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But when she saw that New York had become a hot zone for the worst public health crisis in a century, Clifford knew she had to help out as close to home as she could.

"When you decide to become a nurse, something kind of clicks in you," she said over the phone Tuesday. "We want to be at work, we want to be doing our best and we want to be helping people."

After a conversation with her recruiter, Clifford was on her way to Hackensack University Medical Center in New Jersey, where she's been logging 12-hour night shifts since March 30. She works in a pop-up, 75-bed intensive care unit consisting entirely of patients with coronavirus, or COVID-19.

There's no such thing as a typical night there, Clifford said. Treatment guidelines continue to evolve, supplies are almost exhausted and the virus defies explanation. She's seen patients of all ages and conditions, and the only constant they present has been the speed with which COVID-19 attacks them.

"This virus has no rules," she said. "That is the scariest part. It's like nothing I've seen before aside from cancer."

Clifford doesn't know how many people her hospital has lost to the virus. It's a tough subject, she said, and she knows the number is "not good." But she has a better idea how many people the hospital has sent home, and it's about 270. That's because the number is tracked on a board for everyone to see.

That positive energy, that resolve to lift everyone's spirits, has been another constant during Clifford's time in New Jersey.

She's been able to count on support from not only her hospital, but also her fellow staff. Nurses are often expected to shoulder the burden of their work without showing emotion, Clifford said, but "we absolutely feel everything that's going on." And it helps, even during a pandemic, to be able to share that burden with others.

"When all is said and done, we are in a war zone type of situation. But when you look around and you still see people willing to help and smiling and trying to keep spirits up 鈥� that's what you have to take away in times like this," she said. "What I'm going to remember is the people I'm working with side-by-side in these trenches."

Clifford's bonds with her fellow staff are strengthened by their shared experience. And part of that experience is the extensive routine they follow to protect themselves from exposure to COVID-19.

Clifford has to wear a surgical mask at all times, she said, plus an N95 mask, face shield, hair net and gown around patients. She washes her hands when she enters the hospital, and washes them half a dozen times while removing her protective equipment. The hospital, helpfully, gives her scrubs she returns at the end of her shift for washing, so she goes home in clean clothes. Though she's afraid of catching COVID-19 鈥� anyone who isn't afraid isn't taking the virus seriously enough, she said 鈥� Clifford trusts in her ability to protect herself so long as she has the resources.

The hospital hasn't run out of any of those resources yet, Clifford said. But supplies have gotten low and been fought over. At one point, staff made face shields from sheets of plastic with holes cut in the side for their elastic straps. There have also been shortages of ventilators and IV tubing. And because critical IV medications require nurses bedside, close to the patient at all times, staff had to devise a way to safely extend IV pumps outside a patient's room in order to limit exposure. Such troubleshooting reminded Clifford of her time in Guam, she said.

"It requires pretty critical thinking," she said. "We've gotten creative."

Clifford is on an eight-week crisis contract at Hackensack, she said. She hopes she sees the curve of COVID-19 flatten during that time.

Afterward, she'd like to return to central New York, where her father, Tim Clifford, also works as a nurse, in corrections. She's aware of how much nurses have been held up as heroes during the pandemic, and appreciates the support. But she's just as appreciative of the people in her hometown who are doing their part right now.

"My heroes are the people back home with my family, taking social isolation seriously and keeping them safe," she said. "I thank them as much as they thank me."

Four men 鈥� one in their 50s, one in their 30s and two in their 20s 鈥� and a woman in her 20s tested positive for the virus. The men live outside of Auburn and the woman is a city resident, according to the health department.听

A few of the new positive cases are linked to previously confirmed cases. No other information was released about the connections to past cases. The health department is conducting contact tracing investigations to determine if any of the positive cases had direct contact with other people who were exposed to COVID-19.听

Three patients are hospitalized, but it wasn't disclosed whether any of the new positive cases are among those in the hospital. A Cayuga County dairy farmworker has been hospitalized since last week due to the coronavirus.听

One of the hospitalized patients is in critical condition, according to the health department. Two are in stable condition.听

The health department has discharged three people who were in mandatory isolation after testing positive for the virus. They recovered from the illness and were released.听

Ten people remain in mandatory isolation, including the three hospitalized patients. Forty-eight people are in mandatory quarantine, which means they had close contact with a positive case.听

As of Monday, the county has received 401 COVID-19 test results. Thirteen people tested positive for the virus and 388 were negative.听

The health department is waiting for the results of 49 tests.听

With the number of COVID-19 cases growing in Cayuga County, the health department urged residents to continue following social distancing guidelines. The agency also shared guidance from the Centers for Disease Control and Prevention about wearing a mask or face covering when you're in the grocery and other public settings.听

The CDC recommended the use of a cloth face covering to slow the spread of the virus.听

Cuddy explained that chronic health conditions may have contributed to the man's death. Older people, those with underlying medical conditions and immunocompromised individuals are at a high risk of serious illness if they contract COVID-19.听

"This virus does not discriminate," Cuddy said. "It does not matter if you are male or female. It does not matter how old you are or where you live. The virus is throughout our county and has caused the death of one of our own."聽

The man who died is young compared to other victims. According to state Department of Health data, 82.6% of the COVID-19 fatalities in New York are people ages 60 and older. Deaths among those ages 40-49 are less common, with this group accounting for 4.2% of all COVID-19 fatalities statewide.听

But chronic health conditions have been present in most New Yorkers killed by the virus. More than 86% of fatalities have at least one comorbidity, according to the state health department. High blood pressure and diabetes are among the most common chronic conditions.听

"We may be seeing the most deaths statistically amongst our older population," Cuddy said. "But clearly this impacts younger people as well."聽

For weeks, the hot spot in New York has been the downstate area. A vast majority of the positive cases and deaths have been reported in New York City and the surrounding suburbs. But there is an increasing number of confirmed COVID-19 cases in Cayuga County and central New York.听

One week ago, the county had four confirmed cases of the coronavirus. Now, there are 17 positive cases. Two more confirmed cases 鈥� a man in his 50s and a woman in her 30s, both of whom live outside the city of Auburn 鈥� were announced Wednesday.听

In counties that surround Cayuga County, Onondaga continued to report the most confirmed COVID-19 cases, with 422 as of Wednesday afternoon, followed by Tompkins (105), Oswego (36), Wayne (35), Cortland (19) and Seneca (12). Onondaga also has released town-level data that shows confirmed cases in towns that border Cayuga: Lysander has 11 cases, Skaneateles has 10 and Spafford has one, while Elbridge continued to have no reported cases of Wednesday afternoon.听

There are positive metrics showing statewide hospitalization rates and the number of intensive care unit admissions are declining, but there are indications that the outbreak is worsening in upstate New York.听

Cayuga County Legislature Chairwoman Aileen McNabb-Coleman urged residents to maintain social distancing and stay home as much as possible.听

"This is not the time to think of ourselves only, especially if you are healthy and not at high risk," she said. "This is a time when we need to think of and protect others."聽

McNabb-Coleman declared a state of emergency in March and took other actions to prevent the spread of COVID-19. She signed an emergency order this week to close athletic courts, fields and playgrounds in Cayuga County.听

There are statewide restrictions in place, including the closure of non-essential businesses and public schools. Conversations are ongoing about whether more limits are needed, McNabb-Coleman said. But she thinks residents need to comply with the existing orders.听

Cuddy also asked residents to comply with health-related recommendations, such as staying home when you're sick, frequent handwashing and wearing a mask in public. Compliance is "imperative," she said, to protect the community.

The first COVID-19 death is a significant development in the county's response to the disease. Over the last few weeks, Cuddy and McNabb-Coleman highlighted the impediments to testing, including the availability of personal protective equipment and swabs to administer the tests.听

One week ago, the county had tested 286 people for the coronavirus. As of Wednesday, the number tested jumped to 482.听

With more testing comes an increase in confirmed cases. Of the 17 cases, five recovered and have been discharged from mandatory isolation. One person remains hospitalized in stable condition. Thirty-three people are in mandatory quarantine after having direct contact with a positive case.听

Officials have said they are prepared for the pandemic. But that didn't ease the pain of losing someone to the virus in Cayuga County.听

"Let this be a stark reminder that this virus is real, that it is in our community and it kills," McNabb-Coleman said.听

The state also reported a drop in the number of intensive care unit admissions 鈥� 128, down from 395 on Friday 鈥� and daily intubations decreased by 58%, from 316 to 132, over the weekend.听

The number of patients discharged declined Sunday, from 1,709 to 1,179, but Gov. Andrew Cuomo believes that's due to the recent drop in hospitalizations.听

"These are all good signs and would suggest a possible flattening of the curve," Cuomo said at his daily briefing Monday.听

The curve refers to the number of confirmed cases of the virus compared to the length of the outbreak. Extending the cases over a period of time instead of having a massive peak helps ease the burden on hospitals.听

New York City-area hospitals are already strained due to the pandemic. While there have been cases reported in every New York county, a vast majority of the patients hospitalized with COVID-19 are in the downstate region.

