Only nine intensive care beds were available in the Twin Cities on Wednesday morning amid a surge in COVID-19 that is sending more Minnesotans into hospitals.

Metro ICU bed space grew scarce as nurses and other caregivers were unavailable because of their own infections or viral exposures that required quarantines in central Minnesota and other parts of the state.

"We're at a red alert for ICU beds," said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. "It's bad."

A record 908 inpatient hospital beds in Minnesota were filled with COVID-19 patients, according to Wednesday's pandemic dashboard update. That includes 203 patients requiring intensive care for breathing problems or complications from infections with the coronavirus that causes COVID-19.

COVID-19 ICU admissions have doubled since late September but still make up only 18% of ICU usage. Most of the 1,140 patients in Minnesota ICU beds are recovering from surgeries or being treated for unrelated issues such as strokes and traumatic injuries.

The state dashboard shows that Minnesota has a capacity of 1,501 immediately available ICU beds — and another 408 that could be readied in 72 hours — but one Twin Cities hospital physician said that data overstates availability because open beds are useless without nursing staff to treat patients.

"Beds have been sitting open in the metro due to no RNs, but the current ICU use is functionally at 100% across the metro," said the doctor, who declined to give his name because his parent company had not authorized him to speak on hospital capacity.

The Minnesota Department of Health on Wednesday reported that ICU beds were 98% full in the metro area and 92% full elsewhere and that collaboration was increasing across hospitals to transfer patients and staff where needed.

HCMC moved patients to Duluth and Rochester this week to preserve trauma capacity. Twin Cities hospitals declined transfers from COVID-strapped communities such as Hayward and Baldwin in Wisconsin and Grand Forks in North Dakota.

With beds nowhere to be found in the Twin Cities, Centra­Care is protecting its ICU capacity at St. Cloud Hospital by moving surgeries to other sites and treating more stable COVID-19 patients at its smaller feeder hospitals, said Dr. George Morris, incident commander for CentraCare's COVID-19 response.

Other hospitals are discharging recovering COVID-19 patients more quickly with take-home oxygen and monitoring. The average length of stay has declined because of improved treatment, but that has been offset by the rising number of patients.

Gov. Tim Walz requested 10 more medical professionals from the Federal Emergency Management Agency to shore up staffing in hospitals and long-term care facilities.

"Minnesota's case counts are on the rise, which means the need for staffing support will continue to increase," Walz said in a statement.

Walz last spring used an emergency order to defer nonessential surgeries to maintain bed space. A guiding principle of his pandemic response, including a 51-day shutdown this spring, has been to preserve hospital resources so that infected patients have treatment when needed.

The first hospital surge in late May came shortly after the end of that deferral, when an increase in COVID-19 hospitalizations collided with the resumption of surgeries.

Osterholm criticized hospital leaders for trying to recoup financial losses by maintaining usual surgery schedules in light of the latest COVID-19 wave. He accused the Minnesota Hospital Association of downplaying the threat to maintain operations.

The association's Dr. Rahul Koranne countered that "100% of the COVID patients that have needed ICU and med-surg care have been cared for" but acknowledged that hospitals are getting stretched and that public efforts to reduce viral spread are needed.

"We do not have infinite space, we do not have infinite staff, we do not have infinite resources," he said. "At the end of the day, there will come a breaking point."

Minnesota on Wednesday reported 31 more COVID-19 deaths and a record 3,844 confirmed or probable infections, bringing its totals to 2,530 deaths and 160,923 infections. One newly reported death involved a Hennepin County resident in their 30s.

The Dakotas and Wisconsin have the nation's highest new infection rates, but Minnesota's rate is now 13th, according to the latest state report from the White House Coronavirus Task Force.

"There is a limited time window to prevent further increases in cases, hospitalizations, and deaths," it stated.

South Dakota-based Sanford Health last week announced a delay in non­essential surgeries, though not for its Minnesota hospitals. Sanford's Bemidji hospital added seven ICU beds on Monday in response to rising COVID-19 demands, bringing its total to 23.

Mayo Clinic last week deferred nonessential procedures at its hospitals around Eau Claire, Wis.

"This is not a drill," said Dr. John Hick, an HCMC physician who is coordinating the collaborative response by Minnesota hospitals. He encouraged public mask-wearing and social distancing to slow viral spread and reduce pressure on hospitals.

"We have space, we just don't have staff," he said. "So pretty soon we'll be doing things like cutting back elective cases to free up staff to work in units they don't usually work on, and perhaps increasing the number of patients that nurses have to care for on a shift — things that aren't in the best interests of the staff or the patients but are the best we can do with the resources that we have."

Moderate- or high-risk exposures to the virus can result in 14-day quarantines, which can sideline nurses and health care providers.

A U.S. Centers for Disease Control and Prevention report last week showed that 1,953 Minnesota hospital workers sustained high-risk exposures through early July and that 1,256 of them were quarantined and monitored by the state Health Department.

Among them, 382 caregivers returned to work before the end of their monitoring periods. That was about 37% of all hospital workers who had been quarantined. The report also showed that 45% of the workers had been asked by their hospitals to return to work early, but some refused.

Only 339 monitored workers ended up reporting COVID-19 symptoms, and 13 worked while symptomatic.

Staff writer Joe Carlson contributed to this report.