The first wave hit last week. The emergency department at NYU Langone Hospital in Brooklyn was flooded with people all showing the same symptoms: cough, fever, inflamed lungs.

A week later came the second wave. Many of those same patients were getting worse, said Dr. Tanzib Hossain, a pulmonary and critical care physician dealing with the COVID-19 crisis at the 450-bed teaching hospital.

It's a heartbreaking situation that's playing out in hospitals across New York City, he said.

"This is ... the scary part for physicians in the emergency department. All of the patients that came in, a full five days in, they're all, to put it in the clearest way, they're dropping like flies," he said.

As of Wednesday night, he said, none of the patients who'd been put on a ventilator at the hospital had survived and recovered, though one was taken off Thursday morning and remains in care.

Many people who contract COVID-19 experience less severe symptoms and are able to recover at home.

However, in New York's hospitals, some patients are on ventilators for prolonged periods and most have not improved in any significant capacity, Hossain said.

And it's not just the elderly who are falling gravely ill. Hossain has seen first-hand that adults of any age can experience COVID-19's most severe effects.

"I think that's what was alarming," he said.

Medical workers outside Elmhurst Hospital Center in the Queens borough of New York City on Thursday. A day earlier, Elmhurst reported 13 COVID-19 patients died at the hospital in a 24-hour span. (Angela Weiss/AFP via Getty Images)

That is the reality on the front lines in New York, which has become the epicentre of the coronavirus outbreak in the U.S. As of Thursday, the city alone accounted for a third of all cases in the country, while New York state as a whole made up almost half.

There were 385 deaths in the state as of Thursday. Over the previous 24-hour period, hospitalizations went up 40 per cent to 5,327 and ICU admissions went up 40 per cent from 888 to 1,290, according to city statistics.

"It literally is like a war zone and everyone is in it, in the trenches together, and we rely on each other," Hossain said, referring to his fellow health-care workers.

What weighs on him the most

He said the hospital began putting in place contingency plans in January, after news of the virus emerged in China. The hospital had three intensive care units, a surgical ICU, a neurosurgical ICU and a medical ICU. One by one, they are being transformed into COVID-19 units.

Right now, the hospital hasn't reached capacity and is still expanding its beds and staffing levels to accommodate more COVID-19 patients. But for all the numbers and curves and projections, Hossain says none of that matters when he's one on one with a patient who may never recover, telling that person this might be the last moment they're awake.

It's a conversation that takes place in isolation; patients aren't allowed visitors, so the doctor or nurse is the last person they'll see.

Doctors at St. Barnabas Hospital in the Bronx test hospital staff with flu-like symptoms for COVID-19 in tents that were set up to triage possible COVID-19 patients before they enter the main emergency department area. (Misha Friedman/Getty Images)

"Say a 30-, 35-year-old individual comes into the hospital, just had a cough for a week and now they can't breathe, and I have to go up and tell them, 'I probably have to intubate you right now. So talk to whoever you want to talk to because once we sedate you, once we put the tube in, there's no guarantee we can take the tube out,' because we haven't seen anyone so far come out from this."



That, he says, is what weighs on doctors and nurses on the front lines more than the numbers, more than the lack of personal protective equipment, it's seeing those patients in their final moments.

"People are not recovering at a rate that you would hope and you don't have adequate treatment yet," he said. "The hope is that's gonna come, but until we have that, patients are getting sicker, staying sick, and it's serious."

New York Gov. Andrew Cuomo stated bluntly that every possible scenario for the virus's spread sees hospital capacity overwhelmed, so getting more beds is a priority. That means increasing capacity from 53,000 beds to 140,000 beds statewide.

A sign is posted on the door of the emergency department at St. Barnabas Hospital. Patients in critical care units are held in isolation, so family members are unable to visit. (Misha Friedman/Getty Images)

Hossain welcomes efforts to increase capacity and provide more supplies. He points out that woven into the monumental struggle facing health-care workers is the resignation that many will get sick with the very illness they're trying to treat.

"It just seems inevitable to us. But we're doing the job because this is what we signed up for."

Clear message

With the governor predicting the crisis will peak possibly in 21 days, Hossain knows it will get worse before it gets better.

He says the message is clear: continue social distancing and take seriously all attempts to limit the spread of the virus.

"Individuals at home, I want to make sure you are aware that what you're doing is very important, continue doing that. It's a sacrifice, I understand, but it's a sacrifice that makes a difference to us in the hospital."

WATCH | A pulmonary and critical care physician paints a harrowing picture of the situation inside NYU Langone Hospital in Brooklyn: