NEW YORK — Ms Belinda Ellis had been a nurse for 40 years, and she thought she’d seen it all. She had worked in hospitals in the Philippines, where she was born and got her degree. She was a nurse in Saudi Arabia and then at a military hospital on the border of Iraq when Saddam Hussein came into power.

But when the first wave of the pandemic battered New York City last spring, she still wasn’t prepared. Nor could she have foreseen the immense toll the coronavirus would take on her Filipino colleagues.

As devastating as Covid-19 was in those early months, a number of studies now reveal just how hard the virus hit Filipino health care workers. Of all the nurses who died of the virus nationwide, one study found, close to a third of them were Filipino.

According to an analysis by ProPublica, in the New York City area alone, at least 30 Filipino health care workers had died of the virus by June.

Many of them fell sick, including Erwin Lambrento, a tenacious night shift nurse from the outskirts of Manila who died of the virus in early May. Pictures of him still hang throughout Elmhurst Hospital Center, where Ms Ellis works.

“His presence is still all over,” she said. “If I think about it, I’ll get emotional. It’s still very fresh.”

According to a survey published in September by National Nurses United, the largest nurses union in the United States, 67 Filipino nurses have died of Covid-19. That figure, which was pulled from public obituaries, is around a third of the total registered nurses who have died nationwide, although Filipinos make up only four per cent of those nurses overall.

“It’s really heartbreaking,” said Ms Zenei Cortez, president of National Nurses United and a nurse from the Philippines herself. Ms Cortez fears that the true toll is worse.

“The numbers we are producing are all underreported. I’m sure of that.”

Now another wave of the virus has arrived. The infection rate in New York City has risen in recent weeks, and hospitalisations are at alarming levels; more than 450 New Yorkers have died of Covid-19 since the beginning of 2021.

And many Filipino nurses fear that their hospitals could again be crushed under caseloads that recall the harrowing months of March and April.

Filipino nurses have a long history of working in New York City hospitals, dating at least to the immigration reforms in the 1960s that broadened the categories of foreign workers who could apply for a US visa.

In the Philippines, nursing schools have taught an American curriculum since as early as 1907, granting degrees to English-speaking nurses who could slot easily into US hospitals. They became invaluable in the 1980s as a solution to staffing shortages exacerbated by the Aids epidemic.

It was in 1986 that Ms Ellis was recruited by Bellevue Hospital in Manhattan, where she was quickly deployed to the bedsides of patients with HIV.

San Francisco and New York were especially welcoming to migrant nurses, according to Dr Leo-Felix Jurado, a professor of nursing at William Paterson University in New Jersey who wrote his dissertation on the importation of Filipino nurses into American hospitals.

Dr Jurado, 55, was recruited in 1988 by JFK Medical Center in Edison, New Jersey. He recalls that visiting the employment fairs at Manila hotels felt like an afternoon of barhopping. Recruiters jostled to make hires, sweetening work visas to the United States with signing bonuses and promises of free housing, Dr Jurado said.

“It was very alluring to come as a result of that,” he added.

Over time, Filipino American nurses wove themselves into the fabric of New York City hospitals. They took jobs in acute bedside care at hospitals battered by Aids, and they found housing in Elmhurst and Woodside in Queens, an area now known as Little Manila.

These neighbourhoods were slammed last year by the pandemic. In June, a community group painted a mural in Woodside to fallen Filipino workers. It reads “Mabuhay,” which in Tagalog means “May you live.”

Filipinos are overrepresented in the types of health care professions that require close contact with patients, such as in emergency rooms and nursing homes — a risk heightened by Filipinos’ high rates of hypertension, asthma, obesity and diabetes.

“Everything has been pointing to the risk for Filipino health care workers,” said Dr Ninez Ponce, a researcher at UCLA’s Fielding School of Public Health who studies health disparities.

There is some hope among the nurses that the winter surge won’t be as deadly as the wave that arrived in the spring. Many say their hospitals are better prepared this time: They know how and when to use ventilators, for example, and Ms Ellis pointed out that Elmhurst Hospital now sits on vastly replenished stocks of protective masks and gowns.

In addition, health care workers have priority in receiving the Moderna and Pfizer vaccines, which have been shown to be highly effective.

Ms Ellis received her second shot Tuesday.

But it will be weeks before New York City’s hospital workers are fully immunised. In the meantime, nurses at several hospitals here have warned about a lack of protective gear, and hospitals throughout the city are reviving some of the coronavirus units that became a necessity in the spring.

Over the holidays, Ms Ellis’ Covid-19 unit became so full that it once again had to transfer patients to other hospitals. And recently, a 45-year-old woman had to be intubated, a procedure that hadn’t been done on a patient so young since the spring.

“It’s starting again,” Ms Ellis said. “Definitely.” THE NEW YORK TIMES