There were just 14 fully funded beds in Wollongong Hospital's Intensive Care Unit prior to the COVID-19 threat - now there's 46 and by next month there'll be 84.
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Sixty-three of those beds will be for COVID-19 patients - and they'll all have ventilators. And that's the key to survival said Wollongong ICU head of department Dr Alan Davey-Quinn.
"The majority of people transferred to the ICU will survive this, and the key to surviving is being on a good ICU ventilator," he said.
"These ventilators cost between $50,000 to $70,000 each and are very technical pieces of equipment that work to recreate our breathing, by pushing air in and out of our lungs.
"To get attached to a ventilator you have to have a tube put through your mouth, through your vocal cords into your windpipe under anaesthetic, and you then have to be kept fairly well sedated."
Before the COVID threat, Wollongong Hospital's ICU had a set-up of 24 beds in a two-pod configuration, with 14 of those beds fully funded.
That has now become a dedicated COVID ICU with all beds now funded, with the hospital opening up another completely separate ICU with 21 beds for non-COVID patients.
"We are seeing only a small influx to the COVID ICU of patients, and a small number needing ventilators," Dr Davey-Quinn said.
"However we plan on opening two more ICUs - one with 20 beds in the day surgery unit and one with 19 beds in the old ICU.
"So that will be 63 fully ventilated COVID beds and a total of 84 ICU beds by mid-May - which represents a six-fold increase in our critical care capacity within a month."
Dr Davey-Quinn said all staff in the COVID ICU and wards were aware of the situation in countries like Italy, where there were not enough ventilators for patients - where doctors were forced to choose which patients to ventilate.
"The ICU staff here won't be involved in these decisions," he said. "There's a medical ethics committee at the district level - supported by state and federal committees - which will look at all the options should we reach a catastrophic state where there's not enough ventilators for patients.
"That releases the burden, and the potential harmful psychological effect, of making such a difficult decision on any individual."
There were 95 confirmed cases of COVID-19 in the Illawarra Shoalhaven Local Health District by Wednesday morning. Of these cases, 10 patients are being cared for in Wollongong Hospital, one patient in Shellharbour Hospital and two patients in Shoalhaven Hospital.
Not all COVID patients transferred to the ICU - from dedicated wards or from the emergency department - will need a ventilator. Those that do will need them for some weeks.
"Unlike other patients who may need to be on a ventilator for a week or so, COVID patients tend to be ventilated for one to two weeks or more," Dr Davey-Quinn said.
"The prolonged period of time means that once they're taken off, there's major issues with muscle wasting and weakness and they may take six to 12 months to fully recover."
With no visitors allowed into the hospital's COVID ICU, he said it could be traumatic for patients - and relatives.
"To be in the COVID unit where your only interaction is with someone fully covered in personal protective equipment, I imagine must be very scary," he said.
"We're also fully aware of how traumatic it must be for family when a loved one is admitted to ICU and they're not allowed to see them.
"So we're working with a company called Taleka and the University of Wollongong to install software in the ICU so that patients have access to iPads and have the ability to video conference with family members."
Meantime social workers currently kept families informed of their loved one's condition on a daily basis.
Certain staff - such as older staff or those with chronic conditions - cannot work in COVID areas. Wollongong ICU Dr Kass Thomas said those staff in contact with COVID-19 patients must be highly trained in infection control, and the use of personal protective equipment.
"We have developed guidelines to establish when we use certain levels of PPE, and there's a high level of PPE in the ICU," she said. "All staff have extensive training to ensure they know how to use it, and they're checked by a colleague when they put it on, and take it off."
She said staff did not wear their uniforms home - these were laundered at the hospital - and they underwent extensive screening including temperature checks at the start of each shift.
Dr Davey-Quinn thanked the community for their support - for doing their bit by staying home, for the generous businesses supplying staff with food and coffee, for the UOW researchers 3D printing masks and ventilator parts for the ICU.
"It's quite overwhelming the support we've had," he said.
And he said he started each day with the words of Dr Bruce Ashford, a surgeon and co-ordinator of the Wollongong Hospital COVID-19 Task Group, ringing in his ears.
"The COVID group meets each day, and every day Dr Ashford reads out the mission statement, which is to keep Wollongong Hospital functioning as a hospital during the COVID pandemic," he said.
"Because as well as our COVID patients, all the rest of our normal population still may require intensive care."
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