Explainer: Is New Jersey ‘Flattening the Curve’ for COVID-19 Hospitalizations?

While social-distancing measures have been somewhat effective, officials say more critical-care beds, federal aid are essential to getting a handle on crisis
Credit: NJDOH
Side-by-side graphs compare demand for hospital beds if the state had done nothing to slow the virus’s spread, versus an assumed 31% reduction in interpersonal contact.

In the current health emergency, officials are urging people to stay at home and avoid contact with each other in the hope of slowing the rapid spread of the coronavirus, which they said on Wednesday is doubling the number of infections every six days. The goal of social distancing is to avoid an unmanageable surge in hospitalizations, and spread out infections over a longer period so that the number of cases needing hospital treatment matches the system’s ability to provide it. The process, if successful, is called “flattening the curve.”

Has New Jersey “flattened the curve” so far?

Yes, to some extent. Side-by-side graphs presented at Gov. Phil Murphy’s daily news conferences on the pandemic this week compare demand for hospital beds if the state had done nothing to slow the virus’s spread, versus an assumed 31% reduction in interpersonal contact as a result of the state’s social-distancing policies. The “do-nothing” graph shows a huge spike in demand to about 80,000 beds, about four times the system’s capacity, whereas the 31% graph shows bed demand at about 35,000 sometime in June.

So will hospitals be able to meet demand under the “31%” scenario?

According to the graph, no; the peak demand in that scenario is still above a projected bed total of just under 20,000 in early May. The state already has nearly 19,000 acute-care beds and almost 2,000 critical-care spaces, but even when elective procedures are cancelled, hospitals still need space for patients who give birth, break a leg or have a heart attack. To add capacity, officials are seeking to create another 2,000 beds by establishing field hospitals and reopening closed facilities. Health Commissioner Judith Persichilli has predicted that there will be enough hospital capacity statewide to meet an anticipated surge, assuming more critical-care beds than indicated by the graph, and continued social distancing.

How much has social distancing helped to “flatten the curve?”

Officials don’t know for sure because it’s less than 14 days — the incubation period for COVID-19 to show symptoms — since March 21 when Murphy issued his stay-at-home order, and it has taken a week or more for thousands of test results to come back. That’s why the Department of Health is assuming the 31% reduction in social contact, based on social-distancing policies used in previous pandemics, rather than using any data from the current experience. “We’re seven-plus days away from having a really decent handle on how our compliance can influence that curve,” Murphy said on Wednesday. “God knows, I hope it’s north of 31.”

Doesn’t the demand for hospital beds so far indicate that social distancing is at least helping?

Yes, it does, according to Persichilli. She said at Wednesday’s news conference that demand would be much higher if not for social distancing. “We had identified on a statewide basis, that if we did nothing, it would be here today,” she said, referring to the surge. “We know that it is not here today because on a statewide basis we are not feeling the same capacity issue in the central to the south part of the state.”

But aren’t hospitals in north Jersey already seeing a surge in COVID-19 patients?

Yes, they are. Persichilli said on Wednesday that there is now heavy demand from COVID-19 patients in northern NJ hospitals, but many have doubled their number of critical-care beds, and some resources could be moved from other areas of the state where infection rates are lower. She predicted there will be enough beds but repeated a call to the federal government for some 1,600 more ventilators and more personal protective equipment.

What model is the Department of Health using to project hospital capacity to cope with a surge in COVID-19 patients?

It’s called CHIME, which stands for COVID-19 Hospital Impact Model for Epidemics, a new model from the University of Pennsylvania’s medical school that has been adopted by about 150 countries since it was made available in mid-March. The model is the source of the 31% social-distancing figure; it was based on assumptions about the extent to which interpersonal contact was reduced, and the effects of closing schools and nonessential businesses. Those assumptions were related to reductions in peak hospitalization rates.

Is the state also projecting the total number of cases, including the estimated 15% who are hospitalized?

Persichilli said officials are working on other models that could predict the total number of New Jerseyans who would be infected by COVID-19, but she said it will be hard to project a number without mass testing. “Right now we just want to be able to make sure that we have the resources to take care of people who need care,” she said. As of 1 p.m. Wednesday, the total number of positive cases stood at 22,255, an increase of 3,649 from a day earlier; the number of deaths rose by 91 to 355.

How much longer are we going to have to live with this?

On Wednesday, Murphy predicted the pandemic will persist for at least another six weeks. “I said it was mid-May; I think it’s at least that,” he said. “Unfortunately, I think we’re going to be in a hunkered-down mode for a while.”