Staff were face-to-face with COVID-19, they saw the harm it causes, cared for infected patients and sadly saw one die.

All the while the only thing separating them from the highly contagious and deadly virus, was a thin layer of gowns, gloves, masks and shields.

A rip, a tear, and they could be exposed.

Emergency physician Kirsty Jackson said in the back of every front-line worker's mind were the people waiting at home.

"Initially there was definitely a heightened level of anxiety among our staff when we were working and you could actually feel that," she said.

"It was actually quite palpable when you were looking after patients, and a bit of frustration there as well because you want to protect the patient firstly and make sure they're okay but you also want to protect yourself and staff.

"I'm sure in the back of everyone's minds there's the fact they don't want to take COVID home to their families."

Emergency and intensive care workers are taught to expect the unexpected.

But not even they predicted they would be dealing with a doctor shortage caused by the shutdown of a major city, while working on the frontline of a global pandemic. Early on in the pandemic, staff who were pregnant or had pre-existing conditions were offered deployment to other areas of the health service.

Everyone attending Albury emergency department had to be treated as if they were infectious until they could be assessed.

The division between the hospital and outside world grew as staff began showering and changing clothes and shoes as they arrived and left work.

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Emergency department nurse unit manager Clare Maher said they had to be ready for the worst.

"At the time we were expecting extraordinary numbers that was where the modelling came from," she said.

"Really that was the case for a couple of months, we were expecting we might have this surge of patients that were critically unwell."

A fever clinic was erected outside the emergency department so people could be assessed for COVID symptoms, before being moved to different zones inside the emergency department.

"It adds a layer of complexity to what we're doing, it's already a fairly complex game to work in," Dr Jackson said.

One of the biggest, and possibly least comfortable changes, has been the need to wear full personal protective equipment (PPE) around anyone with symptoms.

"They spend a lot of their day in full PPE, they'll have masks and shields and eye protection and long sleeve gowns and gloves that are all quite hot and cumbersome to work with," Mrs Maher said. "I think from the outset staff just absolutely accepted that was just what needed to be done to keep themselves safe and the community safe."

Dr Jackson said working in full PPE was uncomfortable but had helped protect staff treating COVID-positive patients.

"It definitely adds that layer of discomfort especially in a resuscitation situation where you're already probably sweaty," she said.

"It's quite uncomfortable and you're desperate to get it off when you walk out the door.

"Our staff have done an excellent job with that because obviously there has been no hospital transmission of infection at all from the cases that have come through the hospital."

Director of emergency and intensive care David Clancy said despite the risks and precautions, staff treated COVID-positive patients with the same level of care they would anyone else.

"Staff were fantastic at just accepting it was business as usual, there's a patient and that's the most important thing," he said.

"The patient was the focus no matter what."

In general, presentations to the emergency department decreased during COVID, in part because isolation led to less socialisation and spreading of disease, and a decrease in road accidents.

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But those who do attend tend to be more acute in their needs and mental health presentations have been on the increase ever since bushfires ravaged the region at the start of the year.

Dr Jackson said it was important people knew the department was open and did not hesitated to come in if they were unwell as there were strong COVID safe practices in place.

She said COVID has added a layer of anxiety to everyone's lives and for people with underlying mental health issues that extra layer could "tip them to the level where they need acute service."

"Physically our department just doesn't work the way it is for the number of presentations we have and the number of mental health beds that we have," Dr Jackson said.

The services hopes to incorporate that need and other lessons learnt from COVID into the new emergency department, with the layout design and model of care to be informed by the pandemic.

The health service is also considering bringing temporary structures like the fever clinic into effect during bad flu seasons as a way to triage patients.

In July, when the border closed things got even harder and more stressful for staff while management were left "really scrambling to make sure people had the right pass and could get to work," Mrs Maher said.

The ban on Melbourne-based doctors has also added pressure to the already intense environment.

"That shortfall hasn't been met through the multiple paths we've gone down trying to get assistance," Dr Jackson said.

"A lot of the local staff have been working extra shifts or shifts they wouldn't do to actually try and fill that gap. It's been really significant struggle to actually fill that roster."

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Dr Clancy said changes to the service's visitors policy had been very hard for patients and their families, especially in the intensive care unit.

"We have understood the need for restrictions on visitors, but the impact has been felt by so many of our patients and their families," he said. "It is stressful enough having to come to hospital when you are in a vulnerable state - whether that be from pain, uncertainty, or hearing bad news - and that is where the support from our families and friends is so vital.

"Equally families feel helpless not being able to be present with their loved ones."

Dr Clancy said the border restrictions and isolation requirements added further stress and frustration for patients and families needing to travel to Melbourne for appointments.

"We hope that as we push for more services locally that this is one less stress that patients and families have to experience," he said.

Mrs Maher said so many people had been working tirelessly behind the scenes at the health service, all while juggling their own lives and worries. She said there was a lot more to the hospital than doctors and nurses.

"I think our teams have done an amazing job, they've been so adaptable and flexible," she said. "Outside the challenges of COVID and the border, we have quite a young workforce so lots of them have been homeschooling their children while working shift work.

"There are lots of essential services across the board, support staff like our hospitality staff, our cleaning staff, and our portering staff, they've all been extraordinary."

Dr Jackson said patients were extremely grateful for the efforts of staff, while Mrs Maher said the hospital staff had felt very supported by the community.

"I think it's a good opportunity for us to say thank you as well," she said.

"There's been a lot of local businesses who have been affected by COVID who have been so supportive of the team and dropped off food and lots of treats for the staff. They've been really well celebrated."