By Maura Hohman

When New York City became the epicenter of the U.S. coronavirus outbreak in March, officials in other parts of the country watched in horror. But now, shortly after reopening, other states are experiencing rates of new COVID-19 cases that can only be compared to those early weeks in the city.

One of several states that's repeatedly made headlines lately is Arizona. In mid-June, it hit a record number of hospitalizations and as of early July, the state had the fastest-growing case rate in the U.S.

Responding to these widespread surges are thousands of health care professionals, who choose to travel to meet increased demand. Aya Healthcare, a travel nursing agency based in San Diego, California, has deployed 6,000 people in all 50 states since the pandemic began, a spokesperson said.

One such nurse, 27-year-old Alia Garcia based in Nashville, Tennessee, worked in a hospital in the Bronx borough of New York City from April 20 to June 17, and she recently transferred to Arizona. For the past two weeks, she's been living in Phoenix and working at a nearby hospital in Mesa.

Garcia said that she decided to go on "crisis assignments," because of her ICU and emergency department experience.

"I'm relatively young and have no health issues," she said. "I felt like I had the skills to be successful and really make a difference."

What it was like working in New York City

Reflecting on her first four weeks in New York, Garcia said the conditions were unlike anything she'd seen before.

She explained that traditionally, with travel nursing assignments, you receive a two-day orientation. In New York, her training lasted an hour before she became responsible for four to five ICU patients. In the weeks before she arrived, other nurses were dealing with seven patients and "really struggling," she said.

Usual ICU ratios are one patient per nurse if they're very ill, two if they're less ill. But all of Garcia's patients were still extremely sick, she said, adding, "That was definitely the hardest thing."

A stark memory from her time in New York City: Her hospital had a refrigerated, 18-wheeler morgue outside its emergency room to handle the surplus of bodies.

"Having to walk by that every day was eye-opening," she recalled. "We had dental residents filling our medication machines. It was all hands on deck."

She said her days involved "running from room to room, chasing drips and answering codes," a term that describes an emergency when a patient needs immediate care.

"On top of managing your own four vented, COVID-positive patients, whenever you'd hear a code ... we were the only ones who'd respond," she said. "In the beginning, there was a lot of death."

Seeing more experienced travel nurses, some with 10 to 15 years under their belts, "crying in the break room" and "breaking down in hallways" became a regular occurrence. "I don't think anyone goes into nursing expecting to work in that kind of environment," she said.

The harrowing nature of those nine weeks motivated Garcia to go to Arizona.

"New York got their feet swept from under them," she said. "If (Arizona) did get as bad as New York, I'd be there to help support others."

What hospitals are like in Arizona now

The most notable way the experiences differ is that her hospital in Arizona is more prepared.

"They've been nervous about the spike hitting for a few months now, so they're definitely ready for it," she said, emphasizing the caveat that she "can only speak to" her facility.

Garcia's noticed similar conditions to New York, but nothing as severe. She cares for two vented, sedated patients at a time, and entire units have been converted to treat only COVID-19 patients. Her hospital is getting transfers of coronavirus patients from others nearby, and she's seen many people recover, leave her floor, test positive again and return.

"We're starting to do some of the same things we did in the beginning in New York, like keeping the IV pumps and poles outside the room so you have to go in less times," she said.

At her hospital in Arizona, the nurses put on full-body protective gear only when they go into a COVID-positive patient's room. But in the near future, she expects this to change to wearing it all day to preserve equipment, which was the case in New York.

While she's felt safe at both facilities with regard to her COVID-19 risk, she noted that one nurse at her New York hospital died from the virus. None of her fellow nurses in Arizona have gotten sick yet.

Medical staff are also managing coronavirus patients with "more confidence," she said, whereas in New York, the approach changed "day by day."

But Garcia stressed that the culture of mask-wearing among the public, which she's observed is less prevalent in Arizona than New York, concerns her.

"I hope it doesn't get worse," she said. "I don't think it will get as bad as New York, but you never know."