Having spent much of 2019 dealing with Dunedin Hospital’s still unfinished expansion of its intensive care unit, Dr Carr felt he needed those beds, and then some.
After obtaining permission to open stage 2 of the unit if need be, shipping in extra ventilation, and confirming gastroenterology recovery rooms and general surgery recovery rooms outside operating theatres could be made available, Dr Carr and his team were as ready as they could be.
"That would have taken us up to about 38-40 beds, which is not bad, given we are only actually resourced for 9-10 beds, so to nearly quadruple that was a really good effort."
As things turned out, all that capacity was not needed, but as southern case numbers grew and grew in late March Dr Carr was not to know that.
"Before our first patient with actual Covid we had a couple of patients come in with respiratory failure and a temperature who we were treating as presumed Covid, and that was incredibly useful because they afforded us an awful lot of learnings," he said.
"It turned out that when you are in a sealed room fully dressed in PPE (personal protective equipment) that it becomes very difficult to communicate with staff outside that room, so we got a baby monitor so we would speak to staff outside doing what we call running duties (fetching materials for clinicians as needed).
"The other thing we learned was how many staff you need to turn a patient.
"We had always known you need five minimum, but what you don’t think about is that each of those people have to go through the donning and doffing (of PPE) procedure and that takes about five minutes, so that’s 30 minutes of staff time in that alone, which is a huge drain on time and resources."
Eventually, the ICU accepted its first actual Covid-19 patient, Invercargill woman Jocelyn Finlayson.
In addition to the clinicians who treated and cared for her, one person was at her bedside permanently, and a second person was assigned if she became unstable.
In addition, a runner was always outside the room.
Staffing had to be adjusted accordingly, but with the country in lockdown and acute and elective demand having fallen right off, most of the ICU team would have dealt with Mrs Finlayson during her 19 days in hospital.
Her death on April 22 was an enormously sad moment for all concerned, Dr Carr said.
"The team went in with its eyes open. We had a meeting back in February-March where we looked at the mortality that was being seen in Italy and China, which was more than 50% of ventilated patients with Covid did not survive, although that has improved substantially since as we understood more.
"The staff were despondent that they had not been able to get the patient through to survival, but equally they had done a really good job, there had been no errors we could find in our care ... my impression is that while clearly there was disappointment, the team felt that they had done the very best they could."
Dr Carr and his team remain ready to handle any resurgence of cases in the South.
He is quick to give credit to health workers throughout the province whose efforts have meant the ICU unit and its stand-by capacity have not been needed more often.
"Things could still get very much worse here, we mustn't get complacent ... but it’s a whole team game, and the staff in the CBACs, the staff in the ED, the staff in the ward, the porters, the nurses, the executive organising committee, have been enormous.
"We were very fortunate."
