“Long delays expected”, the HSE warns patients this week, and medical staff just shake their heads. “A major disaster”, said the HSE’s group lead on acute hospitals. The Before Times – pre-February 2020 – seem further away than ever.

And while there is no doubt this is a crisis, there is no sense of panic from staff as they wearily talk again to the media about adapting their work to meet another challenge.

One senior manager almost laughed at the idea of getting stressed. There’s no point, she said. Patients keep coming, we keep going.

From behind their Covid masks, they break out pens and hand-write labels on vials of blood. At least one medic found dusty carbon paper to double up on note-sharing.

One way to deal with stress is by working quickly, efficiently but quickly. Focus on the job and get through it.

That is gone now, as speed is the enemy when there is no back-up.

Even reading an X-ray means leaving the ward, heading down to radiology, and back with your notes.

Behind the scenes, medical scientists once again bear the brunt. Last year, they were the first to see their hours careen out of control, even running out of key materials to carry out Covid-19 tests in the first crazy weeks of the pandemic.

Laboratories were computerised long before other departments, so a paper-based system is only a vague memory. A blood test which took an hour to return before the attack now could take seven.

The strain is spreading, reaching areas the attack did not hit directly.

Investment in IT is a hallmark of the GP sector. While these systems were not attacked, communication with hospitals is down.

Luckily, the ability to order some treatment through private hospitals — also unaffected — was boosted during the pandemic. But regular tests, from bloods to cholesterol, are in limbo.

These less-than-urgent cases are the people who were pushed to the back of the queue when the pandemic started. GPs in Tipperary and Cork have said they worry about what will become of those who haven’t sought treatment yet for potentially serious conditions.

People working in mental health and with Tusla worry about the impact of this on their vulnerable clients. They are trying to phone patients and reassure them while finding a new way to work themselves.

Pharmacists in the community are mainly protected, and their email contact with GPs for prescriptions continues. But ordering high-tech medicines like anti-rejection drugs for transplant patients can now only be done by phone for immediate need.

And as pharmacists open their doors as they have done every day during this pandemic, they wonder what else could possibly happen.