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The second wave of the pandemic is taking shape. Cases, hospitalisations and deaths are rising across the country, most precipitously in the North but with increasing frequency in the South.

The NHS is girding itself for another onslaught although this time around there are early signs the death toll may not be as high, even if the number of hospital admissions overtop those seen in the first wave.

First, clinicians are better prepared. They have had more than six months treating covid cases and in that time have refined and improved how inpatients are cared for.

At first, with the horrors of Lombardy in Italy fresh in everyone’s minds, the plan was to get patients on to ventilators as soon as possible. Now, the use of non-invasive respiratory systems and proning is more widespread and systematised.

Second, the world’s research scientists and clinicians have dramatically expanded the collective understanding of the virus, the disease it causes, and how to treat it, including the emergence of two new pharmaceutical treatments in remdesivir and dexamethasone.

These advances and refinements seem to be having an impact already. An analysis of NHS data by HSJ shows for wave one – from March into April – around 30 per cent of patients admitted to hospital died. That rate was under 15 per cent in the first 30 days of wave two, starting in September and running into early October.

However, this is not a reason to take a more relaxed attitude to soaring case rates and rising hospital admissions. The second wave is at an early stage and the dean of the Faculty of Intensive Care Medicine warned us that benefits from the new treatments, teams and processes have already affected the mortality rates.

The advances brought improvements to outcomes as they came on stream through the summer. Unfortunately, we were told there is nothing to indicate that the mortality rate from before 31 August is going to improve for patients in critical care after 1 September.

With exhausted staff facing a winter of rising covid cases and the usual seasonal pressures, we are not out of the woods yet.