Additional reporting by Carson Kessler and Will Welch

Al, an FDNY EMT who makes ambulance runs all over southwest Brooklyn, has seen a change as of late.

While responding to 911 medical calls from Bensonhurst to Borough Park in the months past the pandemic’s peak, he’d field a cardiac arrest case about once every other week, he estimates.  

But in the last two weeks, he’s logged nearly 10. His wife, an EMT in Brownsville and Crown Heights, responded to four cardiac arrest calls in one day recently, he said.

For them, the runs stir memories of near-constant cardiac arrest calls in the spring for COVID-19 patients whose hearts couldn’t get enough oxygen.

“I’m hoping and praying that it doesn’t get to where it was in March and in April,” said Al, who requested that his last name not be used because he is not authorized to speak to the press. “I don’t foresee that happening again to that level, but I do see there being an increase.”

Citywide, ambulance calls in New York are down from the height of the COVID-19 crisis, even dipping slightly below pre-pandemic levels, officials said. 

But in and around the city’s coronavirus hot zones in Brooklyn and Queens, emergency workers are spotting a difference lately — and New Yorkers there say they are hearing it, too, in the drone of sirens.

‘Fever-Cough’ Reports

Hospitalizations due to COVID-19 have increased 86% in the five boroughs since Sept. 1 from 202 to 375 on Oct. 7, according to state data

At the same time, emergency department visits due to flu-like illnesses or pneumonia — a metric tracked by the city Department of Health and Mental Hygiene — jumped from a rate of 2.6 visits per 100,000 people on Oct. 4 to 3.5 on Oct. 5, driven in large part by people over 75.

The figures come as no surprise to Lee, an FDNY paramedic stationed in East New York.

An FDNY ambulance rushes through Bed-Stuy during the coronavirus outbreak, March 31, 2020. Credit: Ben Fractenberg/THE CITY

Two weeks ago, she noticed a shift in the types of calls coming in from dispatch. Emergency labels she heard often in the spring — cardiac arrest and “fever-cough,” which often indicates a virus case — began popping up on her radio again.

“We’ve noticed for a couple of weeks now,” said Lee, who asked that her last name not be published. “I remember talking about it with my partner. … You can hear a lot more cardiac arrest going over the air.”

Before COVID-19, Lee would get a cardiac arrest call one every “month or two,” she said. Last week, she handled three or four.

Asked whether the city has seen more fever-cough and cardiac arrest calls recently, a spokesperson for NYC Health + Hospitals referred THE CITY to statements made by the health system’s president Mitchell Katz at a press briefing Tuesday.

Katz, who oversees 11 city-run hospitals, noted only two COVID-19 patients were on ventilators, he said at the Oct. 6 briefing.

“It is very low, but we nonetheless of course have plans for how we would deal with the surge if it were to happen,” Katz said.

Calls Spiked Then Dipped

The citywide 911 call volume remained mostly steady over the summer after the height of the COVID-19 crisis, according to Frank Dwyer, an FDNY spokesperson. 

Before the pandemic, a typical day would bring 4,000 to  4,100 emergency medical calls, he said. During the spring, calls peaked on March 31 at 6,500 — a department record, higher than the total received on Sept. 11, 2001.

In recent months, however, the average number of calls has fallen below pre-pandemic levels, Dwyer said, fluctuating between 3,300 and 3,800 per day, and has not risen significantly recently. On Tuesday, the department logged 3,620 calls for medical emergencies across all five boroughs.

“We thankfully haven’t seen a major increase in medical call volume in the past couple of weeks,” he said.

However, the picture in the city areas where growing COVID-19 infection rates spurred varying levels of new restrictions on public life this week appears somewhat different.

Oren Barzilay, president of Local 2507, the union for FDNY EMS workers, said his members in southern Brooklyn report that “fever-cough call types have increased.”

And, overall, he said he’s watched the citywide call volume grow slightly in recent days through figures he sees that come directly from a dispatch database.

“It’s slowly creeping up” to pre-COVID levels, he said. 

For the emergency responders in newly drawn red, orange and yellow zones, the uptick offers grim reminders of the pandemic’s peak. And the sirens coming from their vehicles are giving other New Yorkers flashbacks to March and April.

In one of Queens’ hot spots, Kew Gardens Hills, Daniel Rubin first noticed an increase in sirens wailing around Yom Kippur last month.

