Watford General Hospital is under "severe pressure", a health body has said, as Hertfordshire moves into Tier 4.

Herts Valleys Clinical Commissioning Group, (CCG) says the hospital is looking after a "large number" of coronavirus patients, while West Hertfordshire Hospitals NHS Trust - which runs Watford General - has tweeted multiple times that its A&E department is "really busy" or "super busy".

Jim McManus, Hertfordshire's director of public health, has also warned the situation in hospitals at the moment is “worse than the first wave” and that the NHS is facing "extreme pressure".

As of December 18, figures published on the government's coronavirus dashboard showed West Herts trust was looking after 149 Covid patients.

The previous high at any one time was 146 patients back on April 19.

In a statement, Herts Valleys CCG urged patients to "protect essential hospital services by using the NHS 111 appointment system as an alternative to going to A&E at Watford General".

It said on its website: "The hospital is currently under severe pressure as it is looking after a large number of patients with Covid-19 on top of the additional demands winter puts on health services."

West Herts trust also urged people to use the NHS 111 service.

A spokesperson said: “West Herts Hospitals NHS Trust is currently very busy, but you can play your part to help the NHS by keeping your distance, washing your hands frequently and wearing a mask in public indoor spaces."

In an interview with Watford Mayor Peter Taylor on Facebook on Friday, Hertfordshire's director of public health Jim McManus said all the county's hospitals are under “real pressure” and that the situation is “really really serious”.

Mr McManus said local hospitals are currently struggling due to staff shortages – either staff are off sick or self-isolating.

He said: "Our NHS is under extreme pressure. We are not seeing lots of people die and the reason is because the NHS has done a really good job at moving survival rates from 20 per cent to 80 per cent for this virus.

"But there are wards full of people on oxygen and there are still people in intensive care who need ventilation and that’s really really serious."

Health bosses will want to avoid a repeat of what happened in Watford in the spring.

A critical incident was declared at Watford General on April 4 after the hospital's oxygen system struggled to cope with the demand.

Mr McManus continued: "Some of our hospitals have wards full of people with Covid in Hertfordshire and surrounding areas so its really really serious, and they are trying to do vaccinations at the same time.

"The more the virus spreads, all it will do is clog up the NHS system because of that immense pressure it is on.

"That's no criticism of the NHS, it is just the way things are. It is worse than the first wave."

Hertfordshire moved into Tier 4 today, along with London and other parts of the south east.

The message from the government to residents living in tier 4 is similar to that of the first lockdown - 'stay at home'.

Christmas bubbles in Tier 4 have been cancelled due to concerns around the spread of the new coronavirus variant, Boris Johnson said.

Areas in Tier 4 will not be able to mix with other households during Christmas at all, though support bubbles will remain in place. 

The festive bubble policy across Tier 1, 2 and 3 areas of England will be dramatically scaled back to just Christmas Day, as opposed to the promised five days.