Hospitals around New Zealand are scrambling to triple intensive care unit capacity within weeks, in the face of a potential surge of Covid-19 cases.
Figures put before Cabinet ministers showed New Zealand could treble its current number of ICU or ventilated beds – which stood at fewer than 180.
Dr Craig Carr, the New Zealand chair of the Australian and New Zealand Intensive Care Society, told the Herald hospitals were similarly racing to triple the number of staff trained to use ICU equipment like ventilators.
He previously warned the threat may mean the country's ICU capacity needed to double to meet the threat.
"Now we may need to go to an extraordinary measure and triple it - and what's happened in Italy has shown us that even that may not be enough."
Today, Ministry of Health director-general of health, Dr Ashley Bloomfield, said he was "encouraged" by figures from a nationwide stocktake – which included public and private hospitals.
"The idea there is to not just be prepared, but complement measures we are putting in place to reduce the risk of that worst-case scenario."
Bloomfield pointed to new modelling, which indicated an ICU overload could mean the difference between projecting case fatality rates of one and two per cent.
Potentially tens of thousands of lives could be at risk if no hard measures were taken to control Covid-19, and a surge in cases hit hospitals.
Bloomfield said hospitals had already put in place plans to scale down activity such as elective surgeries and outpatient appointments.
The Herald was aware of large numbers of booked elective surgeries being cancelled across the country.
Carr, the clinical director of Dunedin Hospital's ICU, said current ICU capacity in hospitals across the country was variable.
Around half of ventilated beds tended to be in use at any one time.
"That figure is usually higher in tertiary centres – or those places that are doing cardiac surgery – so there is a fair bit of surge capacity in our existing system," he said.
"What we are trying to do now, in keeping with the experiences of our colleagues in China and Italy, is looking at how we can rapidly increase capacity by utilising ventilators that we have from other places.
"For instance, here in Dunedin, we have 10 normally ventilated ICU beds. But we actually have intensive care ventilators for 18 beds.
"And if we draw on other ventilators – we have some that we prefer to use on children but we keep them aside – then within a few days, we can go from 10 beds, up to 20 beds, and possibly even 22."
Dunedin Hospital was working on a system where it could be running four different intensive care units at once.
"We'll have three of the current intensive care doctors in each one, and then three of our anaesthetist colleagues, and a quarter of the ICU nurses, along with nurses from different acute areas in the hospital."
Hospitals were also looking at other areas that could take Covid-19 cases, such as operating theatres and post-operation recovery areas.
"On top of that, we can use old ventilators and equipment that I used during training back in the 1990s. Even though we have better technology now, they'd still work if we re-commissioned them."
But he added that finding that extra capacity solved only half the problem.
"You also need to have staff to look after these patients. Up and down the country, we are taking note of registrars and doctors who have moved through intensive care as part of their training schemes in the last three or four years."
Anaesthetists, too, had undertaken intensive care training and would prove helpful in meeting demand.
"They use ventilators and look after sick patients in operating theatres every day, plus they're familiar with the same principles we use in intensive care," Carr said.
He said hospitals had also begun running "train-the-trainers" sessions where nurse educators were upskilled over two days, before training their own colleagues.
"You'd be lying if you said you were an expert after a two-day course, but with these workshops, clinicians can at least understand the principles.
"So there is a lot of preparation going on. At the same time, we are looking to buy new ventilators, but clearly, there is a global demand for these things at the moment."
Asked if doctors were worried about what they might be soon facing, Carr said: "I think we would be very foolish not to have anxiety.
"We have colleagues in Italy, the UK, and the US, and the stories coming from them are quite harrowing because they have been overwhelmed.
"We can't promise we won't be, but we are trying our best to make sure we won't be in that situation."
In the meantime, he called on people to be meticulous with their hygiene.
"The single most important thing we can do is to try to reduce the spread between people."