One health board labelled the issue a “perfect storm”, of Covid cases, staff shortages due to self-isolation, staff summer holidays, visits to accident and emergency (A&E) back at pre-pandemic levels and higher demand for non-urgent services because of the Covid backlog.
The admission came as Scotland recorded 22 coronavirus deaths – the highest daily death toll since March 11 – and 1,825 new cases in the 24 hours to Thursday.
Nicola Sturgeon urged Scots to get vaccinated and keep following restrictions to help keep case numbers “on a downward path”.
She posted on Twitter: “There’s always a lag before we see hospital admissions and deaths reduce too.
“A further 22 deaths reminds us of toll virus can take – my condolences go to those grieving.”
Martin MacGregor, vice-chair of the Royal College of Nursing Scotland Board, said the pressure was taking its toll on staff who may not been able to take a break before the expected high demands of winter.
"We are now seeing significant pressures on a number of services which is abnormally high for this time of year,” he said.
"Many of our members are looking on to the autumn and winter with dread."
Reports of staff shortages are “extremely concerning”, he said.
"We are seeing the toll this is taking on nursing staff and other colleagues who are already exhausted and worn down,” he said.
"Urgent action is required to ensure Scotland has the nursing workforce it needs to continue to safe and effective care across both health and social care. Nurses must be given an opportunity to rest and recover, before winter pressures begin.”
NHS Grampian said Dr Gray’s Hospital in Elgin and Aberdeen Royal infirmary are still fluctuating around “code black” or at full capacity, having first revealed this early this month.
Non-urgent operations are being cancelled on a case-by-case basis in the health board, often due to key staff members having to self-isolate.
NHS Highland, which previously declared Raigmore Hospital at capacity, said this is no longer the case, but healthcare services in the area are still seeing high levels of demand.
Some non-urgent procedures are still being cancelled in Lothian, but hospitals are not currently reaching capacity.
A spokesperson said NHS Lothian was “closely monitoring” the impact increased pressure was having on hospital and community services.
"Since July 8 we have unfortunately continued to postpone some planned procedures to focus staff and capacity on the most urgent patients,” the spokesperson said.
"We apologise to anyone who has been affected and are working to ensure appointments are rescheduled as quickly as possible."
NHS Greater Glasgow and Clyde said it was not under as much strain as other health boards, but continues to monitor the situation.
Jillian Evans, head of health intelligence at NHS Grampian, warned the service was facing a “really exceptional situation”.
She told BBC Good Morning Scotland on Thursday the backlog of people waiting for care “will get worse before it gets better”.
“I’ve been around long enough to see the NHS with very, very long waiting times and very long waiting lists, and this does feel like a really exceptional situation,” she said.
"It’s not surprising given what we have been through.
“It is going to take years, and I think it is much better to be honest with people about the challenges ahead, and we have got challenges ahead and dealing with that backlog will be something we will need to deal with across Scotland and it will involve lots of different parties and different sectors to help with that.”
Child and Adolescent Mental Health Services (CAMHS) in Lanarkshire are under “unprecedented” levels of pressure.
High risk and urgent cases are still being seen as a priority, the health board said, but waiting lists are in place for others.
Emer Shepherd, specialist children’s health services general manager, said: “We have seen a sustained increase in the number of people accessing the service, particularly those requiring urgent care
“The complex nature of CAMHS means a range of significant and immediate pressures must be balanced to ensure we respond to demand, but also remobilise the service in such a way that it meets the needs of our young people going forward."
The warning comes after NHS Lanarkshire cancelled further planned surgeries on Monday.
Director of acute services Judith Park said: “The sustained pressure we are seeing across our three acute hospitals is showing no signs of easing.
“In fact, the pressures on our hospitals are as severe as at any time in the whole pandemic."
She added: “Pressures on our staff is also a concern and they are struggling to cope. The increase in Covid cases is having an impact on staffing levels, with health staff having to self-isolate due to contacts outside of work.
“We have some staff isolating with Covid as well as those on annual leave.
“All our staff continue to work extremely hard to ensure that patients are seen and treated as quickly as possible.”
In NHS Tayside, which has consistently seen above average rates of Covid, hospital admissions with the virus have decreased slightly and the number of Covid wards at Ninewells hospital has been reduced from four to three.
But a spokesperson said the Covid-19 critical care unit was still busy and unscheduled admissions across medicine, surgery and orthopaedics were still high.
A total of 488 people were in hospital on Tuesday with recently confirmed Covid-19, down 41 on the previous day, with 58 patients in intensive care, up seven.
So far, 3,989,927 people have received the first dose of a Covid-19 vaccination and 3,028,271 have received their second dose.