New York: After feeling unwell with what seemed like symptoms of the coronavirus, Luis Arellano first tried going to a nearby hospital in Brooklyn, where he was told to come back if his condition worsened.
Days later, as his health deteriorated, his family took him to a New Jersey hospital. He waited eight hours, and after being told they'd have to wait another seven to nine hours, the family left, they said.
By the time Arellano, 65, was finally determined to be sick enough to be immediately admitted into a hospital, his body had already been ravaged by COVID-19, the disease caused by the coronavirus.
He died of cardiopulmonary arrest on April 5 after five days in the hospital. Two days before that, his virus test had come back positive.
"If they would have admitted him, they would have found that he was gravely ill," said Bolivar Arellano, his brother.
Luis Arellano's prolonged attempts to receive care illustrate the quandary nurses and doctors in New York and New Jersey, the two hardest-hit states in the coronavirus pandemic, have faced as they have tried to ration limited resources.
In many cases, health care workers have had to determine in a matter of minutes who was sick enough to receive urgent care in a hospital and who could recover at home. For some patients, the decision was the difference between life and death.
The complicated and still mysterious nature of the virus has made those initial determinations difficult. The condition of a patient whose symptoms might not appear severe at first can deteriorate rapidly.
Luis Arellano began complaining of a fever in late March. By March 26, he was diagnosed with pneumonia at a Brooklyn urgent care clinic, the family said. Two days later, he had difficulty breathing but could not get admitted into a hospital. He was dead in a week.
"It was a week of constantly having to fight for him to get in," Carlos Arellano, Luis Arellano's only son, said of the frantic search for a hospital. "Eventually he did, but it was too late."
In early April, after Mark Levine, the chairman of the City Council's health committee, said on Twitter that hospitals were "turning many people away," including patients with "pneumonialike symptoms," both Mayor Bill de Blasio and Dr. Mitchell Katz, the president and chief executive officer of NYC Health + Hospitals, vehemently denied that was the case.
"Saying that our hospitals would turn away someone with pneumonia is irresponsible, inaccurate and unfair. Mitch, would you like to comment?" De Blasio said at news conference at the temporary hospital at the Billie Jean King Tennis Center in Queens.
The hospital network did tell patients who have mild symptoms to stay at home, Katz said. But, he added, "We are not turning away anybody with pneumonia who is short of breath."
In the days after Luis Arellano first began steadily coughing and complaining of a fever, he began sleeping on a mattress in the living room of an apartment in Greenpoint he shared with his sister and their 96-year-old father.
The family was tight-knit.
Born in Alausi, a small town in Ecuador with a population of about 44,000 residents in the Chimborazo province, Luis Arellano, one of eight children, had been a psychologist in his native country, but had been unable to pass the necessary exams to continue his career in the United States after moving to New York in 1981.
Instead, he took jobs cleaning college dorms and offices.
Recently, Luis Arellano had been working as a home attendant, taking care of older people.
It had been after one of these work days that he began to feel ill.
Luis Arellano, like his sister, was a diabetic, but did not have previous respiratory issues. Still, the family took precautions, isolating Luis Arellano in the living room while he rested at home. But his condition grew worse.
Two days after his visit to urgent care, Luis Arellano began gasping for air at the apartment. His sister called an ambulance, which took him to Woodhull Medical Center, a public hospital in Brooklyn, on the morning of March 28.
That date had been a particularly harrowing moment in New York, the sixth consecutive day in the city in which more than 1,000 people had been hospitalized.
The total number of hospitalizations on March 28 would reach 1,261, according to city data. Luis Arellano had arrived via ambulance to Woodhull in the midst of a crisis.
Family members said they had told the paramedics that Luis Arellano was diagnosed with pneumonia, that he suffered from diabetes and that he was also awaiting for COVID-19 test results from the urgent care clinic. But, they said, the hospital sent him home.
At that point, it appeared hospitals were budgeting beds and ventilators as they braced for the anticipated peak.
"I was shocked," his son, Carlos Arellano, 23, said. "I didn't think that they would send him home. I'm not sure what the reasoning was."
"Our condolences go out to the family of the deceased," said Stephanie Guzman, the deputy press secretary of NYC Health + Hospitals, the public hospital network that oversees Woodhull. Citing privacy laws, she declined to comment further.
With Luis Arellano's condition not improving, his son worried his father might infect the rest of the Greenpoint household. Going to New Jersey, which had fewer cases than New York and where the son lived, seemed like his father's best chance at survival.
Two days after his visit to Woodhull, on March 30, Luis Arellano took 20 minutes to walk down the three flights of stairs at his apartment building to meet his son and his son's mother, who would drive him to New Jersey.
Luis Arellano sat in the car's back seat, breathed heavily and barely spoke during the ride, his son said. They arrived midday at Overlook Medical Center in Summit, New Jersey, where the family was told to go outside to an improvised emergency room waiting area. They waited for eight hours, they said.
By 11 p.m., about 10 patients were still ahead of Luis Arellano. A nurse had triaged him soon after the family's arrival, but they were told by the staff that a bed would not become available for another seven to nine hours. Carlos Arellano chose to take his father home.
"I was in a state of hopelessness," he said. "I could see that he was not going to be able to wait that long."
An unexpected surge of coronavirus patients on March 29 had hit area hospitals, said Robert Seman, a spokesman for Overlook, in a statement.
To combat the surge, he said, Overlook began rerouting patients who arrived by ambulance to other nearby hospitals.
Admissions at Overlook were done on a case-by-case basis, Seman said. He did not specify the criteria.
"While this also resulted in extended wait times, at no point has Overlook turned away anyone who arrived to our facility, including numerous ambulances that still arrived to our emergency department that day," Seman said. "Our care teams worked tirelessly to move patients from the emergency setting on to the appropriate level of care as quickly as possible."
Luis Arellano told his son that the pain felt like someone was cutting through his lungs with a knife. At night, Carlos could hear his father wheezing.
On April 1, they called an ambulance. The paramedics took Luis Arellano to Trinitas Regional Medical Center in Elizabeth, New Jersey. About nine hours later, Luis Arellano texted his son to tell him he had been placed in a private room.
There was never a hint that the end was near. Throughout his father's stay at Trinitas, his son called the hospital every day for updates.
His father had been given the malaria drug hydroxychloroquine and then put on oxygen therapy, he said. His fever was down but he was not getting better, the nurses told Carlos Arellano. On some days, Luis Arellano watched TV. Other days, he was given a catheter because he could not stand up to walk to the restroom. Luis Arellano sent his son two selfies that showed him wearing his oxygen mask. Sometimes he ate solids, but he was still extremely fatigued, his son recounted.
Since Carlos Arellano always initiated the contact with the hospital, he knew something was wrong when he got a call from a nurse on April 5. His father's heart and lungs had suddenly stopped beating, but they had been able to resuscitate him, a nurse told him. Carlos Arellano gave them permission to intubate his father, but before that could happen, only minutes later, a nurse called to say Luis Arellano did not make it. He was pronounced dead at 6:10 p.m.
Without knowing it, Carlos Arellano had sent his last WhatsApp message to his father at 5:45 p.m.
It read: "Hi pa, I hope you are recovering and we love you a lot. Keep fighting because you're very strong. Here my mom and I are well pa."
Luis Arellano did not reply.
Several days later, Carlos Arellano and his 96-year-old grandfather both tested positive for the coronavirus.