The term “elective surgery” is often misunderstood as a procedure like a face-lift or other forms of cosmetic surgery. But in fact, the term covers a wide range of hospitalizations, many of which are serious, such as removing a cancerous tumor.

And as coronavirus cases continue to surge across the U.S., many health systems have yet again had to place a hold on elective surgeries and procedures in order to make room for COVID patients. In some cases, doctors and nurses in certain specialties have been shifted to take care of coronavirus patients while Americans have had to put off routine cancer screenings or heart checkups.

“An elective surgery does not always mean it is optional. It simply means that the surgery can be scheduled in advance,” according to Johns Hopkins Medicine.

“But in some cases it may be for a serious condition such as cancer. Examples of elective surgery include removing a mole or wart, and having kidney stones removed. It may also be done if other forms of treatment are not working.”

There have now been more than 13.5 million confirmed COVID cases in the U.S. and nearly 267,000 deaths. Of course, deaths are a lagging indicator. They’re the final step in a chain of complex medical logistics that begins with receiving a test and then may advance to hospitalization, depending on the severity of the illness.

Health systems from California to Ohio to New York have had to make adjustments given that reality. Cases in the Golden State have soared past 1.2 million as of Nov. 29, a record. Zooming out, nationally, there are currently more than 93,000 Americans hospitalized with COVID-19, according to the COVID Tracking Project. That’s an all-time countrywide high since the pandemic began. And experts fear that a flurry of travelers flying during and after the Thanksgiving holiday will only make matters worse in the coming days and weeks.

The effects have put an enormous strain on ICUs and hospitals. New York Gov. Andrew Cuomo said on Monday that there would be no elective surgeries in Erie County, which houses Buffalo, beginning on Dec. 4.

“Hospital capacity is now the state’s top concern,” he said.

California may also clamp down on elective procedures in the hardest hit regions. Meanwhile, major hospital chains across Northeastern Ohio, such as Summa Health System, will pause elective surgeries beginning on Tuesday.

Peak hospitalizations may not occur until mid-January given holiday travel and the coronavirus’s incubation period. “Obviously, to make this decision, we didn’t do it lightly, and we understand the repercussions of that,” Summa Health System Akron Campus president Dr. David Custodio told local Buffalo affiliate WGRZ.

“I wish we could say exactly we can start [elective procedures] on Jan. 2, but that would be misleading. We don’t know, and that really depends on the trajectory and the capacity,” he continued.