A perfect storm of winter illness, bed blocking and high numbers of Covid-19 cases means St Mary's Hospital is "pretty congested, at this moment in time," according to the Isle of Wight NHS Trust's medical director.
Dr Stephen Parker says the health service is braced for what could be "one of the worst winters in its history."
Many of us hadn't heard about Omicron a month ago.
Now, the fast-spreading variant is delivering an extra pressure to tired frontline medical teams and it must be managed alongside a surgery backlog, waiting list cuts and not being able to free up beds used by healthy Islanders for whom community care places cannot be secured.
Omicron was confirmed on the Island yesterday (Thursday).
Dr Stephen Parker (photo: Isle of Wight NHS Trust).
Dr Parker calls it a "balancing act" and hopes the new variant isn't the "straw the breaks the camel's back," when it comes to keeping the NHS on its feet.
This Christmas, he wants Islanders to take personal responsibility, by sticking to the Hands, Face, Space guideline, even though the slogan has been replaced on the Prime Minister's lectern by the phrase, 'get boosted now'.
Jabs must work alongside other safety measures, says Dr Parker.
"The government's got to balance a safe and effective healthcare system with the public's ability to work and interact with family and friends," he told the County Press.
"My view is you should ask yourself, do you need to go on that journey? Do you need to get on the ferry? Do you need to go to that Christmas party?
"If the answer is no, take personal responsibility."
Recently unveiling its recovery plan, the Isle of Wight NHS had halved its waiting list (albeit measured over 52 weeks, not the required 18).
Whether that reduction continues depends on the next crucial stage.
An extra ward has opened two months earlier than planned, to meet the demands of winter illness.
Usually anticipated in January and February, familiar problems like flu are already putting pressure on hospital beds.
Meanwhile, even if Omicron proves to be a milder form of Covid-19, its increased transmission means more people will get it more quickly and that will translate into patients who need critical care, says Dr Parker.
Add to that increased staff absence, which the Isle of Wight has yet to experience, but which some mainland organisations are already reporting.
Islanders opposed to vaccines, and measures like the increased use of masks and the requirement to show vaccine status, argue letting the virus spread is the best way to get back to 'normal'.
But Dr Parker says, even if some of us become immune, vaccination is faster and more effective and any mutation could trigger another peak.
He has adjusted his own Christmas plans, as the uncertainty of Omicron looms.
Patients in critical care now are different to those admitted during the first Covid-19 wave.
The proportion of unvaccinated older Islanders is smaller, while the number of younger patients, either unvaccinated or not fully vaccinated, has grown.
In the summer, Dr Parker says there were only small numbers of Covid positive patients and those requiring extra care were "very, very" few.
On Wednesday this week, there were 28 patients with Covid-19 on the hospital's wards and three people in intensive care.
So what is the prognosis for the NHS?
Around 95 per cent of staff are vaccinated and those who aren't must start the process by February 3, in time to meet the April 1 deadline for mandatory jabs.
After that, some may need to be redeployed. Care homes have already had to let unvaccinated staff go.
Early in the new year, the hospital's own Covid-19 vaccination hub will open to the public.
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