Sitting on a beach or heading for the hills is blissful escapism from the monotony of lockdown – and day trippers in their thousands are descending on beauty spots and rural idylls.

These seasonal visitors are the lifeblood of rural economies but, this year, locals have mixed feelings about their return. At worst, they fear tourists could bring COVID-19 along with their paddleboards and bicycles and turn host communities into incubation areas for a second spike.

Lucy-Jane Davis, a GP registrar who chairs the BMA South West regional council, says communities are braced for an onslaught of visitors – and a potential health crisis. She likens the situation to waters receding from the coast before a tsunami.

‘In the south-west, there’s a feeling that the water is still sitting out there somewhere and we’re wondering when it’s going to hit. It may well be the real impact of COVID locally comes in the next few months.’

In her corner of Devon, local peculiarities make a mockery of social distancing. There are sheltered coves reached by narrow paths creating ‘pinch points’, narrow streets in quaint villages, the ever-present threat of showers sending people diving for cover in the same olde tea shoppe. Cornwall has a resident population of about half a million – and five million tourists in a normal year.

As with other areas of outstanding natural beauty, the south-west has an older demographic, weaker transport links and more limited NHS infrastructure. Cornwall has one major acute hospital, with a limited number of ventilated beds. As the background infection rate is still high, and robust test and trace processes remain elusive, Dr Davis worries a second peak would overwhelm local health services.

‘We only need a tiny outbreak relative to the number of people who might come to visit to put the entire system under huge strain,’ she says.

Day trippers have returned to these tourism ‘honey pots’ before local amenities have reopened. The continued closure of public toilets has meant nasty surprises for litter-pickers, and the combination of carefree visitors and a lack of lifeguards has proved dangerous. When two coastguard helicopters were scrambled to the aid of three ‘tombstoners’ seriously injured after diving off Durdle Door in Dorset, thousands of people had to be corralled on the beach to clear landing spaces.

Dr Davis has been busy convening discussions between regional clinical commissioning groups and other stakeholders such as chambers of commerce, who all share one concern: the lack of government guidance on how to manage the anticipated crowds.

What they do know is that Exeter’s Nightingale Hospital is scheduled to open in the first week of July. Health secretary Matt Hancock told Parliament on 23 June that Exeter’s Nightingale had ‘more flexible uses than the previous Nightingales’, which could include tackling winter pressures. But the south-west has had winter pressures for many years, and while the Nightingale may well be able to deliver extra capacity, it was not conceived for that reason. It was conceived for COVID patients, and the fact the Government is continuing with its construction when the Nightingale in London, for example, has been mothballed, leads doctors to question whether there are serious concerns for a growth in infections.

‘Clearly somebody is thinking that there might be a need for it,’ says Dr Davis.

These concerns are not confined to the south-west. The Lake District tourist board has tempered its usual enthusiastic welcome for adventure-seekers, with alerts about car-park restrictions and guarded messaging about receiving visitors ‘when the time is right’.

Matlock in the Peak District, where Peter Holden is a GP, is a magnet for the motorcycling fraternity and recent weekends have seen large gatherings with ‘not a lot of social distancing going on’. He’s also concerned about ‘some quite atrocious’ driving he attributes to ‘atrophied driving skills’, and cyclists’ reluctance to recognise that cars are reclaiming the road again. This national park receives more than 13 million day visitors a year.

Dr Holden shares locals’ concerns about the risk to care homes and about the lack of personal protective equipment in the event of a major outbreak.

Yet, he has fewer concerns about the robust local health system being able to cope than about health professionals’ ability to sustain punishing schedules amid mounting backlogs.

‘We’re all utterly exhausted and even if we knew that COVID-19 was dead today and never coming back, we could not deliver “normal” again for many months,’ says Dr Holden, a member of BMA council. ‘We need time to regroup, we need a break.’

But, for Dr Holden, transmission risks have to be set against concerns over the lockdown’s effect on health, well-being and the economy, especially for seasonal workers not covered by the furlough scheme – a balance Dr Davis also recognises. Dr Holden’s call is rather for openness and transparency from the Government.

‘Locals are worried about importation but they also want sound information and honesty so they can make up their own mind about risk,’ he says. ‘There’s a feeling the Government is not levelling with people.’

With the easing of lockdown to allow holiday accommodation, hotels and restaurants to reopen, due in England on 4 July, tourism hotspots are likely to draw ever-larger crowds.

The BMA is launching a public campaign in the form of an infographic offering tourists practical advice such as packing a first aid kit and remembering to bring prescription medicines. It has also produced a document outlining basic principles for tourists, accommodation and service providers and local authorities to consider, including having plans in place should holidaymakers or staff develop COVID-19 symptoms.

‘I’ve lived in a city-centre, one-bedroom flat and I know how mu ch people must crave having a break,’ says Dr Davis. ‘But we need to be sensible about how to make that safe. The best public health crisis is the one that doesn’t happen.’