His ZIP code has recorded a 4.62% rate of cases among those tested for the coronavirus over the 14 days leading to Oct. 6, city Department of Health and Mental Hygiene data shows. It’s one of nine ZIP codes where the positivity rate has been above 3% for seven or more consecutive days.

The lawyer and dad says he hears the sirens every day when he prays with his family outside. To avoid exposure to the virus, he has avoided going to his synagogue.

“Every morning when we’re out there, there’s ambulances. And every evening when I’m out there, there’s ambulances. There’s just no question there’s more,” Rubin said.

It’s not near the same level as the spring, he said, but it does remind him of the “constant droning” from months past. NewYork-Presbyterian Queens, once known as Booth Memorial Hospital, is located nearby.

Near Elmhurst Hospital, one of the worst-hit medical centers in New York this spring, Sascha Segan noticed a slight increase in sirens about a week ago. Segan, whom THE CITY spoke with in late March about life in the epicenter, lives just a few blocks from the hospital and said the noise has definitely increased — while stressing the frequency is “not like it was in April.”

“In April it was constant. In April, there was no moment without a siren,” he said.

‘Catching Things on the Delay’

Getting a clear picture of what is happening with the health of New Yorkers right now is tough, said Bruce Y. Lee, professor of health policy at the CUNY Graduate School of Public Health, because “we don’t have a good surveillance system in place.”

Ideally, he said, the city would track multiple health indicators to monitor the spread of virus, including hospitalization data and “syndromic surveillance” that looks at symptoms cropping up at multiple kinds of health facilities.

Relying on local COVID-19 test positivity rates has drawbacks, he said: We don’t know the percentage of a given community or neighborhood being tested, how often people are getting tested, and differences in health access between high- and low-income areas.

“We’re catching things on the delay — the delay in catching it in the first place, and then there’s also the delay in reporting,” he said.

Elmhurst Hospital. Credit: Ben Fractenberg/THE CITY

Still, even given the limited data picture, Lee considers rises in COVID-19 cases in some parts of the city a possible start to a second wave and urges caution — not because of any one indicator, but because of the “scientific mechanism” of how COVID-19 likely functions.

According to the latest research, he noted, humid weather may dilute the aerosol droplets carrying COVID-19, making it less likely to transmit. Now, in drier fall weather, risks may be amplified.

“If things are drier, everything is more concentrated. The droplets are more concentrated because there’s less fluid, and therefore, you have more virus per volume,” he said.

“There is a significant concern of a pickup of transmission spread in the fall,” he added.

However, New Yorkers should bear in mind: Deaths from the virus may stay low while other indicators of virus spread go up.

Why? Lee offers several explanations: Hospitals are better prepared, people may be more likely to seek care earlier and some recent research suggests that the “infectious dose” — how much virus you come in contact with — may determine how sick you get.

By using masks and social distancing, New Yorkers who do get sick may be exposed to less of the virus than, for example, someone infected in a maskless indoor setting, he said.

‘Sirens Were So, So Bad’

In Brooklyn, Rabbi Emily Cohen begged her Twitter followers this week to wear masks, with a message and a warning: “There are more sirens in Brooklyn these days. A lot more.”

Cohen lives in Park Slope near Flatbush Avenue and would hear sirens on a normal, pre-pandemic day. But, lately, the noise is much more steady — so much so that it’s been interrupting Zoom meetings with her Upper West Side synagogue staff, which has met remotely for months.

“I had to keep muting myself because the sirens were just so, so bad,” she told THE CITY.

“On one hand, things are, in some ways, heading towards something resembling normalcy,” Cohen said, in that you can get a bagel or coffee, or go to the store without “standing in line for an hour.”

“But at the same time, you know, I know that the numbers are going up. And there’s that fear of a second wave,” she said.

That fear, and the memory of the constant wail of ambulances, was a focal point for the governor’s office this week as he and his staff laid out their plan to tamp down the increase in cases in New York city.

“We lived through sirens in this city and we lived through death and we’re not doing it again,” said Melissa DeRosa, top aide to Gov. Andrew Cuomo, at an Oct. 5 news conference.

For Lee the paramedic, the change in the calls she’s responding to is “frightening.”

“Just when you feel like, okay, well, I made it out safe, at least I made it out safe, my family made it out safe. What if it comes back?” she said.

“I remember being afraid of patients, you know?” she said. “Now that fear is coming back.”