Predictive Modeling Suggests COVID-19 Could Be at Peak Impact on NJ Health Care System

But models also suggest no quick end to daily diagnosis of new cases. Governor cautions that state is ‘not even close to the end zone’
Credit: Jeff Rhode/Holy Name Medical Center
At Holy Name Medical Center in Teaneck, Bergen County, one of the hardest-hit so far in the pandemic

New Jersey was slated to reach the peak of the coronavirus epidemic’s impact on the health care system over Easter weekend, according to models designed to forecast the impact on hospital resources. At least one prediction suggested the state would also see its highest daily death toll on Saturday or Sunday.

If true, the Garden State could start to see the impact on hospitals start to decline in the weeks to come. And while there are early indications the number of hospitalizations in the state is rising more slowly than it has in recent weeks, one respected model predicts the death toll will continue to escalate through mid-May and could eventually more than double.

Predictive models indicated the state’s acute care facilities would see their highest COVID-19 caseload on Saturday or Easter Sunday and that patient counts should now start to decline. State officials have also shared data that suggests the pace of hospital admissions is beginning to slacken and more than 1,200 patients have been discharged in the past few days alone.

One respected model, created by the University of Washington’s Institute for Health Metrics and Evaluation, indicates the Garden State would experience more than 13,000 hospitalizations at the peak, including more than 2,500 critical care cases. It also suggests nearly 5,300 residents will die of COVID-19 by the time this is over.

On the surface, New Jersey appears to have escaped the caseload predicted for the peak.

Data on ventilator cases

On Sunday, acute care facilities were treating more than 7,600 patients, including more than 1,700 classified as critical care patients, of whom 1,600 were on ventilators, according to data collected by the New Jersey Hospital Association and made public by the state. (Roughly six out of seven of all patients hospitalized have been diagnosed with COVID-19, officials note.)

While the caseload is far below the figures modeled — at one point the state’s own analysis predicted 15,000 patients at the peak — the impact is not evenly distributed. The virus has taken its heaviest toll on Bergen, Hudson and Essex counties, but is having a growing impact in central and South Jersey.

“It’s too early to spike any footballs, but these are good early signs,” Gov. Phil Murphy said at the state’s daily coronavirus briefing Friday, a message he repeated over the weekend. He said that New Jersey was “not even close to the end zone.”

The governor underscored the need for residents to continue social distancing during the religious holidays to further contain the spread of the virus and protect as many people as possible so we can “celebrate together” in the future. “Please God, don’t wake up Monday morning and behave differently,” Murphy added.

As of Sunday, COVID-19 had been diagnosed in more than 58,000 New Jersey residents, including nearly 2,200 who had died, according to the state Department of Health. Of that total, 251 deaths were reported on Saturday alone; the University of Washington model predicted the state would lose 288 residents daily at the peak.

Expanding hospital bed capacity

New Jersey is also working on multiple fronts to expand hospital bed capacity, should it be needed. Hospitals have greatly expanded critical care capacity by repurposing some areas and the DOH is seeking to reopen as many as four facilities closed in the past decade. The state has also established two field “medical stations” and a third is on the way; and it has created a multi-tiered plan that could involve housing those with limited medical needs at dorms or motels.

That said, other critical health-care resources remain tight. The state has contracted with staffing agencies and tapped thousands of medical volunteers, but the virus continues to take its toll on the health care workforce. Officials have also struggled to collect enough protective gear and other equipment, like ventilators; as of Sunday, the state had only 61 of these devices left in its own stockpile, which is used to backstop hospitals should they run short.

DOH commissioner Judith Persichilli has repeatedly urged residents to continue to stay home to limit community spread and help drive down case numbers.

“I know this is especially tough during the religious holidays when we would normally be congregating for religious services or family gatherings,” she said Friday. “I understand that while this may be disappointing to many … it is imperative to continue to stay home and help slow the spread of COVID-19.”

While hospitalizations continue to tick up in the Garden State, the need had appeared to be lessening slightly, based on statistical methods used to determine the effectiveness of epidemiological controls (like closing schools and workplaces, and insisting people remain largely at home.) On Friday Persichilli noted the “doubling time” for hospitalizations — or the number of days it takes for bed needs to increase 100% — grew three out of four days last week, suggesting that while the case load continues to rise, it is now going up at a slower rate

Positive signs

Some positive signals were also emerging early last week for Dr. Lewis Nelson, chair of the emergency medicine department at Rutgers University’s New Jersey Medical School, who oversees the emergency department at Newark’s University Hospital. The facility cares for a lot of vulnerable low-income patients and has faced a surge of COVID-19 patients; initial data suggests African Americans are suffering disproportionately high rates of infection and death from COVID-19.

“Patients are still coming in and they’re still very sick,” Nelson said early last week, “but when you look at the numbers, they seem to be slowing a bit.”

But Nelson said the hospital still faced a significant challenge; he is also worried the virus could resurge if people don’t continue to stay home and practice strict social distancing.

“We’re certainly not going to see the end anytime soon,” he said.

Regardless of when the peak occurs, predictive models make clear it will be some time before there is an end to daily diagnosis of new cases. While the total number of infections identified depends largely on how we test for the disease — there are now more than 50 state, county and local testing sites in New Jersey, — access is limited and only available to those with certain symptoms. DOH data indicates that, of the more than 58,000 cases identified, nearly 30% have been hospitalized and 3.8% have died.