"We are back in the eye of the storm," said Sir Simon Stevens, the NHS boss.
We can add to this metaphor; the NHS is facing the perfect storm.
I don't like cliches but this one is helpful to understand what is happening to the health service right now.
COVID-19 infections are soaring. The UK recorded more on Monday than at any other time during the pandemic.
This, we understand, is being driven by a new highly infectious variant of the virus.
We now have more patients in hospital requiring treatment than we did during the first wave.
The seasonal winter pressures have yet to kick in.
The mild weather has helped - the cold has reached other parts of the country but, thankfully, has yet to hit London where hospitals are under the most pressure.
Doctors, nurses and paramedics are taking to social media to make us aware of just how bad the situation is.
One doctor, from the Queen's Hospital in Romford, east London, told Sky News there was no room inside the hospital for accepting emergencies and patients were being treated while they were still inside the ambulances that brought them.
Some hospital trusts have posted "SOS" messages on Twitter asking for experienced medical staff to make themselves available.
On Tuesday, there were reports of one trust in Essex asking staff to cancel their Christmas leave and return to work.
The situation is bad. And it's likely to get worse.
There is likely to be a rise in infections after this Christmas period. We have seen the photos of busy supermarkets as people stocked up for the holidays.
We can now see why the government cancelled Christmas. If households were allowed to mix then the virus would have spread further and faster.
The key difference between the first peak and now is that hospitals are expected to stay open for non-COVID treatment.
Some elective surgeries in trusts facing a surge in admissions have been postponed.
But these are now local decisions taken on the ground.
In the spring, all hospitals were told to cancel everything and tilt towards the oncoming pandemic.
We are still learning about the cost of that decision. The full picture of the damage caused may not be known for years.
There is something else that's important. We have much more experience of what we are dealing with.
The exhausted doctors and nurses dealing with this influx of new COVID patients have more knowledge, there are better interventions and more treatments.
All of this will help to save lives.
