Medical workers wait for patients at a special coronavirus intake area at Maimonides Medical Center in New York. Photo / Getty Images
Ten healthcare workers in New York tell The Telegraph what is happening at the US outbreak epicentre.
Scheena Iyande Tannis cannot remember how many people she has seen die from coronavirus, but it is the manner of their departures that has stuck in her head.
When a patient begins to fade at Brookdale Hospital in New York's Brooklyn district, alone in isolation, staff now arrange Facetime video calls for a final goodbye with loved ones.
At home after a 17-hour night shift, Tannis , 40, replayed a conversation she had with a woman on a ward, unable to see her mother dying nearby, moments before the call.
READ MORE:
• Covid-19 coronavirus: New York deaths double in three days, with worst to come
• Covid 19 coronavirus: New York hospitals load bodies into trucks
• Covid-19 coronavirus: New York has surpassed 1000 infection deaths
• Covid 19 coronavirus: Kiwi paramedic's heartbreaking experience in New York
"What do I say to her," the daughter asked. Tannis did not know what to advise. In the end the woman just repeated: "Mommy, I love you" over and over.
"Normally the families can be at the bedside and can have that moment of closure," said Tannis, who has been a critical care nurse for almost 20 years.
"The sad and the scary part is they can't. They're not allowed to … I think that is what hurts us the most."
Such tragedies were once rarities in New York City. Now, with Covid-19 rampant, they are seen almost daily, not just in Brookdale but in hospitals across the city.
The coronavirus case numbers in New York, the epicentre of the US outbreak, are mind-boggling.
Around 46,000 residents have tested positive. That is roughly one in 20 of the world total, or one in five of US cases. It dwarfs Britain's figure of 34,000.
The surge, up from zero a little more than a month ago, has put immense pressure on the city's hospitals, with numbers forecast to soar for at least another fortnight.
The Telegraph has talked to 10 healthcare workers on the frontline of the city's battle against coronavirus to understand what is really happening on the ground.
People working in intensive care units, emergency rooms and ambulances agreed to speak, some asking for anonymity. Hospital administrators, trade union leaders and New York City officials were also interviewed.
A consistent picture emerges of hospitals struggling to deal with unprecedented demand, healthcare workers fearing for their safety and widespread shock at the scale of deaths from Covid-19 - already more than 1,300 in New York City.
"People are dying, just dying left and right," one patient care assistant said. "Each day I just hope we see fewer deaths than the last," said a nurse. A paramedic said: "It is like a war zone."
The most consistent complaint, and the issue triggering most frustration towards US President Donald Trump, is the lack of personal protective equipment such as masks, face shields and gloves.
The availability of N95 masks was repeatedly raised. Usually, when used for operations where infection is possible, the masks - which form a tight vacuum around the mouth and nose - are thrown away after each use.
Yet multiple New York healthcare workers said they were being made to use a single mask for at least a week. Some hospitals even have tables of brown paper bags individually named where masks can be kept overnight.
Gowns are in short supply too. Headlines were made last month when a photograph of three employees at Mount Sinai West hospital posing in bin bags for overalls emerged. The hospitals said they had proper protection on underneath.
Yet a nurse who worked there said concerns over the lack of equipment was real. "We are paranoid," she said. "I don't know what we have to do or say so they believe us – so they hear our cry for help."
Other shortages are emerging. Ventilators which keep a patient breathing in the most serious cases were once never used for more than one person in some New York hospitals. Now they can be split between two or even three patients.
The rapid expansion of bed space - every New York hospital has been asked to increase beds by 50 per cent - is a sign of success. Everything from Wall Street high-rises and Manhattan hotels to the US Open tennis centre have been converted.
• Covid19.govt.nz: The Government's official Covid-19 advisory website
Yet there has not been an equivalent increase in staff, meaning people are thrown into unfamiliar roles, attempting to handle a pandemic that remains little understood.
