About 75% of Alabama’s 14,790 hospital beds are full on a regular day.

That doesn’t leave much room for a surge in patients if COVID-19 cases increase sharply in the next few weeks. As hospitals in states like Washington and New York brace for those surges, how well-prepared are Alabama hospitals?

“If we’re lucky, hospitals may be slammed but they’ll remain within their capacity,” said Don Williamson, president and CEO of the Alabama Hospital Association.

“If we fail to prepare, we run the risk of an absolute disaster. So we have to prepare for the worst case scenario and hope that doesn’t happen.”

Hospitals and health departments in some states have built makeshift hospital wards and COVID-19 treatment facilities on soccer fields, in long-shuttered hospitals and even in a parking garage.

In New York, which had nearly 21,000 confirmed coronavirus cases Tuesday morning, Gov. Andrew Cuomo issued an emergency order to require all hospitals in the state to increase their capacity by 50%.

Alabama had 283 confirmed cases of COVID-19 as of Wednesday afternoon, a dramatic increase from the 36 confirmed cases one week ago. Around 7 or 8 percent of those cases have required hospitalization, said State Health Officer Dr. Scott Harris on Tuesday, but he said actual hospitalization numbers could be higher because of data reporting issues.

“We are aware of hospitals (in Alabama) that are wondering about their capacity and their ability to keep themselves going at the rate they normally would go,” he said.

“Some (Alabama) hospitals are reporting increased numbers of patients who seem like they are infected with this virus.”

Nowhere in the state is a hospital bed shortage more immediate than in Birmingham. Patients already fill 90 percent of available hospital beds in Birmingham on an average, non-COVID-19 day.

“It would not take large numbers of people for them to overwhelm their capacity,” said Harris on Tuesday.

Tuesday afternoon, UAB Medicine reported a jump from 17 to 45 hospitalized COVID-19 patients in just 24 hours. By Wednesday, that number rose to 57, with 18 of those patients on ventilators.

There are about 3,000 hospital beds in Jefferson County, according to numbers from the State Health Development and Planning Agency. And Jefferson County has the largest number of cases in the state, with 99 confirmed cases Wednesday afternoon.

Hospital leaders from all of Birmingham’s hospitals have been holding conference calls at least three times a week to discuss strategies to increase capacity, said Williamson.

“The Birmingham hospitals are talking about ways to expand available beds, including things like using facilities other than traditional hospitals as sites,” said Williamson. “That planning is ongoing. The Birmingham hospitals together are taking a lead to find those potential sites.”

Hospitals are also using other measures to increase available beds, including postponing elective surgeries and sending non-critical patients home.

In Huntsville, the Huntsville Hospital System has not experienced a shortage of beds so far, said Jennifer Lapidus, a hospital representative, partly because the hospital has cut down on elective surgeries.

But there’s a plan in place to increase bed capacity if needed, that could include converting existing hospital units and even entire medical towers into hospital wings. The Madison Street Tower could be converted to an ICU, and the Governors Medical Tower, which is closed for elective surgeries, could also be used, she said.

At DCH in Tuscaloosa, there’s a plan to convert one of the hospital’s less frequently used units into a group of negative-pressure isolation rooms, which means that they are not connected to the ventilation systems serving the rest of the hospital, said hospital representative Andy North. Those new isolation rooms would be suitable for treating COVID-19 patients and would supplement the hospital’s existing 11 negative pressure rooms.

North said the hospital has several contingency plans to address a potential surge in patients, but declined to elaborate further.

“It’s absolutely a concern for us to be able to manage the healthcare needs of the community,” He said. “We’re looking at every avenue to make sure that we are prepared and we have the resources to serve the need.”

Other hospitals contacted by AL.com offered fewer specifics for how they would deal with a patient surge.

Baptist Health in Montgomery has opened two testing clinics to divert possible COVID-19 patients away from the hospital’s emergency department. Kadie Agnew, communications specialist with Baptist Health, said the hospital staff is looking at other potential needs.

“We’re assessing day by day,” she said. “Right now, our two clinics we’ve opened are working well and seem to be sufficient.”

In Mobile, University of South Alabama Health is “taking all necessary steps to preserve the delivery of vital crucial care services” while also preparing for a potential surge of COVID-19 patients, said Gary Mans, associate vice president of marketing and communications at USA Health, in a statement, but did not provide details about the steps being taken.

UAB Hospital in Birmingham “has planned and continues to plan for a variety of scenarios, including one where we need to accommodate more patients,” said hospital representative Savannah Koplon.

Brookwood Baptist Health in Birmingham referred all questions to the Alabama Hospital Association. St. Vincent’s in Birmingham and EAMC in Lee County have not yet responded to a request for details on their plans.

If hospitals have to open up additional sites, who would foot that bill?

It may fall on the hospitals themselves. Williamson said some of the COVID-19 assistance legislation that Congress passed recently may provide federal money to help pay for additional beds, but exactly how much and how it would be distributed remains “murky and unclear.”

“We’re beginning now, working with the department of public health for a surge plan for the rest of the state,” said Williamson. Harris said public health officials are putting together a plan of action that could be executed by the state’s Emergency Management Agency.

A few options: The state health department has medical tents that could be used. Some hospitals can increase their beds at their existing facilities. And the idea of opening some of Alabama’s recently closed hospitals isn’t off the table, Williamson said.

“While that’s not the ideal solution, because of location and staffing, we wouldn’t exclude any solution if the situation is dire enough.”

Read more: Birmingham hospitals now facing first wave of coronavirus patients, 57 being treated, 18 on ventilator