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Counties Manukau Health chief medical officer Dr Pete Watson said in a statement it was "critical" that anybody needing urgent care got it as soon as possible.
"The hospital is safe to attend. People should not delay seeking medical help – if they wait too long their condition may deteriorate," he said.
"We know that alert level 4 and recent news about Covid patients at the hospital can be worrying. But we have strict processes in place to keep everyone safe."
The ED is open, and patients are being "carefully and fully assessed" on arrival.
Anyone with possible Covid symptoms or a suspected exposure to Covid would be managed through a dedicated pathway, including being kept separate from other patients during assessment and treatment in the ED, wards and intensive care units.
Everyone coming to the ED was socially distanced, and had to wear a mask if they were an adult. All staff had to wear appropriate PPE, including N95 masks and goggles.
Middlemore was also testing more patients than normal when they arrived in the ED "as a result of the greater precautionary approach required at this time".
"We are urging any of our community who are very unwell, to come to see the emergency department as soon as possible. We are here to provide safe, high level care to anyone who needs it, no matter what their medical requirements are."