I remember the first time I heard the claps outside my window. It was 7 pm on a gloomy spring day in Brooklyn, New York, as I sat on the edge of my bed trying to catch a bit of sunlight at the end of another grueling day of work amid the COVID-19 pandemic. I had already seen the viral videos online from places like London, Madrid, and Manhattan. That day I finally heard them: the claps celebrating the healthcare workers– in and out of hospitals– that were risking their lives fighting an invisible enemy with visible consequences. 

Anything could make me cry those days. But those claps were different. I knew they’d go away some day– as trends like these usually do– but I still cried thinking of those hidden faces we usually take for granted. The doctor in the ER. The psychologist taking care of families with economic and immigration issues across the city. The caregivers whose jobs were halted. The nurse whose job instantly changed overnight. The scientists trying to educate the public about this pandemic. 

The claps stopped by mid-summer, but the pandemic didn’t. More than 300,000 healthcare workers in 37 countries have been infected by the coronavirus, worsening fears for coworkers and reducing staff capabilities to care for infected patients. In the United States, 4,000 healthcare workers have died from the coronavirus. Long shifts have become endless as governments struggle to contain the virus in most of the world, filling hospitals’ intensive care units and emergency rooms. Outside hospitals other types of healthcare workers have also felt the strain of the pandemic, as the crisis challenges their professions and mental health. 

As vaccines start rolling out, there is a light at the end of the tunnel for healthcare workers, who have been left alone on the frontlines of an unprecedented crisis with little to no help. These are some of their stories. 

Michelle M. Ramírez, Pediatric Care Unit Specialist, NYU Langone Hospital

Every day, right after seeing a patient, Michelle Ramírez would discard her N95 mask, following hospital protocols. The mask, which is designed to protect the wearer from airborne particles, is not supposed to be reusable. But in late March 2020, Ramírez started recycling hers, dropping it into an envelope every day after work and picking it up the next day when she arrived for her shift. 

“We used the same mask for weeks,” Ramírez says. 

As New York City became the epicenter of the coronavirus pandemic, the NYU Langone Hospital, where Ramírez serves as a pediatric intensive care specialist, halted all non-essential procedures to care for COVID-19 patients with severe symptoms. Ramírez remembers watching this from the pediatric care floor wondering if the chaos was coming for her floor next. And it did– fast. 

Born in Puerto Rico, Ramírez has worked with pediatric patients her entire career, since graduating from the University of Puerto Rico, and conducting a fellowship at the New York Presbytarian Hospital and a residency at Jackson Memorial Hospital. She’s also the disaster relief director of Puerto Rico Rise Up, a female-led non-profit that connects Puerto Rican communities with health and wellness resources, that was born after Hurricane María. 

Ramírez had never worked with adult intensive care patients, but she found herself obtaining credentials from Langone Hospital when patients kept arriving in critical shape. She felt mixed emotions at the sudden shift. Although she was stressed about working outside of her specialty, she was thankful to be of service in this crisis. Within a few weeks, she started caring for patients up to 34 years old. “The rate at which patients were dying was shocking,” Ramírez says.

Her team quickly adapted, gathering treatment resources and techniques from experienced hospitals in Asia and Europe. Some of these included proning, a technique used to relieve respiratory distress by turning the patient on their stomach, and clinical studies to analyze the efficacy of hydroxychloroquine and plasma therapy. “You can gather resources and learn from others but it’s just not the same as when you have to do it yourself,” Ramírez says. “The rate at which patients were dying was shocking.”

At home, Ramírez tried as hard as she could not to infect her daughter and husband and leave the crisis at work. She continued her exercise routine and focused “on the big picture.” The emotional toll of working through a pandemic, she says, was like nothing she’s ever experienced. “In medicine, you work to save lives but you are almost always more comfortable with the concept of death than others,” she says. “When you have a lot of patients that you can’t just help, that impotence is very powerful.” 

Amalia Hernández, Caregiver

Amalia Hernández says she used to be a very loving mother, giving her adult children hugs and kisses whenever she got the chance. In March 2020, she was particularly excited to welcome her first grandson and pass along the same alcahueterías she imparted on her children. But as the COVID-19 pandemic raged on, Hernández’s role as a caregiver put her at risk of infecting her family. The hugs stopped. 

