Surgeons are still taking a pen to their theatre lists every day, cancelling patients' operations at the last minute.

That was despite optimism from health bosses that the situation of overloaded hospitals was improving as the numbers presenting with Covid dropped for the second week in a row last week.

Those working on the frontline said in some places the situation was as bad as it has been at any point in this winter, compounded by staff sickness.

Association of General Surgeons president Rowan French directed a surgical team and said he often started his day going through the list of scheduled operation to cross off those that had to be cancelled.

"It's hard not to feel bad about it but, by the same token, when we've got 20 people waiting for beds in ED who are sick, they have to take priority," he said.

He worked at Waikato Hospital, although could not comment for them, speaking instead on behalf of the surgeon's association.

The hospital had been at 120 percent capacity at times in the past few days with a lot of Covid among patients and staff.

Sometimes cancelled patients or their whānau had already taken time off work, booked accommodation, arranged for the grandparents to babysit.

Medical teams were making similar tricky calls all over the country, weighing up what work was time critical and what could wait, he said.

They were also forced to make tough decisions about whether patients could be discharged early because ward beds were needed.

Even in normal circumstances, surgeons liked to get people home as quickly as possible so pushing that further was a worry, he said.

"It becomes a matter of a balance of risks - the risks to that patient being discharged earlier than you would like and something going wrong in the community, versus a patient waiting in ED with a problem that also needs a nursed bed," he said.

Waikato Hospital. File photo Photo: RNZ / Simon Rogers

Many hospitals, including Waikato and Canterbury were leaning on private hospitals to help out.

Private Surgical Hospitals Association president Richard Whitney said they were feeling the pinch too.

They sometimes had to call off operations because staff were sick or patients had tested positive for Covid.

Common surgeries they helped out on included eye, orthopaedic, and ear nose and throat.

Te Whatu Ora Canterbury said it had outsourced 500 operations to the private system between now and the end of October and was also using their operating theatres.

Across Te Waipounamu, public hospitals were helping each out in a bit of a patient-go-round.

Chirstchurch and Dunedin were still under a lot of strain so Timaru was doing colonoscopies or joint replacements for them.

West Coast patients were heading to Christchurch because of nursing shortages or other hold ups in Greymouth.

Te Whatu Ora said the winter had been an unprecedented challenge and health teams have stepped up to meet that.

It hoped the pressure would ease from here on in as winter illnesses dropped.