Liverpool hospitals are treating more coronavirus patients than they were during the peak of the first wave of the pandemic, the medical director says.
Dr Tristan Cope, of Liverpool University Hospitals NHS Trust, which runs the Royal, Aintree and Broadgreen hospitals in the city, said the numbers were continuing to rise.
Liverpool has the third highest infection rate in England and the city region was the first area to be placed in a Tier 3 lockdown with the harshest restrictions.
Writing on Twitter, Dr Cope said: "Sadly we are now treating more patients in hospital with Covid-19 @LivHospitals than we did in April at the peak of the first wave and numbers continue to rise.
"So important that people in #liverpool and @LivCityRegion adhere to social distancing restrictions.
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"Treating so many Covid patients in addition to usual acute and emergency care of patients with non-Covid conditions puts a huge strain on @LivHospitals staff.
"Thank you to all our staff for their incredible hard work and dedication in dealing with this very difficult situation.
"We can all help reduce that pressure by doing the right thing and taking some very simple measures: washing our hands frequently, keeping our distance from others from outside our household and wearing face coverings in indoor settings."
Chief nurse of the hospitals trust Dianne Brown wrote on Twitter: "As Covid rates @LivHospitals exceed the number back in April, need to recognise the impact this is having on our staff .
"Thank you to each and everyone of you, it is mentally, physically and emotionally exhausting - you are doing an amazing job."
Last week, harrowing video emerged showing Covid-19 patients on ventilators on an intensive care ward at Royal Liverpool University Hospital.
Doctors begged people to stick to the rules as Liverpool City Council posted warnings from frontline NHS medics who work on the ward.
One sister said conditions on the ward are like "your worst nightmare" as the country is hit by a second wave of the virus.
Louise Lightfoot, an ITU sister at the hospital, said: "It's like living your worst nightmare. Honestly.
"We're coming into work, staff are seeing it first-hand what's happening as a result of what's going on outside the hospital.
"How ill people are becoming, very, very quickly deteriorating much more of a faster pace now.
"We're all doing the best that we can to keep everyone safe, but we need more people out there to do what they can also."
She added: "This isn't going away any time soon."
Liverpool City Region became the first area of the country to become subject to Tier 3 ("very high risk") restrictions, which include the closure of bars and pubs which are not serving food, last week.
Liverpool has the third highest infection rate in the country, according to the latest figures, although the numbers are dropping.
In the seven days up until October 17 there were 2,970 recorded new cases, meaning a rate of 596.3 cases per 100,000 people, down from 691.7.
Knowsley, Merseyside, has England's highest rate.
It recorded 1,006 new cases in the week up to October 17 - the equivalent of 666.8 cases per 100,000 people.
This is down from 709.3 cases per 100,000 in the seven days to October 10.