New Jersey has faced public health threats before, from AIDS to West Nile virus, and the emergency response to disasters like 9/11 and Superstorm Sandy remains hauntingly familiar to many residents. But, for most, those now pale in comparison to the novel coronavirus outbreak.
While the scale and nature of the epidemic — which has now infected 2,844 New Jerseyans with COVID-19, including 27 who have died — are unprecedented, public health experts agree there are valuable lessons from crises of the past that can help us to combat this new virus. But the lessons we have learned, and whether this knowledge has been converted into effective preparation, are still a matter of debate.
COVID-19 cases are now rising rapidly as testing options expand, with 935 new positive diagnoses announced Monday and cases now in all 21 counties. Hospitals are filling up across the state and health officials are scrambling to expand capacity, restock critical medical supplies like protective masks and gowns, and call in reinforcements for the health care workforce.
‘The most disruptive force’
“I’ve been a health care leader for 35 years,” said Robert C. Garrett, CEO of the large Hackensack Meridian Health system, who joined Gov. Phil Murphy at the state’s daily coronavirus briefing last Thursday. “But I have to say that I’ve never seen anything like this. This pandemic is by far the most disruptive force that I’ve ever seen in our health care system. We are literally engaged in a global war with the COVID-19 coronavirus.”
Experts have discovered that the virus that causes COVID-19 is closely related to the SARS (severe acute respiratory syndrome) that emerged in China in 2002 and eventually infected more than 8,000 people in a dozen countries; both are forms of coronavirus. SARS was largely contained, however, resulting in positive tests for just eight U.S. residents — all of whom traveled to outbreak areas — according to the federal Centers for Disease Control and Prevention.
While SARS didn’t result in community spread in this country, that epidemic prompted health care leaders to prepare for infectious disease outbreaks in ways that are helpful now, according to Dr. Ronald Nahass, an infectious disease specialist and epidemiologist with Robert Wood Johnson University Hospital Somerset (RWJUH-Somerset), part of the RWJBarnabas Health system. For one, it resulted in a better understanding of how a virus like this spreads through droplets of saliva, he said, and the importance of protecting frontline medical workers who are at high risk for contracting the infections coronaviruses cause.
“I think that’s informing a lot about how we can protect health care workers and others,” Nahass said last week. “We learned that if we don’t respect this virus that it can affect the health care worker population.”
RWJUH-Somerset, like other hospitals, created an “emerging respiratory pathogens” plan in response to SARS. Nahass said those plans are now being “dusted off” and put to work to address the new coronavirus, although the scope of the current outbreak is far more severe that what happened with SARS in this country.
“Clearly, this is overwhelming. It’s much bigger than anything I’ve seen in 32 years of doing infectious disease medicine,” Nahass said.
Better prepared after Superstorm Sandy, Ebola
Some suggest that New Jersey’s past experiences leave it better positioned than some states to face the current crisis. “I have to tell you New Jersey is certainly better prepared maybe than some (states) in terms of emergency preparedness. We had Superstorm Sandy. We had Ebola,” HMH’s Garrett said. (The system’s flagship hospital, Hackensack University Medical Center, was a designated site for Ebola patients and treated several suspected cases that turned out to test negative for the deadly disease, he said.)
“There are lessons each time there is a disaster or an emergency or a health crisis. The emergency teams do ‘lessons learned’ type charting and an audit to make sure the next time we don’t repeat some of the same mistakes we made,” Garrett added.
In preparing for Ebola, Garrett said the Hackensack hospital added an isolation room in the emergency room — so infected patients would not need to traverse the hospital — and made other physical changes that have been useful in its COVID-19 response. HMH also keeps a current list of retired doctors, nurses and respiratory therapists that it can tap into to backstop the existing workforce, he said.
But hospital officials acknowledge these preparations alone can’t address the need for some resources, including beds — particularly critical-care room beds — and the gowns, masks and other personal protection equipment health care workers need, as well as staff itself. State officials are now working with the U.S. Army Corps of Engineers to retrofit and reopen closed hospital facilities and are pleading with federal officials for more supplies from the national medical stockpile. The state has also waived various licensing requirements to enhance workforce capacity.
“Health care workers are on the front line of everything that is happening,” Garrett said. “They are truly our heroes in New Jersey. We must understand that we are in this for the long haul. This will tax our clinical and human resources like we’ve never seen them tested before.”
Murphy — who made comparisons to World War II during a media briefing on Sunday — has also sought to reduce pressure on the hospital system by enacting increasingly strict social-distancing measures, closing schools and most workplaces and ordering people to stay at home. Once a virus like this enters the community, experts note that such standard methods can help slow the spread. (Officials also urge the so-called worried well to not go to the doctor or hospital so that personal protection supplies can be preserved for those who need treatment for COVID-19 or other urgent health issues.)
“We are going to get through this. I say that unequivocally. And we are going to get through it together. Again not unscathed, not without mistakes or bumps in the road, but let there be no doubt, we will get through this together,” Murphy said on Friday. “But it requires each one of the 9 million of us, each one of us up here, and everyone around this state, to do their share.”
‘Here we are, 40 years later’
Some public health leaders are worried, however, that we haven’t learned enough from these past experiences, given the current scramble to compile critical resources in the coronavirus response. Professor Perry N. Halkitis, dean of the Biostatistics and Urban-Global Public Health program at Rutgers University’s School of Public Health, said that while AIDS, Ebola and other past health crises presented different challenges, they should have left us better prepared to battle COVID-19.
“Here we are, 40 years later,” from the AIDS crisis, “and we still have a country that is bumbling through,” Halkitis recently told NJ Spotlight. “I find it unbelievable that New Jersey doesn’t have a playbook to pull out right now.”
State officials declined to provide much detail last week on any statewide public health response plan, which agency is responsible for it and how it is updated to reflect past epidemics.
“Due to the rapidly evolving COVID outbreak, the Department of Health’s COVID response document is being updated to reflect changing guidance. The department intends to release the document as soon as possible,” DOH communications director Donna Leusner said.
Public health experts note that, to be most effective, emergency response efforts must involve local officials who know their counties and communities best, especially in a crowded and demographically diverse state like New Jersey. But many also fear that the local health departments — now responsible for much of the response to the epidemic, including investigations into the disease’s spread — are significantly under-resourced, without the funding to hire the workforce and expertise they truly need.
“I believe in local power and local knowledge,” Halkitis said. The federal government must also do more to support these offices, he said. “I hope (the coronavirus) is a wake-up call. But I thought AIDS was a wake-up call. I thought 9/11 was a wake-up call. I thought SARS was a wake-up call,” Halkitis added.
While good news may be hard to find in the current coronavirus crisis, Nahass of RWJBarnabas underscored another lesson from past epidemics: The case load will go up for some time, but it will eventually go down again, thanks to medical interventions and mitigation strategies to slow the spread. “They all follow that pattern,” he said, “and this one will do the same thing. Some can take comfort in that fact.”