Concern is growing over an escalating COVID-19 outbreak in the NSW Hunter New England region, which accounts for almost a quarter of the state's daily cases.
Sixty-three of the 265 new local COVID-19 cases reported in NSW on Monday were recorded in the local health district, taking the number of active cases there to more than 1600.
Lake Macquarie Mayor Kay Fraser warns the region's health system is struggling with the current outbreak.
"Our local hospitals are at breaking point," she told ABC News on Monday.
"I'm really concerned about our frontline workers and the health system being able to cope if there's an upswing in the numbers here."
Fifteen of the new cases are from Lake Macquarie, 13 from the Mid North Coast local government area, 12 from Newcastle, 11 from Maitland, and six are from Cessnock.
Only one local health district - South Western Sydney - recorded more new cases on Monday.
Another five deaths were also reported across NSW, including a Cessnock woman in her 30s.
The unvaccinated woman had underlying health conditions and died at John Hunter Hospital.
Two people from the Hunter New England, which takes in Newcastle, Taree, Cessnock, Tamworth and Armidale, were also among the deaths announced Sunday.
An upswing in cases is expected when free travel between Sydney and the regions resumes on November 1.
Regional travel has been delayed twice already, to give people in the regions more time to get fully vaccinated.
But Ms Fraser said vaccination rates remained low in parts of her region.
"Even though we have over 95 per cent single dose, we still around about 65 per cent double dose which is a real concern," she said.
"Lake Macquarie is faring quite well, but if you look around Cessnock and Muswellbrook and the Upper Hunter, they're doing far worse - some are around 50 per cent - so it's a real issue for us."
Some 16 cases were also reported in the Illawarra Shoalhaven on Monday, 10 on the Central Coast, eight in the Murrumbidgee local health district, five in the Nepean Blue Mountains, five from the Southern NSW local health district, two from Western NSW and one in Northern NSW.
Australian Associated Press