"It's really bad," said a pediatric nurse at an NYU medical centre now redeployed. "You're working on a unit you've never worked on before so you don't know where anything is. You don't know the doctors, you don't know the other nurses."
The immense pressure being forced on the city's healthcare system is felt from start to finish.
Medical emergency calls to 911 have spiked, with more than 6,500 a day - a third higher than normal. Such levels have not been since the September 11 attacks.
At the same time Covid-19 is ravaging the emergency response workforce. Some 20 per cent are off work, up from around six per cent in normal times. That means waiting times for ambulances are increasing.
Michael Greco, a paramedic working in Queens for 13 years and a president at the union Local 2507, said hundreds of ambulances had been called from other parts of the state to help meet demand and firefighters were stepping in as drivers.
Once at the hospitals, the problems continue. MGreco claimed one Harlem hospital was so busy that a doctor came out to treat a Covid-19 patient in the ambulance. Resuscitation was attempted and the person was pronounced dead without ever entering the ward.
"In my 13 years I've never seen anything close to this," Greco said. "We've gone through blizzards, we've gone through a micro-tornado, we've had Hurricane Sandy. Those, while all major operations, were time-stamped. This has now been two weeks."
And then there is what comes next for those who do not make it. New York City authorities have ordered in 45 refrigerated trucks that are now positioned ominously by hospitals - a sight, again, not seen across the city since 9/11.
They are being used to store dead bodies. Usually the city's morgues have capacity for around 900 bodies. That has been been increased to 3,500 as officials brace for the worst.
"We are trying our hardest to treat these people with respect and dignity," said Aja Worthy-Davis, a spokesman for the city's chief medical officer.
But it is another emotional toll on nurses. "When their families ask if they can see them, it's impossible to tell them where they are," said one nurse of those that pass. "No one wants to think of their loved ones being in a freezer truck."
Aside from the elongated hours, the pressure of treating the sick and the mental anguish of seeing so much death, another fear hangs over the medical workers - the concern of contracting Covid-19 themselves.
One New York hospital worker compared beginning a shift right now to "going into a war without any armour". Another said: "It is like walking into a burning building just knowing you're going to get burned."
She drives home sitting on plastic bags which are then binned. Once there she removes her uniform before entering, puts it straight in the washing machine and takes a shower.
She then wipes every surface touched with disinfectant, gargles salt water and lemon - she has heard it helps avoid infection - and uses a saline nasal spray.
"I stay focused because I don't want to miss a step. One wrong thing I could do at home could mean infecting everybody else. I could never forgive myself," she said.
Most worrying of all for New York's doctors and nurses is that the worst is yet to come.
Bill de Blasio, the city's mayor, issued an urgent nationwide call for more resources earlier this week, giving Sunday as the deadline.
On his wish list was 3.3 million N95 masks, 100,000 isolation gowns and 400 ventilators as well as 1,000 more nurses, 300 respiratory therapists and 150 doctors.
"Here is the blunt truth: without them, now, New Yorkers we could have saved will die," de Blasio wrote in a letter to the US president. There are three days remaining.
For Tannis, speaking with swollen feet propped up after another gruelling day of disease and death, it was hard to imagine that things can get worse.
"I am emotionally spent," she said. "I don't think I can produce the words … You have no idea what is happening inside hospitals. You have no idea how people are being traumatised."
She pleaded with New Yorkers, and all Americans, to take in a simple message: "I implore you. People need to understand - stay home."
Above all the concern is passing the disease on to loved ones. One woman who works in a Staten Island hospital described the lengths she takes every day to make sure the virus is not accidentally carried home to her children.
• Cases: 83,712
• Deaths: 1,941
• Refrigerator truck morgues: 45
• Masks needed by Sunday: 3.3 million
• Nurses needed by Sunday: 1,000
• Portion of US total cases found in New York: 1 in 4
The Boeing 777 aircraft disappeared from radar screens carrying 239 people in 2014.