"We are looking really hard, and looking after our staff, because it's hard looking after Covid patients, fully PPE'd up."
Watson said the hospital was making preparations.
"We've got a Covid ward almost full, so we're looking to have patients in another ward and in other parts of the hospital.
"People are feeling as if we will manage, but it's going to be hard and tough over the next weeks as we head towards Christmas."
Watson concedes Middlemore suffered its share of problems early in the current outbreak and the disease remains a fierce and unpredictable enemy.
But he believes hospitals and the New Zealand health system are not in danger of being overrun, and clinicians are now forewarned and forearmed.
Vaccine rates hitting 90 per cent in his DHB would make "a huge difference", he said.
"We're seeing more numbers come into the hospital - every day at Middlemore somewhere between 5 and 10 people are presenting with Covid... but people who are presenting are not as unwell as they have been previously.
"Which is meaning that fewer people are requiring longer stays in hospital, and fewer people are requiring intensive care."
He reiterated that even with outcomes improving, some people would become very unwell, and some would die; "We are very worried for those people who are unvaccinated."
At the beginning of the pandemic survival rates were bleak for Covid-19 patients admitted to intensive care units, particularly in places like Italy or New York, that experienced the steepest earliest surge in case numbers.
Clinicians faced a new disease that required different treatment strategies to other diseases - and that hard-won knowledge has now been refined and shared worldwide, to improve survival rates.
Watson said there is also now a clutch of medications known to be effective in treating Covid, which have been approved overseas and in New Zealand, including antivirals.
"That's been one of the things that has really put New Zealand in a better position than other countries is that we have been able to receive these drugs.
"Covid's a different illness to other respiratory illnesses - it's taken a while for people to learn how best to treat it. So we are getting better at using ventilation, at using steroids, and with the advent of the new medications coming on board that's given our teams a headstart."
Those advantages equate to fewer patients as desperately sick and for less time and mean less stress on resources.
"It enables our teams to provide all of the care to everybody who can benefit. There will be people who become very unwell - there will be people who die from it, but just the numbers will be lower."
Watson stressed the best way to help medical teams, and to keep communities and whānau safe was to get vaccinated.
