Since the beginning of the COVID-19 pandemic, firefighter-certified first responders, emergency medical technicians, and paramedics have been the tip of the spear fighting coronavirus. First responders have triaged, resuscitated, and transported thousands of people affected by coronavirus disease 2019 (COVID-19). The American people owe a debt of gratitude for the heroic work they have done.

In this issue of JAMA Cardiology, the report of Lai and colleagues¹ highlights the dramatic burden that COVID-19 has placed on first response systems. At the height of the pandemic, New York City (NYC) emergency medical systems (EMS) responders attended to nearly 6 times the number of out-of-hospital cardiac arrests compared with the same period in 2019. This represents the tip of a massive iceberg; at the same time, the cumulative incidence of EMS calls for respiratory symptoms and fever skyrocketed. Although the typically bustling NYC streets remained eerily deserted, the characteristic cacophony of sounds of the “City that Never Sleeps” was replaced by sirens wailing all hours of the night.