Interviewer(s): Henry
Interviewee(s): Nora

Henry: OK. So this project is about the precrisis period of COVID, so from approximately late December-early January, up until the first wave hit New York.

Nora: OK.

Henry: I'm looking into perceptions of the crisis around that time; medical workers perceptions.

Nora: OK.

Henry: Just to see if if everyone was caught flat-footed or how people were getting information, that sort of thing.

Nora: Absolutely. OK, great.

Henry: Any questions for me before we start?

Nora: No, I don't think so.

Henry: Perfect. So is what's your name?

Nora: [full name].

Henry: And how old are you?

Nora: I am 44.

Henry: And where are you?

Nora: I am in Queens, New York, working in the Bronx.

Henry: So what was your job in January of 2020?

Nora: I was, and still am a physician’s assistant within [department] at [organization].

Henry: And are you in an emergency response role?

Nora: No. It's more of a primary care role.

Henry: So are you in a hospital, or a clinic, or…?

Nora: I'm in a clinic. I'm in a clinic. Outpatient clinic setting.

Henry: So when did you first hear about COVID?

Nora: I am going to say I first heard of COVID in December 2019.

Henry: Do you remember how you heard about it?

Nora: Likely the news. You know, some news media. I do not think it was through work. Initially anyway. Yeah.

Henry: And what were your initial thoughts?

Nora: Truthfully, my initial thoughts were not super alarming. I think that I had the perception that it was somewhat isolated at that point to China. And I think that my perception was that there might have been more understanding of what the what the virus was. In terms of a Corona virus, because we have seen Corona viruses before and that type of a thing.

Henry: OK, right.

Nora: Yeah.

Henry: So did you discuss this with anyone?

Nora: The first person I actually remember discussing it with was the medical director of our of our department, Dr. [name]. And that was probably in January 2020.

Henry: And how that discussion go?

Nora: So we had an interesting discussion because she I think she was kind of minimizing my concern about it because we hadn't seen much in terms of concern in the New York area at that time. But she had a- or has a close colleague who is an infectious disease specialist who amongst her friends and family were like she was ringing the alarms, like ‘this is going to be huge’.

This is a huge, huge public health issue. And so that was the first conversation in January 2020 where I actually had a moment of pause and said, oh, this is probably much bigger than I realized.

Henry: The medical director was ringing alarms?

Nora: Her friends rung the alarms to her. And so she and in turn was telling me that she was actually quite concerned and that we should likely be paying much more attention to it.

Henry: OK. And did that change how you perceive things?

Nora: Not immediately, to be honest. Not I mean, kind of like. So I think at that point, after we had that conversation, I was much more in tune with kind of the daily news and what was coming out of China and kind of what the the sentiment was here was that maybe we should be more alert to what was happening over in China.

Henry: And this is in January?

Nora: Correct? 2020. Yeah.

Henry: So how were you feeling around this time?

Nora: How was I feeling back that right?

Henry: Yes.

Nora: But I have to say, I don't think I was still at that point and I don't think I was super concerned, you know, unfor- on I guess, you know, about about our population and our and our patients here in New York City.

Yeah, I think I think I was super concerned- You know, I think when we saw again, I think this was media. We're seeing the hospitals being built in China. Right? Like at very fast paces and wondering actually how many people were passing away from this. And they were you know, that's when I started to, of course, be concerned for for them over in Asia.

But again, I wasn't super concerned personally, I have to say.

Henry: OK. So I guess, why not? If you were concerned for them, but not New Yorkers?

Nora: Well, I didn't think we were going to see it en masse as quickly as we did. You know, I thought I guess in the back of my mind again, I thought by the time it reaches here, you know, unfortunately for where it was, where it was starting, but by the time it came to New York, we would likely have a better grasp of diagnosis, treatment, intervention, that type of thing.

Kind of like when Ebola was an issue in Africa, right? And we kind of we got to start we got to start looking at this. We better start paying attention and then we kind of unfortunately, you know, we had a few cases of Ebola, but it never turned into a mass epidemic right? Here. So, yeah.

Henry: When you're working during Ebola?

Nora: I was.

Henry: Was that different?

Nora: I think it was I think it was different. I certainly and I was actually living very close to, in Brooklyn where the physician actually I don't know if you remember, he went bowling. He got off a flight and went bowling with his fiancee. Like three days later. I was maybe a mile away from that site.

And I was definitely crossing paths probably with it, you know, within Williamsburg. And I lived not too far from there. So that was concerning for sure. And then we realized, I think that the, you know, the I think it's the R factor, the point of contagion wasn't what we really you know, people weren't like coming down with Ebola just because they crossed paths with them. For a few minutes. Yeah. So that simmered my hysteria, I guess. Yeah.

Henry: This was I guess it was different Yes.