As an elder caregiver, Hernández’s fears about the pandemic were valid. She didn’t know much about the virus, she says, and the mixed messages about its mortality rate, symptoms, and infections were some of the main reasons she feared going to work. Still, she remained calm, telling herself that “two weeks would pass by fast.”

By November 2020, when we talked over the phone, Hernández admits she didn’t quite understand what the world was in for when the World Health Organization declared the pandemic in March 2020.

Hernández started working as a caregiver in 2014, when her sister developed a cerebral issue that left her right side of the face immobile. Today, Hernández manages a caregiver cooperative that connects workers to clients and advocates for the rights of caregivers, who have some of the lowest wages in the United States. 

A few weeks after the pandemic was declared, Hernández quickly understood that work would stop for some of the members of the caregivers collective she runs with the help of the New Mexico Caregivers Coalition and the increased demand for personal protective equipment would also make it more expensive for the caregivers to protect themselves. Within a few weeks, gloves that used to cost $4 per box were sold for $12, she explains. 

In New Mexico, elderly home facilities have become one of the central points of infection throughout the pandemic. By early December 2020, facilities in New Mexico were registering an average of 20,000 positive tests per week. This is one of the main reasons why Hernández’s co workers started losing clients who canceled or paused services, causing a financial strain on caregivers. A statewide poll by Latino Decisions revealed that 20% of parents, including undocumented immigrants, had lost their job. While organizations like Catholic Charities have helped some of her co-workers, Hernández says the aid is not enough to make up for the loss of employment since a wide number of them are undocumented and unable to receive Medicare and unemployment assistance. 

“We all thought this would go away sooner,” she says.

Karen Caraballo, Psychologist

For decades, psychologist Karen Caraballo has seen firsthand how immigrant communities in New York City struggle to find and receive mental health care. As a bicultural clinical psychologist and independent assessment provider for the New York City Department of Education, Caraballo was uniquely prepared to attend to the challenges the coronavirus pandemic would bring for Latin American families in 2020. 

“The main symptom I see is anxiety,” she says. “And anxiety is triggered by fear.”

Since the pandemic started, Caraballo has been working from Puerto Rico, where she was born, after fleeing New York City in early March, scared of what would come. Telehealth is now the norm for Caraballo, who has worked as a clinical psychologist for more than a decade, focusing on immigrant families. 

The coronavirus pandemic has impacted communities of color disproportionately. Hispanic and Latino communities are nearly three times more likely to die from the virus, according to the CDC. It’s also affected working families, who live paycheck to paycheck. At least 72% of Latino households face severe financial struggles, due to pay cuts, layoffs, and lack of savings. 

“A lot of these families already live in a precarious state of alert and shock,” Caraballo says. “But you add this crisis on top of that, and it makes it even worse.”

Caring for these families has also put an emotional strain on mental health care providers, who are also struggling with their own experiences during the pandemic. Caraballo says this has been the case for her, but she’s tried to keep a sense of normality within the uncertainty. “I try to wake up every day with intention and a plan,” she says, adding that sometimes she tries to do her makeup or dress up to maintain her good spirits in check. 

One of the few silver linings in her escape from New York is her proximity to her family, she says, which keeps her at ease. “The main reason I left was to be close to them if something happened in this pandemic,” she says. “Imagine if something happened to my mom and I wasn’t there.”

Being at home has also allowed her to help communities in the island. As an executive director of Puerto Rico Rise Up, she’s been able to connect with agencies and other non-profit organizations to deliver personal protective equipment and food to communities across the island, especially to kids who have been left without their daily school meal since the Department of Education transitioned to remote learning. 

“I had the responsibility to come up with a plan,” Caraballo says. “We always respond to a crisis and this was no exception. ”

Rebeca León, Nurse

In March 2020, Rebeca León was celebrating her first year as a full-time nurse and had started training to become lead nurse in her unit, which took care of general surgery patients, at the Emory University Hospital in Atlanta, Georgia. She was shocked when the hospital started mobilizing to make space for coronavirus patients and her unit had to shut down. 

“We didn’t have much of a lead up,” León remembers. “That meant we had to immediately become Covid nurses.”

León had always dreamed of working hands-on with patients. While she had originally planned to become a doctor, she quickly realized she’d never get the same interaction with patients than she would as a nurse. Born in Venezuela, she came to the United States as a 6-year-old, and learned from generations of healthcare workers in her family that 12-hour shifts were the norm in this industry. “ I always knew it was going to be like that,” she says. 

