A doctor working on the COVID-19 frontline in New York has described dealing with an "intense" volume of sick patients and the difficulty of having to support those dying from the illness who didn't have their family there.
Having recorded about 340,000 cases and with a death toll of more than 27,000, New York has been brutally impacted by the COVID-19 illness. Images and video footage has emerged from the state of refrigerator trucks storing bodies and hospitals under incredible pressure.
Dr Gregory Larkin is a specialist in emergency care who has worked in an assortment of roles around the world, including in United States universities, advising ministries of health, and conducting research. He is also the University of Auckland's inaugural Professor and Lion Foundation chair of emergency medicine.
While he hasn't worked on the frontline for a while, he took up the call to serve during the COVID-19 crisis in New York.
"It has been really busy. I haven't worked this hard since I was a young intern. It's pretty much 30 shifts almost in a row, 12-13-hour shifts. The volumes were quite intense. They are starting to level off, which is great. Now, they are down below average," he told The AM Show.
"Many people, perhaps some of whom shouldn't being staying at home, are still staying home and having their heart attack at home is not such a good thing.
"I worked only in the hot zones with the most high-acuity people so I was around all the very, very sick people the entire time."
In the early weeks of the United States' war on COVID-19, many doctors and nurses complained about a lack of personal protective equipment (PPE) with some having to buy their own or use materials from around their homes to protect themselves.
"I have been very fortunate. Some of my mates in neighbouring hospitals, in Brooklyn, in the Bronx, didn't have some of the same equipment I had in terms of protective equipment. I had a bit of spacesuit on almost all the time. I felt pretty good about that. I was doing a lot of invasive procedures where I was very fortunate to have that equipment," Dr Larkin told The AM Show.
"I brought my own equipment with me. I was not in New York. I came to New York at the Governor's request to have emergency specialists show up and I showed up. I realised it was an opportunity to serve and I was happy to do it."
One of the biggest challenges, Dr Larkin said, was having to support elderly patients dying from the virus who weren't able to have their families there with them due to the tight restrictions imposed within hospitals.
"It was really tough… It is definitely disproportionately affecting elders and many in nursing facilities and other long-term care facilities. Those were really difficult. It was made much more difficult by the fact that families couldn't be there to hold their hands."
"There were times where I was really a bit uncomfortable because I was trying to be a surrogate son and I would be holding up an iPad on a stand so the daughter or real son could be sort of close by while their mother or father died. Those are really difficult."
While most people have recognised the severity of the virus, others have complained it is just another flu, despite evidence from the World Health Organization and the United States' Centre for Disease Control and Prevention that the mortality rate of COVID-19 appears to be much higher.
Dr Larkin said there have historically been deadly outbreaks of flu, such the Hong Kong flu or the Spanish flu, but this is a different sort of beast to the common influenza.
"Flu does kill a lot of folks, but not like this. This is a different virus and it is a very clever virus and it has an ability to do things that other viruses before it have not been able to do. It has an amazing ability to dodge a lot of the usual treatments and it has the ability to affect multiple organs, not just the lungs."
While more research is necessary, doctors have learnt that people's cardiovascular systems can be damaged by the virus - such as what happened with the woman believed to be the first death from COVID-19 in the United States - and it can also cause blood clotting.
"We have been collaborating a good deal internationally to try to learn on the fly how to best manage this population of sick patients," Dr Larkin said.
But he does believe a vaccine will eventually be developed to handle the virus.
Dr Larkin also paid tribute to Dr Lorna Breen, the medical director of the emergency department at New York-Presbyterian Allen Hospital in Manhattan, who died from self-inflicted injuries in April.
Dr Breen had contracted the virus but returned to medical work just a week-and-a-half after recuperating. The hospital sent her home and after a family "intervention", her father said, she went to Charlottesville, where she later died.
Her father said she seemed "detatched" and was speaking a lot of the patients dying from COVID-19 at the Manhattan hospital.
The Charlottesville Police Department put out a statement at the time acknowledging the extreme toll the crisis was having on healthcare workers.
Dr Larkin said Dr Breen had been in a "very difficult position".
"I didn't know her personally, but it certainly is a great tragedy. She was a top doctor on the frontline. Sometimes we are putting our most vulnerable folks on the frontlines when they are not always ready. Many of us, not to be uncharitable, feel we were born to do this," he said.
"It is a very difficult job and it can get to you if you are not careful. You have to be able to balance your heart, your mind and your soul with everything you are doing and it is not simple.
"She was in a very difficult position in a very difficult part of New York. She had really an almost impossible job. You have to embrace that with a certain kind of gusto and say 'okay, this is my chance to really help and my chance to serve.' I think she was overstressed and overstretched and it is really tragic because she was highly trained and definitely one of our top doctors."
