Back in March, when we talked with an anonymous local ER doctor about what it’s like being on the frontlines of the pandemic, there was one message that stood out more than any other: “Really,” the doctor implored, “try to eliminate your contact with people and stay home as much as possible…if I could sum it all up: please, God, listen to that.”

In the intervening six weeks, a lot has happened in all of our lives. But nothing compares to what this doctor—who caught the virus shortly after our initial conversation—and colleagues go through everyday.

We checked back in this week to see how life has changed for hospital workers since the start of the pandemic—and what we all need to know as we head into the long game of controlling the virus. (This, the doctor wants to make clear, is not intended as medical advice; for that, check with your primary care physician.)

Katherine Rapin: First of all, how are you feeling? Shortly after we talked, I know you got sick and tested positive for Covid-19. What was it like? And what has it been like being back at work?

MD: I had the classic Covid experience: I got a really intense burning in my chest with shortness of breath, body aches like I’ve never had before that lasted like five days. And the shortness of breath has lasted longer. I went back to work and worked for three days and I couldn’t concentrate. I was so out of breath I felt like I was being choked and I had to go back out for another week and a half. There are people who have been out for 30 days; it just keeps hitting them.

The novelty has worn off and the endurance race is on.

I’m still feeling the effects, a month or so out. I find that if I’m walking around and start talking I have to stop and take a deep breath. I still use an inhaler every once in a while. It’s exhausting to be at work. You’re breathing through an N95 mask and a face mask—you feel like you’re being smothered. And the patients are old and complex and confused and you’re fighting with them—it’s exhausting. I have been more exhausted in the past month or so than I’ve ever been. If I work more than two days in a row, I’m just wiped.

KR: How are things at the hospital different than when we last talked over a month ago?

MD: The system of addressing patients with Covid has become much more routine now. Volumes are down in most hospitals, people are staying home and having to put their surgeries on hold.

But that being said, we do have a steady and almost rising population of Covid patients at the moment, mainly the elderly. We have these large care facilities where Covid runs rampant throughout the community there. The hospital volume is down, but the patient complexity is increased. People are way sicker and especially once you start adding the co-morbidities, it’s even worse.

The novelty has worn off and the endurance race is on.

KR: Are you seeing changes in the other trauma—like gunshot victims—coming in?

MD: Normal urban violence seems to be holding. The summer months are when that picks up, so we will see.

KR: We heard a lot about Personal Protective Equipment shortages—at this point, do you have what you need to protect yourselves?

MD: In the ER department we’re doing okay. We thankfully have access to the things that we need—just making sure that we’re not being wasteful, which is hard to do. We still are using the N95 masks for a week, and there are some concerns about reusing gowns. But getting the essentials in a rural hospital system with less money—they’re hit a lot harder.

KR: How does testing work these days?

MD: There’s a rapid test that gets results within an hour, which is nice. There’s also the standard non-rapid test that’s getting results in 24 to 48 hours.

KR: And about how many people are you testing each day?

MD: It vacillates, I would say 50 to 75 on average. We’re trying to use a little more discretion. Young, healthy people who present with sort of ambiguous flu-like symptoms or respiratory issues that aren’t in any distress, they’ll send them with suspected positive. A 24-year-old male who feels under the weather, there’s not a whole lot of reason to test them, it’s not going to change the course of their treatment. If you’re an older person who’s acutely ill, obviously you’re being tested.

KR: And how many patients are you seeing in a shift?

MD: Between 25 and 35, but that varies.

KR: How’s morale among your colleagues?

MD: We still have to make light of the situation when we can. We try not to inundate ourselves with too much Covid talk. Most people are sick of it already and are trying not to think about the longevity of it and just take it day by day.

The light moments are heightened camaraderie between the ED staff. Everyone at home has their own set of stressors that we have to deal with on top of this pandemic. Coming into work and being able to vent, see someone else besides your immediate family member, and know you are supporting each other is really a wonderful experience.

