Honolulu firefighters face multiple threats from COVID-19 — working side by side while often the first to respond to emergency calls for the sick, as well as living together and living in the community.

Eleven Honolulu firefighters at three stations have tested positive for the new coronavirus thus far — five at Hawaii Kai, three at Kalihi Uka, and three from Moanalua.

“Over the last one to two weeks, it’s been nonstop,” said Bobby Lee, president of the Hawaii Fire Fighters Association, referring to calls from union members. “Lot of apprehension out there. A lot of them worried about taking stuff home to their family, of course. They’re there first, responding to potential COVID cases every day.”

But Lee’s main concern is about public safety and a possible manpower shortage due to quarantining.

The current spike in Oahu COVID-19 cases — there were 201 new cases Friday — is reflected within Honolulu’s fire personnel, said Honolulu Fire Department Capt. Jeffrey Roache.

As has been reported in all cases of COVID-19 among Honolulu firefighters, the firefighter testing positive is placed on leave and self-isolates. All personnel from the station are instructed to self-quarantine.

HFD redistributes personnel from other stations to maintain emergency response coverage for the area. The affected station, trucks and equipment are sanitized and disinfected.

Lee says as more individuals are quarantined, the department has to move manpower around and personnel are going to different stations, which “increases the chances of getting an exposure.”

He added, “For me what is very disturbing is that when you have a positive case in the fire station, that could be one person, but that one person can take out 10 people, 15 or 20 people.

“When you start losing firefighters in those kind of numbers, now is where the public safety issue comes in. You’re taking out two, three, four trucks from responding. You have to find more people or reduce the crew down to three people (from the usual four or five).

“That’s the danger part. One positive could impact 10 to 20 firefighters in one swoop,” Lee said.

Roache said the department does not know how the firefighters contracted the virus, but what HFD can control is minimizing the probability of getting it at work, and ultimately it is about protecting the public as well.

He said he does not want to speculate, but it’s very likely one person came to work with the virus and spread it to another person.

HFD has put into place new protocols to prevent the spread of the corona­virus, and that includes modifications inside the firehouse.

“They live together 24 hours a day,” Roache said. “It’s like our second home.”

Now it’s just one person cooking to minimize the number of people in the kitchen.

Mealtimes used to be a time “to eat together and talk story,” Roache said. “You can’t have a mask on while eating,” so the crew spreads out on a bench outside, a few in the kitchen and elsewhere.

Everything is done in accordance with the Centers for Disease Control and Prevention guidelines, Roache says.

During shift changes, firefighters limit to 10 minutes briefing the incoming crew. After each call, there is a cleaning and sanitizing regimen for the trucks and equipment.

Firefighters responding to an actual fire are probably best protected against COVID-19 with all the respiratory gear and protective clothing they wear, Roache said.

But they respond to many more medical calls to aid the sick or injured.

In addition to the bag valve mask worn when performing aerosolized procedures such as CPR, they now use a HEPA (high- efficiency particulate air) filter. Their equipment includes goggles, gowns and N-95 masks.

They try to maintain social distancing guidelines; however, it can be difficult in the variety of situations they are called upon to act, such as a rescue.

“We cannot let our guard down,” Roache said. “We’re doing things to stay safe when we come to their homes.”

He said that there always has been an emphasis on firefighters maintaining good health.

HFD is working with the city’s infectious disease officer, who is monitoring the situation, and with the Department of Health.

Lee said many of the complaints have been about complacency among the leadership and failing to adequately prepare stations following the first case in March, including setting up places to quarantine.

Many have elderly living at home or personal situations where they cannot go home, he said.

Most ended up going home to quarantine, but a handful are in Department of Health hotels, he said.

In contrast to the Honolulu Fire Department, the Hawaii (County) Fire Department offered rentals to firefighters who had to quarantine and provided care packages for them, he said.

Hawaii County’s fire department had only one positive case of a battalion chief, headquartered at the Waikoloa station, who tested positive for COVID-19 after traveling to Oahu, but remained asymptomatic.

Lee said on Oahu, the union has been working with the Honolulu Firefighter Foundation to provide meals and other necessities for firefighters in quarantine or isolated at home.

Because firefighters are exposed to smoke, chemicals and carcinogens, they have a greater risk of cancer, and their lungs are impacted, Lee said.

COVID-19 does damage to the lungs, and “there is a lot of apprehension from our firefighters,” he said.