Alabama Gov. Kay Ivey on Friday issued a state of emergency as state hospitals face a surge in COVID-19 cases, an order that came the same day the state tied a record low for available intensive care unit beds.

Ivey issued a limited state of emergency aimed at giving medical providers flexibility on staffing and capacity decisions and easier shipment of emergency equipment and supplies. The Republican governor stressed she would not be issuing any closure orders or mask mandates.

”I want to be abundantly clear: there will be absolutely no statewide mandates, closures or the like. This state of emergency is strategically targeted at removing bureaucracy and cutting red tape wherever we can to allow our doctors, nurses and hospital staff to treat patients that come through their doors,” Ivey said in a statement.

The order came as medical providers described a “tidal wave” of COVID-19 cases that is putting severe stress on Alabama hospitals. The state on Friday tied the record low for available intensive care unit beds with just 39 vacant beds statewide, said Dr. Don Williamson, the former state health officer who now heads the Alabama Hospital Association.

“The system is slowly becoming overwhelmed,” Williamson said.

Of the state’s 1,567 intensive care unit beds, 689 are filled with COVID-19 patients and just 39 are empty.

Alabama ranks fifth in the country for new cases per capita, according to researchers at Johns Hopkins University.

The state on Friday also saw a record number of pediatric cases with 40 children hospitalized with COVID-19, Williamson said.

Williamson said the emergency declaration will allow hospitals to take steps such as expanding facilities or opening an antibody infusion center without getting state permission. It will increase the number of nurse practitioners and other staff positions that a doctor can supervise.

Medical officials have said a surge in cases is being driven by low vaccination rates and the highly contagious delta variant, and implored people to get vaccinated and wear masks to combat the spread and prevent severe illness.

Alabama has one of the lowest vaccination rates in the country.

“Unlike last year when we were hoping for a miracle, our greatest weapon against COVID-19 today is the vaccine, so, if you can, roll up your sleeve and get the shot,” Ivey said.

Dr. Sarah Nafziger, vice president of University of Alabama at Birmingham Hospital Clinical Services, said Thursday that the hospital has had to limit the number of procedures they are doing and decline transfers to the hospital.

“We are seeing an absolute tidal wave,” Nafziger said. She said the hospital is providing care and emergency services, but she said the trends and projections are alarming.

“When you think about running out of hospital beds, and running out of health care resources, that is the path that we are on.”