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On its worst day, the COVID-19 outbreak could force about 5,000 patients into intensive care, according to modelling used by the Federal Government to plan its response.

Until recently, Australia was not remotely prepared for that.

But as public life has ground to a halt and millions of Australians have committed to staying at home, the logistical machine behind our healthcare system has been ramping up.

The ABC has had exclusive behind-the-scenes access inside the nationwide effort that has mobilised tens of thousands of healthcare workers, scientists and manufacturers.

They’ve had to overcome dodgy operators, competition from countries with more buying power and promised supplies mysteriously disappearing.

It is all in preparation for a peak that health authorities are increasingly hopeful will never come, but one the country must brace for.

‘We don’t want to waste any time’

The clock has been ticking for Andrew Stripp since just before Australia Day.

His hospital in eastern Melbourne, Monash Medical Centre, received the first patient in Australia to be diagnosed with COVID-19 on January 25.

Since then, the CEO of Monash Health, Victoria’s largest public hospital network, has been preparing for a massive influx of patients.

“We don’t want to waste any time,” he says.

“I’m probably doing 16-hour days at the moment — so are many others.”

At midday every day, Andrew Stripp stands before a large screen in his office to run a virtual command meeting with his senior staff.

Updates flow in from his team about the treatment of patients, training of staff, supplies of critical medical equipment and reserves from the national stockpile.

“It’s been quite a revolution in a very short period of time — really quite an extraordinary transformation.”

“We have 50 ICU beds. We’re working on expanding that in the order of 150 to 200 ICU beds if we need to,” says Andrew Stripp.

“Hopefully, we won’t need them.”

At hospitals across Australia, entire new COVID wards are being created in the space of weeks or even days.

The Federal Government is planning to more than triple the number of intensive care beds from 2,200 to 7,000 to handle a feared surge in coronavirus patients needing life support this winter.

The Victorian Government has the most ambitious plan — it wants to increase the state’s ICU capacity eight-fold.

To meet the national target, the federal health department plans to at least triple the number of intensive care staff.

Each ICU bed requires a specialised nurse 24/7, so the department has a radical goal to lift the number of nurses in ICU from 10,000 to 35,000 as soon as possible.

It’s counting on a patchwork of measures to boost the hospital frontline: commandeering beds and staff from private hospitals; re-registering medical workers who have recently retired; and funding urgent online training for 20,000 nurses to work in the ICU.

More than 18,000 nurses have registered for the online course in less than a fortnight.

After 20 hours of lectures, they’ll hit the ICU floor to learn on the job, working around the clock to manage one critically ill patient each under the guidance of a senior nurse.

“It’s going to be very challenging for them,” says the course’s designer, Ken Hambrecht, from e-learning company Medcast.

“But this is a time of crisis. If we hit that critical mass [of patients], it’ll be too late to say we need another 5,000 nurses.”

On the ground, nurses and doctors have been frantically training for one of the most challenging jobs in the medical profession.

Nurses respond to call to arms

Anna Kidman has been a nurse for ten years and usually works in neonatal critical care.

When the call went out for nurses to upskill and handle the increased demand on intensive care units, she was one of the first to put her hand up.

“It has been several years since I’ve looked after critically unwell adults,” she says.

Given Anna’s experience in critical care, her learning curve isn’t as steep as some nurses joining the COVID-19 fight.

“If you’ve been out of the game, it would be really daunting coming back and working in a hospital, let alone in a critical care setting,” she says.

“But I think it reinforces how vital basic nursing skills are and how transferable skills are.”

To get up to speed, Anna spent a day shadowing a senior intensive care nurse before taking part in a training simulation on how to intubate and ventilate a COVID-19-positive patient.

The room is usually crowded with medical staff during an intubation, but numbers will be minimised to limit the risk of the virus spreading and the need for personal protective equipment, which is in high demand.

A muscle relaxant is administered, meaning the procedure is more controlled and can be performed without having to work as close to the patient’s mouth.

It’s for this reason that Monash’s emergency response to COVID-19 patients is being run by anaesthetists.

‘I think… we are ready’

The pace of life has changed dramatically for anaesthetist Dr Belinda Phillips.

A month ago, she was on long-service leave, preparing her youngest child for school and training to run the Great Ocean Road marathon.

Now, she’s running Monash Health’s COVID-19 response training program for the hospital.

“It certainly was a sprint to get ready,” she says.

“The amount of work undertaken in the last couple of weeks by the hospital has been immense.”

Normally, Dr Phillips would spend most days in an operating theatre but, with elective surgeries on hold, she’s been drafted into the massive medical overhaul to up-skill staff. That includes running intubation drills for other doctors and nurses.

It’s just one of many scenarios made more difficult by infectious droplets which can spread from patients to frontline medical workers.

“Two weeks ago, we were still working on a lot of this, [but] it was not as organised and people were working a little on the back foot,” she says.

“I think we are now at the point where we are ready.”

For now, Australia’s ICUs are unusually quiet. The cancellation of non-essential elective surgery has decreased their normal business by at least 30 per cent.

Meanwhile, there are signs the coronavirus infection rate is already flattening. The number of ICU patients with coronavirus is at 81, with 35 of them on ventilators — just a fraction of the forecast peak.

For Dr Phillips, the next challenge is ensuring the hospital system can cope with a long-term flow of COVID-19 patients.