Nora: I think COVID was different because once people started falling ill and I would say honestly, that was the beginning of March 2020, when we started to see people hypoxic, short of breath, fevers. It happened, as we all know, so rapidly, in such quick succession. It wasn't one patient. It was, you know, we’d hear- we have I think we have like nine patients in our clinic.

We'd have like, you know, close to a dozen at a time. We’d hear of being ill. Staff was becoming ill within the clinic, and it happened very rapidly. So I think that was a little that was a lot different. Yeah.

Henry: Are we working during any other novel diseases? I mean, Ebola is not novel. But, you know.

Nora: The H1N1 flu of 2009, that was definitely again, certainly concerning. And I had a two year old daughter at the time, and she we had her double vaccinated. They had us come in and get a new flu shot for her. And my my husband got H1N1. Now he's a PA as well. But again, I think it did not cause the same hysteria and the same panic so.

And so every other kind of health emergency that I have been a part of was so different. So different.

Henry: Than COVID or Ebola?

Nora: And COVID then. Yeah, yep.

Henry: What about the original SARS?

Nora: Yup, the original SARS was in the early 2000s right? Was that 2003 or something? Around there? So I was a student. I was definitely in PA school at that time. And again, I'd heard rumblings of it. I definitely SARS and MERS. Right. I'd heard rumblings of all these concerning viruses. Right. But again, and it's unfortunate to say, but it was so like kind of far removed, right, from my personal and professional kind of life that it never really impacted too much, yeah.

Of my day to day. yeah.

Henry: So you mentioned you had these conversations with Dr. [name]. And she was sounding the alarm because one of her friends in [infectious disease] was sounding the alarm. Correct?

Nora: Yes.

Henry: Was there anybody else?

Nora: My my husband who works in urgent care was also a pay. I mean, if we had definitely had conversations about it, and in retrospect, I realize that he and I were talking, but he just kept perseverating on the fact it was a bad flu season. He was seeing so much, quote unquote, flu or flu like symptoms. And even if someone tested negative for flu, but they had flu like symptoms, sometimes we would think that maybe it was a negative rapid test, or right the swab didn't accurately capture it.

So you would have those types of pathogens. It's such a bad flu season seeing so much of it. So in retrospect, we wonder how much of that might have actually been there yeah.

Henry: When was that?

Nora: That was January to February. 2020. And he works, he works in Queens. yeah.

Henry: So did your perception of this change at all before the first wave hit?

Nora: Uh…. really thinking about that. Did it change…? For sure? For sure. I was I think I when we when I started to hear about the I mean, the hospitalizations and unfortunately the deaths, that we even still to this day are not sure of the actual number, I think, in China. But how rapidly people were severely ill and dying and running out of ventilators. And the /young/ population that was that was so severely ill, that's I'd say in February 2020 I started to get pretty nervous. For everybody. But it did take that long.

You know I would say honestly between December 2019 to like February 2020 it was still just a… you know it's just in the back of my mind type of situation. Yeah.

Henry: Did you have like a eureka moment or an oh shit moment?

Nora: Absolutely. Absolutely. And I can tell you when it was, it was March 2020, I'm going to say it was the second week of March, maybe March 10th, something like that. I remember very distinctly like those first few days of realizing what was happening. One of my coworkers - this is like the first day or two - that everyone said, you know, we should be masked, we should really be masked.

So that was like the second week of March to 2020. And one of my coworkers without a mask knocked on my door, said, I have a fever, I have a headache, and I had an oh shit moment. Because I said, until proven otherwise, now that we know what's happening, this is Covid. This is Covid. So we masked her up.

I don't even we didn't have any tests. No, we didn't have any, any way to treat her. And I think we sent her to the emergency department at that time to see if they had could do anything to diagnose her. But that was my oh shit moment, like it's in the clinic. It's here. Yeah.

Henry: So can you describe how you were feeling around this time?

Nora: Again, I really think, and I know this sounds - I don't know, it wasn't hysteria yet. It wasn't hysteria. It was still kind of like you know, this is bad. This is not - this is unprecedented, but we're going to we're going to handle this. We're going to handle this. In fact, one of the - and I was so like not the right person to do this, but nobody was there -

One of the administrators asked me to speak to the staff about COVID. So I remember, you know, being called in to a meeting with all the counselors, the social workers, to try to just give them a brief kind of summary of what we knew about COVID19 and how to protect ourselves and our staff. And even then I remember being like, OK, we have to maintain like some kind of composure.

We can't like all just full on panic. And so I talked about the other coronaviruses and what we did know about them and what we knew about flu and other respiratory viruses. Right.

But that was different. That was like the simmering of the hysteria, I think, at that point. Yeah.

Henry: How’d that talk go over?

