A Kiwi doctor in New York says the particular way coronavirus has swept the city holds lessons for New Zealand.
Avinash Sharma works in surgical oncology at Manhattan's Memorial Sloan Kettering Cancer Center, a world-leading hospital dedicated to the treatment and study of cancer.
On a research stint when Covid-19 began to take off, the 38-year-old has been confined to his apartment, reading about the crisis, checking the latest data and hearing from friends at the frontline in other hospitals.
A timeline from his pandemic diary notes just over 1000 cases in the United States on March 11, when President Trump shut borders to Europe. A week later there were 7000 confirmed cases. Now there are more than 640,000, a third of which are in New York City.
"It has been pretty scary," the 38-year-old told the Weekend Herald. "From something looming in the distance and really bad in Italy, to all of a sudden a full-blown catastrophe.
"Over the last two or three weeks it's been really desperate in terms of numbers of cases flooding the system - hospitalisations, ICUs have been running at three or four times the capacity, healthcare workers are doing long shifts and they themselves have been getting sick.
"I've heard of healthcare workers in their 20s and 30s actually being intubated, and in some instances actually dying from Covid as well. It has been right across the board."
Sharma has a masters in public health from the University of Oxford and spent time at a teaching hospital in Nigeria, as part of a research fellowship. That sometimes involved surgery by torchlight, because of power outages that could last days. A nurse would squeeze a manual resuscitator.
There's now a similar make-do approach in New York. Operating rooms in some hospitals hold makeshift ICU beds, staff re-use protective masks, a US Navy hospital ship is docked off the coast and a convention centre in Hell's Kitchen hastily converted to a hospital.
"There is a hospital set-up in Central Park right now. You would never, ever dream of that happening," Sharma said. "Unless your N95 mask is visibly soiled you are still using that for the duration of the shift, because up until even the last couple of days there has really been a feeling of 'When is this going to end?'"
The Memorial Sloan Kettering Cancer Center has multiple floors and bedspaces for patients who also have Covid-19, and, like other hospitals in the city, is using an incident command system similar to what was set-up following the September 11 terror attacks. Non-urgent electives have been cancelled to free-up capacity and get PPE and equipment to where it's needed.
Sharma, who is mentored at the hospital by NZ ex-pat Sir Murray Brennan, is currently working remotely from his Upper East Side apartment, leaving only to get essential supplies. On the day of our interview, New York Governor Andrew Cuomo announced all residents would have to wear a mask or face covering in public. Total deaths approach 15,000 and a stay-at-home order has been extended into next month.
"It's pretty eerie," Sharma said. "There are very, very few people out on the streets, and if anyone is out most people have got masks on - it's almost surreal compared to what life is like normally."
Sharma's wife returned to Auckland for work in March, and his days are spent calling her and other family, working and monitoring news and research into the virus. It's clear those living in poorer areas are taking the brunt, he said.
"If you look at New York across the five boroughs, the highest rates of cases are in places like Queens, where people are on lower household incomes. There is no doubt about that - if you take a district like East Elmhurst their rate is over 100 times the city average," said Sharma, whose cutting-edge research has looked into why some groups suffer higher cancer rates.
"These areas are poorer, with lower socio-economic status, and no doubt there's more crowding in homes, with more underlying disease. While the virus affects young and old, healthy and sick, it is patients from these areas that are making up more cases."
That should act as a warning to authorities in New Zealand, he said, as the country looks ahead to a possible easing of restrictions.
"If things do open up you have to be very, very careful looking at those [socio-economically deprived] areas, and keep very close surveillance on cases. There has to be really strict isolation for cases that are identified.
"We need to ensure that we have adequate resources in place to be able to deal with a surge in cases later on down the line, as we approach winter."
Around the world, life won't be the same until a vaccine arrives. In New Zealand, any return to level 3 will widen some people's "bubbles" and allow takeaway food. In California, leaders have suggested disposable menus at restaurants, temperature tests to enter buildings and staggered start times for school students.
There are glimmers of hope in New York City - hospitalisation rates have slowed, although it's not certain if that represents a rounded peak or plateau.
"Probably the best way to describe it is a very, very cautious optimism," Sharma said. "But the ICUs are still at three to four times capacity. People are still tired and just wary, and it's really difficult even now.
"Fingers crossed, over the rest of the month we can see a bit of light at the end of the tunnel."
Sharma is making plans to return home permanently, and will gladly accept the state-enforced quarantine.
"I'm very happy to ride out my two weeks. Because I would not be able to live with myself if I picked up infection asymptomatically while travelling and passed that on to someone."