September 1, 2021 11:40 AM EDT

On Thursday, as Hurricane Ida loomed as a Category 4 storm that threatened massive flooding, high winds and power outages along Louisiana’s Gulf Coast, health administrators at Marrero Healthcare Center, located just northeast of where Ida made landfall, decided to evacuate upwards of 80 residents to safer ground.

Two days of hurried packing later, the residents, most of whom are ambulatory, piled onto two school buses from LaFourche Parish for the expected four hour and 40 minute ride inland. Another bus transported medical supplies and equipment as well as food for the trip. Twenty one of the bed-bound residents were wheeled into a large emergency vehicle in bunks stacked three high on each side of the truck.

“It’s so hard on the elderly folks, many of them, just to travel for an hour or two in a car. But to travel on a stretcher for six hours? That’s a strong generation. Very little complaints, and they did well,” says Elizabeth Dowden, nursing home director for Many Healthcare, the residents’ new temporary home. The journey ultimately took up to seven hours for part of the caravan as thousands fleeing the southeastern coast standing directly in Ida’s path packed the highways leading inland. Once the residents arrived in the town of Many, police officers and sheriff’s deputies met the buses and over the next three hours, helped the passengers to disembark and unload their belongings.

Marrero’s residents were among the fortunate who made it to safety. Hundreds more stayed behind, not all by choice, because they couldn’t afford to leave or because they needed to care for loved ones who could not travel. Still others remained because they were recently diagnosed with COVID-19, and didn’t want to infect others in a shelter or hotel.

Any natural disaster strains local health systems, and Louisiana’s medical community is bracing for the inevitable surge in emergency room visits as people injured in the storm, or those seeking medical care they couldn’t get during the peak of the crisis, flood hospitals again. But health care workers are also wary of the additional burden weighing on them in recent months from COVID-19. With only about 40% of Louisiana residents vaccinated, the Delta variant is spreading as quickly as Ida’s floodwaters; weeks before Ida struck, the state recorded its highest daily number of new cases since the pandemic began. Since August, around 15% to 16% of COVID-19 tests in the state have come up positive and 88% of the state’s ICU beds are occupied, about half of them by COVID-19 patients. Ida didn’t change any of those trends, but it did put them temporarily on the back burner as the more urgent needs of the storm took precedence.

Read more: How to Help People Impacted by Hurricane Ida

But with Ida now moving away, the dual challenge of shouldering the anticipated storm-related health emergencies on top of COVID-19 care looms large for the area’s hospitals. A day after Ida made landfall in Louisiana on Aug. 29, the state’s largest non-profit, academic health care system and its 40 hospitals remained on emergency power and water supplies. With no water provided through the New Orleans municipal system, Ochsner Health System’s main hospital in the city was relying on its own well water maintained for such emergency situations.

“Ida was a pretty rough ride yesterday,” Ochsner Health’s president and CEO Warner Thomas told reporters during a briefing. “The sustained winds that lasted for a much longer period of time than folks anticipated did create significant damage across our system as it did across the entire region.”

Thomas said many of the network’s facilities experienced roof damage and water leaks and Ocshner has evacuated nearly 100 patients from three hospitals most affected, two of them in the Bayou region. Many of the network’s smaller health centers in flood-affected areas remained closed on Monday, although all emergency departments stayed open and days after the hurricane, doctors were already seeing patients pour in with COVID-19, storm-related injuries, heart attacks and strokes.

Ochner’s health system is currently caring for 772 COVID-19 patients, and while their care hasn’t been affected by Ida, because of the high number of those patients already occupying critical care beds before the hurricane, the health system isn’t as able to accept transfers from other Ida-damaged facilities.

Other hospitals are anticipating difficult days and weeks ahead with respect to their COVID-19 care. North Oaks Health System—which is based in Hammond, a city between Baton Rouge and New Orleans—paused elective procedures on July 11 to accommodate the surge of COVID-19 patients. That hold was supposed to lift this week, says CEO Michele Kidd Sutton, but Ida had other plans. North Oaks is currently running on generator power and focusing on emergency care. The storm also knocked out the hospital’s phone system, which means staff can’t call COVID-19 patients families’ to update them on their loved ones’ conditions. “Many people are just coming up to the front door and asking for updates,” Sutton says.

Read more: Hurricane Ida Leaves Hundreds Trapped by Floodwater and 1 Million Without Power

Prior to the hurricane, Children’s Hospital New Orleans was treating record numbers of young COVID-19 patients—roughly 15 on any given day in August, according to hospital officials. Laurie Schulenberg, the hospital’s chief nursing officer, says she hopes the hurricane won’t exacerbate that situation, but it’s too soon to know. If people hunker down in private homes to wait out the storm’s aftermath, it could help stop the virus’ spread, she says. But some people have been forced to take up residence in communal shelters, and the virus may travel with them. “I would hope that situations like this would just encourage people to be vaccinated, because there’s only so much control we have over who we come into contact with on a daily basis,” Schulenberg says.

For many medical centers, the biggest challenges over the next few days will be related to staffing, and making sure that employees whose own homes have been leveled or damaged by the storm have the resources they need. Ochsner’s New Orleans hospital is serving as both convenience store and hardware store for its hardest-hit employees. The health system secured hotel rooms for employees whose homes aren’t accessible, and is stocking personal items that people may need so they aren’t without essentials like toothbrushes and other toiletries. “We’re essentially running our own mini mart for these types of items, and not selling them but giving them away so people can come get what they need for themselves and their families,” Thomas said. Ochsner also procured tarps and plywood for those who need to protect their properties.

At the moment, space is tight at Ochsner system’s main hospital in New Orleans, as patients who otherwise would be discharged or released to follow-up-care facilities aren’t able to leave because either their homes or those facilities have been damaged by the storm. “The situation will right-size itself over the course of the next couple of week,” says Michael Hulefeld, chief operating officer of Ochsner Health, “but it will be tight. It’s been tight throughout COVID-19. We have adequate physical space, but it’s all about the people and staff who are available to serve our patients. As we have throughout the process, we will manage it day to day.”

Thomas is confident that the entire system would weather the storm without compromising patient care. So far, the storm hasn’t directly caused any patient or staff injuries, and he said contractors were already on site at the various facilities to start repairs on damaged roofs and leaky ceilings.

The respite, however, may just be the calm before the next storm as the uptick in hospital visits continues from people returning to their damaged homes and getting injured trying to repair and recover their property. And once people start coming back to evacuated areas, SARS-CoV-2 will be ready to continue its relentless mission of infection as well.

—With reporting by Jamie Ducharme and Tara Law

Contact us at letters@time.com.

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