Statewide, there are 16,387 people in the hospital and 4,504 patients in intensive care units. The death toll rose to 4,758 by midday Monday.听

If the trend continues, the state could fall short of its high and moderate projections. One estimate suggested that the state would need 110,000 hospital beds to treat COVID-19 patients. Another projected the state would need 55,000 hospital beds.听

The current number of hospitalizations is well below that mark and it's possible that the state is "potentially at the apex or beginning at the apex at this moment," said Dr. Jim Malatras, president of SUNY Empire State College and one of Cuomo's advisers during the pandemic.听

At the current rate, the cases won't peak in New York. Instead, there will be a plateau where the number of hospitalizations levels off for an extended period.听

"If we are plateauing, it's because social distancing is working," Cuomo said. "So we have to make sure social distancing actually continues."聽

Cuomo doesn't want New Yorkers to get overconfident and rush to resume their pre-pandemic lives. He highlighted what happened in Asian countries, including South Korea, when there was a large dip in COVID-19 cases. As people returned to work and social activities, the number of cases spiked again. He wants to prevent that from happening in New York.听

The maximum fine for violating the state's social distancing rules will be doubled from $500 to $1,000, Cuomo announced Monday. He's also encouraging local governments to aggressively enforce the guidelines.听

The New York on PAUSE measures, which Cuomo implemented in March, will continue through April. Non-essential businesses and public schools will be closed until April 29.听

"I know that's a negative for many, many reasons," he said. "I know what it does to the economy. But as I said from day one, I'm not going to choose between public health and economic activity."聽

In other news:聽

鈥� Cuomo provided an update on the state's efforts to increase hospital capacity and help relieve the strain on New York City-area medical facilities.听

A temporary 2,500-bed hospital at the Jacob Javits Center in Manhattan will be staffed by military personnel. Cuomo said a majority of the military service members will arrive Tuesday.听

"That Javits Center will be a major relief valve," Cuomo said.听

Cuomo also plans to speak with President Donald Trump about his request to use the USNS Comfort for COVID-19 patients. The initial plan for the Comfort, a Navy hospital ship, was to treat non-coronavirus patients. But with a sharp decline in the number of patients seeking treatment for other conditions or injuries, Cuomo hopes that the Comfort can be used for COVID-19 patients in need of care.

Fifteen parolees also tested positive for COVID-19.听

Five coronavirus-related deaths 鈥� two incarcerated individuals, two individuals parolees and a civilian employee 鈥� have been reported. DOCCS said that the official cause of death is pending for the two deceased inmates.听

Citing security reasons, DOCCS won't disclose the correctional facilities where the positive cases are employed or incarcerated. The agency also won't reveal where confirmed cases are hospitalized.听

"With each confirmed case, DOCCS works with the Department of Health to identify any potentially exposed individuals to provide notifications and to stop the spread of the virus," DOCCS wrote in an email to 水果派AV.

There has been concern about an outbreak occurring in New York state prisons. DOCCS has more than 43,000 incarcerated individuals in its 52 correctional facilities. The agency employs approximately 29,000 people.听

In March, a former Auburn Correctional Facility inmate tested positive for the coronavirus after being transferred to a western New York prison. The New York State Correctional Officers and Police Benevolent Association, the union representing the state's correction officers, told 水果派AV that at least two dozen employees quarantined due to possible exposure to the positive case.听

With an increasing number of confirmed COVID-19 cases in state prisons, a coalition of criminal justice advocacy groups called on Gov. Andrew Cuomo to release incarcerated individuals who are at high risk of serious illness if they contract the virus.听

Seniors, people with chronic health conditions and those who are immunocompromised could have severe symptoms of COVID-19. Cuomo has been asked about whether he will release some inmates from state prisons to prevent the spread of the virus, but he hasn't made a decision.听

On Tuesday, Cuomo said there was "nothing new" to report.

"A record number of people are sick, lives have already been lost and a ticking time bomb looms over New York state," the coalition, which includes the Release Aging People in Prison Campaign, Parole Preparation Project, #HALTsolitary Campaign, VOCAL-NY and Worth Rises, said in a statement. "The governor must act now by granting clemency to older people and others in prison to whom this virus presents a life and death risk."聽

DOCCS has implemented measures to combat the spread of COVID-19 in state prisons. The policies include suspending visitation, limiting inmate transfers and allowing staff to wear personal protective equipment.听