On Friday, 166 people were in Hunter New England hospitals with COVID, with five in intensive care.

This compared to a high of 119 people in hospital in January, when the BA.1 Omicron subvariant was dominant.

"We think we probably are reaching or getting close to reaching the peak of the BA.5 subvariant," Hunter New England Health physician Dr David Durrheim said.

There were 15 deaths reported in the Hunter due to COVID a fortnight ago, in the week ending July 23.

Across the state this week, there were 164 COVID deaths reported, with six of those people aged under 65. There were 2267 people in hospital with COVID in NSW.

In Hunter-New England this week, about 11,000 COVID cases had been notified by PCR or RAT tests.

"We think that's probably about 50 per cent of the actual case numbers."

Sewage testing also showed viral fragment loads were no longer rising in the Hunter, which gives further evidence of a plateau and possible peak in cases.

The peak in hospitalisations and deaths in the region, though, has not been reached. It normally occurs about a fortnight after the peak in case numbers.

Dr Durrheim warned against complacency.

"We're all tired of this BA.5 wave, but we don't want to give the virus another opportunity to surge again."

He advised people with respiratory symptoms - like cough, sore throat or runny nose - not to attend workplaces and schools.

"Go and get a PCR test. The PCRs are much more accurate than RATs with the BA.5 strain," he said.

"And mask wearing in indoor environments is a very good idea. There's compelling evidence now that mask-wearing quite drastically reduces transmission."

Dr Durrheim said BA.5 now "accounts for about 85 per cent of cases, BA.4 about 10 per cent of cases and BA.2 is on its way out".

These subvariants were evading immunity, but people should get boosters.

"The big issue is the vaccine protection against severe illness lasts for a shorter period of time. You get a really good pick up with the neutralising antibodies, but they are only effective against these breakthrough strains for a shorter period of time - three to four months.

"We're still using the vaccines developed against the original Wuhan strain. The fantastic thing is, with a fourth dose you get higher antibodies than you would have got with your first, second or third dose, if you have a Moderna or Pfizer shot.

"It's quite clear that the vaccines have saved a huge number of lives."

Dr Durrheim said emergency departments [EDs] were "always under pressure during winter".

"This winter has been worse than any other. But we've seen the number of ED presentations turn around in the last 10 days or so.

"Maybe that's a good sign we're plateauing. Obviously they've had to use their surge plans, which they've done. They seem to have done that very well."

The huge case numbers are not translating into a relatively huge amount of deaths and people ending up in ICU.

"If you reflect back on the original Wuhan strain, people were talking about 1 per cent mortality. So the vaccines have changed things dramatically.

"Obviously they don't prevent all the illness. The worry there is the ongoing impact of long COVID."

Data from the US Centres for Disease Control and Prevention shows a death rate of 1.71 per cent for unvaccinated people, 0.22 per cent for vaccinated people and 0.1 per cent for people who had a booster shot.

Scientific American reported that for the month of March, "unvaccinated people 12 years and older had 17 times the rate of COVID-associated deaths, compared to people vaccinated with a primary series [two doses] and a booster dose".

"Unvaccinated people had eight times the rate of death as compared to people who only had a primary series."

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