For Julio Pascual, a sharp rise in coronavirus admissions at the Barcelona hospital he serves as medical director carries an unwelcome sense of deja vu.
As Spain's total registered cases near one million, daily admissions at the Catalan capital's Hospital del Mar have more than doubled to around 16 over the past few days.
Situated in a pandemic hotspot, the hospital is better prepared to treat COVID-19 patients than it was in March, but Pascual is concerned over a chronic shortage of nurses, and risks that overworked staff could burn out.
"It is not the speed of the first wave but there's an evident uptick in cases," he told Reuters.
"If the rhythm (of COVID hospitalisations) of the past week continues, rescheduling and suspending some non-priority activities will become unavoidable."
With the most confirmed cases in Western Europe, Spain is struggling to manage its second wave.
Restrictions have been imposed across the country, notably in the two hardest hit regions, with Madrid placed on partial lockdown and Catalonia shutting bars and restaurants.
"We need to convince people not to socially interact. What's at stake are the non-COVID patients ... The resources that were working well until a week ago are simply not enough anymore," said Xavier Borras, medical director at the Hospital de Sant Pau, also in Barcelona.
In the 24 hours to Tuesday afternoon, coronavirus admissions there rose to 11, the highest since late April though still far off the peaks of 50-60 daily hit in late March, he said.
Borras said the hospital was expanding its number of beds for coronavirus patients, which could eventually lead to the cancellation of scheduled non-urgent operations.
Since Oct. 5, national health ministry figures show COVID-19 hospitalisations are up around 20%, but with sharp regional variations. In Catalonia they surged 71% to 2,410 while in Madrid they fell 12%.
A source at Madrid's La Princesa hospital said a few non-urgent procedures were postponed around two weeks ago, but admissions had since stabilised.
