Interviewer(s): Henry
Interviewee(s): Antonio

Henry: And any any reference to your organization is, your organization's not gonna be named directly.

Antonio: Okay.

Henry: Okay. Would you like a preamble or should we just get into it?

Antonio: Oh, we could just get into it.

Henry: OK, great.

So how old are you?

Antonio: 30.

Henry: And where do you live?

Antonio: I live in [city]

Henry: Is that where you work?

Antonio: Yes.

Henry: What's your current position?

Antonio: My current position is technically fire service paramedic.

Henry: You do medical?

Antonio: Yeah. Yeah, that's just the title. They refer to it as on the job.

Henry: And how long have you been there?

Antonio: Um, I've been where I'm at right now for five years.

Henry: So was this where you were working in January 2020?

Antonio: Yes.

Henry: So can you tell me about the time that you first heard about COVID?

Antonio: I think I first heard about it late October early November 2019, when it was just kind of a whisper saying how, oh, there's something going on in China. I think it was around that time where it's like people just started mentioning it.

Henry: October?

Antonio: I think it was like October, November 2019. When they’re first making mentions of a virus spreading through China. I may be off, but I feel like that's when it was just slowly being mentioned.

Henry: Are you sure you're not talking about the plague outbreak that was there?

Antonio: Uh, I'm not fully sure. All I remember is that around that time of year, maybe closer to December, in all honesty, ‘cause it's been that long, that mentions of a virus from China just started hitting the news. But at that point it was like, oh, these outbreaks happen. They get dealt with fairly quickly. So it was just like on the back burner.

No one cared about it.

And I guess especially during the years prior, every time there was a big scare, some sort of virus that had a large scale capability of, you know, disrupting things, it was usually handled relatively quickly.

Henry: So what were you thinking at first?

Antonio: Um, like I said, based off of like initial reports at the start, I thought nothing of it um.

Henry: Why? Why did you think that?

Antonio: Like I said, previous big name viruses that kind of take over the news space, they usually are dealt with fairly easily. You hear about them for a couple of weeks. The powers that be do their job. And then if they do hit U.S. soil, it'll be in small numbers and then kind of just not spoken about from there.

Henry: Thank you for that.

OK, so were you- did you talk about the new virus with anyone around this time?

Antonio: No.

Henry: No? Nobody on the rig?

Antonio: No, no, no. Because, I mean, I follow a lot of global news, so that's probably why I heard like even the slightest inkling of it that early.

Henry: But- okay, so when it started getting into it, so let's say around January or February. Yeah. Then it starts coming into the news more, right?

Antonio: Yeah. That's when I felt like it made more of a global presence and early March 2020 is when I feel like it really started to hit U.S. soil.

Henry: But, um, around January, February, were your thoughts changing at all.

Antonio: No, no, sorry. I said we were too use to these stories hittingthe news. They stay in like the mind space of the public for a couple of weeks and then just kinda dissipate away without anyone having to do anything. Well, not anyone, but anyone as in the everyday common man. There's always organizations that be who deal with them accordingly.

But it's out of sight, out of mind.

Henry: Okay, so in in January and February, though, were you talking with anyone about this?

Antonio: Nah.

Henry: Um, I guess so, I mean, it was, they said out of sight, out of mind. You trust the organizations that are responsible for disease control or pandemic control or prevention… Did that change at all for you before March?

Antonio: I think the first time I really- it really stuck in my head this may become a problem is when the news stories started coming out of Italy. And I think that was like around maybe a couple of weeks prior to hitting the US soil.

Henry: And then what were you thinking when you saw those?

Antonio: I was thinking, was this interesting…

Henry: And other people around you.

Antonio: Um.

The people closest to me at work weren't really making a big deal of it. It wasn't really something that was spoken about. The first time it really became a topic of discussion of course, once it started affecting the daily lives of people. once we started realized, Hey, we have to ramp up PPE usage. Hey, we have to screen for this and act certain questions.

And then once you saw the influx of both lockdowns and acutely ill patients presenting with COVID, that's when it became a true discussion.

Henry: So it started affecting your field practices?

Antonio: Yes.

Henry: Do you remember when that started kicking off?

Antonio: Um, about, I'd say like a week or two after the lockdown took place, that's when I started seeing like acutely ill COVID patients.

Henry: Did you have a like a Eureka moment or like an oh shit moment when you realized how bad things were going to be.

