The chaos of an attempted resuscitation. The scene is all wires, beeps, and urgent voices amidst a swirl of acid-yellow scrubs and translucent plastic—set against the sickening tone of a flatline. At the centre, the rhythmic violence of a doctor performing chest compressions. Then, as time wears on, a change. A slowing. Finally, someone calls a time, and the attending medics form a circle, suddenly, wearily still. They stand for one minute in silence. Of the doctors themselves, through a slit in their scrubs, you only see the eyes. It’s enough.
It’s March 2020, and COVID-19 cases are appearing fast in the Intensive Care Unit of New York’s Long Island Jewish Medical Centre. The patients are the beginnings of a wave of a disease that would devastate the city in more ways than one. The images of its deserted streets—streets so famously synonymous with frenetic activity—so early in the pandemic would send a frightening signal that something was happening unprecedented in the modern age.
Inside the hospital, film-maker Matthew Heineman and his crew were shooting the first scenes of what would become The First Wave, a devastating documentary from National Geographic—following a team of medical professionals during the first New York City COVID-19 surge.
Frustrated by a 'tsunami' of misinformation and statistics without any visuals of the crisis, Heineman negotiated rare access to the hospital near his home—what he saw as an ‘enormous obligation to put a human face to this crisis.’ At the time he, like everyone else, couldn’t know what was coming.
“We had no idea,” Heineman tells National Geographic UK from his office in New York. “We naively thought this would be like one or two weeks, and then it would all be over. Obviously, our production lasted for months and we’re still living with the virus today. You have no idea where the story’s going to go.”
In the documentary, we are dropped back in time—though not far—onto the medical frontline of a war against a still-mysterious virus, without vaccines, without insight, and without answers in the fight against a disease that would go on to kill five million people and counting around the world. It’s a film of startling intimacy, witnessing a small group of doctors and patients during the most frightening period of their lives.
An unsettling aspect of the The First Wave is its strange unfamiliarity: that this was caused by the same disease we all now know—but that few of us know like this.
A ‘document of record’
“I knew that [journalists] didn’t have the access that I had,” says Heineman. “And I felt an enormous responsibility with that access. I didn’t want to screw it up. I didn’t know if the film would be good, if people would want to watch it… but I always knew in the back of my mind that this was going to be one of the documents of record of what happened. With all of the highs and lows that that meant.”
New York, as would quickly become apparent, became a COVID-19 battleground. A city so conditioned to being the centre of the media’s attention soon became the centre of its own nightmare.
On the news, scenes seemingly spliced from science fiction movies and history books played out under the glare of a world still scrambling for certainties: An island city in lockdown, reports of hospitals and morgues overflowing with the sick and the dead, and the chilling sight of mass graves being dug on offshore islands by workers in hazmat suits and masks. Politicians called for calm while doctors screamed for help— while every minute, patients were being wheeled in for care there wasn’t the capacity, or knowledge, to provide. But from inside hospitals, there was little reaching the public’s eye.
No stranger to fear-laden situations, the Oscar-nominated director—whose previous films include the acclaimed City of Ghosts, A Private War and Cartel Land—had just entered a very different kind of conflict.
“There’s a reason why people go to warzones. Why we see images coming out of Vietnam, or Iraq, or Afghanistan—they inform discourse, and inform public opinion." Says Heineman. ”[With COVID-19], we weren’t seeing those images… what was happening inside those hospitals. We weren’t viscerally connecting with this topic. That’s what allowed misinformation to fester.” (Related: A guide to overcoming COVID-19 misinformation.)
“One of the greatest tragedies of COVID is that it became so politicised,” he adds. “At least in the US, it further fractured a fractured country.”
Four months of chaos
The documentary follows an internist named Dr. Nathalie Dougé and her team as they care for COVID-19 inpatients—many on ventilators, suffering the most severe form of the disease. These patients weave their own threads, two in particular – both young, people of colour and frontline workers, and both very sick: Brussels Jabon, a Filipino-American nurse who delivered a baby by emergency caesarean before being placed on a ventilator. And Ahmed Ellis, a Black police officer with a young family, who was struck down by severe COVID-19 at the age of 36. Through these patients’ journey, Heineman’s camera captures the highs and lows of the critical care staff around them, amidst a healthcare system at breaking point. Then, on May 25, George Floyd was murdered.
“If you told me in early March that this film would include protests against systemic racism three months later I would say, that doesn’t make any sense, that’s not part of this story,” says Heineman, of the unrest that erupted across America and the world, whilst his crew were still embedded. “But that’s exactly where this all led. I think the film is about much more than just COVID.”
Most of the patients featured in The First Wave are people of color—a cohort of minorities vulnerable to COVID-19, not least down to a high proportion working in frontline positions or subject to low income, thus at high risk of catching—and at a disadvantage when fighting – the disease.
