'Entering Red Zone': Inside a Covid ward and ICU

Emma Russell
Emma Russell

Multimedia Journalist

Only those inside our Covid wards and intensive care units truly understand the brutality of Delta. A lead nurse and top ICU specialist open up on the human cost of Covid. Emma Russell reports.

Every night after another gruelling shift at the frontline of caring for Covid patients, Joyce Pereira takes off her protective gear and says a little prayer.

Some days she can't help tears falling down her cheek as she reflects on the atrocities she and her colleagues have witnessed inside the walls of Auckland City Hospital's Covid ward and intensive care unit (ICU).

"It does scare me," she tells the Weekend Herald through her mask. "I am always worried about what will happen if not enough people get vaccinated."

Pereira, a nurse unit manager, is speaking nearly 600 days after New Zealand was hit with its first Covid case, which has since left dozens of families heartbroken after losing loved ones and many suffering long-term effects of the virus.

New Zealand's Covid death toll sits at 28. Since the pandemic reached our shores, more than 5000 people have become infected - the population of a small New Zealand town.

As of Friday morning, 790 of those were still infected.

Since Covid first struck in March last year, Auckland City Hospital alone has seen 150 patients infected with the virus - some end up in the Covid ward and those who are critically ill are rushed to ICU.

As of Friday, there were 51 patients in hospital with Covid across the country - North Shore (8), Middlemore (18), Auckland (24), Waikato (1). Seven were fighting for their life in ICU.

But even with the emergence of the more aggressive Delta strain, Pereira said she was wary our "greener than green" country had not yet experienced the viciousness of Covid that has ripped through other countries.

She's often reminded of this by her friends back in India, where she trained to be a nurse before moving to New Zealand with her family in 2005.

When she prayed, her mind flicked to her 23-year-old daughter, her husband and her 85-year-old mum.

Auckland City Hospital's ICU specialist Dr Colin McArthur, left, and Covid ward nurse unit manager, Joyce Pereira open up on the human cost of Delta. Photo / Supplied
Auckland City Hospital's ICU specialist Dr Colin McArthur, left, and Covid ward nurse unit manager, Joyce Pereira open up on the human cost of Delta. Photo / Supplied

The thought of the lethal virus striking those she cared most about in the world was terrifying.

"Personally, I do say a little prayer every day for everyone out there."

As case numbers continue to climb, Pereira and her team have seen patients bedridden, struggling to breath and fighting for survival from the preventable but extremely aggressive virus.

She wouldn't wish it upon anyone.

"It varies from patient to patient and depends on whether they have any other underlying health issues. Most patients come in with flu-like symptoms; shortness of breath, fever, increased heart rate, cough, fatigue, loss of taste and smell."

Some days are harder than others, "especially when you see those high case numbers announced by the Government".

But when Pereira steps into the Covid ward each morning at 7.30am, she tells herself she has a job to do and puts those personal feelings aside.

"We have to be strong for our wonderful patients, so we are very encouraging whenever we are in a patient's room or caring for them. These are the attributes that make us who we are as nurses."

The locked doors separating the ward from the rest of the world are sign-posted with the words: "Entering Red Zone - Put on PPE".

Her safety routine before crossing into the sterile room has become seamless. She has repeated it hundreds of times before.

It takes her about six minutes to wash her hands thoroughly, put on her gloves, tie up her apron and securely fit her mask and eye protection.

In her role, she is responsible for leading her nurses, who she dubbed "the real heroes", and making sure the ward is running effectively on a day-to-day basis.

"So I look at the roster and make sure there is safe staffing and I look at the patients who are there ... I check if any patient can be discharged and which patients are really unwell and need more treatment, so I know by heart what each patient requires and the nursing support needed," Pereira says.

Twice a day she meets with her team, including her superiors, to debrief. She answers any questions and seeks expertise on the matters she is unable to answer.

Inside the Covid isolation ward is like no other part of the hospital.

Up until a few weeks ago, the ward was filled with empty beds, ready for the moment Delta-infected patients would come rushing through.

Now those beds are filling up. Hand sanitiser hangs off the edge of each one and oxygen masks and ventilators are positioned above each pillow.

A metal box on the wall labelled "Room Pressure Control Panel" has a "negative" button, green light beaming. This indicates negative air pressure inside the ward, so contaminated air cannot escape if a door opens.

Stacks of packages with ready-to-use masks and gloves cover one of the cupboards. They are monitored daily to ensure supplies are sufficient.

Pereira had to learn to read her colleagues' body language through their eyes as the rest of their bodies are covered in protective gear.

Despite having 25 years of nursing experience and having helped prep the hospital for other possible pandemics such as bird flu and Ebola - which never made it to New Zealand - she found Covid came with many unknowns.

