A Day on the Coronavirus Front Line
In an isolated room upstairs in the Austin Hospital’s intensive care unit a bare-chested man infected with coronavirus is hooked up to a ventilator.
His chest rises and falls slowly under the bright lights of the monitors, as an intensive care unit nurse, wearing a pale blue isolation gown, face mask, plastic goggles and gloves, checks his vitals.
“The ICU nurse is like the Swiss army knife of nursing, they can do anything,” the hospital’s director of the intensive care unit, Dr Stephen Warrillow, explains.
“For most people what will keep them alive is access to an ICU bed, a ventilator so they can eventually breathe on their own and access to a bedside nurse. To survive coronavirus you need the trifecta. If one of those elements is missing, then we have a problem.”
The door of the patient’s room is firmly sealed and there is a bright yellow sign on the window: COVID-19 room. Quarantine area. No visitors allowed.
There is an eerie calmness in the hospital in Melbourne's north-east amid a looming unease about the likely onslaught of seriously ill patients to come. The emergency department has never been so quiet, but staff are poised to act.
This could all change quickly. Health authorities are warning the peak of the virus could hit in May or June.
"There is this apprehension, it is the calm before the storm," Dr Warrillow said. "We are treating this virus with a very healthy respect."
A recent deadly outbreak of coronavirus in the oncology ward The Alfred in Melbourne, which led to the death of three cancer patients and the infection of several staff and other patients, has fuelled fears of more hospital outbreaks.
“What we have learnt to do from the very outset is to have a very high index of suspicion of all our patients,” Dr Warrillow said. "This is critical to protect staff and patients. My default position is, 'could this patient be affected'? I need to be persuaded that they aren't before I let my guard down because you don't want to miss a case and have it delayed."
Each morning before 7am, there is a huddle of doctors, nurses and patient services assistants inside the hospital's coronavirus screening clinic that would rival that of a suburban football club.
“It’s a bit of pep talk,” said Associate Professor Jason Trubiano, an infectious disease physician who oversees the screening clinic. “We come together to talk through the day.”
By 8am, patients wearing face masks are lined up outside the clinic. On Friday morning, a young man nervously fidgets as he waits, while a mother soothes her three restless children.
The door to the screening clinic bursts open and Taylor Swift's hit song Shake It Off can be heard humming in the background. A masked doctor dressed in a pale yellow isolation gown and goggles holds a clipboard as he calls out for the next patient.
“One patient joked that it’s a bit like game show host telling the next contestant to come on down," Associate Professor Trubiano said.
Humour is a lifeline when you are working on the frontline of a pandemic.
“We are quite jovial,” he said. “Our job is to reassure patients. We treat them with the best care we can and keep everybody’s spirits up. I’d be lying if I said there weren't times when we've all had a cry. It's very confronting seeing the numbers of cases rising in Australia and what is happening overseas. We are really hoping the things we're doing here are going to prevent those scenes from happening here.”
Under the fluorescent lights of the screening clinic, staff work with military precision. No workers are allowed into the area without full personal protective equipment, also known as PPE, including masks and gowns.
PPE is the greatest protector against the virus for frontline workers, but widespread global shortages have fanned fears hospitals could run out in the midst of the pandemic.
"The most important thing right now is for us to conserve our PPE and use it appropriately," Associate Professor Trubiano said.
Nurses wear face-shields while taking swabs from patients inside two small testing rooms, while other patients sit in chairs as they have their temperatures and blood pressure checked.
"We see up to 190 patients before we finish at 8pm and we get can get test results within about 24 hours now," Associate Professor Trubiano said. "We expect this number to grow considerably in the coming months."
Front-line staff change into their scrubs at work. When their shift ends, they leave their scrubs to be cleaned at the hospital.
But some still leave their shoes at the door when they get home from work and soak their clothes in hot soapy water.
The hospital’s emergency department will soon be split in two. The downstairs emergency triage centre will be for suspected cases of COVID-19. Rooms with ambulance access have been set-up for COVID-19 patients who require resuscitation on arrival.
A row of empty white marquees outside the hospital will soon be used as an expanded screening clinic. A section of the hospital used for out-patient care will be converted into an emergency department for non COVID-19 patients.
Nearby, a ward has been converted into a COVID-19 isolation area where a team of doctors and nurses tend to seven patients who have tested positive to coronavirus, while another two remain in intensive care.
In the hospital’s surgery recovery area, rows of empty beds fill the ward, which is now an expanded intensive care unit.
“I’d love to be wrong, but I think all these beds will be full soon and then some," Dr Warrillow said.
The hospital has firm plans to double the capacity of the ICU and then triple its 69 beds with more beds to fill the day surgery area soon.
"There are plans to increase capacity by 400 percent and potentially beyond," Dr Warrillow said.
Every healthcare worker who has worked at the Austin Hospital has been contacted and a spreadsheet of their names is ready should they be called on to help in the fight against COVID-19.
Some patients will simply require oxygen to breathe while their immune systems fights the virus. Others will experience lung failure. In rarer cases, there could be heart or kidney failure.
"The more organ failure you get the more complicated and risky and the more intense care required," he said. "This is not in a sense, an exotic disease for intensive care specialists. It causes illness in a pattern that is very familiar to us and we're good at treating it. The challenge will be how many patients we will be faced with."
While nurses monitor ventilators, physiotherapists could be used to help flip patients onto their stomachs, a temporary measure, which can save the lives of those experiencing lung failure.
Speech pathologists could be used to help with tracheostomies as patients are weened off ventilators.
Dr Warrillow said heeding health warnings, like self-isolation and social distancing, is the only way to slow down the rising tide of infections threatening to overwhelm hospitals.
"Our frontline workers are our single greatest contributor to a patient's survival," Dr Warrillow said. "Nobody will ever know their names. They come in every day, when their families are worried and they just get on with the job. As a society we owe them a huge debt."
The Age was granted access to the first tour inside a coronavirus screening clinic and COVID-19 intensive care unit in Victoria.