In June Dougé, herself the child of Haitian immigrants, takes part in a healthcare worker’s protest, and we witness the weary impact of months of a pandemic on the doctor. At one point—surgical mask emblazoned with the now tragically multifarious phrase ‘I can’t breathe’—the doctor imparts: “with COVID, you word so hard trying to preserve human life… to see the blatant disregard for [it]… that was enough to kind of break my soul a bit. That was the final straw for me.” Later the camera watches Dougé diffuse a potential altercation between a police cordon and an emotional Black protestor, who later collapses weeping into her arms.
“I think I met Nathalie [Dougé] in the first couple of days shooting in the hospital,” remembers Heineman. “She had this electric personality, she was deeply empathetic on camera, deeply empathetic to her patients. She allowed us into some incredibly intimate moments in her life, at the most difficult moment in her life. I had no idea where her story would arc.”
Trust amidst a nightmare
This immersion is what makes The First Wave so powerful. You are in the room as people fight for life, people are saved, people die. As doctors steel themselves at the beginning of a shift that could be the worst of their lives, and disintegrate into a kaleidoscope of complex emotions—from anger, to fear, to desperation—at the end of it. The First Wave’s camera, never acknowledged, pierces a veil of vulnerability rarely seen in a profession where the heroes are real, but are also real people. (Related: Women are on the frontlines in the fight against COVID-19.)
“There’s definitely moments we felt like we shouldn’t be there. But that’s exactly why we were there.” Says Heineman. “Moments that were deeply troubling, deeply intimate. And that’s why the trust with your participants is so important. They let you be there. To the point where you become part of the fabric of their daily lives.”
As it happened, those daily lives involved an escalating number of life-and-death moments. “We spent a lot of time with the rapid response team, the team of specialist ICU nurses that goes around when people are coding...” [in cardio-pulmonary arrest] says Heineman. “Sometimes there are dozens of codes per day, just for that one team of nurses to deal with. I mean, they’re used to people dying. People die in hospitals. But the volume, and the frequency, was just unprecedented.”
Capturing those moments presented substantial practical challenges for the film-makers in a conflict where the enemy was more insidious than any human insurgent. “It’s invisible. When you’re in a war zone, there’s spurts of really terrifying moments, and a lot of boredom. But with this, there was never a second we could let our guard down. Every single aspect of this was terrifying.” Heineman describes the scenario between the doctors, the patients and the filmmakers as “all going through this experience together, in different ways.”
“[For the doctors,] the fear was many-fold. And the trauma. There’s obviously the fear of getting it; and the fear of spreading it amongst their family. Then there is the fear of the inability to do your job. Imagine spending your entire career studying the human body, fixing the human body, then everything you’ve learned is thrown out the window.”
Doctors and nurses are seen consulting with each other and patient’s families through iPads wrapped in plastic; holding up the devices for those at home to see their loved ones, and acting as a kind of technological go-between for a family and what is sometimes a patient’s final moments. At one point a doctor breaks down at the frustration of these suddenly critical devices running out of batteries—with everyone scared to share chargers through the fear of cross-contamination.
“That was one of the most insidious aspects about this disease, is how isolating it was.” Says Heineman. “Isolating for caregivers, for doctors and nurses, most importantly for family members—to be making these decisions through devices, and to not be there with their loved ones in their final moments.”
Triumph of spirit
In the early stages of the pandemic, with little concrete information known about the spread of SARS-Cov-2, The First Wave's crew, like the doctors, had to take every precaution, with little protective equipment, and no guarantee.
Everything from putting the camera down for a moment, going to the toilet, putting a microphone on someone, to eating and rubbing tired eyes, were all potential contagion risks. “The last thing we wanted to do was infect our crew, infect ourselves, worst of all spread the virus amongst the people we were filming. [But] the science was so sketchy in March. Now we have preventative measures, we have vaccines, we have treatments… at that time we literally had no tools in our toolbox. We all lost about 80 layers of skin scrubbing our hands. And PPE was really scarce at the time.”
The filmmakers wore scrubs and one n95 mask they had to re-use, “with a surgical mask over the top just like the doctors and nurses did, because we wanted to fit in as best as possible.” Then, when the day was over, the subject matter kept rolling.
“On a normal documentary shoot you wrap, you get in the car, you turn on the radio, and you’re on to whatever is well in your life.” He adds. But with the decontamination process and cleaning out their equipment “it was at least three, four, five hours from the last frame of shooting until we could quote-unquote ‘relax.’ And then we were living the same thing we were documenting… scrubbing down our groceries, figuring out how to get food, toilet paper. After 12 hours in a hospital. You could never, ever turn off.”
“It’s the hardest film I’ve ever made, by far—emotionally, logistically physically,” says Heineman. “But the overwhelming feeling that I had was feeling really inspired by the power of the human spirit.”
“If I was going to distil it down to one thing it’s about how human beings come together in the face of crisis,” he adds. “That was a really, really beautiful thing to witness. And that’s what drove us, every single day, to keep making this film.”
This story was adapted from the National Geographic U.K. website.