Antonio: Yes. When I would listen to the radio and there was like a couple nursing homes- nursing homes are hotbeds for disease. They due to like the proximity to patients and poor conditions. Disease spreads fairly quickly, do nursing homes. That's why I like you'll see like runs of sepsis and like upper respiratory infections in like nursing. I mean, like skilled nursing facilities that primarily have ventilated patients so I remember this one nursing home in West Philly almost every hour on the hour someone was getting dispatched for a cardiac arrest in there. now granted they would be, I guess, the target population that you’d expect for this to affect them negatively, but the frequency that it was affecting it, it was just kind of staggering.

Henry: So in like the weeks leading up to that point.

Antonio: Yeah.

Henry: Did you do anything to prepare personally?

Antonio: Um, I'd say I just like, read, just like the base knowledge that was out there, how to prevent infection, how to protect yourself as a provider. What signs and symptoms to look for. At the same time, it was just like such a varying degree of symptoms that was just kinda hard.

Henry: And did you like change your personal behavior at all?

Antonio: Um, I wouldn’t- I wouldn't say I changed my personal behavior. I just was kind of rolling with what was being dealt with.

Henry: OK. And, uh, how did [organization] prep?

Antonio: That's the thing. A lot of people didn't have much prep time because they didn't think it was going to hit as hard as it did. So it was kind of dealing with it in real time. We're trying to get PPE as we could. That was difficult for everybody. People were using N95s, we were using face masks. We were using like one piece suits to try and mitigate the possible spread of COVID.

We were trying to heavily decon[taminate] trucks in between runs so.

Henry: Were there any meetings or group discussions like in February, say, about this?

Antonio: Um, the ultimate issue with that is the way my organization is structured. It doesn't really prioritize keeping the people on the lowest part of the totem pole in the loop. So I'm pretty sure the higher ups were having their meetings, but they weren't feeding information to us as quick as they can. They were sending out regular emails in regards to how to deal with these patients, how to deal with the possible exposure and all those things.

But it was like, there was no like verbal communication between us and that.

Henry: What was the protocol for a possible exposure?

Antonio: Um, I don't remember because it's obviously changed so many times, but I think early on it was like, I think early on, like early, early COVID was like if you would, if you had someone who's COVID positive, they were taking you off the streets immediately.

Henry: That must have changed pretty quickly.

Antonio: Yeah, that, that evolved with the times to the point where… you already know how it is now. you can come to work Covid positive and they don’t care.

Henry: I don't know because I have a job khkhkh

Antonio: Khkhkh Oh, okay.

Well, yeah, initially there was like the, the- they were trying their best to limit exposure and like I said, anyone tested positive, everyone who worked in that firehouse that day was immediately taken off the streets. They were deconning firehouses head to toe and it did take a toll on staffing. So I think at one point we were down like a quarter of staff members.

Henry: OK that's interesting actually.

I'm going to come back to you on that one.

Okay. So in- was anyone trying to push for more action to be taken before it really started to hit?

Antonio: No.

Henry: So no.

Antonio: Not, at least no one that I saw or know of. No.

Henry: Were there any conversations with your partner like, hey, we should we should be more worried about this?

Antonio: No.

Henry: Okay. So looking back on it, do you think what do you wish that the organization had done differently?

Antonio: I guess transparency, but that's like an issue that's always going to exist. You gotta learn to be a bit more forthcoming and learn to communicate better with field staff. But that's, that's not unique to Covid and it's not unique to my organization. It's just an issue all of us exist with this job.

Henry: And what would you have done differently as an individual?

Antonio: I think I personally fared incredibly well during the COVID, so… I did I could to limit exposure personally. I tried to keep all my equipment clean. I wasn't really going out, but no one could because there was nowhere to go. So yeah, I did all I could and I wouldn't really change anything in terms of my response.

Henry: Did you, were you still like going to bars and socializing in February and March?

Antonio: Only people I was interacting with were people from work. So other paramedics other EMTs sometimes and firefighters.

Henry: Okay. Were you working in emergency medicine during Ebola?

Antonio: I don't remember, to be honest. What year was that.

Henry: 13, I think.

Antonio: 13.

Henry: 12 or 13.

Antonio: I was an EMT at the time, but I don't remember anything from there.

Henry: Do you know if any of the [city] hospitals got hit pretty bad?

Antonio: Oh, yeah, yeah, yeah. It was, it was horrible.

Henry: Were any, any worse than others?

Antonio: Well, if I remember correctly, this coincided kinda with when Hahnemann shut down which was a major hospital, of course, in the city. Um, so Temple was already overwhelmed by essentially an ever growing area of coverage, and that didn't make any things better.

Henry: Okay, so let's- just looking at the time from, like, when you first heard about it to when it really started to hit, like can you tell me about how you felt?

