In the early hours of Tuesday morning, he took to Twitter again with a lengthy thread detailing what a day in the life of an ER doctor dealing with coronavirus cases is like—and explained just how bad the situation is in New York City is.

Spencer, who was diagnosed with Ebola after treating patients in West Africa five years ago, said he woke up at 6.30 a.m. and made “a big pot of coffee for the whole day, because the place by the hospital is closed” before heading to work.

Walking into the hospital for his 8 a.m. shift, he was “immediately struck by how the calm of the early morning city streets is immediately transformed.”

“The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in,” he added. Nearly every patient was the same, whether young or old; cough, shortness of breath and fever.

Doctors were “really worried” about one patient, he wrote, who is on the “maximum amount of oxygen we can give, but still breathing fast.” After a “long and honest” discussion with the patient and her family over the phone, the decision is made to put her on life support before “things get much worse.”

But while that was being set up, he was notified of another “really sick” patient coming in. That patient needs to be put on life support too.

“Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10am yet,” he added. For the rest of his shift, almost every hour, he was paged with more and more patients who desperately need help.

At some point in the afternoon, he realized he hadn’t drunk any water—but was too afraid to take off his mask. “It’s the only thing that protects you. Surely you can last a little longer - in West Africa during Ebola, you spent hours in a hot suit without water,” he noted.

Late in the afternoon, he needed to eat, but everything is closed, save for the hospital cafeteria. “You grab something, wash your hands (twice), cautiously take off your mask, & eat as fast as you can. Go back. Mask up. Walk in,” he wrote.

Nearly every patient he saw that day is assumed to have COVID-19, he wrote. “We wear gowns, goggles, and masks at every encounter. All day. It’s the only way to be safe. Where did all the heart attacks and appendicitis patients go? It’s all COVID,” he added.

When his shift comes to an end, he wiped everything down—his phone, badge, wallet, coffee mug. “All of it. Drown it in bleach. Everything in a bag. Take no chances,” he added.

When he gets home, he has to strip down in the hallway and put his clothing in a bag before showering. “Your wife tries to keep your toddler away, but she hasn’t seen you in days, so it’s really hard. Run to the shower. Rinse it all away. Never happier. Time for family,” he added.

Spencer added that for some, it must be hard to understand how bad the pandemic is, and how bad it is going to be, if all they see are empty streets.

But he had a dire warning for those not taking measures to curb the spread of the coronavirus seriously. “Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don’t stop,” he wrote.

“Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be stat notifications. More will be put on a ventilator.

“We were too late to stop this virus. Full stop. But we can slow its spread. The virus can’t infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don’t care as much about the economic impact as I do about our ability to save lives.”

Spencer added: “You might hear people saying it isn’t real. It is. You might hear people saying it isn’t bad. It is. You might hear people saying it can’t take you down. It can.

“I survived Ebola. I fear #COVIDー19. Do your part. Stay home. Stay safe. And every day I’ll come to work for you.” Spencer has been contacted for additional comment.

The U.S. has more than 46,000 confirmed cases of COVID-19 and 593 deaths, according to the latest figures from Johns Hopkins University. New York state has more than 20,000 confirmed cases of coronavirus and 125 deaths, New York Governor Andrew Cuomo said on Monday—and has become the epicenter of the virus in the U.S.

Globally, the novel coronavirus has sickened more than 392,000 people and killed more than 17,000. More than 102,000 people have recovered.

This infographic, provided by Statista, shows the number of confirmed COVID-19 in the U.S. as of March 24.

Hygiene advice

Clean hands frequently with soap and water, or alcohol-based hand rub. Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste. Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing. Avoid touching your hands, nose and mouth. Do not spit in public. Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.

Medical advice

If you feel unwell (fever, cough, difficulty breathing) seek medical care early and call local health authorities in advance. Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask usage

Healthy individuals only need to wear a mask if taking care of a sick person. Wear a mask if you are coughing or sneezing. Masks are effective when used in combination with frequent hand cleaning. Do not touch the mask while wearing it. Clean hands if you touch the mask. Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask. Do not reuse single-use masks.