Middlemore Hospital is planning to set up a tent to triage COVID patients as early as next week, as Auckland braces for a surge in cases.
Daily cases numbers in the city are expected to double within a fortnight, hitting three figures, with the government saying the outbreak was escalating faster than it anticipated.
Middlemore Hospital's emergency department and ICU clinical director Vanessa Thornton said the hospital was preparing for an increase in cases, including having a tent at the emergency department to triage COVID patients.
"We're monitoring on a day-by-day basis but we're planning for that tent to be up and going next week, based on the predictions," she said.
And a second COVID ward was ready to go if needed.
The existing one had 17 beds and there were 11 patients in it yesterday, she said.
Extra nurses from other parts of the hospital would be called on if needed and were really stepping up to help the cause, she said.
Middlemore had had a lot of experience in treating COVID patients and knew what it needed to do.
"It is going to be challenging if it gets very, very high but we're just hoping people will respond to things like the Vaxathon and other events to get vaccinated," she said
It was hard to say exactly when the extra ward capacity will be needed, she said.
Middlemore teams were watching daily case numbers, had their own modeller and were getting advice from colleagues overseas, including Australia.
All of Auckland's public hospitals have built extra negative pressure intensive care rooms to prevent spread.
Patients will be transferred around the city to where there is space and there are plans to use theatre nurses and other staff as back up if required.
The College of Intensive Care vice president Rob Bevan, who works in Auckland, said ICU teams were anxious about the predictions for the rising cases.
The back-up staff from other parts of the hospital would be a help but COVID patients were particularly complicated so the fully trained intensive care teams would always be needed to provide oversight.
"We usually have to admit those patients because they have difficulty in breathing, because they are short of breath, which is a particularly distressing phenomenon," he said.
"People will find they are short of breath with minimal exertion - and that's a scary situation."
It was hard to predict how busy intensive care would be in the next few weeks, with much depending on how many people were vaccinated as cases surged.
If intensive care was busy, there would be even more patients on the wards, in the emergency departments and in general practice in the community, he said.
Other hospitals have been preparing for that influx.
At Auckland Hospital, they built 18 negative pressure isolation rooms for their COVID ward in about 10 days - there were only four when Delta arrived.
Both Dr Thornton and Dr Bevan wanted to reassure people they would get good care if they had to go to hospital, for COVID or other conditions.
But it was better to be vaccinated which could help avoid the need for hospital level care in the first place, they said.
Dr Bevan said it was not too late to get protection for this outbreak - even one jab lowered the risk, but two made a huge difference to whether someone was likely to need intensive care.
Case numbers at Middlemore 'gradually increasing'
Middlemore Hospital's chief medical officer Pete Watson said the triage tent outside the Emergency Department will help with the flow of patients, who will be assessed for COVID-19 and put into the appropriate area.
"The majority of people are receiving a [COVID-19] test, we're using the rapid antigen test as well as the PCR testing.
"We're putting layer on layer of assessment in there now so we continue to improve our ability to detect COVID at the front door and start treatment early."
The number of COVID-19 cases at the hospital are "gradually increasing" with six turning up yesterday and four admitted, he said.
Asked if he supported Auckland returning to alert level 4 to buy time for more people to get vaccinated, Watson said he backed any effort to raise vaccination rates.
"We don't have a particular view on what the status of alert levels should be," he said, but vaccination was "the key".
"Whatever we can do to increase it I think is really worth considering, because as we're seeing in Auckland now the numbers are building."