Doctors in Northern Ireland have warned of the growing likelihood of a deadly surge of Covid-19 before spring.
Doctors responding to a British Medical Association (BMA) survey have also made a grim warning over the ability of the health service to cope in the event of another spike.
The poll of Northern Ireland BMA members has highlighted significant concern among doctors here, with more than 80% of respondents saying a second wave "is likely or very likely to happen within the next six months".
Dr Tom Black, chair of the BMA (NI) Council, said it is essential that every effort is made to suppress the virus ahead of the winter, explaining that many hospital doctors and GPs are already burnt out as a result of working through the first spike.
And a children’s charity has urged families to brace themselves for further hardship as furlough ends and unemployment is set to rocket.
Action for Children charity director Lorna Ballard said “families across Northern Ireland are hanging by a thread as they face one of the bleakest winters of their lives”.
It comes as a number of local lockdowns come into force today, while a further 87 people have tested positive with Covid-19 but no further deaths have been reported to health officials.
However, statistics show 46% of those who have been diagnosed with Covid-19 over the past seven days are aged 40 and over, while there are 22 active outbreaks in care homes.
Dr Black said: "The past few days have clearly demonstrated that we are only through the first phase of this pandemic and there is going to be a long winter ahead.
"Our members, who have worked throughout the last six months either on the wards, in practices, in the community or remotely, are rightly worried that we have not been able to get his disease under control."
Dr Black said a fit-for-purpose track and trace system and a coherent, rapid and consistent approach to bringing local outbreaks under control will all help to prevent a second surge.
"Last week the Executive made the right moves in that direction with localised lockdowns and alongside that we need clear messages for the general public, so they understand what they are being asked to do and why," he continued.
Chair of the Stormont health committee and Sinn Fein MLA Colm Gildernew said the survey has highlighted the importance that doctors have access to proper personal protective equipment in the coming months.
He also said a robust test and trace system will be essential to keep the virus under control.
Alliance Party MLA Paula Bradshaw, also a member of the Stormont health committee, said: "This warning from the BMA reinforces the need for clear messaging from the Executive, and most people I speak to are unconvinced that we have had that.
"It seems contradictory to be warning the public of a second wave and introducing localised restrictions in homes at the same time as removing restrictions in some commercial premises.
"Ultimately getting the virus under control will be reliant on voluntary compliance from the public, but that requires clearer and more consistent communication of the risks and what people can best to do mitigate against them."
A spokeswoman from the Department of Health said it is important that everyone in Northern Ireland listens to the real concerns of the medical profession and follow the public health advice.
"As we approach winter our health service will come under increasing pressure and given the recent increase in cases all of us must do all that we can to limit the spread of this virus now," she said.