Liverpool's University Hospitals Trust has the highest number of patients with coronavirus in the whole of England.
There are currently 251 inpatients being cared for at the Trust's hospitals - The Royal Liverpool Hospital, Aintree Hospital and Broadgreen Hospital.
Of those, 27 people are in critical care.
Steve Warburton, the chief executive of the Trust, told colleagues the figures were approaching the capacity of patients admitted in spring, at the time of the Covid-19 peak.
Then, there were 390 patients in those three hospitals with the virus.
Correspondence sent out by Mr Warburton to staff, and seen by the ECHO, has highlighted the growing problem facing the region with the pandemic.
He said: "In recent weeks we have seen a significant increase in people testing positive for Covid-19 in our communities.
"While there are high rates of infection across much of the northwest, Liverpool in particular is seeing an increasing prevalence, of infection among the over 65s.
"This has led to a growing number of people being admitted to our hospitals.
"We currently have 251 inpatients, 27 of whom are in critical care, who have tested positive for Covid-19.
"This is the highest of any hospital trust in the country.
"To put that in context, at the peak of the last surge, we had 390 in-patients with Covid-19.
"The increase in activity has placed significant pressure on us all and I do not underestimate how challenging it has been."
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To cope, Liverpool University Hospitals Trust has reinstated daily senior meetings, arranged patients into red, green and yellow areas depending on their conditions, and redirected resources from clinics into additional medical wards, where needed.
In the week up to October 6, the region saw 7,075 new cases of Covid-19, according to data released by the government on Friday afternoon.
The data show cases in the region have doubled in less than two weeks.
A further 13,864 lab-confirmed cases of coronavirus in the UK were reported on Friday, and 87 more deaths were confirmed of people who died within 28 days of testing positive for coronavirus.
Nottingham has the highest rate in England, with 760.6 cases per 100,000 people - a huge jump from 158.3 per 100,000 in the seven days to September 29.
Knowsley has the second highest rate, which has leapt from 391.1 to 657.6 per 100,000, while Liverpool is in third place, where the rate has also increased sharply, from 419.0 to 599.9.
Separate figures suggested coronavirus cases are doubling about twice as fast in the North West, Yorkshire and the West Midlands as for the whole of England.
