The trials of this year's pandemic brought a certain occupation to heightened acclaim: medical professionals.
Doctors, nurses, medical technicians and other staff have been deemed "front-line heroes" for quickly adapting, many working tirelessly and risking their own lives as the novel coronavirus spread in waves and continues to overwhelm the system and workforce.
They've been serenaded and given rounds of applause from rooftops in New York City and countless cards and signs showing thanks.
Nearly all for the first time treated patients with an illness they knew nothing about, fearing for the safety of their patients, families and themselves. And they've borne the brunt of the pandemic in multiple ways.
About 6% of adults hospitalized with COVID-19 from March through May were healthcare workers and over a third of them were nurses or nursing assistants, according to data from the Centers for Disease Control and Prevention.
Roughly 28% were admitted to an intensive care unit and 16% required a ventilator. Four percent died.
As nurses and other front-line workers have dealt with the unprecedented strain, they've pushed their employers for more. Across the country, hospital staff have staged strikes, citing lack of personal protective equipment and other resources to fight the novel coronavirus.
Some have sent their complaints to the Occupational Safety and Health Administration — healthcare facilities overwhelmingly hold the most COVID-19-related workplace safety complaints across all industries.
Healthcare workers at the University of Pennsylvania's flagship hospital, an academic medical center in Philadelphia, admitted their second COVID-19 patient on March 9, Jessica O'Hora, a progressive care nurse on the unit, said.
What followed was a steep learning curve. O'Hora recalls needing extra hands not only to handle an influx of patients but also to monitor staff and their appropriate donning of personal protective equipment, then in short supply as workers nationwide faced conflicting advice from health officials and within individual health systems.
Her team laid out a new unit and staffing guidelines, bringing on "nurses we had never met before with all different backgrounds," O'Hora said.
Hospitals across the country quickly overhauled their operations this spring, some faced with a surge of coronavirus patients or local lockdowns and restrictions on elective procedures.
Workers faced the harsh economic reality of some systems' historic financial losses as some temporarily or permanently reduced the size of their workforce.
Patients with non-urgent conditions were told to stay at home, giving way to a rise in telemedicine visits, which some physicians at Hospital of the University of Pennsylvania (HUP) were trained and redeployed to do.
"There's not an area in this hospital that was not touched, that their service structure wasn't touched by COVID," a nurse who also manages the advanced practice providers at HUP's medical intensive care unit, said.
"There's not an area in this hospital that was not touched, that their service structure wasn't touched by COVID."
Joan Hoch Kinniry
Nurse at Hospital of the University of Pennsylvania
Providers working through the ongoing public health crisis certainly haven't — and won't — come out entirely unscathed.
Two-thirds of U.S. physicians reported worsening levels of burnout and loneliness during the pandemic, a September survey from Medscape found. More than half said they aren't considering switching careers, but 25% said they now plan to retire earlier than expected due to the pandemic.
Some providers though, like Hoch Kinniry, feel "there is a certain comfort that comes from having navigated it once."
"The first time around there was no plan," Hoch Kinniry said. "We planned every day as it evolved. We had a bit of an idea from New York, but Philadelphia was pretty early in the U.S. so we didn't really have a lot to learn from."
Since the worst this spring, HUP's coronavirus patient population has waxed and waned, though it's currently experiencing an uptick not unlike many other systems across the country.
O'Hora said it feels they're very much still in it, but not to the same extent as earlier this year. "The patients change all the time, the acuity changes all the time," she said.