A quarter of the 20 beds at Gore Hospital are now being used by Covid-positive patients.
When pandemic preparedness plans were initially drafted for Otago and Southland, it was intended that any Covid-positive patients at regional hospitals would be transferred to Dunedin Hospital.
"We are mindful that we not only have to care for our own people, but that doing so means that we are keeping pressure off Dunedin and Southland," he said.
"To be honest, it is just the reality of the world we live in, that we no longer have the luxury of saying ‘sorry, we’re staying green’ [Covid-free].
"Those days are gone, and the sooner our staff can manage those cases locally the better for everybody."
Southland Hospital had been an immense help, Mr Metzler said.
"They have been fantastic and sent us up a lot of high-end equipment to help set up negative pressure rooms, which has allowed us to not only hold those patients here but also to manage them a lot better.
"Five is a substantial number of cases and we only have four single rooms ... it is not elegant, we have had to put up plastic screening to create isolation areas, but we don’t have the luxury of being able to create a ward."
Staff absence through illness had been reasonably low in recent weeks, which had helped, Mr Metzler said.
"The thing that will overwhelm us won’t be patients, we can manage that, it will be if the staff go down, because in a small rural hospital that will sink you.
"We did have that kind of crisis point about six weeks ago but we managed to just get through and now we are in a reasonably good place," Mr Metzler said.
There were 55 people in hospital in Otago and Southland who had Covid-19 yesterday, well up from 35 on Monday.
Of those, 30 were in Dunedin Hospital, 14 in Southland, five in Gore, four in Dunstan, and one apiece in Oamaru and Lakes.
"Although we have seen a reduction in our Covid-19 case numbers recently we remain acutely aware that any exposure event in our hospital system has the potential to put an immense amount of pressure on our health system," Mr Ashton said.
"The level of Covid-19 sick leave across all staff groups remains high, and staff are working hard to cover acute and essential care and, as always, give the best care to our patients."
Planned and elective surgery was still being performed, although only about 60% of the usual level, he said.
"We are also experiencing high demand through our emergency department and pressure across the system to due reduced staff capacity."
Yesterday the Ministry of Health reported 5939 new cases of Covid-19 in New Zealand, 581 of which were recorded in Otago and Southland.
A further 21 people who had Covid-19 had died, taking the national toll to 2475.
None of the newly reported deaths were in the South.
Covid-19 Response Minister Ayesha Verrall yesterday opted to keep New Zealand at the Orange setting.
She said significant pressure on hospitals meant current measures were still required.
The next setting review will be next month.