The announcements came the same day that Gov. Pete Ricketts announced updates to state directed health measures meant to deal with an unrelenting surge in coronavirus cases and hospitalizations.

Currently, Ricketts said about 20% of patients in the state's hospitals have active cases of COVID-19. Because of that, he is directing hospitals to postpone what are known as Class D and E surgeries. Class D surgeries are ones that can wait four weeks, while Class E surgeries are ones that can wait up to 12 weeks.

Bryan Health on Friday said in a letter it sent to its medical staff that starting Monday, any elective surgical procedure requiring an overnight stay that can be postponed at least 30 days must be rescheduled. That edict will last at least through the end of the year, the letter said.

"We regret we have reached this point; however even with your flexibility and the incredible effort from the Bryan operations team, nearly all available options have been exhausted," said the letter, which was signed by Bryan Medical Center Chief of Staff Ken Gross and CEO John Woodrich.

As of Friday morning, Bryan had 121 patients with active cases of COVID-19 and nine more who had the disease, have since tested negative, but are still hospitalized. That's slightly lower than Thursday, but it's much higher than it was just two weeks ago.

"There are few options left to explore and immediate actions must be now taken to alleviate extreme pressures and to keep patients, providers and staff as safe as possible," said the letter, which noted that Bryan is currently caring for 85-90% of the COVID-19 patients hospitalized in Lancaster County, more than 60% of which are residents of other counties.

The letter noted that there will be exceptions to the policy, such as urgent and emergent situations with cancer patients and others with serious medical conditions.

According to a list Bryan provided, some of the surgeries it expects to be postponed include joint replacements, hysterectomies, hernia repairs, minor back surgeries, bariatric procedures and elective heart valve repair and replacement surgeries.

The three largest hospital systems in Omaha — CHI Health, Methodist Health System and Nebraska Medicine — also announced similar restrictions, saying about 25% of the patients in their hospitals are COVID-19 patients.

Ricketts said Friday that if hospitals statewide reach a 25% threshold of COVID-19 patients, hospitals also will be required to postpone Class C surgeries, which are ones that can wait a few weeks but not longer than four weeks.

Dr. Cary Ward, chief medical officer for CHI Health, said the reduction in surgeries would free up about 40-50 beds throughout its health system.

The number of COVID-19 patients in the state's hospitals has more than doubled in just the past three weeks, and those patients tend to have long stays.

Dr. Bill Lydiatt, chief medical officer of Methodist Health system, said the average COVID-19 patient stays in the hospital for five days, and that increases to seven if they wind up in the ICU. He said that's about 50% longer than the average flu patient.

Lydiatt said Methodist has 25-30 coronavirus patients who are still in the hospital even after their active illness has ended and many have been in the hospital for 28 days or more.

Dr. Harris Frankel, chief medical officer of Nebraska Medicine, said he feels confident there's adequate hospital capacity for at least the next week or two, "but that could change rapidly."

All three hospitals said they can create more beds if necessary, but Ward reiterated what hospital officials across the state have been saying for weeks.

"Space is not the issue," he said. "Staff is."

Bryan staff who care for COVID-19 patients