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Brief update from the front lines: The second wave is definitely here and NHS hospitals are putting the finishing touches to their escalation plans. Time to make the difficult call on how many COVID-19 patients to prepare for. 1/8
Shooting for a very large COVID capacity means planning to shut down some or all of our routine NHS work. Many doctors are concerned about protecting services for cancer, stroke, heart disease etc. 2/8
Plan A for a lot of hospitals will be preparing for a peak of around two thirds of the COVID numbers we saw in the spring. We can keep many routine services going at that level albeit at reduced capacity. 3/8
Right now that seems the right approach. Hospital admissions with COVID-19 (not just positive swabs) definitely rising but not as steeply as March. Also, possible that fewer patients are needing ventilation in ICU. Looking more like a slow burn than a second wave. 4/8
This time we will see hospitals work together much more. Patients will often be transferred between hospitals to maximise COVID free & #39;green zones& #39; keeping usual services going. This will also protect smaller hospitals which cannot expand capacity. Families should expect this. 5/8
Meanwhile, there are relatively few concerns about supplies. Last time we ran with a one-day supply of PPE. Stocks now much more resilient. Drug supplies also better except perhaps remdesivir (not the most important drug to be honest). Plenty of ventilators too. 6/8
Staff morale currently pretty good. A very calm routine on @teamaccu this week. We feel safe but still worry about our resilience on what for us is a second tour of duty. Lives are on hold. Many staff are missing close family who live abroad. 7/8
Hopefully the deniers will calm down and note what has happened to their icon Donald Trump. #HandsFaceSpace works! Thank you to everyone for doing your bit. I will leave you with a pic from this week& #39;s ward round. Stay safe 
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