Long waiting times in emergency departments are becoming normal, with some patients spending days in A&E wards before they can be moved into other hospital beds, emergency physicians have warned.
Leaders of the Royal College of Emergency Medicine (RCEM) and the Society for Acute Medicine (SAM) said that some hospitals had effectively run out of space, meaning patients could not receive the right care until a bed became free.
NHS figures for September show that 5,025 patients waited for more than 12 hours to be admitted to hospital in England. That is only 1% of the 506,916 admitted via A&Es, but it is more than 10 times as many as the 458 waiting more than 12 hours in September 2019 and nearly twice as many as the January peak of 2,847.
Scientists at the Zoe Covid study said last week that UK cases of coronavirus may have peaked. But the React study at Imperial College found that the R number was between 0.9 and 1.1 with Covid cases at their highest levels.
Pressures on hospitals have prompted the Royal College of Nursing to call for a return to compulsory mask-wearing, while Sadiq Khan, the mayor of London, said that ministers should reimpose a legal obligation to wear masks on public transport, allowing police to enforce the law.
Last week, Roland Sinker, chief executive of the trust running Addenbrooke's hospital in Cambridge, told his staff that the situation was so serious that it was "ceasing to function as a hospital" and that they were "thinking about restricting access to care". Leeds Teaching hospitals trust also cancelled a large number of planned operations last week because of Covid pressures.
Dr Ian Higginson, RCEM's vice-president, said that the national picture was grim. "Our staff are still turning up for work and still doing their best to provide the best care they can. But we are in a vicious spiral. We're seeing more patients than we can cope with."
Hospitals have seen ambulances queuing outside waiting for patients to be treated, and when they arrive in emergency departments, more are facing long waits for treatment.
"Now, in some parts of the country, patients are waiting days before they can be admitted to hospital," Higginson said. "There are patients in emergency departments for one, two, and in some cases, many more days. And that's becoming accepted as the norm. It's totally wrong."
Dr Susan Crossland, the president of the SAM, said the annual winter crisis affecting the NHS was getting longer and longer.
"Since Covid, it's been like one long, eternal winter. Our members are reporting that their trusts are running at over 100% capacity. All the beds that they normally have available are full. Most of the wards that we would normally open in winter are full. And they're scrabbling around looking for other places."
Hospital bed occupancy was at 85% for England between April to June, as the second wave of Covid reached its lowest point. Even then, nine hospitals reported that more than 95% of their acute beds were occupied, and the trusts running Leeds and Addenbrooke's were among a further 34 at above 90% occupancy.
Higginson said: "Certainly, many of us work in hospitals where occupancy is declared to be much higher than that, and feels much higher than that."
Diverting patients from hospital into clinics might relieve some of the pressure, Higginson said. Doctors at University Hospitals of Leicester NHS trust are about to conduct a trial of new telemedicine "robots" that may speed up diagnoses. The machines will enable several specialists to remotely join a bedside consultation of a patient with complex needs.
Saffron Cordery, the deputy chief executive of NHS Providers, said: "While staff continue to work extremely hard to address the significant backlog of care, trust leaders across the country are telling us they are under significant pressures, and they are increasingly concerned as we move further into a difficult winter."
She said that rising demand and staff shortages combined with Covid were causing capacity problems, and the NHS had lost 4,500 beds since the pandemic due to infection control measures.
Social care problems were "having a major impact on whether patients can leave hospital in a timely way when they are medically fit to do so", she added.
The government's decision to end all Covid restrictions on 19 July was criticised at the time by the Royal College of Nursing. Rose Gallagher, the RCN's professional lead for infection prevention and control, said: "It was extremely shortsighted of the government to end compulsory public mask-wearing, and they can't say they weren't warned - it must be reinstated without further delay to prevent avoidable transmission."
Sadiq Khan said: "While most Londoners continue to do the right thing and wear [a mask], it is clear the changes brought in by the government have given passengers mixed signals and affected compliance.
"The evidence that face masks can make a substantial contribution towards lower transmission is getting stronger all the time. I continue to urgently lobby ministers to bring back this requirement and enable British Transport Police officers to enforce the wearing of face coverings across all TfL services."
Covid cases among 10- to 14-year-olds in England have been the highest of any age group since 9 September, shortly after the start of the autumn term, but began dropping when most schools started half-term on 22 October.
In the north London borough of Enfield, cases began falling earlier after some schools took matters into their own hands. St Anne's Catholic High School for Girls in Palmers Green had seen cases rise sharply, so that by 4 October there were 117 positive cases, according to Emma Loveland, the headteacher.
"That was over 10% of our student population," she said. "The figures were getting quite scary."
Loveland convened a meeting of the school leadership team, and after consultation with Enfield public health team, they decided to introduce three measures.
"Masks became compulsory again, unless exempt of course, so students wear them in class, in corridors, queuing up - and staff as well," she said. They also increased the amount of cleaning, and asked the children and their families to pay much more attention to symptoms.
"We saw our cases drop over the following three weeks to 55," Loveland said. "I don't think masks in isolation would have changed things, but they were a big part of it. Half-term is always a concern because usually you see a spike, but we haven't experienced that, and we are now on less than 20 students with Covid."
Case rates in Enfield have been on an upward trend over the last three months, according to the government's dashboard, rising from a seven-day average of 74.1 cases a day on 15 September to 125.7 by 27 October.
The highest rates have been among schoolchildren and 40- to 49-year-olds. Among 10-14s, cases peaked at 840 per 100,000 on 8 October but had dropped to 443 by 31 October.
Jim McManus, the acting president of the Association of Directors of Public Health, said that although numbers had fallen since half-term, they were likely to rise again. "Cases remain at very high levels and are disrupting education and business. We know that the combination of face coverings, ventilation, plus vaccines and testing is the key to keeping numbers low.
"What matters is the action we take - a combination of measures that directors of public health and schools and workforces are advising people to take. These are not restrictive measures - they are simple preventative tools that will avoid the need for further restrictions."
Related: Record 5.7m people in England waiting for hospital treatment
The NHS said: "Staff have gone above and beyond over the last year, contending with record levels of A&E attendances, all while treating more than 470,000 seriously ill Covid patients, and this has inevitably lead to increased pressure on emergency departments.
"The NHS has set out a 10-point action plan to support hospitals with the significant demand ahead of winter, so anyone who needs the NHS should come forward through the appropriate route so staff can help you with the best option for your care, and it remains as important as ever to get your lifesaving Covid jab and flu jab if you are eligible."