For the last 19 years, Sept. 11 has cast a lingering shadow on John Feal.
The Nesconset, New York, resident and former construction worker suffered long-term health damage from working at Ground Zero and endured the emotional pain of seeing his fellow responders die from ailments contracted at the pile.
Feal told ABC News that despite all of those hardships, one of the biggest challenges he's had to face was COVID-19, which he contracted in March.
"Nothing scares me at all, but COVID scared me," he told ABC News.
Feal is one of the more than 1,400 Sept. 11 survivors and responders who have contracted the coronavirus so far as their compromised immune systems, particularly their ailing respiratory symptoms, make them more susceptible to the virus, according to health officials. As of Aug. 21, at least 191 have been hospitalized and 44 have died, according to data from the World Trade Center Health Program.
A program representative said the data represents a sample and not the complete number of the program's patients or the total coronavirus case numbers from the community.
"Every 9/11 survivor I know is looking over their shoulder thinking, 'Am I going to get cancer?'" Feal said. "Now they are looking over their shoulder twice thinking, 'Am I going to get cancer, or am I going to get COVID?'"
Feal, the founder of the non-profit advocacy group the Feal Good Foundation, is sounding the alarm on COVID-19: a drive shared by other responders and survivors.
Since the spring, they have been using their voices and their experiences to convince more people to heed health warnings. The 9/11 community is also working to honor the 19th anniversary of the attacks amid the pandemic.
Michael Barasch, an attorney who has worked with Feal and the 9/11 responder community for better health care, told ABC News that responders really began to pay attention to the coronavirus in late February when cases in the U.S. began to rise.
Barasch said he was particularly concerned for his clients because among the most common ailments seen among the women and men who worked at Ground Zero were respiratory illnesses, such as asthma, lung cancer and COPD.
"What's even scarier is if you had cancer and chemotherapy you have no immune system. So if you do have coronavirus, it's a death sentence," he told ABC News.
Barasch said he had heard from some members who weren't taking the health warnings too seriously, especially face coverings, because of mixed messages in the media and rhetoric from elected officials.
"It was bad enough that the federal government lied to the community when they said the air was safe," he said during the Aug. 26 interview. "Fast forward 19 years and our federal government tells people, 'It's not bad. You don't need to wear the mask,' and we have over 175,000 people dead."
Feal said he was walking on eggshells during those early months. Over the last 19 years, he's had 30 surgeries related to Ground Zero health problems, including an injured foot, scarred lungs and acid reflux. He also donated a kidney to a stranger in 2007.
"I took it seriously. I knew a virus like that would compromise our symptoms," Feal said.
On March 12, two days before New York recorded its first COVID-19 death, Feal and Barasch released a video on Barasch's Facebook page warning everyone about the virus.
"Those in the 9/11 community need to be vigilant, proactive and heed the advice of the CDC," Feal said in the video. "This is no longer a joke. We can all place memes on Facebook, but what is most important is that you listen to the advice that is given."
'Like I was living underwater'
Feal said he learned just how vulnerable he was about two weeks after he posted the warning video on Facebook.
Despite wearing a face covering, social distancing and washing his hands, he began to feel feverish. He developed a rough cough and other COVID-19 symptoms. After he was initially diagnosed with pneumonia at a hospital, Feal said he stayed at home but the symptoms got worse, and a coronavirus test confirmed he had the virus.
Feal recalls having aching skin, and he said there are moments during his battle against the virus that he doesn't remember.
"I felt like I was living underwater and I had to come up every couple of moments to catch my breath," he said.
After nearly three weeks, Feal said the symptoms subsided and he eventually tested negative. He said his family watched with great worry during his ordeal, especially during the recovery period.
Feal said his regular functions did not come back overnight and every part of the recovery was a fight.
"The last thing to come back was my breathing," he said. "I feel lucky, really lucky."
Caring for the sick while vulnerable
Barasch said responders and survivors have another concern on their minds: What happens when their loved ones contract the virus?
Their vulnerable status makes it dangerous for them to care for a family member who contracted the disease.
"A lot of first responders are scared," he said.
