Doctors revealed last night that a second “satellite” intensive care unit had been opened at the hospital in preparation for a likely surge in Covid-19 cases.

Michael Richmond, the chief executive of the Bermuda Hospitals Board, said he was “confident” the King Edward VII Memorial Hospital was up to the problems created by the coronavirus pandemic.

But he added the pandemic had drained the hospital’s cash reserves to the stage where the BHB “had to avail of an overdraft facility as a safety net” in March.

Dr Richmond admitted it was “a somewhat exceptional measure”.

He added: “I’m happy to say it has not been utilised, but it is there on an as-required basis.

“To illustrate, our working financial commitment on a monthly basis is just short of $30 million.”

KEMH has the capacity to accommodate up to 30 intensive care patients in need of ventilators because of the virus at present.

But Dr Richmond warned: “It would be an enormous challenge to provide manpower to support those 30 over time.”

He said the hospital had created extra reserve capacity, but its use was “dependent on having appropriate carers in place”.

Dr Richmond added: “There is an ability for some flexibility. Is it exhaustible? Yes.

“When you have a sustained high number of very sick patients needing significant ongoing attention, that is very draining and exhausting.”

Dr Richmond said in a worse-case scenario where the hospital became overwhelmed, flying Covid-19 patients overseas for treatment would be at the discretion of a receiving hospital.

He added: “Other jurisdictions might accept some of our non-Covid patients, which might support our ability to deal with an influx.

“That’s not a scenario which has been tested to date.”

Dr Richmond said the island’s significantly higher level of vaccination against the virus, compared with the number of jabs that had been administered during the last surge in the spring, had given “some confidence going forward”.

He praised the “extremely resilient, extremely professional and committed” mood among hospital staff despite 18 months of pandemic stress.

But Dr Richmond warned: “What has to be recognised is there is evidence of burnout, compassion fatigue and separation from loved ones. There’s evidence of stress. That plays out in a number of ways.

“From an organisational perspective, we’re certainly extremely aware this is an issue to be dealt with by being sympathetic and empathetic to our colleagues.

“I think it’s self-evident that our emergence of yet another potential wave is in itself something to be concerned about.”

Dr Richmond said the highly infectious Delta variant of the coronavirus had forced the hospital to cut back on hospital visits.

He added: “We do it with a heavy heart, but we do it mindful of the fact that Covid-19 lives and breeds off human traffic.

“If there’s any indication we can take the brakes off, we will do so and allow patient and family contact to be resumed.”

Dr Richmond said it was too early in the new outbreak to “look over the horizon” as the island faced its fourth wave of the virus.

He added there had been a “gradual” increase in the number of people attending the KEMH with Covid-19, although not all needed treatment.

Wesley Miller, the BHB’s chief of staff, said the hospital had already been affected by rising case numbers.

Dr Miller said: “We have challenges where, contrary to the notions of those who think Covid is like the flu or something simple, we are now seeing increased numbers coming through the emergency department.

“That has placed pressure on staff.”

Dr Miller added the hospital had put up its emergency tent because of the surge in cases, which included younger people than had been seen in earlier outbreaks.

He explained: “The purpose of that is not to house patients, but to allow for a more streamlined assessment.

“Some of the Covid patients will be stable enough to go home but others we will have to admit.

“We can reassure the public that we have enough respirators and enough oxygen. That’s not a challenge.”

Dr Miller appealed to people who were “on the fence” over the jabs should “go out and get their vaccine”.

He told the public: “It is your best chance of staying out of the hospital.”

Vaccination numbers surged for a short period after the US Food and Drug Administration approved the Pfizer vaccine, but numbers have dropped again.

Dr Miller said the UK government had promised to supply Bermuda with more vaccine – but only if there was a demonstrated need.