Already under pressure to deliver in November, Eddie Jones' task just got more difficult with news of an all too common problem - injured Bath players.
England's injury troubles have worsened with outside back Anthony Watson and centre Jonathan Joseph ruled out of the November internationals.
Winger Watson ruptured his left Achilles during England's defeat by Ireland in March and his Bath team-mate Joseph twisted his ankle in a loss to Saracens in April.
Bath director of rugby Todd Blackadder said Watson underwent a second surgery for his injury and was a doubt for the 2019 Six Nations.
Joseph could return around Christmas.
"The initial surgery didn't take basically, (he needed) another tear to have surgery again. He's had to start afresh and it was done about a month ago," said Blackadder.
"JJ (Joseph) is still on track. He'll be somewhere around Christmas time... It's hard to put a timeline on these things."
The duo, who missed England's series defeat by South Africa, are set to be sidelined for home matches against South Africa, New Zealand, Japan and Australia.
A slew of injuries to players sustained during England training camps prompted a war of words between the national team's head coach Jones and Bath owner Bruce Craig in May.
Blackadder said he hoped to work closer with the England set-up to ensure players' health.
"There will be lessons learned on both sides on how we get the best out of all our players," he said.
"Hopefully common sense will prevail and we send players (to England) in the best possible nick they can be and we just hope that is reciprocated."
England face South Africa, New Zealand, Japan and Australia this November, with Jones under pressure to turn things around after a poor Six Nations and Tour of South Africa.