Every day, before the pandemic, she’d arrive at work in the afternoon ready to work a 12-hour night shift, which she started doing after realizing she was not a morning person. General surgery patients require care every three to four hours, she says. She’d perform a full-body check right at the beginning of her shift and continue to administer medication, treatments, and even a bit of mental health care to her patients. It sounds like a lot of work, but she prefers the hands-on, face-to-face interaction with her patients. 

“At night, you get to have that hands-on work with patients because doctors and therapists are not coming in as much as they do during the day,” she says. 

Although healthcare is her passion, she was terrified when coronavirus patients started arriving at Emory Hospital. They were still in the dark about much of the protocols, symptoms, and treatments of this novel coronavirus. Still, her outlook on the job changed when she realized she’d have to care for her patients and herself too, and the face-to-face interaction she craved became too risky. In Georgia, over 10,000 people have died of coronavirus. The state has registered over 600,000 cases since the pandemic started. 

As a young nurse, this pandemic has proven to León that she made the right choice. Prior to the pandemic, she says, the public didn’t have much of a clue of the diverse roles of healthcare workers in the medical system, from respiratory staff to cleaning staff. Instead, the spotlight, she says, has mostly been on doctors and physicians. “Seeing that narrative shift has been super special,” León says. “It’s given me a new appreciation for my profession.” 

Mónica Feliú-Mójer, Director of Communications and Science Outreach, Ciencia Puerto Rico

It’s quite challenging to educate communities during a pandemic in the age of misinformation. Whatsapp chains claim to know every remedy to fight COVID-19, while so-called experts on Facebook spread fear in communities that are left misinformed by government agencies and public officials. 

That’s when people like Mónica Feliú-Mójer come in. As a science communications specialist, Feliú-Mójer’s job is a hybrid that combines her love of science and her passion to connect with communities, especially those at home in Puerto Rico. 

“I always longed to come back and give back to Puerto Rico,” she says. 

Feliú-Mójer grew up in a farm, surrounded by nature and animals, ignorant to the possibilities a career in science could give her. But in 2004, she left Puerto Rico to pursue a career in science, earning a PhD from Harvard University in Neurobiology. But it wasn’t until she met Ciencia PR’s founder Daniel Colón that Feliú Mójer immersed herself in science communications. 

“I had a freedom to pursue whatever project I wanted within the organization,” she remembers of her first experiences with Ciencia PR, a non-profit organization that’s focused on the advancement of science in Puerto Rico, as well as connecting communities with education and resources within the various fields of science. 

Amid the pandemic, Feliú-Mójer saw an opportunity to fill a void left by government officials in Puerto Rico, whose main messaging to fight COVID-19 has been “a fatalist approach.” Instead, Ciencia PR is using their resources to publish op-eds, connect experts with journalists, and give practical solutions to Puerto Ricans to “responsibly live with the virus.”

The first op-ed she worked on was published on March 9 and authored by Fabiola Cruz López, who warned the pandemic was coming. The response claimed Cruz López was “alarmist.” Since then, Ciencia PR has published over 80 articles and op-eds in various publications, like El Nuevo Día, in Puerto Rico with over 60 experts; all coordinated and edited by Felió Mójer. (Ciencia PR typically publishes on 30 op-eds annually.) Feliú-Mójer has also coordinated a series of Instagram live conversations between influencers and science experts to connect with communities online and give practical advice on how to navigate this crisis and everyday activities safely. (Editor’s note: Emperifollá participated in this series.) 

“Before the pandemic, science coverage in Puerto Rico had gotten better,” she says. “But right now, science is at the heart of everything we are living.”

As Latinx communities are impacted heavily in the United States, Feliú-Mójer says she can’t precisely say how it’s impacting marginalized and poor communities in Puerto Rico because “no one is measuring it.” Still, she’s seen firsthand how rural, poor communities are being impacted by misinformation during this pandemic, citing a recent community workshop where people showed a lack of trust in federal and local agencies that are responsible for taking care of them. 

“Someone asked, ‘Are vaccines going to come to my barrio?’,” Feliú-Mójer remembers. “The uncertainty, fueled by distrust, and in the end we’ve seen that it’s the people who save themselves.”

Photographs by Maridelis Morales Rosado

Video by Stephanie Stoddard-Cortés