“Pacing is critical — we can’t keep the sprint pace going for very long.”

An unruly bidding war

Dr Finkel has been tapping into some of the country’s brightest minds to develop a domestic manufacturing industry for ventilators.

The Federal Government has set a target of at least 7,500 ventilators by June — at least one for every ICU bed — but there’s a global shortage and the international marketplace has devolved into an unruly bidding war.

“When we started nearly four weeks ago, we were in the period where the number of new cases was doubling every five days or so, so there was a significant sense of anxiety that we had to move fast,” Dr Finkel says.

“Governments around the world have got their purchasing agents out there looking to secure whatever ventilators are being manufactured, so it’s become very competitive.

“Sometimes a lead will dry up because it’s bought before you can respond.

“The Australian Government has been prepared to go from [an] opportunity to offering to pay for transport and pay onsite in just a few hours and sometimes that doesn’t work out.

“Then of course there are unsavoury characters out there who are purporting to be suppliers.”

In one recent case, Australian buyers raced to a warehouse near Shanghai in response to an offer of a stockpile of American ventilators.

“We had a line of sight to a few hundred very legitimate ventilators from a major international company and somehow they disappeared from the warehouse before our trucks arrived to pick them up to take them to Australia,” Dr Finkel says.

With the supply chain to Australia unreliable, Dr Finkel has worked with ICU specialists to develop minimum specifications for locally produced ventilators, while the manufacturing industry has banded together to set up a line of production.

Local manufacturing begins in earnest

At a factory in Port Melbourne, a 3D printing company is cranking out parts for ventilators as part of an effort it hadn’t imagined less than a month ago.

3DMEDiTech mostly made dental devices and children’s orthopaedics, until co-founder Paul Docherty got a call from the Federal Government’s new medical supply taskforce to make personal protective equipment (PPE) and address the global shortage of ventilators.

“For the last three weeks, we’ve been every day on this project,” says Mr Docherty, an entrepreneur and chair of the Melbourne Rebels rugby union club.

Until the COVID crisis, 3D MEDiTech could never have competed with the low production costs of overseas operators making PPE.

But now the company is feeding an insatiable demand, churning out parts for HAZMAT suits, thousands of protective face shields and trialling the first locally produced COVID testing swabs.

“We’re actually looking at expanding our staff to cope with the demand that we’ve currently got,” Mr Docherty says.

“Initially it was incredibly daunting to be pivoting the business.

“At the outset, it was the lack of coordination, not understanding exactly what we were going to need, what the virus was going to do, what was going to happen in lockdown.

Now, the company is transitioning again, working with Australia’s manufacturing sector to help set up a local ventilator industry.

Pending approval from the Therapeutic Goods Administration, 3DMEDiTech will contribute ventilator filters and valves — just some of the hundreds of components each machine needs.

The company is a cog in a vast machine attempting to grind into gear in the space of weeks.

“We’re moving at maximum speed possible,” says Ian Burgess, who has been coordinating the efforts by companies to both import and produce medical devices, as part of the national taskforce.

“Australia is on a war footing and the medical technology industry is on the frontline.”

Mr Burgess, the chief executive of the Medical Technology Association of Australia, has secured an exemption from competition law so members can share their data and design specifications to address urgent global shortages.

He’s helping broker business for a consortium of Australian companies led by Victorian firm Grey Innovation, which last Friday announced a deal to produce 2,000 ventilators by July.

Another 500 invasive ventilators are being manufactured in Sydney by Australian medical device company ResMed, which normally makes sleep apnoea machines.

“It’s extraordinary times. Companies that were competitors are now working together day in, day out to ensure that we meet this crisis,” Mr Burgess said.

“[They’re] sharing information around supply, sharing designs, even in terms of proprietary information that was previously commercial-in-confidence.”

Curve trends toward cautious optimism

As a last-ditch supply, the taskforce has been planning to repurpose alternative devices — even ventilators used in veterinary clinics for household pets.

According to Dr Alan Finkel, Australia’s ICUs will have the 7,500 ventilators they need.

“[We’re] not seeing that as the end point but a minimum we’d like to get to and trying to achieve that by the end of June,” he said.

“But there are enough irons in the fire that if all goes well by that time frame and certainly into July, we’ll have significantly more than that.”

That tone of qualified optimism is echoed by Australia’s Deputy Chief Medical Officer, Nick Coatsworth.

“We have been preparing for a sprint with the constant knowledge that if we contained this virus, one of the consequences of flattening the curve is you extend the burden on the health system — it’s just that the burden becomes manageable,” says Dr Coatsworth.

“At the moment with the curve as it is, we have done an exceptional job to contain the epidemic.

“But we have to be cautious because the ongoing community transmission could push up those numbers, so whilst we’re cautiously optimistic we’re taking our preparation very seriously.”

The race is far from over, but Dr Coatsworth offered a glimmer of hope to those Australians asking when public life might return to some semblance of normality.

“We have been prepared for this to be a marathon, we have been talking to the Australian public and the Prime Minister has indicated that six months is the duration that our lives are going to change, so we have to be prepared for that.

“Equally, we have to be prepared and provide advice on how we lift some of these measures and do it in a way that is safe for our healthcare system and safe for Australians. That is the next step here.”