Nora: And it did not go well. And I just and I think it's because everybody we were all just kind of shocked and stunned silence at what what seemed to be taking place. So I remember there, like there weren't many questions, there wasn't much talking. It was like everyone wear(?) a mask. If someone is sick, they cannot stay in the clinic.

We have to get them home with isolate that, but it's not going well. Yeah.

Henry: So you made some operational changes.

Nora: Yes. Very quickly, very quickly. Yeah.

Henry: During March?

Nora: During March. I would say during March we didn't very- and I'm sorry, I don't really specific timeframe- but patients who usually come to our clinic every day, we started spacing their their time in the clinic so they would come once every other day, once every week. Paid staff was was quickly put to remote work.

Every other week, once a week, they would come in and then they would spend a lot of the time at home. It's pretty quick, I think I would say late, late March 2020.

Henry: Late March. OK.

Nora: Yeah. That started happening.

Henry: But the clinic does anything to prepare, you know, during like January or February?

Nora: No, to my knowledge. To my knowledge, I don't believe so.

Henry: And that, Dr. [name] is the medical director for the clinic, right?

Nora: She is for the entire department. Yes. Yes.

Henry: So, you know, despite the warnings, do you know if she did anything or...?

Nora: We don't know offhand if she didn't. Right. And I'm sorry, because I probably I don't work in her clinic specifically. I actually just have to work with her that day. But our medical director who who is very aware of the stuff he was pushing, in fact, he now that we're talking about, he did tremendous work. He actually put up he advocated for the nurses who see our patients very close up within six feet.

He advocated for them to be wearing masks even before the mask mandate started. And he came in on a weekend, which was lovely, and put up plexiglass dividers because we give methadone, right? We just dispense methadone on a daily basis. So there was nothing between the nurses and the patients and they were very close within three feet. I'd say so we put up these Plexiglas dividers like a bank and where they would just slide the metal underneath.

And he did that on the weekend by himself, which was lovely. And I'm going to say that was again early March 2020, not before then.

Henry: Do you speak with him at all?

Nora: Yes, quite a bit. Again, I probably didn't have much conversation with him before March 2020 about it. But certainly when it started, we were speaking on a daily basis that. Yeah.

Henry: And you personally, did you do anything to prepare?

Nora: So I had an interesting situation which I think a lot of New Yorkers did. A lot of people had these random viruses in early 2020, and I had a very severe never before had a similar prolonged viral gastrointestinal illness, like a GI illness for weeks. Very, very sick, but functional, but like, you know, chronically ill had an endoscopy done.

I'd never had symptoms like this before and this was February of 20, 20 and my GI doctor said I don't know what virus you have, I can't find the virus. You definitely have a viral illness, but I can't tell you what it is because we're testing everything that's coming up negative. So my - by the time COVID - and I improved clinically after a few weeks, so by the time March 2020 came along, I had already questioned whether I had been exposed, which I think a lot of New Yorkers had, because some of us had had just some random illness. I think I was more concerned for personally like my young children and maybe my elderly relatives right at that point, to be honest. Yeah.

Henry: Did you change your behavior at all?

Nora: I'm sure I did, and I'm trying to remember exactly when I did so so I think it was mid-March when the kids got pulled out of school to do remote work. And then I, too, probably was too soon after one or 21 week later or something. I was home remotely, and we really did try our best to personally lock down outside of work.

Yeah. So we definitely did.

Henry: OK, so back to the back to the clinic for a second. So you said you had you gave this talk to the nurses in early, mid-March?

Nora: Yes.

Henry: Were there any meetings or group discussions before then?

Nora: There were. They were email only. And I remember being conflicted about the fact that we were gathering for the meeting. I was to talk to them about in person, maskless I think. So so I remember I mean, again, it was like the second week of March, more like I don't understand why we're gathering right now. Because everything prior the week or two prior had been email and again, very, very brief.

Like if someone has a fever, if someone has respiratory symptoms, put a mask on them. That was kind of our preparation besides like, you know, staff members wearing masks and things like that. It was more for patients. I think that was the preparation. Yeah.

Henry: Did anyone - I mean, I guess it's it's an outpatient methadone clinic, but, did anyone try and get you get them to do something more? I guess the medical director. But anyone else?

Nora: Yes, there was a big push and it was really like scavenging for PPE. There was a real big push to find any PPE that we, you know, gowns, gloves, the disinfectant, the purple top tube disinfectant that we used. So there was a big push, even within [organization], within the whole organization. I think we were getting emails like, you know, keep what you have, keep it under lock and key. This is going to be very, very important that you keep it and you have it. So that was the preparation I remember most for us, was keeping us protected and trying to find all this stuff that nobody had in March.

Henry: Do you remember when the supply shortages started happening?

Nora: Yes. I'm going to say the second or third week of March. 2020 yeah. And it was gloves and gowns. Gloves and gowns. Yeah.

Henry: Did you have the mask shortage?

