“It’s crazy,” Dr Mithun Murthy tells me as he rushes off to see another patient.
We’re standing in the middle of ward A7. It’s one of Warrington’s COVID-19 treatment wards.
All around us there’s a buzz of frenetic activity, machines bleeping constantly, doctors and nurses moving between patients, gathering in huddles to plan their expert care.
The ward is almost full with mostly elderly patients, and from what I can see they are mostly women.
It is a specialist respiratory treatment ward. Patients with COVID-19, who need extra care but are not critical, are brought here.
Christopher Gardham has just been wheeled in his bed from a neighbouring ward.
The 60-year-old HGV lorry driver was admitted last Wednesday after he had trouble breathing.
He has tested positive for COVID-19 and Dr Murthy, a consultant respiratory physician, wants to keep a close eye on him.
“I just feel drained, rough. Drained,” Mr Gardham says. And he looks it. His speech is laboured, slow and heavy.
Sitting upright in a chair next to his bed, he looks up and moves his head slowly to answer my questions.
“It was more than just a positive test, it was something deeper down,” he says. “It need to gets sorted out.”
I ask him why he has been moved to this ward.
He replies: “This is a more respiratory [specialist] one to check my breathing better and check my oxygen levels and make sure we’re on the right track.”
The better news for Mr Gardham is there are more known, effective treatments now than there were at the start of the pandemic.
Dr Murthy is treating him with steroids.
“Anyone that comes into hospital that is needing oxygen and meets the criteria for severe COVID infection gets steroids,” Dr Murthy says.
Mr Gardham is on dexamethasone and that got started as soon as he arrived in the emergency department.
I asked Dr Murthy if these new interventions are having an impact on patient care.
“Absolutely,” he says.
The hospital is determined to continue with elective treatments, but managing the beds and capacity is like a game of chess.
Everything needs careful planning, constantly moving resources to manage a surge with zero capacity.
But these are not pieces, they are people. And this is no game. It’s life or death.
Warrington, like all hospitals across England’s North West, is busy. Really busy.
Dr Murthy says every infection, every case, brings more pressure on the hospital.
“Infections are really high, people still ending up in hospital,” he says.
“It’s not just a simple cold. It’s much worse than that.
“People are presenting earlier and slightly milder but you still wouldn’t want to end up in hospital, you wouldn’t want to end up on a CPAP mask, you wouldn’t want to end up on a ventilator. God forbid.
“We need to protect beds. Even one person less presenting at hospitals is helpful to us.”
The huge rise in COVID infections is impacting the hospital at every level, including A&E.
During the peak of the pandemic, patients stayed away because they did not want to burden the NHS and because many were afraid of becoming infected.
Now they are returning, so hospitals are dealing with COVID-19 and non-COVID-19 emergencies at the same time.
Dr James Wallace, an emergency medicine consultant, tells me the emergency waiting area is almost full.
“We’re about the same in terms of business as we would be if we didn’t have coronavirus. When you add in COVID patients or patients with suspected coronavirus, we are much busier,” he says.
“We are seeing a difference day-on-day, week-on-week, even compared to the first wave several months ago.
“We are not only seeing the same number of A&E admissions we would before coronavirus, we are now seeing significantly higher number of patients with respiratory symptoms.”
The hospital needs to manage what it calls its “patient flows”.
This means separating COVID-19 from non-COVID-19 patients, so every available space is squeezed; overflow areas found and divided into hot and cold zones.
All of this adds to the pressure. And it’s building day by day. Infection by infection.