Intensive-care staff are most at risk from Sars, but their focus is on keeping up the morale of patients fighting for their lives It is where the spectre of death always hovers, shifting silently from bed to bed. The intensive care unit (ICU) at Prince of Wales Hospital has transformed into a battlefield over the past two months. The elusive but deadly enemy: Sars. Patients in various states of health and consciousness often have no idea of their own fate. Some are unaware that their loved ones have died of Sars as medical staff shield them from shocking reality. The patients, sedated by drugs as they breathe through artificial ventilators, are a danger to medical staff working there. Every time they cough or sneeze, the invisible killer virus escapes into the air. Bonnie Lau Po-yin and Hidy Chan Yin-fung, two dedicated nurses at the ICU, are on highest alert working every day in what they describe as 'ultra high-risk' conditions. They change their protective clothes, masks and face shields every time they enter and leave the hazardous patients' area defined by a solid yellow line on the floor. Getting in and out of all their gear is long and tiring. But Ms Lau and Ms Chan know they cannot afford any mistake. The terrible disease has already claimed the lives of three health-care workers. The two nurses have a heavy workload in dangerous conditions, but this is not their greatest source of anguish. More painful by far is having to keep secrets from their patients: life and death secrets about what has happened to loved ones. In one case, an ICU patient died but Ms Chan dared not pass on the bad news to his younger brother, who was lying just a few beds away. 'The younger brother did not even know his brother was there,' she says. 'The men's mother was also at the ICU and failed to respond to treatment. The man was very weak at the time and we did not want to tell him all this terrible news.' Ms Lau says: 'Sars is so terrible that when your loved one pass away, you don't even have a chance to say goodbye.' Ms Chan has been trying hard not to break the news to a woman patient that her son has also caught Sars. 'I am worried that she will be very depressed once she knows her son is infected. She may lose the strength to fight on,' she says. The two nurses have been partners in crisis before. They helped to treat students seriously burnt in the 1996 Pat Sin Leng hill fire. The fire killed two teachers and three children and injured six students. 'I changed the dressings for them,' Ms Lau recalls. 'It was torture for those young people. They cried and screamed. It took more than an hour for us to finish the procedure. I really felt for them. I kept asking myself how I could reduce their pain. 'That was a tragedy, but Sars is even worse. This time our own safety is in danger. We work every day with fear. But we cannot show the patients that we are also worried about getting infected. We have to give them confidence.' Ms Lau says although she has to face the danger of being infected at work, she has a sense of mission that keeps her going. 'At the ICU, each patient is looked after by one nurse. We have to take care of almost all aspects of their daily lives. We have to clean them, feed them and talk to them when they need someone to listen. These patients are separated from their families - we are the only ones at their bedside to take care of them,' she says. 'The time we see the patients sent out of the door is the happiest time we have.' The tragic flood of severe Sars patients has stretched the hospital's ICU to its limit, with its 24 beds all occupied for the past two months. Unit director Gavin Joynt is now helping the Hospital Authority review intensive care services and make projections for future demand. At the peak of the Sars outbreak, he says, 150 patients were receiving intensive care at public hospitals, taking up half of Hong Kong's ICU capacity. Doctors say that because ICUs have been overburdened, some Sars patients have died without having the chance to receive intensive care. Some patients who would have normally been referred to an ICU have been treated in ordinary wards. Dr Joynt, who is also an associate professor at Chinese University, says the occupancy of ICU beds under normal circumstances is between 70 to 90 per cent. 'There are a number of patients who would normally be in ICU were not in ICU as a result of Sars,' he says. Currently, there are only 400 ICU beds out of the 29,000 public hospital beds in Hong Kong. To cope with the crisis, Prince of Wales Hospital has stopped major operations that may require intensive care. Early this month it opened five more ICU beds to take care of Sars victims. 'We could easily expand by five to 10 beds and have them completely utilised, and that's without Sars. When Sars came along, you have to find a way to exclude other patients from using ICU. It is not a terrible thing, it is the reality of life,' Dr Joynt says.