Antonio: Uh, Like I said, it was just kind of a thing that was in the background that I wasn't thinking too heavily about. And of course, until it actually hit, everyone was kind of just ‘meh’ about it, including myself.

Henry: But did you think it was going to be a problem?

Antonio: I didn't think it was going to be what it became.

Henry: Why not?

Antonio: Like I said, any time we've had an issue like this arise in the past, it's always been dealt with incredibly well. But due to changes in administration and those in power, it wasn't taken care of the way it should have been. Granted just with how large of a scale it was on the global stage. It was going to hit the US shores regardless.

There was going be no way around that. But I think it could have been handled a bit better by the administration who was in power at the time.

Henry: The federal.

Antonio: Yeah. On a federal level.

Henry: But you think- You think it was just going to- you thought it was just going to be a matter of time.

Antonio: I thought it was going to be. I thought it was. I never thought it was going to be... I never thought it was going to change my daily ongoings. I never thought it was going to be that severe.

Henry: What other follow up question did I have… were you surprised?

Antonio: I'd say I was. Like when they first initially announced the US lockdowns, I was like, Oh, okay, this is a thing that's happening.

Henry: Were you working that night?

Antonio: I don't remember. I don't remember where I was when they first announced the lockdowns.

Henry: You don't remember?

Antonio: No, I don't remember where I was when they first initially announced them.

Henry: But did did you talk about this with anyone on the on the truck?

Antonio: Oh, yeah, yeah. I mean, that was a topic of conversation because like I said, everyone's daily life was massively disrupted. People had to adjust. Schools were shut down, so that affected a lot of people. People couldn't do the activities that they grown to, you know, essentially do on a daily basis to kind of keep them sane.

Henry: Do you remember what those conversations were like?

Antonio: A lot of annoyance, a lot of anger, a lot of confusion.

Henry: Confusion?

Antonio: Yeah. We… we as a collective, never got like anything like this in our lives before. And we had massive issues, but nothing like this.

This is this essentially affected every facet of life.

Henry: OK that’s really it actually. I have a few follow up questions. these interviews are really variable in length because some people really like to talk.

Antonio: Gotcha.

Henry: So did you ever feel, um. You ever feel scared at any point, like before, Like before, like late March?

Antonio: No. No.

Henry: What area do you work in of [city].

Antonio: [neighborhood].

Henry: All right, so, um, so you covered this before. Um, so what would you like to tell me about how you were feeling in early 2020?

Antonio: I'd say me in early 2020… Just like anything else in life, I kind of just deal with things as they go. There's no time for irrational thinking. So it was kind of just, listen to... Well, for me. I understood the fact that since we were actively dealing with an issue that we have not dealt with before, it's a new disease process.

They don't know what they're looking at, what signs and symptoms to look forward. They don't know how to properly treat it. So I knew that information was constantly going to be changing. As time went on, I knew that treatments were going to change. I knew signs and symptoms are going to change. I knew everything was just going to be in constant flux.

So I kept reminding myself of that. So when one day they're like, Hey, we're looking for respiratory related signs and symptoms to, Hey, now these people have a lot of GI issues. And so on and so forth. I just knew that essentially that could be either cause of the virus mutating or just the fact that we're dealing with something so new.

You're getting information from so many different data points that the essential assumption, whole algorithm is going to constantly be changing. So for me, I always dealt with things and tried to remain as adaptive as possible. So that's another reason why I didn't necessarily feel one way or another, or feel like some severe emotional distress in regards of this.

Henry: How did you handle that uncertainty?

Antonio: The uncertainty?

Henry: The uncertainty, yeah.

Antonio: It I guess I feel like in the field that I work, there's a lot of uncertainty, as is. There's a lot of just flying by the seat of your pants and just dealing with an issue as it arises.

Henry: It makes a lot of sense, actually.

Antonio: How so?

Henry: because more so I've been into I've been doing some interviews and I've interviewed some- you, I've interviewed an emergency medicine doctor and both of both of you have said you know, there's going to be uncertainty. You know what best practice is going to work? Infection control, source control and everything else.

You kind of deal with it as it comes.

Antonio: Yeah.

Henry: And you two seem to have dealt with this and it seems, that seems to have been a very healthy response. Um, are there any questions that you think I should have asked that I didn't.

Antonio: Um, not necessarily. I Think you essentially covered like the mind space of a medical practitioner in early COVID space, which is what matters.

Henry: And is there anything else that you like to tell me?

Antonio: Um, not at this time.

Henry: OK. I’m gonna stop recording.