Observed trends suggest opposing effects of ICU strain and clinical learning. Further investigation is needed to identify modifiable system factors that could alleviate strain in future epidemics and changes in clinical practice that contributed to improved patient outcomes.

Population cohort of all 10,287 patients with COVID-19 appearing in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020.

Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region, and multivariable regressions were used to estimate differences in 28-day mortality, adjusting for variation in patient characteristics over time.

Admissions to ICU peaked on 1 April, nine days after commencement of “lockdown”, and occurred simultaneously across regions.

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