'I do not have hope this will turn out well': Hospitals brace as NJ COVID second wave hits
They’ve stockpiled masks and gowns. They’ve reopened the COVID-only patient units created as the pandemic peaked last spring. But as New Jersey hospital officials brace for another rising tide of sick coronavirus patients, the resource they worry most about is human.
Will there be enough doctors, nurses, respiratory therapists, patient-care technicians and others to care for everyone who needs them?
“That is the one thing that I think keeps us up at night,” said Gov. Phil Murphy. "The staffing piece."
The one concern that will “determine what happens with this second wave is staffing,” said Dr. Daniel Varga, chief physician executive at Hackensack Meridian Health, which runs multiple acute-care hospitals as well as in-patient behavioral health and children’s facilities. “Remember, we’re trying to run a full-service hospital as well as take care of COVID patients.”
Patient numbers have risen more slowly than they did in March and April, when hospital loads spiked from a single COVID patient on March 4 to more than 8,000 six weeks later. This time, the climb has been steadier, from 533 admitted patients on Sept. 1 to 2,568 over the weekend. This fall's COVID patients have been younger, on average, spent less time in the hospital and recovered more quickly.
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But three possibilities worry health care officials: If Thanksgiving gatherings spread the disease more widely among older people, if nursing home outbreaks continue to worsen, and if the virus morphs in unpredictable ways — then all bets are off.
Here’s why staffing has emerged as the major concern:
- Doctors, nurses and others can’t be redeployed within their institutions, because it’s still business as usual in non-COVID areas of the hospital. Same-day surgery, elective treatments and procedures, and screening measures such as mammography continue as normal. Murphy has not ordered the cancellation of non-emergency care, as he did in March.
- Agencies that supplied nurses and other medical staff, often flown in from other states, can’t come to the rescue as they did in the spring. Their staff is needed in hot spots elsewhere in the country, where every state except Hawaii has experienced a surge of cases.
Health care workers are also getting sick themselves because of high COVID rates in the broader community. Newark, for example, has reported positive test rates of close to 20% over the last two weeks, and Bergen County’s positive rate was near 10% on Friday.
Some 650 employees in the Hackensack Meridian system were out sick on Thursday, a large percentage of them with COVID, Varga said. Bergen New Bridge Medical Center in Paramus launched a testing program for all 2,200 employees, to screen out COVID-positive workers, even if they are asymptomatic.
"Now is the right time to expand our testing to all employees throughout our facility," said Deborah Visconi, CEO of the county-owned New Bridge, which includes a large nursing home and in-patient behavioral health and substance-abuse programs as well as an acute-care hospital.
Health care workers weary, anxious
In addition, health care workers are frustrated and wary. They have seen this before. They have held iPads for families to comfort frightened patients just before the patients are intubated. They have stood at the bedside as patients die without loved ones because visitors are prohibited. They don’t want to do it again.
“I’ve never had this much anxiety to practice medicine,” said one emergency room doctor at a North Jersey hospital, decrying the absence of stronger national and state measures to contain the virus’s spread. “I don’t want to bring this disease home.”
“We’re pretty scared we’re seeing a repeat of what we saw in the spring,” added the doctor, who asked that neither he nor his institution be named. “We don’t want to relive what we went through.”
That anxiety is pervasive — and serious.
The latest on COVID:New Jersey sees record COVID numbers ahead of Thanksgiving
“PTSD is real," state Health Commissioner Judith Persichilli said when asked recently about the post-traumatic stress disorder some nurses report as they face the second wave.
“It’s not only nurses,” she added, but everyone who worked in a hospital in March and April who is “having some issues with the anxiety related to what they went through." Many health care institutions and universities have offered their staffs counseling.
'Nervous, but prepared'
Hospital leaders feel more secure when it comes to the availability of beds and personal protective equipment, or PPE, than in the spring.
“We've been planning since this started, so we are much better prepared for this surge,” said Judy Padula, the chief nursing officer at St. Joseph’s Health. Its two hospitals, in Paterson and Wayne, had 143 COVID-positive patients late last week.
Other medical executives echoed those sentiments. “We’re nervous, but prepared,” said Adam Jarrett, chief medical officer at Holy Name Medical Center, where the number of COVID patients was in the mid-30s.
The average COVID patient at Holy Name now stays three to five days, Jarrett said. Patients are treated with remdesivir, an anti-viral medication, and high-dose steroids to reduce inflammation.
At Hackensack University Medical Center, it's now rare to have a COVID patient on a ventilator in the ICU for months at a time, Varga said.
Many fewer patients overall need intensive care — two-thirds fewer at St. Joseph’s, said its chief medical officer, Dr. Joseph Duffy.
“We're seeing more younger people, who are easier to treat and turn around,” he said. “We’re intervening sooner, and the treatments are better.”
Protective gear stockpiled
In addition to the state’s stockpile of PPE, health systems have amassed several months' worth of surgical masks and the more protective N95 masks, along with gowns, face shields and gloves. "I do not believe that we will plow through our formidable stockpile of PPE or ventilators or bed capacity,” Murphy has said.
Supply officers are keeping a wary eye on the nationwide shortage of gloves, however. And protocols have been put in place to manage resources.
For example, at most institutions, the rule is that each staff member involved in direct care of potential or positive COVID patients receives one N95 mask per day, not a new mask for each patient. “You need to treat that thing like gold,” said the emergency room doctor, “and take it off very carefully, because the front is littered with virus.”
Overall, the state’s 71 hospitals had about one-third of the number of COVID-positive patients Sunday — 2,568 — that they had at the mid-April peak. Those patients occupy just a fraction of the overall total of hospital beds, with flu, cancer and cardiac patients, among others, filling most of the beds. They included 466 ICU patients on Sunday, of whom 237 were on ventilators.
"There is still significant capacity in our hospitals,” Persichilli said.
And if overflow space is needed in the northern region, for example, the Army Corps of Engineers completed construction of two field hospitals at Bergen New Bridge in May. The hard-sided, semi-permanent facilities are equipped for 98 patients.
Still, the next few months are likely to be hard for health care workers.
They admit they are nervous.
"Any measure you enact today is not going to show an effect for weeks to come," said the ER doctor. With records being set nearly every day for new daily case counts in the state, he worries about what is to come. "I'm a pretty resilient physician," he said, "but I'd be lying to you if I didn't tell you I was looking for work elsewhere."
Hospital officials continue to implore the public to observe precautions. “We need everyone in the community to double down on efforts to reduce spread,” a spokeswoman for Englewood Health said. That means “masking, social distancing, hand hygiene and avoiding indoor gatherings.”
As the St. Joseph's medical officer outlined his concerns about the next two months — college students returning home, convivial gatherings over drinks, families reuniting around the Thanksgiving table — Duffy was grim.
“I do not have hope that this will turn out well," he said.
Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in the medical world affect the health of you and your family, please subscribe or activate your digital account today.