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Some Texas hospitals are erecting tents, planning to add beds, and eyeing vacated buildings as overflow facilities while they prepare for what may be a deluge of COVID-19 patients.

The efforts to quickly add capacity come after Gov. Greg Abbott waived hospitals’ occupancy restrictions Sunday and ordered healthcare providers to postpone surgeries that are not “immediately, medically necessary” — directives he suggested could free up half of some hospitals’ beds for COVID-19 patients. The steps are early preparation in Texas, which has not seen the level of crisis that countries like Italy or states like New York are now experiencing over the outbreak.

Texas on Wednesday was reporting almost 1,000 confirmed COVID-19 cases, though the number is almost certainly an under-estimate due to community spread and lack of testing.

In an East Texas region that’s seen four rural hospitals shuttered since 2014, local officials and medical personnel have mapped out space for cots in a local civic center and are considering reopening a hospital that closed five years ago to handle a potential influx in patients.

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“We’re thinking [about a] more long-term type situation. If you had something like Italy or what’s going on in New York — something long term and larger scale — that’s when something like that’d be available,” said Terry Scoggin, chief executive officer of Titus Regional Medical Center, in Mount Pleasant. “I think everybody’s in the same boat this week trying to figure out what our options are. We are going to be working under new normals. I think everybody understands that we’re going to have to learn to live in a world of social distancing.”

Employees have already moved equipment out of a wellness center and reserved the third floor for isolated patients. Scoggin expects the hospital could nearly double its capacity by adding a cot or second bed to each room, and will add 10 rooms this week by repurposing hospital space.

Hard-hit states like New York have planned temporary hospitals, and are considering using university dormitories as overflow facilities. A military hospital ship has been dispatched to California to relieve the pressure on the local healthcare system, and another is expected to go to New York, which is converting a convention complex into a medical facility.

In Texas, Abbott said medical tents and vacated healthcare facilities may be used. The National Guard will “be involved in the process of standing up these additional healthcare facilities of whatever type. They could be medical tents, which is what the hospital CEOs told me was their first choice,” he said Sunday.

Texas hospitals are required, under an executive order issued Tuesday, to report daily their bed capacity to the state health services department, which will share it with the U.S. Centers for Disease Control and Prevention.

Urgency to add beds has emerged in Denton already, where local officials asked Abbott to build a temporary hospital at a state-run home for people with disabilities that has already had a half-dozen cases of the virus.

But hospitals are preparing in different ways for a possible wave of patients that has yet to come.

In Houston, MD Anderson Cancer Center has added a temporary triage center in an ambulance bay, a hospital spokesperson confirmed, and taken a number of other precautions to protect patients and workers.

The University of Texas Medical Branch on Tuesday erected triage tents — with hard floors and Wi-Fi to connect medical devices — outside its emergency rooms in Clear Lake and League City. Employees plan to add more this week at their facilities in Galveston and Angleton, said Maureen Milligan, president of the Teaching Hospitals of Texas. Unused buildings, like closed acute care hospitals, have been identified as possible surge facilities, she said.

“They are passionate, smart, committed and innovative and are working hard and creatively to grow hospital service capacity,” Milligan said, of the teaching hospital staffs. “We ask that Texans support them by following shelter-in-home orders and limiting exposure.”

Other facilities are adding capacity within their existing walls. Some are preparing to add second beds to single-occupancy rooms, or are repurposing areas once used for outpatient care. Elsewhere, alternatives to in-person clinics are being offered using telemedicine and staff are being moved to help screen or treat patients suspected of having the novel coronavirus.

The Texas Hospital Association has said the system is facing “increasing pressures,” and that facilities have “activated their emergency plans” and are “planning for significant surges in patients.” On Tuesday, a spokesperson for the association said in a statement “we’re working with our state partners to identify additional temporary beds.”

“There is a tremendous amount of planning happening behind the scenes. Of course, we’re still pushing hard on the public to stay home, wash hands and don’t go [to] the ER unless it’s a true emergency. We want people to stay home and stay healthy, so we can preserve precious hospital resources for those who are going to need it the most,” said Carrie Williams, a spokesperson.

As the state’s rural hospitals brace for more patients, they must also contend with smaller staff head counts and precarious finances.

Swisher Memorial Healthcare System, in Tulia, is seeking approval to treat possible COVID-19 patients at an off-site location they’ve secured to minimize nurses’ and other patients’ exposure. A COVID-19 case at the hospital left nine employees quarantined for two weeks, chief executive officer Luke Brewer said, knocking 10% of the clinical staff out of rotation. The facility has doctors willing to travel down from Amarillo to lend a hand, but the cost of hiring traveling nurses or adding physical beds would be costly.

“Whether they show it or not, deep down inside, everyone’s a little nervous about what’s going on,” Brewer said, of his medical staff. He’s approved all overtime and received several community donations of protective equipment for the healthcare providers to use, he said.

Eastland Memorial Hospital, which is licensed for 52 beds but can only staff up to 32, treats primarily geriatric patients and is the only hospital on a 120-mile stretch of Interstate 20. Officials said they may cordon off a wing to treat COVID-19 cases, and have talked to temp agencies about traveling nurses to have on hand should they run short on staff.

The hospital’s employees are preparing for a slog, with key personnel ready to stay overnight in rooms they use during ice storms.

“Out here in the rural areas, we don’t have that large population. So the nurses that we have, the techs that we have, we pretty much already employ them,” said chief financial officer Ron Hunt.