Work is under way to heal the severely burnt skin of White Island’s volcano eruption victims. But as the injured remain in hospital, their invisible wounds also threaten lives.
On Monday morning, the cruise ship at the centre of the tragedy, Ovation of the Seas, sailed back into Sydney after what passengers described as a “surreal” and sombre journey.
In New Zealand, divers were expected to resume a search for two people still missing at the ashen island, amid fears of further volcanic activity.
NZ Prime Minister Jacinda Ardern will lead a minute’s silence at 2.11pm local time, marking exactly one week since the deadly blast off the coast of the north island. Prime Minister Scott Morrison asked Australians to also mark the minute’s silence.
At 12:11pm today (AEDT), the exact time the volcano erupted, Australians and Kiwis will join together to observe a minute’s silence for those who died and those injured in this terrible tragedy, as well as to offer our support to their loved ones.
— Scott Morrison (@ScottMorrisonMP) December 15, 2019
Meanwhile, another technical mission continues as highly skilled burns specialists at The Alfred in Melbourne and several Sydney hospitals work around the clock to save survivors.
Finding unburnt patches on survivors’ bodies is among the priorities, as doctors might use that to regrow a patient’s damaged cells.
Another 1.2 million square centimetres of allograft skin is being brought to NZ from the US. Donors have also come forward to Australian hospitals.
The doctors’ task has been described by a top plastic surgeon as “emotionally one of the hardest things” they will ever have to do.
Sydney couple Nick and Marion London are among the patients to have made it through their first round of skin grafting.
Both suffered burns to almost half their bodies, as well as internal chemical burns from breathing in toxic gas during the fatal blast.
Tom Nieuwland, a close family friend, told The New Daily that their surgeries at The Alfred “went well”.
“The doctors are all keeping a very close eye on them as it’s still early days,” Mr Nieuwland said on Sunday.
“Doctors have told [their son] Matt that the recovery time will be months, not weeks, due to the intensity and severity of the burns.”
Of the 19 patients in hospitals in New Zealand and Australia, it is likely all are in induced comas and on ventilators.
At Sydney’s Concord Hospital, another Australian who had been rescued and flown home could not be saved. His death was the first in Australia since the eruption.
NZ authorities said on Saturday that another of the initial survivors had died at Waikato hospital.
The deaths in hospital took the eruption toll to 16.
New Zealand police also confirmed they had identified three more Australian victims – Adelaide’s Zoe Hosking, 15, and her stepfather Gavin Dallow, 53, as well as Sydney’s Anthony Langford, 51.
Local tour guide Tipene Maangi, 24, was also named.
Facing high chances the volcano would erupt again, a crack squad of rescuers ventured back to the island at the weekend. They retrieved six bodies on Friday and returned on Sunday to look for two that remain missing.
The body of Melbourne woman Krystal Browitt, 21, was among the six returned in coffins to families on the mainland.
Two people – an Australian tourist and a New Zealand tour guide – are yet to be found.
Authorities believe it’s possible they may have been washed into a ravine after the eruption.
While authorities weigh up conditions before deciding when the search can continue, the arduous task of identifying the bodies so they can be returned to their families for burial goes on.
Teams analyse jewellery, clothing, dental records and fingerprints, as well as DNA samples from belongings such as hair and toothbrushes.
Many of the tourists left their luggage on board Ovation of the Seas while they went to White Island.
Dr Tony Tonks, an experienced plastic surgeon who has worked in three of New Zealand’s major burns units, said he had faith in the “excellent teams” treating eruption victims.
“I know my old colleagues will be working around the clock to get the job done,” Dr Tonks told The New Daily from his clinic in Canberra.
“It is really distressing for everyone involved – the family, the patient, and the teams looking after them. Treating patients with major burns is emotionally one of the hardest things you have to deal with.”
Dr Tonks said it’s likely surgeons would have started emergency treatment by performing an escharotomy to help the patients retain their fluids and blood.
“When someone suffers a full thickness burn, the skin shrinks and strangles the muscles – it’s like someone’s got a belt and tightened it around the area,” Dr Tonks said.
An escharotomy involves a deep incision around the burned area to help release some of the pressure caused by the skin contractions.
Dr Frank Lin, a plastic surgeon at Melbourne’s Epworth Eastern Hospital, said that unlike a sunburn – where the skin can regenerate by itself – a full thickness burn means the skin “essentially dies”.
“Beyond performing a barrier role, skin helps to regulate our body temperature and to protect the body from UV – it’s no less important than any other major organ,” Dr Lin told The New Daily.
“[A full thickness burn] is a major trauma and serious injury.”
The blast from the eruption would have also damaged victims’ airways, with many inhaling toxic gases, ash and hot water, Dr Tonks said.
The remaining patients are expected to have surgery in coming days.
It will be a long road to recovery, and survivors with badly burnt airways may require tubes to help them breathe.