Swansea's biggest hospital has admitted patients to a makeshift intensive care ward an an outpatient waiting area for the first time as pressure on hospital beds grows.
Bosses at Morriston Hospital have been forced to act as the the number of Covid patients in hospital beds with Covid-19 continues to grow - and remains above levels last seen in April.
There are now 175 invasive ventilated beds occupied in Wales - the most acute type of hospital care used - which is more than the normal capacity in the Welsh NHS of 152 intensive care beds.
Of these, 70 on November 24 were occupied by Covid-19 cases and 106 by other patients as hospitals try to manage their routine and emergency work while battling the the second wave of the pandemic.
In Swansea alone, there are 34 patients in ventilated intensive care beds - of which the majority, 21, are coronavirus patients. The Morriston Hospital ICU ward normally only has a capacity of 28.
During the first wave of the virus, Swansea Bay University Health Board developed Enfys, additional beds in the large open-plan outpatients waiting area, as part of their initial response to the pandemic back.
It comprises 43 critical care beds, which would be available for use if the main intensive therapy unit (ITU) at Morriston became full.
The unit has not been used until this week, when the first patients were admitted.
Morriston Hospital director Deb Lewis said: “We stated at the outset that we hoped we wouldn’t need it, but it was there if we did.
“Unfortunately, we now need it because things have worsened.
“In the first wave we were able to manage in ITU without going into Enfys because there was a drop in non-Covid patients.
“This time we are not seeing the same drop.”
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Latest figures show a further 28 people have died with coronavirus in Wales and more than 1,200 new positive cases have been confirmed.
As of November 24, 1,692 hospital beds in Wales were occupied with Covid-19 related patients, an increase from 1,653 beds on the same day in the previous week.
The figure represents 22% of all hospitalisations.
Of those, 959 beds were occupied with confirmed Covid-19 patients, a decrease from 1,031 the previous week, with 238 beds occupied with suspected Covid patients and 495 with recovering Covid patients.
Swansea Bay has 21 Covid-19 patients in intensive care, Cwm Taf Morgannwg has 19, Cardiff has 10, Betsi Cadwaladr has 10, Aneurin Bevan has 7, Hywel Dda has 3, Powys has 0,
According to Welsh Government figures, the number of new daily admissions with suspected or confirmed Covid fluctuates.
Since the end of September, the seven day rolling average generally increased, although admissions have been generally decreasing in recent weeks, and in the last 7 days, an average of 75 people a day were admitted to hospital as confirmed or suspected with COVID-19.
Morriston Hospital’s ITU unit has a maximum capacity of 28 patients, and is staffed with a ratio of 50 per cent one-to-one nursing and 50 per cent one-to-two nursing.
Mrs Lewis said: “Earlier this week we reached 30 patients in ITU, 26 of whom required one-to-one nursing, 20 of them Covid-positive.
“Because of the way we manage Covid patients, we ran out of space in ITU so we have now moved 10 Covid-positive patients to Enfys.
“This has allowed us to manage the remaining patients, Covid and non-Covid, in ITU.”
Mrs Lewis said the number of COVID admissions into the hospital remained high, with a number of patients becoming very unwell and needing intensive treatment.
And she paid tribute to the work of ITU staff to continue to provide excellent care under very challenging circumstances.
“People need to remember that Covid is out there,” she added.
“They cannot become complacent or ignore the restrictions. They do not want to end up in ITU, on a ventilator.”