Nora: That, we were very lucky. I don't think we had a significant masked mask shortage within our clinic because we're used to potential TB exposure. We have a lot of patients who live in congregate housing: shelters, incarceration, and so we're ready, so to speak, to put on an the 95 for us and put masks on our patients for TB, potential TB.

Henry: Are there frequent TB exposures that you deal with?

Nora: There are definitely a lot of patients who have latent TB, so they'll have a positive PPD like a TB test or positive QuantiFERON blood test. Or will have known exposure and have been treated for tuberculosis in the past while they were incarcerated or in the shelter yeah. They usually know their status. They usually know their status. It's not that they're coming in with active TB. It’s only latent.

Henry: So anything you wish that the clinic had done differently?

Nora: Oh, that's a good question.

I'm trying to think, is there anything I wish we would have done differently? I think we could have stopped group meetings a lot sooner than we did. I don't know that there were any repercussions from it, y’know? I'm talking staff. We were having staff meetings right probably a little too late into the into the pandemic. Yeah.

Henry: And is there anything that, looking back, you would have done differently personally?

Nora: That's a great question too. What would have done differently? If anything, let's see… I probably would have… I think I would have liked to have been a little more aggressive. I'm usually not in my style super aggressive with- I don't like scare tactics. I think sometimes I think, especially with my patients, our patient population, scare tactics don't work. I think it's kind of like, you know, with with substance abuse, patients with substance abuse, sometimes we meet them where they're at and we try to.

But this I think I would have tried to impress upon them the seriousness of the situation a little bit more, sooner than we did. Mm hmm. Yep.

Henry: OK, we’re both New Yorkers. So we talk fast, so we’re pretty under time. So you've talked about these conversations with [Medical Director] and how [Medical Director] was sounding the alarm through her friend.

Nora: Yep.

Henry: And it was kind of… it may have been in the back of your mind, but you know, you maybe thought it wasn't going to be a problem in New York?

Nora: Yeah, truly, at that time, I really did. But I think my you know, lack of true insight into what was happening, I really did not see it becoming-. In fact, that was my conversation with her. I'm like, I you know, I know we have to keep watch on it. I'm sure, you know, I feel terrible for for everyone over in the eastern part of world, but-

-and she's like, Nora, no, you know, I'm telling you this. This woman is telling us, get ready, because this is nothing like we've ever seen before this generation. And so I definitely heard her words but again, day to day in February, 2020, we're going out. We're eating in restaurants, right? We're congregating. The kids are going to school.

So. Right? I really can honestly say I was just blindsided until March 2020. Even with my viral illness, I'm like, well, maybe it was that, you know, yeah.

Henry: So how were you… How were you feeling about that time?

Nora: Yeah, I was I guess the best way to describe it again, I think for me was like cautiously optimistic. Cautiously optimistic. It's bad. We're going to handle this. We're going to handle this.

And again, I think a lot of that had to do with maybe even just being in New York and the prior experiences like we were talking about, about H1N1 and the few cases of Ebola and just really you know, thinking that it was going to kind of, you know, hit somewhere hard and then peter out. Little did we know. Little did I know. Khkhkh. Yep.

Henry: You know, [doctor] said something similar, but yeah, about AIDS. He said the same thing about AIDS and Hep-C.

Nora: Right, right.

Yeah. And then just, you know, and I definitely tell everybody I know, like just my whole family we had Omicron. We definitely had it confirmed positive. Yeah. So to be on this end of it now, after two years of panic, and you know, stress and and then doing everything we thought we could do, and then you're exposed, you know. so it's still happening.

It's still interesting to try to detach and see how this unfolds. Yeah.

Henry: OK, so to wrap up are there any questions that you would ask that I have not asked?

Nora: No. Not that that come off, you know, that I can think of off the top of my head. I think that was very insightful for me too.

Henry: And is there anything else that I should know?

Nora: No. The only thing that I kind of tell everyone who doesn't live in our area is that I know more people who have had confirmed covid at this point that don’t - that haven't, which I think is a very interesting statistic. More people I've spoken with and know personally have had a true diagnosis than haven't. And so I think we need to, as we say, pivot or our perception that we have to live with this virus, that it's not something that we can ultimately avoid for the rest of our lives. Yeah.

Henry: The scope of this is pretty unprecedented.

Nora: Yeah, completely. And I think really humbled us at least in the medical profession. That really humbled us. Yeah. Um.

Henry: OK, one last thing. This ID doc that [medical director] was talking to, were they at [organization]?

Nora: No, in fact I believe they were in DC, or somewhere in the mid-Atlantic. Yeah, in DC.

Henry: And the clinic is your only job, right?

Nora: That's correct. That's the only place I work. Yep.

Henry: Ok. I'm going to stop recording unless you’re going to feel sad?

Nora: Nope. I think that's it.