In New York hospitals, staff are working extra shifts and searching desperately for more bed space as they battle a surging toll of dead and infected at the US epicenter of the coronavirus pandemic.
At the beginning of the COVID-19 crisis, which has so far claimed 385 lives across the state, patients were mostly elderly or sick, according to one respiratory therapist, who works in the New York City borough of Queens.
"Now it's 50-year-olds, 40-year-olds, 30-year-olds," said the employee at the Jewish Medical Center, who declined to give his name.
They "didn't listen about not going out or protecting themselves and washing their hands," he added.
"To watch somebody in their thirties die, it's hard. You can't have visitors. They're in the room by themselves on a ventilator. It's very depressing." Governor Andrew Cuomo has ordered New York hospitals to increase their capacity by 50 per cent, or even double it if possible, as the state's coronavirus death tally soars.
"You have certain floors that will go COVID overnight," said an administrative worker at the same hospital.
"They're dedicating that whole floor to COVID patients and just seal that off and that's it." Despite occasional shortages, the equipment nurses need to battle the virus -- masks, gloves, scrubs -- is still available, staff say.
There is also no shortage of artificial respirators and doctors have not been forced -- as they have been elsewhere in the world -- into choosing which patients to save. But that hasn't stopped the dead piling up.
"We have a lot of deceased patients," said a nurse at Mount Sinai Morningside hospital in Manhattan who wished to remain anonymous.
"It's mostly cardiac arrests. It's getting rough." The extra hours are also taking a physical toll on staff.
The therapist at the Jewish Medical Center usually works three 12-hour shifts per week.
"But now I've been doing five, six days... so 60 hours the last couple of weeks."
In front of the Elmhurst Hospital Center in Queens on Thursday, a long line of people, most in masks, stood three feet (a meter) apart under police watch as they waited to be tested.
An ice cream van drove by, playing its jingle, adding to the already surreal scene. Wearing a protective mask and gloves, Juan Rodriguez was waiting while his son Jimmy queued to get tested.
"He has been coughing and has had a fever for the past four days," he said.
"We came yesterday, but there were too many people, so we went back home. And so I've been here queueing for him since seven this morning." Officials have warned that the peak of the pandemic in New York is unlikely to occur for another two or three weeks, spelling more anxiety and stress for responders who are already at maximum capacity.
"The next few months will be painful and stress our health care system like never before," New York City Mayor Bill de Blasio tweeted Thursday.
Anthony Almojeria, a leader in the emergency medical services union, said they were receiving "over 6,000" calls every day.
It is "breaking records. We didn't have this many calls on 9/11," he said, referring to the September 11, 2001 terror attacks.
"It's scary but this is the profession we chose," said the respiratory therapist at the Jewish Medical Center.
"This isn't the time now to abandon your patients. They need you. If somebody in my family got sick I would want people to do the right thing by them. That's all I can do.
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