The COVID crisis in NSW is expected to worsen and Illawarra nurses are calling on the state government for more support, saying hospital staff are already overwhelmed.
On Friday it was revealed that a record 1431 new cases emerged in NSW and another 12 people had died.
The Illawarra Shoalhaven Local Health District reported another 13 cases: nine in the Wollongong local government area, two in Shellharbour, and two in Shoalhaven.
They bring the number of COVID infections among residents of the LHD to 123 since the beginning of this outbreak in mid-June, and 290 during the entire pandemic.
Of the new cases, investigations continue into five in the Wollongong area, one from Shellharbour, and the two in Shoalhaven.
They came the day after the Illawarra saw its highest daily increase in cases since the pandemic began, with 22 infections detected in the 24 hours to 8pm Wednesday.
Premier Gladys Berejiklian warned that the state's daily case numbers were expected to rise even further.
"The next fortnight is likely to be our worst in terms of the number of cases," Ms Berejiklian said.
"But as I have said it is not the number of cases we need to be focusing on but how many of those cases end up in our intensive care wards and hospitals and how many people we have vaccinated as quickly (as we can)."
The premier has flagged October will bring the worst in terms of serious illness and hospitalisation.
Wollongong Hospital nurse and branch secretary of the NSW Nurses and Midwives' Association, Genevieve Stone, said there were already staffing issues.
More nurses were not being hired but instead existing employees were getting redeployed to other areas, she said, casual staff were being pulled into testing and vaccination clinics, plus there was also the pressure posed when nurses had to get tested and isolate.
"[Health Minister] Brad Hazzard says we're coping well, but that's not what I'm seeing on the floor," Miss Stone said.
She said the local health district was doing all it could, but the government needed to step in with more funding.
The fact that the peak in hospitalisations is likely still to come is a concern.
"It makes me very nervous, because we don't have the staff to man those beds," Miss Stone said.
She said it was also an emotionally distressing time for staff and patients with the visitor ban, especially with some hospitalised for lengthy periods.
Shellharbour branch secretary Debbie Simpson also said there was already stress around understaffing, as well as the ongoing fight to increase nurse to patient ratios at the hospital to improve patient safety.
"Morale has sort of gone down a bit, people are stressing about things, and it's just that fear of the unknown," Mrs Simpson said.
On top of that, she said, more people were presenting at the hospital because they could not get into their GP or waited too long to see their doctor.
She said it was the government's responsibility to do something to help.
"Management are doing all the right things, but staff are very much overwhelmed," Mrs Simpson said.
The premier said the system would be "stretched" in the coming weeks and "very different procedures" might be in place, but planning had been underway for 18 months.
There were preparations in place to triple intensive care capacity in NSW, including staff, Ms Berejiklian said, should the demand arise.
She will release the government's plan for the healthcare system next week.
Deputy Premier John Barilaro said the welfare of healthcare staff was a priority, but acknowledged the system was under stress.
Dr Bruce Ashford, co-chair of the Illawarra Shoalhaven LHD's COVID taskforce, said the jump in infections had been anticipated.
"It's just not surprising to us, we expected these sorts of numbers and we expect numbers to grow," Dr Ashford said.
Dr Ashford said the challenge now was to maintain the capability of the hospital.
However, he said there was capacity within the COVID wards and intensive care unit to meet current demand and more, and plans were in place for the possibility that the situation would worsen.
"Wollongong is probably in as good a position as any hospital, and our LHD is well-prepared," Dr Ashford said.
Every step of the pandemic the situation was evaluated and steps were considered, he said, and there was a plan for escalation.
Healthcare workers in the community are also facing their own stresses presented by the pandemic, and this outbreak in particular.
Alexandria Pritchard, a practice nurse at Bulli Medical Practice, said that while there had been challenges, it had been rewarding to see the gratitude of the community for the care she and her colleagues were able to provide. "We haven't shut our doors to everybody, the community really appreciates that, and it's just been really wonderful to see that," she said.
The pandemic - and this outbreak especially - have also presented as a busy time for the surgery, especially since it began offering COVID vaccinations.
Ms Pritchard said coming into contact with people every day and not knowing if they had COVID could be worrying.
"But the biggest fear is probably not getting it myself, it would be to give it to one of my patients or my family members - that would be the biggest fear, the most stressful," she said.
Pharmacist and owner of Shellharbour Village Pharmacy, Dr Shabbir Kermali, also acknowledged the community for their support during a challenging time for those working in health.
"Everybody's really good, they sign in every time they come in, they're always wearing masks, they're very respectful... They're all very, very mindful of the environment that we're living in now, so as far as I can see we've had a really good response, and the public's been really accommodating for what we need to do, as well as what they need to do," Dr Kermali said.
Increasing demand for deliveries during the pandemic - as customers found themselves in isolation or avoiding unnecessary contact with others - and now having COVID vaccination on offer has kept the pharmacy busy.
But Dr Kermali said he and the other pharmacists had assessed demand and put procedures in place to ensure they could meet demand without becoming overwhelmed, as well as have the time to talk to customers about the vaccine.
As a healthcare professional, he said he was not surprised by the rising numbers.
Now it was a case of managing the risk of illness
"The only one thing left for us and for us all, is to get vaccinated... so if you do end up getting the infection, you don't get it too seriously, or you don't get so ill that you end up in hospital," he said.