Michael O'Connell, 44, retired from the fire department in New York in 2009 after he was diagnosed two years earlier with sarcoidosis, an autoimmune disease that he said he contracted while working in Ground Zero.
O'Connell told ABC News that except for essential needs shopping, he stayed at home once the pandemic began, but that changed once his senior citizen mother contracted the disease in mid-March.
"She probably went through it for a month but the most severe symptoms were for two weeks," he said. "Her most difficult time was at night when she couldn't sleep."
Although his mother recovered from the virus, O'Connell said it was heart-wrenching for him not to be at her side during the quarantine period due to his condition.
"Through the winter and into this whole pandemic we were put through the wringer," he said. "I'm always one of the guys who throws his name in the hat anytime someone asks for help…but with this, we were definitely very fearful."
O'Connell said other responders share this concern, particularly for their sisters and brothers who are answering 911 calls. He said several members at his old Queens firehouse contracted coronavirus.
"When you hear that people are normally healthy human beings are dying because of this disease, it becomes an eye-opener," he said.
Calls for caution
Feal and other 9-11 responders said this fear motivated them to use their voice to help fight the pandemic.
Feal himself donated plasma eight times and his organization has provided relief supplies to essential workers in New York. The most important mission for him was to call on the public to unite and take the precautions seriously.
Through social media posts and videos, and interviews with local press, Feal has urged anyone that can listen to his voice to wear a mask, socially distance and listen only to medical experts.
"I don't care if you're wearing a flag on your car, you're not patriotic if you're not wearing a mask," Feal said.
Barasch said that he is confident that Feal and other responders have been making a difference in changing attitudes on the pandemic. He noted that the responders have always been upfront about the health dangers that came at the hands of their altruism.
"They have a lot of credibility," Barasch said. "People are sympathetic to what they are going through and I think they can change a lot of minds."
Feal said the community's message of unity is no different than the one made after 9-11. His group has worked with elected officials and celebrities like John Stewart to pass federal bills, like the 911 Victim Compensation Fund, which provided health aid to any 9-11 responder who was hurt.
Feal said COVID-19 precautions will be a part of the community's message during this year's anniversary, even if they won't have a physical stage to tell their story.
A different memorial service
Due the coronavirus, the annual ceremony at the 9/11 Memorial in downtown Manhattan will be scaled back.
According to the National September 11 Memorial & Museum, there will be no stage or live readings of the names of the dead this year. Instead, a recording of a previous reading will be played.
Survivors, first responders and their families are still allowed to be present during the ceremony, but they will be required to wear masks and practice social distancing in the eight-acre space.
"The heart of the intentions was the health and safety of everyone and giving a lot of thought to the members of the 9/11 community who is at risk," Olivia Egger, a spokeswoman for the memorial told ABC News. "None of these decisions were made lightly and [they] were made in consideration of the community."
Barasch said many in the 9/11 community were disappointed in the new ceremony regulations but in the end came to an understanding of the situation. The one thing they were not happy with was the initial cancellation of the Tribute in Light, according to the attorney.
But on Aug. 15, Gov. Andrew Cuomo stepped in and provided the necessary health resources and personnel to ensure the Tribute in Light didn't skip a year.
Feal said he completely understood both the memorial's strict regulations and the frustrations from his fellow responders, especially since the community has lost dozens of its members over the years. For them, the ceremony was the only time they got together and with hundreds dying every year.
"There's a group of 10 guys and they get together every year, and one year there's only eight left, and the next year there's only five left and they're dying off," Feal said.
Feal hopes that the country will use the anniversary as a turning point in the pandemic, recalling the days after the attacks where New Yorkers of all backgrounds and ages put aside their differences and unite to help pick up the pieces.
"If we were to bottle Sept. 12 and we learned to live like everyone did that day, the pandemic would go away a lot faster," he said.
This report was featured in the Friday, Sept. 11, 2020, episode of “Start Here,” ABC News’ daily news podcast.
"Start Here" offers a straightforward look at the day's top stories in 20 minutes. Listen for free every weekday on Apple Podcasts, Google Podcasts, Spotify, the ABC News app or wherever you get your podcasts.