The pressure of the Omicron wave of Covid-19 is building on hospitals in our region as rising admissions and surging staff absences combine.
The ECHO understands that there are now more than 300 covid positive patients being cared for at Liverpool's main hospital trust - which includes the Royal Liverpool and Aintree hospitals.
Concerningly, it is also understood that staff absences at the trust have rocketed to over 1,000 as the highly transmissible variant of the virus continues to cause chaos across the sites.
Read more: Latest Merseyside area Covid-19 figures as cases soar
Staff members are now being asked to volunteer their non-clinical time - such as doing paperwork or responding to emails - and instead head to medical wards to help out with clinical jobs.
One senior doctor at the trust told the ECHO that staff are braced for more trouble coming soon.
He said: "Things are fluid and rapidly changing.
"The real concern is staff shortages across the board.
"General wards seem very short of nurses in particular. One ward sister told me she had 12 staff absences on her ward alone.
"Very few beds are available for routine cases. I think things will get worse in the next week or two."
Those fears are not unfounded when you look at the explosion of cases in the city.
The latest infection rate for Liverpool is now around 2400 cases per 100,000 residents - far higher than anything we have seen before in the city.
Perhaps the best metric for highlighting just how prevalent the virus now is in the city is the positivity testing rate.
This indicates that more than 40% of all covid tests carried out in Liverpool in the past week came back positive.
Omicron's milder impact and the fact so many people are protected by vaccines should mean that these surging numbers don't result in the same awful levels of serious illness and death that we saw in Liverpool last January.
But sky high infections will still - and already are - lead to many people needing hospital treatment, with fewer staff available to care for them.
In other areas - like Greater Manchester, where non-urgent surgery has been paused in most hospitals - the challenges are different to previous waves.
It is not intensive care units reaching capacity, but general hospital beds. Greater Manchester now has around 96% of its general beds taken up.
Many are concerned that this difficult combination of steeply rising admissions and continuing staff absences could make things much worse for our region's hospitals in the coming weeks.
Dr Peter Hampshire, the director of critical care at Liverpool's main trust, said on Twitter this week that the Omicron wave appears to be 'different but not better.'
He said: "The Omicron wave seems different to previous waves, when main impact was on critical care. Different, but not better. We've seen number of people with Covid in the hospital double since Christmas Eve.
"And lots of staff off with covid and self isolating, which means it's harder to staff wards and keep beds open.
"We also need to keep infectious patients away from others and as Omicron is more infectious, the risk it spreads between people in hospital is higher."
He added that the good news is fewer people needing intensive care so far.
Speaking about the increasing pressures, Professor John Brennan, Interim Medical Director at Liverpool University Hospitals NHS Foundation Trust, said: “We are seeing rapidly rising rates of COVID-19 transmission locally and that is reflected in our patients and impacting on our staffing.
"Our staff are working incredibly hard and we are deeply grateful to them for the heroic effort they continue to put forward in such challenging circumstances.
“We would urge the public to do everything they can to protect themselves, their friends and their family, by ensuring they are fully vaccinated, following guidance around social distancing, wearing masks, washing their hands regularly and ensuring spaces they are in are well ventilated.
“NHS services are open and it is vital people come forward for care when they need it but it is important the public access NHS services appropriately, using NHS 111 to direct them to the best service for their needs and only attending the Emergency Department when it is absolutely necessary.”
Of course it's not just Liverpool where cases are surging and more pressure is landing on the health services.
A doctor based at a hospital in Wirral told the ECHO that exhausted staff have been having to come forward to cover for covid-sick colleagues for weeks already.
She said: "Staffing shortages mean we are relying on the goodwill of staff exhausted by previous waves.
"I did two shifts to cover a colleague last week. All unpaid. Because that's what we do, I guess."
The region's ambulance service is under such strain now that it is receiving support from the army, with around 150 military personnel attempting to alleviate some of that pressure.
Back In Liverpool, the fear is for the coming days and weeks.
The city's Public Health Director Matt Ashton is worried the hugely transmissible strain could leave a 'trail of destruction' in the city.
With cases now at record levels, he said: "It is clear that the Omicron wave is well and truly upon us in the North West, following the experience in London and the south east.
"Yorks and Humber, and East of England, in similar position, and rest of the country will follow very shortly.
"Hopefully this wave will be over quicker than previous waves, and with a milder variant, but it would be naive to assume it still isn’t going to leave a trail of destruction in its path. This destruction will be greater in poorer communities."
He added: "The impact of this wave of course is not just on people with covid, but on people needing help and support for anything and everything else - a challenge that is already bigger in some areas."
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