Being able to laugh with fellow staff after a grueling day, knowing that you have this shared experience, and coming out the other side in one piece because everyone worked as a team is extremely rewarding and helps with the mental fortitude necessary to endure protracted periods of high stress.

KR: We’re getting a lot of conflicting info about longevity—I know there are so many changing variables, but how long are you and your team planning to be dealing with this in a critical way?

MD: I think a year is a pretty conservative estimate for things being pretty much in high gear. Especially if we get hit again in the fall. The concern is that this type of virus will just stick around—maybe wane at the end of the summer and then ramp up again and that will be compounded by the flu season. It’s just too early to have any sort of firm grasp on how Covid will behave in the long term.

Obviously, anything can happen. The new research out with the antiviral medication—I don’t know how that’s going to factor into it.

This virus is a whole other animal in terms of how it presents and what it does—that’s been amazing to see and terrible at the same time.

KR: What have you learned about the virus in the last month or so? Is there anything you would have done differently knowing what you now know?

MD: The main thing that people are learning is that the symptoms vary so much, which makes it so difficult to get a grasp on a lot of the disease and virus. There are symptoms everyone knows are related to the flu. With Covid there are so many varieties of symptoms that are related to the virus, for hospitals to appropriately triage people and put them where they need to go is proving even more difficult. Sometimes people will be in the non-Covid area and will be getting a chest X-ray for some unknown reason and then on the chest X-ray they see pneumonia that correlates with Covid—now you’ve had a breakdown in keeping people separated.

This virus is a whole other animal in terms of how it presents and what it does—that’s been amazing to see and terrible at the same time. There’s no way that anyone could have planned for that except through trial and error and learning how this thing works. The medical community was pretty united in their concern about what was going on.

The burden unfortunately falls on our government, and it really screwed the pooch. In February, that was the key moment to act, and nothing happened and we sort of allowed this crisis to get away from us. You can never get ahead of something that’s already ahead of you, unfortunately. That will go down in history as our biggest mistake: not acting quick enough.

KR: What resources are you using to stay up to date on the latest research and information about the virus?

MD: It’s funny that you say up to date because that’s actually the name of the source. And I’d say our hospitals are doing a great job. There are daily emails coming out with updates and information and they do a town hall at least once or twice a week where people can ask questions. It feels like something that was done that morning is no longer the way it should be done by the afternoon. People can get frustrated by that, but the situation is just developing so rapidly you just have to stay fluid.

KR: Has your view of medicine changed at all throughout this?

MD: I don’t think my internal experience has changed, but I would hope other’s perspectives on medicine has changed. Realizing the necessity of listening to science and medicine and understanding the type of sacrifices that people make. It’s nice that people are celebrating healthcare workers more than usual. I definitely think doctors and nurses get their fair share of respect, but I would just hope that people would understand the nature of the job and how much everyone is invested in their different communities.

So many people are so quick to tell me that they don’t get a flu shot because they don’t believe in it or they think it makes them sick. You’d have to be sort of nuts, in this time, to still be skeptical of vaccinations. Maybe the collective understanding of public health will be much more celebrated because we’re realizing how much everyone is interconnected.

Are you willing to do something that you maybe don’t even believe in but seems to be for the greater good, or do you insist on doing what you want to do because no one can tell you what to do?

KR: How can Philadelphians help healthcare workers right now?

MD: The main way would be to continue to isolate. You have to give the virus the opportunity to spread—it won’t sustain on its own. The real test is when the weather’s good, and people have been stuck inside for a month and a half and the sun’s out. If Philadelphia could just hold the course and remain committed to socially distancing and reducing unnecessary travel, that’s going to be the big factor.

Not only is this exposing the shortcomings of our systems—our healthcare systems and the way other essential workers are treated—it’s also going to be a gigantic moral question, too: Are you willing to do something that you maybe don’t even believe in but seems to be for the greater good, or do you insist on doing what you want to do because no one can tell you what to do?