Although some hospitals established COVID-19-free surgical pathways to create safe elective surgery capacity,3 the National Health Service (NHS) in England has not returned to pre-pandemic elective surgery activity levels. 

Data suggest that if the number of COVID-19 inpatients were to reach levels seen in April, 2020, rather than continue at levels seen in October, 2021, 100 273 fewer elective surgical procedures would take place over the next 3 months—a 15·3% reduction.

Further disruption to elective surgery seems inevitable unless robust measures are urgently introduced to prevent escalating COVID-19 hospitalisation rates in England. Delayed implementation of COVID-19 mitigation measures risks lockdown, which itself could amplify disruption to urgent surgery.

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