The number of new cases of Covid-19 in Ireland has declined over the last few days, but the Chief Clinical Officer of the HSE said the strain on the health service will intensify even more.
Dr Colm Henry said that even if those cases "peak and fall" over the coming days, we will see "a hospital system that has never been so stretched, in 11 months of a pandemic, and perhaps never in a more precarious position".
His warning comes as the number of Covid related deaths reported on a single day reached a record high of 93 today.
Today's figure means that 434 people with Covid-19 have died so far this month, and it's only 19 January.
"Sadly, there will be more", said Dr Henry, as continuing high levels of disease in the community feeds through to the hospitals.
The first stage of a patient's hospital journey begins in the Emergency Departments, which are now operating two separate Covid and Non-Covid ED's.
In St Vincent's University Hospital in Dublin, the Covid pathway is now the busiest one, and up to 50% of patients there are being admitted into the hospital, compared with about a third of non-Covid patients.
Professor John Ryan, a Consultant in Emergency Medicine at the hospital says that they are now seeing "the effects of Christmas".
"Patients are coming in every day. When we see them, they're given oxygen, they're given steroids, they go to a ward, and we can tell they're going to end up in ICU. They're on this trajectory to stay in hospital for quite some time," he said.
But not everyone who goes through the ED with Covid symptoms will be admitted.
"I think we saw 50 patients through the Covid stream yesterday, we admitted about 50% of those, the others were well enough to be able to go home," he said.
Professor Ryan said it was important for people to remember that non-Covid emergency departments are still open for people who need them.
"People with diabetes, heart disease, gastroenterology problems - they all continue to have acute emergencies. That's what we are here for."
While overall hospital admissions soared above 2,000 yesterday, they fell below that mark again today.
However, he said this hasn't been felt on the ground yet.
"Hopefully that will continue and we will get the benefit of that. It will be another 2-3 weeks, but until that happens, we are pretty much in the eye of the storm," said Professor Ryan.
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Staff under pressure
Frontline staff are feeling the pressure as the pandemic continues.
ED Nurse in Cork Michelle Kingston said it's "very intense and very draining".
Michelle said that the difference between this wave and the first or second wave is that the patients are "younger and sicker".
"For us as nurses, minding younger people who can't breathe is overhwelming," she said.
Michelle urged people to listen to the public health advice, by wearing masks, keeping social distancing and washing their hands.
"These are simple things to do. You don't want to end up inside hospital. It is very, very real. If they saw the amount of young people in here, it is not scaremongering, it is real and I'm seeing it every single day."
She said she hopes that there is light at the end of the tunnel if the public continue to do what they're doing.
It's not just hospitals in the larger cities like Cork and Dublin that are implementing surge plans.
At the Regional Hospital in Mullingar, Respiratory Consultant Dr Mark Sheehy said it's been a busy two weeks, with large volumes of younger, sicker patients who require high levels of care.
"We have filled our ususal ICU capacity with Covid-19 patients. We've had to open a second surge ICU for non-Covid related illnesses and just this morning we had to open a third ICU for Covid related intensive care. This is a problem logistically from a staffing point of view," he said.
Dr Sheehy said that staff are becoming "more exhausted than is normal" but that they are managing at the moment and that hospital staff from all areas have "pulled together" to improve patient care as best as they can.
He acknowledged that the pandemic is a difficult time for patients.
"They're apprehensive and scared, and then moved into isolation facilities with no contact from their friends and family. They're being managed and cared for by people in full PPE. And it's also difficult for family members, with medical staff phoning them with updates on how their loved ones are doing," he said.
A record number of 330 critical care beds are now open and staffed, with 209 Covid-19 patients among them tonight.
The surge can continue at the current standards of care up to 350 beds, but there are concerns that the level of care could be reduced beyond that.
This evening the Chief Medical Officer Dr Tony Holohan said that we cannot afford to drop our guard, and urged people to stay at home.
"The more that each individual follows this advice in their everyday lives, the more we can drive down the spread of Covid-19 and minimise the impact on vital healthcare services, patients and frontline workers."