After an eight-hour shift in the emergency room, Dr. Kit Delgado opened Twitter and typed his distressing realization: “Just at the beginning of a long, excruciating marathon. Worst is yet to come.”

Doctors and nurses on the front lines are going on social media, sharing intimate looks at their battle to save lives, one person at a time, and taking thousands of readers and followers right into the ER.

Delgado, a 40-year-old attending physician in the Penn Presbyterian Medical Center emergency room, is seeing more and more COVID-19 patients come through the hospital doors.

He and other medical professionals in the Philadelphia-area, and around the world, are hoping their stories provide a window into the near, frightful future.

The coronavirus pandemic is being equated to fighting a war. But unlike war, where ravaged buildings and injured bodies lie in plain sight, making for powerful imagery, the coronavirus pandemic is playing out behind hospital walls.

Those sharing stories on social media said they felt compelled to tell the public about the battles they cannot see. They post about intubating patients who could no longer breathe on their own. They post about their lack of personal protective equipment, including face shields made out of a snorkel mask.

They beg people to stay at home, since they can’t.

Delgado has been retweeting harrowing accounts from health-care workers in New York, Louisiana, and Boston, about how the coronavirus is overrunning their hospitals. He worries people don’t realize how bad it is.

“It’s hard to know something is serious going on when you walk outside your front door and the sky is blue and kids are riding bikes,” Delgado said. “The outside of your hospital may look quiet, but inside it’s a different story.”

Physicians and hospitals are bound by patient-confidentiality rules, so when medical professionals divulge information about dire conditions inside their workplace, they have to be careful.

“Now it’s a kind of medium of solidarity: ‘I’m going through this and my peers across the country are going through this and let’s share our experiences,’” said Steven Joffe, a professor and interim chair of the University of Pennsylvania Perelman School of Medicine’s medical ethics and health policy department. “People are really feeling like they are at risk, they’re putting their families at risk, and it’s just intolerable.”

Health-care responders are using social media to not only share what they are seeing, but ask for advice. They’re tweeting medical observations, like benefits of proning COVID-19 patients (lying them face down), and primary care physicians are asking emergency room doctors what symptoms to look for while conducting telemedicine appointments. These transparent exchanges in the public view also show how doctors, just like the general public, are trying to figure out how to beat this pandemic.

“People want to share the lessons that come out of those stories,” Joffe said.

These unfiltered accounts are different than the usual strict media interviews, and some hospitals are pushing back.

Dr. Ryan Stanton, a board member of the American College of Emergency Physicians, said some doctors and nurses have been fired for public comments about how the pandemic is overwhelming hospitals and workers don’t have adequate personal protective equipment.

“Some facilities out there are still putting their image over their people, which is an unfortunate situation,” said Stanton, an emergency physician in Lexington, Ky.

A nurse at a central New Jersey hospital, who asked not to be named because she worries about repercussions from her employer, shares her thoughts behind an anonymous Twitter account. She has heard about medical professionals being punished for speaking out at other places, and doesn’t want to be the first at her hospital.

Her Twitter anonymity affords her certain leeways that using her name wouldn’t. She was enraged after reading President Donald Trump’s tweets downplaying the virus. She replied to one and urged Trump to tour her emergency room, see the lack of personal protective equipment, and watch doctors intubate a patient.

Others are trying to share brighter moments. Some hospital workers post photos of sidewalk messages of encouragement, and medical teams are learning the latest TikTok dances to remind people that the nurses and doctors behind masks are people, too.

Sally Kamara, 26, a registered nurse in the neuro trauma ICU at Jefferson Hospital, stood with five coworkers, all wearing blue scrubs and face masks, and danced to “Something New” from Wiz Khalifa and Ty Dolla $ign. This song and dance are part of a TikTok trend celebrities like Jennifer Lopez and LeBron James have also jumped on.

“Let’s take a second and put a smile on someone’s face and let them know that it’s going to be OK,” Kamara said, explaining her reasoning for the video. “And I think that’s important, too.”

Jeffrey Salvatore, a clinical nurse specialist at Thomas Jefferson University Hospitals, is part of what he calls the Swab Squad — a group of nurses operating a coronavirus testing site. The Squad’s debut video featured the nurses doing the “Blinding Lights’ challenge," a TikTok trend where people do a choreographed dance to a song by The Weeknd.

They posted another TikTok trend, dancing to Ciara’s “Level Up.” Ciara herself gave them a shout out.

People who think they have COVID-19 come to the site nervous and apprehensive, but so do the nurses.

“When you get put in a parking lot to test people for a pandemic virus, it is an unusual situation,” Salvatore, 29, said. “We just took all of that energy and decided to make it as positive as we could for ourselves.”

Every morning, they come together in a huddle like a sports team before a big play. They put their feet in, instead of their hands. One day, as they broke, a nurse said, “Swab Squad!" The name stuck. They started dancing to stay warm between patients on chilly days and that too has become a sort of tradition.

Salvatore said one nurse is taking a travel assignment in North Jersey, an epicenter of the pandemic. After a tough day, she showed a coworker the video of the Jefferson Swab Squad. It made them smile.

“A lot of health-care workers, we’re isolated because the whole world is isolated” Salvatore said. "But this is a way to experience camaraderie. It’s a way to stay connected.”

Jeffrey Salvatore (center) a clinical nurse specialist at Thomas Jefferson University Hospitals, starts the morning off with some dance and exercise with his colleagues on the Swab Squad.
JESSICA GRIFFIN / Staff Photographer
Jeffrey Salvatore (center) a clinical nurse specialist at Thomas Jefferson University Hospitals, starts the morning off with some dance and exercise with his colleagues on the Swab Squad.