Hospitals are the backbone of the COVID-19 response and increasingly state officials are watching to see whether health care networks will be overwhelmed the pandemic's second surge continues. 

New York public health officials are linking another closure of the state's economy to hospital capacity. At the moment, no hospital in New York has reached its limits, and the state would have what amounts to a three-week heads up before that happens. 

"No hospital in the state believes they're going to hit 85 percent (capacity) by January 8," Gov. Andrew Cuomo on Friday said. "No hospital in the state. That's good news."

Hospitals are currently using what's known as a surge and flex model for ensuring they have enough space for patients and staff as COVID cases continue to mount. 

And for hospitals themselves, the challenge is expanding capacity not just for beds, but ensuring there are enough people to treat COVID patients. Healthcare Association of New York President Bea Grause says hospitals are especially concerned about ensuring they are fully staffed. 

"As state may become COVID positive either in a nursing home or a hospital, so your available staff fluctuates," she said. "So making their staffs stay healthy and safe has been a top concern."

More than 6,000 people in New York are currently hospitalized due to the virus. Hospitalizations are highest in the Finger Lakes and central New York regions as a percentage of population. But the health care networks themselves are yet to be overwhelmed. 

"Hospitals are 100 percent ready for COVID and non-COVID patients," Grause said. "You don't need to do anything different. It depends on what you need."

One of the bigger issues, too, is communication by hospital to hospital, and that's going to be a factor to ensure these smaller hospitals are not overwhelmed with patients if there is a surge in a community. 

Hospitals will also be playing a key role in vaccine distribution. It will be up to local hospital systems to begin vaccinating people with underlying health conditions at the end of January when the second phase begins. 

"There will be a communications strategy to make sure we allay peoples' fears and that people understand a vaccine is safe and incredibly important for people to receive," she said.