Looking at COVID-19 admissions this past week, we are seeing a change. More patients are testing positive for the virus and getting sick enough to need ICU. Definitely a second wave but we don't know how big. Sad news but we have reasons to be more confident this time (thread):

1. We understand the disease: The baptism of fire in March-May taught us how COVID-19 behaves. NHS teams have reflected on what worked and what didnt. For example, we know we will see problems like blood clots and kidney damage more often than usual for ICU patients.

2. Treatments are more focused: The media furore about wonder drugs was a massive distraction for doctors. Fortunately @NIHRresearch delivered major clinical trials which busted a few myths eg hydroxychloroquine but also showed some simple things saved lives eg dexamethasone.

3. Escalation plans: The vast planning exercise before the first wave has lasting impact. All hospitals have an escalation plan for COVID, tried, tested and improved from first time round. We know how to use our real estate to the optimum making patient care more efficient.

4. Normal patient care wont stop: In the first wave, treatment of other diseases stalled almost completely. But we now have very robust procedures so we can keep treating cancer, stroke and heart attacks safely - patients should not worry about visiting hospitals if they need to.

5. Logistics are in place: Equipment supply chains were under huge strain in March. We came very close to running out of PPE, ventilators, dialysis equipment, clothing ('scrubs') and lots more. The supply chain is now much more resilient and well stocked.

6. Calm routine: In the first wave our planning was very excitable and sometimes it showed. We wasted time managing people with ill-conceived ideas which weren't going to work. This time we know what to do. Staff are well drilled in 'donning and doffing' PPE. Training is routine.

7. Second wave or slow burn? We talk about a second wave but the most likely experience will be a steady flow of patients with COVID-19 over the winter months. We think (hope) we will avoid the very high peaks of demand which put services most at risk.

There are also some reasons to be worried. NHS staff, like all key workers, were inspired by the massive community response to the crisis. This time we see push back from deniers and people putting personal freedoms ahead of others' lives. Some of this is very hard to take.

The NHS is still here - ready and waiting. We are proud to look after you but staff are tired and stressed. We have not properly decompressed from the spring. Please keep up your amazing work and #staysafe. The routine is a grind but it works. Thank you.

Thanks @jometsonscott for this and other amazing photos