In the hours before he began to spit up blood, before his breathing became seriously labored, before many of his vital functions crashed in a free fall, Alvin Simmons encouraged his girlfriend to sing karaoke.

Simmons loved karaoke. He was especially fond of R&B. "Olivia," from The Whispers, was often a go-to choice — a song with an understated smooth groove that belies the painful life of the song's central character.

But, on March 13, as he lay in bed, hoping that tomorrow would bring more health and less congestion, Simmons asked his girlfriend Lisa Williams to sing solo.

"He said, 'I want you to do karaoke,' " Williams remembered. " 'I can't join. I want to hear your voice.' "

The next night Simmons, 54, was at Rochester General Hospital — a patient struggling for his life at the same hospital where he had worked only days before as a maintenance man.

During the short ambulance ride there, he lost most of the oxygen to his brain, according to his sister, Michelle Wilcox. By day's end, he was largely if not completely brain dead.

Simmons later was removed from his lifelines. He was pronounced dead on March 17 — the first person in Monroe County to be fatally felled by COVID-19.

Alvin Simmons and Lisa Williams Provided photo

That was hundreds of cases and more than 30 deaths ago, a number that may well change before this story is read. Yet, the lingering questions about Simmons' death — how did he contract the coronavirus? How many others were put at risk? — will surely be the same questions that hang over many of the past and future fatalities.

In life Alvin Simmons, an Army veteran, sometimes struggled, having spent time incarcerated. But in recent years he was in a good place, finding peace and love and, after difficulties with prospective employers concerned about his past, a job.

It was a job in a place where he had long longed to work — a hospital. While he might not have been a doctor or a nurse, he was in a place where people helped; where people healed; where kindness manifested itself many ways each and every day.

"He always wanted to work at a hospital, even when he was a child," Williams said. "He use to walk around smiling, and singing, 'I got a job, everybody. I'm working at a hospital.' "

Breathing difficulties

When he began to have difficulties breathing in early March, Simmons parted with cigars. That was a tough move; he loved his Black & Milds. But, he assumed, the popular cigars might be the cause.

On March 12, as his breathing issues worsened, he went to the emergency room at Rochester General Hospital — the same medical facility where he'd begun his maintenance job on Feb. 24.

"Based on his symptoms and clinical evaluation, he was tested for the COVID-19 virus," hospital spokeswoman Veronica Chiesi said in an email. "He was discharged from the ED (emergency department) in clinically stable condition."

He was diagnosed with pneumonia and prescribed antibiotics on the chance his infection was bacterial, but he did not significantly improve.

He told his sister in a phone call he planned to watch a movie, looking for something to take his mind elsewhere. But little seemed to help.

"He fought it out on the 13th" of March, Wilcox said.

But his condition continually worsened. He sweated so much "I could wring one of his shirts out," Williams said.

Hoping it would pass, Simmons asked Williams to sing karaoke to him. She chose a song from one of their favorite artists, Luther Vandross.

Simmons lived for karaoke, and wanted to join. He said he did not have the energy.

They would not sing together again.

Happy texts and messages

Alvin Simmons sent Lisa Williams many texts and funny memes before she decided to date him in 2018.

"When I first met Alvin, I was going through some personal things with a child," she said. "He use to send me things through Messenger, like uplifting songs. He'd send me messages like 'Hold your head up.' "

He worried he might be too aggressive, once saying, "I don't want to seem like a stalker."

Williams agreed to go out with him, and on the first date he cooked her a dinner of baked chicken at his sister's house.

"We've been together ever since, nonstop. He was my best friend."

As his affinity for karaoke showed, Simmons loved music — and he seemed to have a sixth sense about how to use it. He once sent a friend a song. She called back in tears.

Alvin Simmons (tallest) was the first COVID-19 fatality in Monroe County, NY. He died on March 17, age 54. Simmons was an employee of Rochester General Hospital. Provided photo

"That was my father's favorite song," she told him, according to Williams. Her father had died that very day.

Simmons came by his affection for music honestly. He has five brothers and three sisters now, and all were exposed to music. Karaoke was a constant at family gatherings, Wilcox said.

