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William Paolo was working with other patients in the emergency room when Onondaga County’s first COVID-19 patient arrived. The county announced its first two cases, a woman in her 70s and her husband, on March 16, 2020.

Soon enough, the emergency room at Upstate Community Hospital was divided with barriers separating patients who had COVID-19 symptoms — cough, fever, loss of taste or smell — from others. But doctors were careful never to call it the “coronavirus side.”

“We didn’t want to freak people out,” said Paolo, an associate professor of emergency medicine at Upstate Medical University.

Medical professionals in Syracuse and across central New York have fought the disease for a year, learning previously-unknown treatment methods, navigating possible equipment shortages and watching patients die isolated from loved ones, all while grappling with their own mental health.

In February 2020, doctors were only allowed to test patients for COVID-19 if the individual had traveled recently or come in contact with someone who tested positive, Paolo said. This limitation led to missed asymptomatic cases and undetected community-based spread, he said.

Paolo, like other medical professionals, had dealt with flu epidemics before, such as SARS and MERS, which ended fairly quickly. But when he heard about the first COVID-19 cases in Seattle, which could not be traced back to travel, he knew the virus might be coming to Onondaga County.

As virus “clusters” began popping up in New York City and cases increased in nursing homes, Paolo and other medical professionals knew the pandemic had taken an unforeseen turn.

“Mid-March was when we knew it was going to be bad. Then it got worse, quicker than we anticipated,” Paolo said.

Jay Brenner remembers assuring his first COVID-19 patient that the hospital would do all it could to treat him. The patient died shortly after. In the early days of the pandemic, when much was unknown about the virus, there weren’t as many treatment options available as there are now, Brenner said.

“I remember just trying to reassure him that we were going to do the best we could for him. But this was before we had any approved treatments, and we were still learning exactly what to do,” Brenner said.

Since the virus was unfamiliar to doctors at the beginning of the pandemic, it created apprehension for emergency room doctors, both Paolo and Brenner said. When the virus first reached Onondaga County, doctors were unsure how it spread, whether it could do so by touch or only through airborne transmission, Paolo said.

Paolo remembers having Zoom sessions with physicians from Wuhan, China, as well as doctors in Italy and Seattle — places the virus hit before reaching Onondaga County.

“None of us knew anything about the disease,” Paolo said. “We were just seeing the first cases on Earth that any of us had ever seen.”

One especially stressful moment came when hospitals feared they would run out of ventilators, Paolo said. There was discussion among hospitals in the state of using special technology to “split” a ventilator between two people and about ethically reallocating ventilators to patients who needed it more than others.

“It was a very nervous time when you had a multidisciplinary team of religious leaders, bioethicists, community-based leaders, physicians all talking about how you would ethically allocate scarce resources if it came to it,” Paolo said.

Fortunately, it never came to that.

Since the beginning of the pandemic, medical professionals have learned that it’s actually best to keep COVID-19 patients off a ventilator for as long as possible, Brenner said.

The big difference between treating COVID-19 patients and other diseases seen in the emergency room is the risk posed to doctors, Paolo said. COVID-19 is the first disease in a while where doctors treating it have also faced concern for their own personal safety and health, he said.

“We take care of a lot of things, and a lot of awful diseases, but for the most part we can go home and not have to worry about bringing that to our friends, family or loved ones,” Paolo said.

Some medical professionals had concerns about whether there would be enough personal protective equipment for doctors, and to what extent that equipment could even protect them, Paolo said.

Now, medical professionals know that the hefty protective equipment used in hospitals is enough to prevent transmission, he said.

Different communities experience the pandemic differently, Paolo and Brenner said. Upstate saw more COVID-19 patients this fall than in the spring, they said. Paolo said the county’s peak, which he said occurred from November to January, was “uncomfortably busy,” as the COVID-19 ward filled and spilled out into other wards.

Lisa Olson-Gugerty, an associate teaching professor of public health in Syracuse University’s Falk College who’s also a nurse practitioner in emergency medicine, has worked at several urgent care centers and testing centers across central New York throughout the pandemic.

“The demand now for work is endless,” she said. “I can’t seem to stop working because the demand on health care workers, especially in this area, has gone significantly high.”

Medical professionals said the most devastating part of the pandemic was watching patients die in isolation. Paolo said he watched patients say their last goodbyes to loved ones through a screen, only to later die alone or surrounded by strangers.

“Not that people have perfect ways that they want to die, but if you talk to most people about how they want to die, it’s generally surrounded by loved ones at home, in a place that’s comfortable for them,” Paolo said. “This pandemic has taken that away from a lot of people.”

The pandemic is dragging on like a “slow-moving” natural disaster, and the mental toll that the pandemic has taken on professionals in emergency medicine persists, he said. Burnout is common in the medical field, but it has especially been a problem throughout the pandemic.

“The mental toll of the pandemic is still rearing its ugly effect, and I think it will for years to come,” Brenner said.

Paolo and Brenner both mentioned the loss of their colleague, Lorna Breen, who treated COVID-19 patients at NewYork-Presbyterian Allen Hospital. She died by suicide in April. Breen’s family has pushed to pass legislation, called the Dr. Lorna Breen Healthcare Provider Protection Act, to provide mental health assistance to health care workers.

While the public treated medical professionals as “heroes” in the beginning of the pandemic, that rhetoric has since quieted, and in some ways, changed completely.

“You’re there, you’re taking care of so many sick and dying people day after day, and then you come home to news reports of people protesting shutdowns or wearing masks,” Paolo said.

One of the most taxing parts of the pandemic, especially at the beginning when treatment options were scarce, has been the sense of helplessness and inability to provide patients with the care that they need to fight an unknown disease.

Brenner said he’s found support in colleagues, family and friends, all of whom he’s been able to lean on throughout the pandemic. For Olson-Gugerty, the most memorable times from the pandemic have been the camaraderie and sense of teamwork between colleagues she worked with at testing sites.

Olson-Gugerty has now been helping distribute vaccines to eligible patients over 60 in Ithaca.

Onondaga County has seen a downward trend in cases since January, and the rollout of vaccines also has been “nothing short of miraculous,” Paolo said. But still, he wishes that support for medical professionals would go beyond words.

“I speak for all of us when I say we’d rather be funded than called heroes,” Paolo said.

Visit SuicideIsPreventable.org to learn about the warning signs for suicide and find local resources in your county. If you or someone you know may be at risk, call the National Suicide Prevention Lifeline at 1-800-273-8255 for immediate help.

Published on March 16, 2021 at 12:16 am

Contact Sarah: scalessa@syr.edu | @sarahalessan