THE impact of demands and pressures on the NHS are a big cause for concern as we approach winter.

That was the message from NHS Wales chief executive Dr Andrew Goodall at Wednesday's Welsh Government coronavirus briefing.

He said that the number of people being treated for coronavirus in Wales would fill 50 hospital wards. With the usual demands on the NHS, which will rise during the winter, this will put the NHS and its staff under pressure.

“The NHS remains open for essential and emergency services and also for routine care," he said.

“But with high levels of coronavirus infection in our communities, and high levels of people with coronavirus in hospitals, services will find it increasingly difficult to operate normally."

He said that overall Wales is continuing to see a fall in the rate of cases.

But we are also, he added "continuing to see very high numbers of people dying from coronavirus".

There are four levels of escalation in Wales to monitor how busy hospitals are, and Dr Goodall said that today, 18 hospitals are reporting being at levels three or four, the highest two levels.

"The NHS continues to balance winter and emergency pressures with the demands of caring for people seriously ill with coronavirus," he said.

Dr Goodall said there are some early signs that hospital admissions for coronavirus are stabilising in Wales.

But, as of yesterday, there are 1,654 coronavirus patients currently in Welsh hospitals, which is still eight per cent higher than at this time last week.

And while there are lower numbers in critical care than at this time last week, Wales' normal critical care capacity of 152 beds has been exceeded, with 157 patients requiring that level of care.

Almost half of those admitted to hospital with coroanvirus "will be there for more than a week", said Dr Goodall.

And around a quarter will be in hospital for at least three weeks, with some needing even more time to recover sufficiently to be able to go home.

"This has a knock-on effect on available bed capacity,” said Dr Goodall.

Coronavirus has "affected every aspect of healthcare" and the pressure facing critical care is "immense".

Dr Goodall gave a "snapshot" of life for staff at the frontline, caring for coronavirus patients.

They must work in PPE for a full shift, and that is "hot and difficult", and means there is an increasing need for breaks so they can take off the equipment for a while.

Coronavirus and non-coronavirus patients need to be kept separate, and that increases the complexity of the system.

There is also a higher level of staff sickness, with people becoming ill due to coronavirus, and having to self isolate because of that, and because they may have been in contact with others who have tested positive.

He said the picture he was describing meant it was important for us all to stick to guidance and adhere to restrictions.

Dr Goodall said the worry he had would be seeing the impact of social interaction having an impact on the 'R' rate, and increasing the virus.

Where there are high numbers of cases in the community, this translates into high hospital admissions, high critical care needs, and then more deaths.

"The more patients there are in hospital beds across Wales, the more deaths there will be," he said.

Dr Goodall said the main message for Christmas irrespective of the politics, "is to focus on the need to still limit social interactions and comply with the guidelines on social distancing and hand hygiene, as they make the most difference".

He stressed again that the NHS is already under enormous pressure, but staff have been happy to see the way people in Wales have responded over the past few weeks.

He also said there should be more of a focus on what we should do and not what we can do.