The experience of northern Italy hangs over New Jersey’s health care workers like a specter. If they can’t create the bed space now to handle an inevitable surge in coronavirus patients, they’ll face the same agonizing decisions as their counterparts in Italy: whom to help and whom to turn away.
But as the number of confirmed COVID-19 cases in the Garden State soars above 800 and the death toll ticks up, its leaders are meeting the challenge with the urgency — and creativity — of war.
Hospitals are postponing non-emergency surgery and procedures. They’re discharging other patients to nursing homes, while nursing homes are seeing who can safely be cared for at home. Operating rooms now sitting unused are poised to become intensive care units. Hospitals have set up tents to screen potential coronavirus patients away from crowded emergency rooms.
“This is a battle against a pathogen,” said Dr. Shereef Elnahal, president of University Hospital in Newark and the former state commissioner of health. “Every hospital has to create the surge capacity where it can.”
That’s not all. Medical centers have already brought 260 additional hospital beds online by reopening wings that had previously been shuttered. There are plans to bring another 227 beds online across the state’s 71 hospitals within the next month, current state Health Commissioner Judith Persichilli said this week.
Persichilli also directed Inspira Medical Center Woodbury, which ceased acute care operations in December, to reopen as a fully functioning hospital. Rapid renovations there, involving everything from HVAC repairs to installing a nurse call-light system, could add another 300 beds. “I hope it’s not months,” Persichilli said. “We’re hoping 3-4 weeks.”
On Friday, she said officials are working with the U.S. Army Corps of Engineers to renovate another former hospital in Plainfield, now “gutted,” which could provide 200 additional beds on roughly the same timeline.
Will it be enough? That’s the question on everyone’s mind, and it’s a difficult one to answer.
The state estimates that it will need to double its number of critical care beds to 4,000 within the next two weeks.
But the outbreak may not peak for many weeks or months, and the need for hospital beds will increase until the number of new coronavirus cases levels off.
A study published this week by researchers at the Senator Walter Rand Institute for Public Affairs at Rutgers-Camden — and referenced in a letter Gov. Phil Murphy sent to President Donald Trump — found that New Jersey, in the best-case scenario, would need 123,000 more hospital beds at the peak of the coronavirus outbreak than it currently has. That number is roughly five times the total number of beds in New Jersey now, rendering the few hundred new beds coming online wholly insufficient.
Other experts have made lower, but still alarming, estimates. Irwin Redlener, director of Columbia University’s National Center for Disaster Preparedness, for example, told Reuters last week that the U.S. as a whole may be short 75,000 to 100,000 intensive care unit beds, which have equipment to deal with the most severe cases. That’s about twice the current number of ICU beds in the U.S.
Darren Spielman, executive director of the Walter Rand Institute, said his organization’s predictions could change based on several factors. “A big variable nobody knows yet is if the warmer summer months will slow the progress of the disease, so that’s a big question,” he said.
In addition, it’s yet to be seen what effect mandated social distancing and enhanced testing will have on the spread of the coronavirus, he said.
New Jersey opened a drive-through testing site in Bergen County on Friday and is expected to open a second site in Monmouth County within days.
“South Korea has successfully reversed its curve, which is to say they now are having fewer new cases than recoveries,” Spielman noted. “One of the ways they were able to do that was with extensive testing.”
Another dynamic may work in New Jersey’s favor. A general shift in health care over the last several years from in-patient to out-patient or community-based settings has left a string of shuttered hospitals in its wake, said Kerry McKean Kelly, a spokeswoman for the New Jersey Hospital Association. She suggested that those facilities, like the hospitals in Woodbury and Plainfield, could be tapped for the coronavirus response, even if they’ve since been used for non-medical purposes.
“For example, if you had a closed wing of a hospital that you converted to office space,” she said, “in times like this, especially if you have the help of the New Jersey National Guard or the Army Corps of Engineers, you might be able to convert that back to patient bed space rather quickly.”
Beyond physical capacity, though, the problem remains how to ensure there’s adequate staff to care for coronavirus patients and adequate equipment to protect that staff. A day after the head of New Jersey’s largest health network said about 150 of its workers were in quarantine, state Attorney General Gurbir Grewal temporarily waived rules for out-of-state health care providers to offer services to New Jersey residents.
Meanwhile, front-line workers in New Jersey, as in other states, still have access to just a fraction of the masks, gowns, hand sanitizer, ventilators and other equipment needed to respond to the ballooning crisis.
“Even as we identify and secure additional facilities, those efforts will be futile unless we have the personal protective equipment needed to allow health care workers to operate and the ventilators that are needed to treat patients,” Murphy said in his letter to Trump, in which he also requested help with hospital expansion from the U.S. military and Army Corps of Engineers.
The New York Times reported that medical leaders in Washington state, which has the highest number of coronavirus deaths in the U.S., are preparing a triage strategy to determine which patients may have to be denied care should health systems become overwhelmed. Officials there have asked a U.S. Navy hospital ship to dock near Seattle to handle seriously ill patients besides those with COVID-19, and are building a field hospital on a soccer field north of the city.
“I would love to learn, a month from now, that the social distancing measures we adopted did indeed curb the outbreak enough to avoid going into that crisis zone of activity,” one Washington doctor told the Times. “But that would be poor planning — to simply hope.”