New York City, which currently has more than twenty thousand confirmed coronavirus cases, is facing a dire medical emergency. Hospitals are reporting increasing numbers of deaths and critically ill patients, as well as shortages of medical staff, ventilators, and basic protective equipment. On Monday, Governor Andrew Cuomo issued an order requiring state hospitals to increase their bed capacity by half. Some hospitals in Queens are now constructing makeshift morgues for coronavirus victims.

I recently spoke by phone with Antonio Dajer, a longtime Manhattan emergency physician, who is currently treating coronavirus patients. On September 11, 2001, Dajer was the assistant director of what was then called N.Y.U. Downtown Hospital, the closest hospital to the World Trade Center; the planes struck during one of his shifts. During our conversation, which has been edited for length and clarity, we discussed the similarities and differences between 9/11 and the current crisis, what preparation time allows medical staff to accomplish, and the frustration of medical professionals over the way the federal government has managed the coronavirus pandemic.

What have your last couple weeks been like?

I am working at NewYork-Presbyterian Hospital, at the Cornell campus in midtown east and the lower-Manhattan campus. There has been a lot of working out of protocols to protect patients and providers, and also to intelligently triage patients either into or out of the E.R., if possible. And also to reassure the worried mild patients. Also, I am not part of this, but the telehealth process is really robust and has been really critical. Given the lack of testing, a lot of what is being done is clinical judgment, and the telehealth people are doing a phenomenal job of reassuring patients and also deciding who needs to come in to be cared for. They are very much helping to keep the emergency departments themselves from being overwhelmed.

Let’s take a step back. What was your experience on 9/11?

I was the only attending physician on duty at the hospital, which was four blocks away from the towers. We had done a drill for disaster preparedness a couple months before, and also had gone through the 1993 World Trade Center bombing. So my hospital was very well prepared and pretty much on high alert for anything similar. We got an avalanche of patients immediately, within about ten minutes of the towers being hit, so managing that onrush of patients, many of whom were in critical condition, was quite an experience, as you might imagine. But I felt pretty well prepared for it, or as much as you can be, because of what we had practiced. And I am happy to say that, despite overwhelming numbers, the hospital was never overwhelmed. We did not miss any patients or lose anyone who could have been saved, which is something I am eternally grateful for.

Can you explain more about why, despite overwhelming numbers, the hospital wasn’t overwhelmed?

I think it was partially the preparation. I think 1993 was a very good drill, and people had plugged the holes we had discovered. Also, as a small hospital where everyone knew each other well, there was very clear leadership and a very clear allocation of resources. I directed the response, and I had already been there for a while and was well known within the hospital, so there weren’t any questions about who was in charge of the emergency department, or who was in charge of surgery or any of the other departments.

I think my big takeaway from 9/11, as far as medical staff dealing with an emergency, is that if you give trained doctors, nurses, physician assistants, nurse practitioners, and all medical providers clear direction and adequate resources, they will self-organize and do a very impressive job. The key is to have clear direction and a clear allocation of space and resources.

So, you had adequate resources as well as personnel?

We did. But we were also able to offload. When we reached capacity and had to transfer patients who were stable, other hospitals uptown immediately accepted our patients. We would simply load ambulances and shift patients uptown—burn patients to Cornell, long-bone fractures to uptown hospitals for special surgeries. All the different hospitals north of us didn’t ask any questions and took all the patients we needed to get out.

The critical surprise on 9/11 was how hard communications were. Cell phones went down. It was very difficult, partially because the city’s Office of Emergency Management was destroyed because Mayor Giuliani, for very unclear reasons, had put it across the street from the North Tower. It was destroyed in the attack, and left us pretty much leaderless, with all the communications systems pretty much down. But people worked around that with physical relays and messengers and simply walking or running or grabbing a car and going to the different sites to stay in touch.

Were you afraid that the hospital as a physical building was going to be under threat?

We were pretty afraid. We were seeing people jumping off the towers. We were that close to the towers. When the first dust cloud came, I thought that they had attacked another building, and they were taking out successive buildings in lower Manhattan and we could be next. So the fear was certainly there. I don’t remember being terrified or paralyzed by it. I just remember thinking to keep dealing with what I was dealing with and to fix one problem at a time. The hospital itself was so physically damaged, in terms of the smoke clouds, and later that day losing ventilation and power and other resources, that we were adapting all day long. So it was a combination of the hospital being both damaged and impaired and dealing with an overwhelming number of patients.

Did hospital workers face long-term health consequences from the dust or anything else?

Yes. And I think that that was underplayed. We did not think about it much at the time. We were handing out masks, but everybody kind of shrugged. There was no place to go, so we were in it. But I think my biggest regret about 9/11 was about how the risks were downplayed in the days afterward. After the first two days, when it was clear there were no more survivors, putting people’s lives at risk to sift through rubble or dig through the wreckage really made no sense. It was a very emotional, almost headlong rush into the rubble, because people wanted to rescue and somehow undo the devastation. But there was no logical reason for it. The reconstruction could have waited, and in my medical opinion was not well managed by authorities.

What did you mean about everyone shrugging at the masks?

We used them for a while, but it was around everywhere, and it was almost as if you couldn’t get away from it anyway, and people got tired of them, and I don’t think we used them as systematically as we needed to. I remember thinking at the time, “Gee, I wonder if there was asbestos in those buildings. They were built in the 1970s.” And it turned out there was. So you do these quick calculations in your head about what you are able to do and keep functioning, and the long-term risk is so difficult to calculate that you almost don’t even pay attention.