require hospitalization.

The jarring reality is that Madison County, home of Huntsville, has seen it COVID-19 positive tests skyrocket in the past week – increasing almost five-fold to 96 by Tuesday morning. Healthcare workers, however, look at a different number.

No matter how many positive tests a community may have, the true measuring stick for a hospital are the numbers of those who need inpatient care. As of Monday morning, only eight were hospitalized in the Huntsville Hospital system and only two of those needed ventilators. That's eight COVID-19 patients out of roughly 800 inpatients throughout the system, Spillers said.

Those are easily managed numbers. For now.

"For our community, the burden on the healthcare system is what we're trying to flatten," said Dr. Pam Hudson, CEO of Crestwood Hospital in Huntsville. "There will be people get very sick with this. But there will be many, many, many more who are not very sick with it. And we're trying to flatten that because you have a really good health system in this community. We need to make sure we don’t overwhelm it so that everybody gets the care that they need."

Said Spillers, "If a lot of people test positive and a small percentage of those need hospitalization, that's not necessarily a bad thing. The ones we really worry about are the ones that need hospital care. That's where the crunch will come if too many people require hospitalization."

Identifying those who need care, though, is not getting easier. Huntsville Hospital has closed its drive-thru COVID-19 testing site because of a lack of test kits. And to look across rural counties of north Alabama is to see such small numbers of positive tests that it seems clear people aren't getting tested.

Spillers said that's detrimental to the overall effort to combat the coronavirus. And for those to be sick with the virus and not know it and potentially spreading it is the scenario that can eventually lead to a run on hospitals.

And it's why no matter how much preparation is done today, more will be done tomorrow. Spillers said his staff is beginning to map out a plan for possibly using hotels to board patients and, later this week, he is meeting with the U.S. Army Corps of Engineers about solutions for more hospital beds if needed.

Those meetings are ongoing throughout the state at the largest hospitals, Spillers said.

So what does ready really mean?

In making frequent appearances at daily televised briefings in Huntsville, Spillers, Hudson and other healthcare officials never forget to remind everyone: Sanitize and separate. Wash your hands, maintain six-foot social distancing.

It's the hope that these new behaviors will help combat the coronavirus and, at the same time, protect hospitals from being overrun.

"We don't want it to happen here," Spillers said of those horrifying scenes from hospitals in New York and New Orleans, in Milan and Madrid. "And I think we as a community can keep it from happening here if we're going to follow the rules that have been set up."

As you do your part, hospital leaders say they are trying to do theirs.

“We’re doing everything we can to predict how much supplies we will need and acquire those – either through our normal distribution channels or going directly to China or trying some unique and unusual things to get supplies,” Spillers said. “But every other hospital in America is doing the same thing.”