“NHS staff have a sense of dread about what’s around the corner. While we understand things need to open up some time, the timing feels like utter madness while we are so close to successfully vaccinating the population, and with a more contagious variant circulating.” That view, expressed by a frontline respiratory consultant, is widely shared across the NHS. The doctor concerned has already grappled with the first two waves of Covid. She is now steeling herself for the next one which, despite being in its early stages, has already led one major hospital trust, in Leeds, to cancel scheduled surgery, including several cancer operations. Among an NHS workforce weary after 16 months dealing with the pandemic there is a mixture of apprehension, nervousness, fear, a here-we-go-again resignation at the return of a familiar foe, stoical readiness to do their best again, and also anger that they will have to. The same doctor adds: “We’ve seen a steady increase in [Covid] numbers over the past few weeks and are back to having a full Covid ward and patients on intensive care. While they are overall a lot younger, sadly deaths are slowly creeping up despite this. “Healthcare professionals are deeply anxious about the impact of relaxing restrictions further given the current surge in Covid cases. To do away with risk-mitigating measures like social distancing and wearing of masks is incomprehensible to many of us. I feel anxious and frustrated. “The dread and anxiety are because we’ve been here before, we’ve lived through the first two – or three depending on where you are – waves. We don’t want to be back in that place where we are on ‘escalation’ rotas, routine work is cancelled and we are dealing with deaths that we believe could have been preventable with a better public health strategy.” Dr Nick Scriven, the immediate past president of the Society for Acute Medicine, who works in a hospital in Yorkshire, says: “Us up north are experiencing a fourth wave in community cases, with an uptick in hospital cases. Although numbers are not massive it’s both frightening and upsetting for staff as ICU cases are rising with unvaccinated people, either as they are young or by choice or both. There is to me a growing feeling that vaccination makes this almost preventable.” However, doctors and hospital bosses are a bit more relaxed about the coming next surge in cases because they expect it to be different to the intensely demanding first two: smaller, less dramatic and less likely to cripple the NHS. Dr Rupert Pearse, an intensive care consultant in London, tweeted sardonically last weekend to say: “As we did in November 2020 we are projecting a ‘slow burn’ of hospital admissions rather than a third wave. Let’s hope our forecast is more accurate this time.” Covid admissions to hospitals generally and intensive care units specifically are going up again, reflecting the sharp recent growth in infections. But the numbers involved remain low compared with spring last year and last winter, and the trajectory, while unmistakably upward, is nothing like as vertical as it was then. Chris Hopson, the chief executive of hospital group NHS Providers, says: “For this set of variants, vaccines have broken the link between infections and previously high hospitalisations/mortality rates. So there’s high confidence among trust leaders that increasing community infection rates, even to the levels we saw in January, will not translate into the levels of hospitalisation and mortality we saw in that peak; a peak that brought extreme pressure to the NHS.” But Hopson said in a thread of tweets this week on the NHS’s readiness to withstand the next wave that even a smaller surge in Covid cases posed a threat to a health service that is already – and official figures bear this out – the busiest it has ever been. He pointed to the NHS’s efforts to tackle the huge backlog of people needing hospital treatment and deal with the record number of people turning up at A&E, while trying to give tired, stressed staff some much-needed time off and function with fewer beds than pre-pandemic because social distancing in hospitals means an eight-bed ward now contains just six. He is also increasingly concerned about the burden that the rising number of cases of “long Covid” is now placing on hospitals – a much less prevalent problem during the first and second waves. Scriven says: “It’s overwhelming busy even without another Covid wave. Moving forwards, the government-projected rise [in infections to 100,000 a day] due to unlocking is a concern. Even if the hospital numbers don’t reach the same levels, the NHS is in a really difficult place. Any rise in Covid will seriously challenge elective [surgery] recovery and urgent and emergency care that is already struggling under the demand.” Hopson and his counterpart at the NHS Confederation, Matthew Taylor, have warned in recent days that a new influx Covid-positive patients arriving when an overloaded, under-staffed service is facing winter-like demand for care in July would inevitably force hospitals to limit the amount of surgery they can perform. “Any significant Covid surge this summer will place even more strain on a system struggling to cope,” said Taylor. With ministers putting pressure on the NHS to give the 5.3 million people on the waiting list in England the treatment they need as soon as possible, the service’s inability to do so – and the prospect of a fresh suspension of normal care – could become a key political issue. Hopson points out that this time around the risk for the NHS is not “the likely absolute level of Covid-19 hospital admissions”, which thanks to the vaccination programme should be much lower than before. It is more about the next wave’s timing and the service’s underlying fragility after a decade of austerity funding and chronic staff shortages. Delays to surgery can have consequences, he says ominously, suggesting they may prove unavoidable, depending on events outwith the health service’s control, especially what happens in England after “freedom day” on 19 July. “Trust leaders obviously have a mission to avoid any unnecessary harm. So they are instinctively uneasy about potential harm to any patient. But they also recognise wider issues at stake here.”