"We were learning from what the world was grappling with and the lessons they had learnt and making sure we have the best safety nets to care for our patients.

"It was evolving every day with different messages, so it was very overwhelming. There were times when I was asking the same questions that my frontline staff were asking. "

Hospital staff had to implement change really quickly, she says.

"Safety was our biggest hurdle to cross over."

Before entering the "Red Zone" frontline staff spend six minutes putting on safety gear. Photo / Supplied
Before entering the "Red Zone" frontline staff spend six minutes putting on safety gear. Photo / Supplied

She says the moment she realised it was real, all sorts of emotions started running through her, including determining what was right from wrong.

"I think we did a great job as working as a team putting together the processes that we were learning really quickly and implementing the change and keeping safety in the forefront of everything."

At home, she said she became "Dr Google" to her friends and family. "I do tell them the clinical information that I have but I do guide them to the Ministry of Health site to read more."

Working on the frontline wasn't easy as fears about how quickly the situation could escalate circulated among staff.

"There is a lot of anxiety that comes through the ward, some days can be really hard."

She said it was important to her to have a culture in her department to let staff speak freely so that they could be supported and feel confident to deliver the best care possible.

The most important thing people could do to help her team was get vaccinated, Pereira says, because those that were not ended up in a far worse condition.

Some patients she sees only briefly before they go to ICU, where specialist Dr Colin McArthur works.

He says that early on in the pandemic there was a lot of nervousness among the staff about whether they were adequately prepared.

"I think everyone's found that once you get into it and you find - well, actually we've done the training, we know what we're doing and it all works - I think people are a lot more comfortable now than they were."

Many of the patients McArthur has treated had compromised lungs and struggled to get oxygen into their bodies.

When Covid first hit, the only additional support available was ventilators - which helped pump oxygen into the lungs but did nothing to alter the course of the disease.

"As we saw in China and Italy, particularly when it first broke out there were many, many hundreds and thousands of patients affected, with a very severe illness mainly affecting their lungs."

McArthur, who is also a clinical researcher, has since March last year led a clinical trial assessing a number of potential treatments for Covid patients, including steroids.

"They found hydrocortisone, a commonly used intravenous steroid medication, and tocilizumab, a treatment for rheumatoid arthritis, reduced deaths and time on organ support in ICU," McArthur said.

This research reinforced the results of Britain's wide-ranging Recovery trial into Covid treatments, which showed the effectiveness of dexamethasone, another steroid medication used to treat rheumatic problems and chronic obstructive lung disease.

The trial started in March and was published by July. Because it involved most of the UK's hospitals with a large number of patients participating, results came quickly, McArthur says.

"In the space of about two months, we had our first answer, which was pretty good really."

Before that, McArthur says, most doctors thought anti-viral medication was the best treatment because it focused on the virus itself.

"[Using steroids] was kind of an out-of-left-field idea, that maybe if we also affected
and modified the body's response to the virus, the immune response, it might also be beneficial."

"There was a lot of concern that if you gave people these kind of medicines things would get worse rather than rather than better, so hence the need for these trials".

McArthur says using steroid medication showed "quite a profound effect".

When he first heard the news about Covid out of China, McArthur said he anticipated the virus would be like influenza. Then it became very clear it was not like that at all.

"It was quite a lot worse, and so I had to kind of change my perspective and consider that this was actually a much more major thing, which the world was going to be struggling with for a while."

Asked why he got into medicine, McArthur says it was a combination of an interest in science and the humanity.

"Both of those are appealing and blending the two together, I think, was why I ended up in this direction, I went further down the route of the intensive care because I guess I've got a more of a technical bend."

Staff are on guard ready for the next Covid patients to rush through the doors. Photo / Supplied
Staff are on guard ready for the next Covid patients to rush through the doors. Photo / Supplied

But caring for the critically ill means comforting patients when they were dying, McArthur says.

"When we're unable to save them and all the treatments have been given but the patient is unable to improve from that, we have to work with the families to help them through that process ... and to make our focus on the nature of dying and the comfort of the patient."

McArthur says this could be very hard as a doctor but as it was a very common part of the job, it had to be approached in a professional manner.

"With compassion, but a little bit of distancing so you don't get emotionally involved too frequently, otherwise it becomes very draining - so it's a careful balance."

The difficulty was the majority of patients dying of Covid could have been saved if they were vaccinated, McArthur says.

"Around 200 or so that we've seen... they're absolutely dominated by people that have not been vaccinated."

While many remain removed from the brutality of Covid, the solution could not be solved within the walls of the hospital, McArthur says.

Like Pereira, he emphasises that getting widespread vaccination coverage was the only way from stopping our fellow New Zealanders from becoming critically ill and dying.