• crowding
• infection
• management
• emergency care systems

The first confirmed cases of COVID-19 in the UK were recorded on the 29 January 2020; 3 days later, the UK government declared a level 4 incident, allowing for an extraordinary increase in powers and control. Similar severe measures happened all around the world. The first UK death happened 6 days after the first recorded cases and many tens of thousands of deaths rapidly followed. EDs around the world underwent rapid reconfiguration as national strategies moved from containment to mitigation. The Emergency Medicine Journal has led the way in quickly and usefully reporting these changes with the ‘Reports from the Front’ series.1 The overarching aim of these reconfigurations was to increase capacity for an expected surge in seriously ill patients and to provide a safe working environment for patients and staff. Staff rotas were rewritten, allocating staff to acute areas and increasing senior presence. It proved impossible to predict how many staff would be off sick or need to self-isolate, and many of us were blindsided by the apparent vindictiveness of the virus to older men, diabetics and those from a non-white background. Processes and protocols had to be all modified to answer the question ‘what if this patient has suspected COVID-19?’. Simple working arrangements suddenly became more complex and routine clinical tasks became much more effortful.

Many hospitals gave welcome extra space to the emergency medicine service. Quick rebuilding jobs were carried out to increase the amount of space where potentially infectious cases could be seen. Many changes have been implemented very quickly, and the normal safeguards to ensure they work as intended may be missing. In these cases, it is important to evaluate the changes carefully and adapt where necessary. Some changes may have been harmful, and it is important we are alert to how these might affect our …