Facing supply shortages and the fear that this could just be the beginning, a nurse working in a New York City emergency room, with 12 years' experience, tells the BBC what it's like on the front lines of America's coronavirus outbreak.
What have you been seeing in ER in the last few weeks?
We've seen an influx of patients that are coming in with the typical Covid symptom - fever, cough, sometimes sore throat, lung pain, chest pain. Other people are coming in with gastro-intestinal symptoms which are nausea, vomiting, diarrhoea, which have been identified as possibly an early symptom of Covid.
We're also noticing that our patients are coming in with red eyes, their eyes are red around the rim. You can look at these patients that are coming in that turn out to be Covid positive and you can see the sickness in their face, in their eyes.
Our emergency room is completely Covid. And we're short staffed, so it puts an even bigger strain on our emergency-care system.
Do you have enough equipment?
The short answer to that no, we don't. As of the last day that I worked, we were running out of pumps. When a patient has an IV hooked-up, there is a machine that's sitting next to you that calculates the medication, making sure it is being given to you at the right time and the right amount. We are running out of those pumps.
We're giving patients medications to sedate them and we don't even have the correct equipment to monitor them.
We are being rationed PPE - which is our personal protective equipment. We're getting one N-95 mask and we're having to reuse it for five shifts. Before this pandemic, you were never to reuse this equipment. It was one time use and it was thrown out. It was discarded. Now we are being told to use it for our shift, put it in a paper bag and save it for next shift. After five shifts, we turn it in and we'll get a new one.
We're running out of basic supplies because all of our patients are requiring so much.
How are you coping?
I believe that I'm coping with it as best that I can. I'm exhausted at the end of every shift. My feet are numb, my legs are numb. I'm sore. I soak through my scrubs. Stuff like that doesn't bother me. The things that bother me are making sure that my family and friends are okay.
I'm making sure that my family knows that, hey, if you go out, know that you are not protected, that you're being exposed to things. And if something were to happen to you, or if something were to happen to me, and God forbid, I pass away, or God forbid you get sick or you have to be intubated, we're all going to have to do it alone. Our hospitals are no longer allowing visitors so all my patients are going out and battling this virus alone.
I don't think that I was ever prepared for something like this. I mean, you are always prepared for the worst as a nurse, in nursing school, you're always given the worst-case scenario, and how to get out of it. This situation has proved to be a situation that none of us knew was going to happen. And my co-workers and I are doing the best that we can to get through every day.
Currently, we are so stressed at home. And we're thinking about our patients. We're thinking about our family members. There's nurses that won't even go home because they have children at home. They have their elderly parents at home. Luckily, I live by myself, I don't have to worry about stuff like that.
But we're so stressed, we're clinging on to the little things that we have, which is food delivery, which is, you know, laughing as much as we can, sharing the memes on the internet, taking pictures of each other in PPE because things like this we never thought would happen.
It's just taking out everybody you know, we had a nurse die. He was a nurse manager. He passed away this past week from Covid. And a nurse manager usually isn't on the front lines. They're more of a back office person, they help when needed. But he passed away this week. And, you know, everybody talks about how healthy he was. And he was the first nurse to always get up and help, he was a true team player. And he passed away taking care of his patient and helping out his co-workers and helping out the patients in need.
What keeps you awake at night?
My fears regarding this pandemic are specifically in New York City because I feel like we've been hit harder. And we've been hit first. And I feel like we're setting the standard for what the rest of the country is going to do and how they're going to respond. I am fearful that we haven't even gotten the worst.
And we're already running out of critical items that we need. I am fearful that we are going to go to war-time medicine. And when I say that, I mean triage, being with a patient and saying 'this person doesn't have a good quality of life to begin with so we're not going to take heroic measures to save them'.
That's my biggest fear. I also fear that we're just not going to have any supplies. Are we going to be mandated to be at work for 24 hours? What else is going to happen? The fear of the unknown is what bothers all my co-workers.
What would you like to say to people who are not on the front line?
The message I would like to convey to everybody who's not in health care is stay home. You know, I hate staying home, I hate being locked in my house.
But at the end of the day, the chance of you getting sick and dying is extremely, extremely high at this point. And Covid is not just focusing on the immune compromised, the old, the elderly. It's everybody at this point.
It doesn't matter who you are. It is take no prisoners. So my message is to stay at home.
In the coming weeks, what are your expectations?
I believe that this pandemic will go on until at least May or June. We in the healthcare system, especially in New York, we believe that this will go on until the summer time. The only way that I believe and that a lot of my co-workers believe that we can get a handle on this is there needs to be an entire lockdown on the entire country. And that means food delivery is shut down. That means everything is shut down except for truly essential employees. And that means police, nurses, doctors, those are the only people that need to be going out because we're truly trying to tackle this.
Anybody else needs to be at home and we need to completely lock the country down. That's the only way I think that we are going to tackle this. Otherwise, it's just going to keep going and going and going.
The nurse we spoke to preferred to remain anonymous