As the Covid-19 pandemic loomed, the staff at one hospital in the English Midlands braced themselves. Quickly they found themselves at the centre of a coronavirus hotspot - and nothing turned out as they anticipated. Liz Rees sat down at her dining room table to take the call. It was a Sunday in early March and, from down the line, a voice was telling her about some test results that had just come back from the lab. This wasn't a normal diagnosis. Dudley, the town where Liz has worked for 20 years as a consultant microbiologist, had its first case of Covid-19. That, in itself, wasn't a surprise. She'd watched on TV as the virus had spread from Asia to continental Europe before reaching the south of England; it had already been detected in nearby Birmingham and Wolverhampton. "There was an inevitability about it," she says. "But the first one makes it real." Liz was the doctor in charge of infection prevention and control at Russells Hall Hospital in Dudley. She'd spent her career anticipating what to do in the event of a pandemic. And she knew the town - a one-time industrial powerhouse, the capital of the Black Country - intimately. Her husband joked she was attached to an elastic band that wouldn't stretch more than 10 miles out of Quinton, the nearby Birmingham suburb where she was brought up. Still sitting in her dining room, Liz hastily convened an incident meeting over the phone with hospital staff. There was a list of things to check: That the patient was receiving the best possible care. That the staff on the ward were comfortable with what they were doing. Which infection precautions needed to be put in place. The mood was calm. Everyone had a plan to follow. But this was uncharted territory. "I think we were aware that we would probably be getting more cases within days," says Liz. For some time now, a Yorkshireman named Paul Hudson had also been anticipating that the outbreak would reach Dudley - and thinking hard about how to respond. But the first case came as a shock: "It wasn't from somewhere we expected." Paul's job was divided in two. He spent half his time as consultant anaesthetist at the hospital, a role he'd occupied since 2009, and the other half as deputy medical director of the trust that runs it. As the virus approached, he'd been closely involved in planning what to do - drawing up new guidelines; working out how to "zone" new arrivals at the front door into Covid and non-Covid streams; setting up a respiratory emergency department; and making sure there was enough stuff - oxygen, personal protective equipment, ventilators, drugs and people. "We had, I think, quite a good plan in place," Paul says. It was just a question of waiting for patients with severe respiratory symptoms to start showing up at the door. But that wasn't what happened, at least not at first. "All of a sudden, we had a patient - an in-patient - test positive," says Paul. This individual was being treated for something else entirely, having been admitted before they started showing symptoms. There were protocols in place for dealing with a situation like this to stop the virus spreading - but it was a difficult start all the same. "I think that set the tone for a lot of the next few weeks and months," says Paul. "That has been, I think, one of the themes of this illness - that it has been unpredictable." Qadar Zada sat in his office at the hospital. He'd been born less than a mile away and never lived anywhere other than Dudley. And yet everything around felt new to him. In January 2020, Qadar had started as deputy head of operations at the trust. Part of his job involved making sure medical staff had all the support they need to do theirs. He'd spent his career working in NHS management and felt he had a good idea of what had to be done. There was a problem, though - most of his colleagues were strangers to him. "For me, I think the biggest challenge personally was that I didn't know people in the organisation," he says. The plan to give him a structured induction fell away. As the workload increased, no-one had time for a getting-to-know-you chat: "So at the point that we were talking to people about planning things, I was having to introduce myself." There was also the duty he, a local councillor, felt towards his community. "I was worried, obviously, for those people in Dudley, family that I have in Dudley," he says. "I was worried for colleagues in the trust as well. But I was also aware of everybody's responsibility, including my own."