"Anywhere we went we had karaoke machines," she said.

Simmons was a jokester, with one line he found comical but others had no idea how it originated.

"He would tell a lot of jokes and at the end of every joke it would include the year 1942, like 'I haven't seen you since 1942,' " Wilcox said. "No one knows why except him."

At her city home, as she stayed in isolation after learning of her brother's COVID-19 diagnosis, Wilcox turned to videos of her brother singing karaoke, watching them over and over again.

She had little else to remember him by.

The COVID-19 onslaught

On the late afternoon of March 14, an ambulance took Simmons to Rochester General Hospital. COVID-19 had not delicately or mildly invaded his body. Instead, it was wrecking his insides.

At home he'd been spitting up blood. He was hesitant to go to the hospital, but Williams insisted.

After calling 911, and as they waited for the ambulance, Simmons seemed to weaken by the second.

"He kept going in and out," Williams said. "He was dying, I felt, right in front of me. I couldn't help him or do anything."

He was still awaiting his test results for COVID-19. They had yet to return.

Wilcox was later told that he'd lost a significant percentage of oxygen to his brain, and suffered multiple seizures.

The next day, the family was informed that Simmons was brain dead, Wilcox said.

That was the same day his test results returned.

"While he was hospitalized, RGH received the results from the state on March 15, 2020, confirming that the test performed in the ED on March 12 was positive for COVID-19," RGH spokeswoman Chiesi said in her email.

The family recognized the decision they had to make — as difficult as it was. He was removed from life support.

Alvin Simmons died on March 17.

Alvin Simmons (left) was the first COVID-19 fatality in Monroe County, NY. He died on March 17, age 54. Simmons was an employee of Rochester General Hospital. Provided

The loss of a boyfriend and brother

Lisa Williams, who has suffered health issues in life, went into quarantine. She tested negative for COVID-19. Her daughter, who lived with her and Simmons, tested positive. She now appears as if she will come through her quarantine in good health.

Both Williams and Wilcox wonder just where Simmons contracted the virus. They suspect the hospital, while hospital officials say that is unlikely. He cleaned the room of a deceased woman in the days before he fell ill, Williams said, and found himself bothered by the job. Rochester General said Simmons was its first patient to test positive for the coronavirus; if the dead woman whose room he cleaned had COVID-19, it was undiagnosed.

"We have no evidence to suggest that Mr. Simmons was at a heightened risk of exposure to COVID-19 by virtue of his training or employment duties at RGH," Chiesi said in the email.

Simmons also took the bus to and from work, but neither the health department nor Regional Transit Service have said whether they're aware of the virus being transmitted on buses.

When the novel coronavirus first made its way into Monroe County, health department officials hoped to "contact trace" those who tested positive to see just where they may have contracted the virus. But as COVID cases continued to climb and climb, such an endeavor became less realistic.

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Now Simmons' family and Lisa Williams are left with more questions than answers — similar questions for many in the region and, for that matter, the state, country and world. Where did his disease originate? Could quicker test results have made a difference?

And, they experienced what many others are experiencing — the inability to be with a loved one in the final hours of life.

Simmons mother is 75, and he "was her oldest child," Wilcox said. "And she was not able to be there. She was not able to hold his hand."

As the coronavirus numbers mount, Wilcox said she had a simple message: "If we want to stop the spread of this virus, we have to stay home, wash our hands. If you claim to love people, you would not want anyone to suffer this way."

Williams has Simmons' ashes at home now. On a recent night, she sat the ashes on a table and played the R&B he loved, including Luther Vandross.

"I just got the music on and just played the music like he was still here, to try to have that feeling of him being here with me."

The family is planning a memorial service for his birthday in August.

There will be karaoke.

Alvin Simmons sings 'So Amazing' by Luther Vandross Simmons loved karaoke. He was especially fond of R&B. Submitted, Rochester Democrat and Chronicle

Contact Gary Craig at gcraig@gannett.com or at 585-258-2479. Follow him on Twitter at gcraig1. This coverage is only possible with support from readers. Sign up today for a digital subscription.