With cases rising, NJ hospitals prepare for what’s ahead

Masks, gowns and other supplies are stockpiled, but some worry about staffing levels amid a national COVID-19 surge
Credit: Jeff Rhode/Holy Name Medical Center
The ICU at Holy Name Medical Center in Teaneck, as seen during the early days of the pandemic.

No one anticipates the same surge of patients that flooded hospitals last spring, but health care leaders in New Jersey said they are taking steps to ensure proper resources are in place to care for rising numbers of coronavirus cases in the months to come.

State government and hospital officials said they have stockpiled months’ worth of masks, gowns and gloves — the critical personal protective equipment, or PPE, that was in short supply early in the pandemic — and are amassing medications to treat COVID-19 patients. Some acute-care facilities are signing advance contracts with staffing agencies in case they need to supplement their existing workforce.

“Health care providers are taking the potential for a second wave very seriously. It’s been a looming concern ever since the very beginning of the pandemic,” said Kerry McKean Kelly, vice president of communications for the New Jersey Hospital Association, which represents the state’s 71 acute-care facilities, some of which were nearly overwhelmed with COVID-19 cases six months ago.

“The good news is, the health care system is better prepared today than we were when the first (coronavirus) case arrived in New Jersey in March,” McKean Kelly said. “We have a good playbook that was largely written by those clinical teams on the front lines in New Jersey.”

There have been significant advances in COVID-19 treatment — resulting in better outcomes, including lower mortality — and other lessons learned. But state and health care officials say preparations are not foolproof. The biggest worry is sufficient staffing, especially given a long-standing nursing shortage.

“We definitely are concerned,” said Debbie White, president of the Health Professionals and Allied Employees, a union for thousands of nurses and other frontline caregivers statewide. “We’ve always heard, ‘We can’t afford to staff for ‘what ifs.’ I get that, but we’re in a pandemic now, so who do you have on hand?” White said.

Dr. Daniel Varga, chief physician executive with Hackensack Meridian Health, said he is worried not just about staffing levels, but about workers’ ability to emotionally withstand another surge.

“There’s a brittleness in the workforce we have today. They’ve been through hell and back,” he said, noting that the Hackensack Meridian system — one of the state’s largest — lost 20 frontline workers to the virus. “There’s a lot of PTSD out there,” Varga said, “so it’s both numbers and resiliency.”

Numbers at two-month highs

New Jersey has experienced a steady rise in new COVID-19 numbers over the past month, with 1,036 new cases reported Tuesday — a third day in a row topping 1,000, a level not seen in months. In all, more than 222,000 residents have tested positive for the disease, and more than 16,000 are believed to have died as a result.

State statistics also show more than 780 patients were hospitalized with either confirmed or likely coronavirus infections Tuesday. While that’s just a fraction of the caseload New Jersey experienced in mid-April — when nearly 8,000 hospital beds were occupied — it is the highest COVID-19 patient total in more than two months.

State Health Commissioner Judy Persichilli said Monday that her team holds daily calls with hospital leaders to check on bed capacity and other resources, including staff — a protocol that has continued, unabated, since the pandemic began.

“We’ve never stopped working with the hospitals. We never considered the (first) wave to be over,” she said. “It’s an everyday event. We’re working with the hospitals and preparing with them every step of the way.”

The state DOH worked with the hospital association to create a database for all providers to report their PPE capacity; the department also requires hospitals to keep 90 days’ worth of surge-level supplies in stock, according to a spokesperson. Persichilli said the state is also stockpiling protective gear and some medicines — in particular Remdesivir, which appears to benefit some patients.

“My anticipation is that our biggest struggle will be staffing as we experience community spread,” Persichilli said Monday as she urged the public to keep up with infection control measures. “People that work in hospitals and in long-term care facilities also are members of a community.”

“These are very valuable individuals that we need, but if they fall ill, backup will be difficult … because every other state in the nation is having the same difficulties we’re having,” she said. In the spring, other states then relatively spared by the pandemic sent backup staff to help New Jersey.

In addition, members of the National Guard were deployed to assist at nursing homes.

A look at what’s being done

At RWJBarnabas Health, another large multi-hospital system, officials said they have stockpiled a week’s worth of PPE at each facility plus at least three months’ more at regional sites. The group created its own “float pool” of critical-care nurses — backup staff who can be deployed as needed — and has also signed a contract with a vendor for additional nurses, said Dr. John F. Bonamo, executive VP and chief medical and quality officer.

But White, with the HPAE union, underscored that there are only so many nurses available to fill in if the workforce is stressed; she said members also remain concerned about a lack of adequate PPE to keep them from getting infected.

“Where are you going to pull all these nurses from? There’s a limited pool of agency staff and we can only stretch them so far,” she said.

Dr. John F. Bonamo

While they were severely tested by the spring surge, Bonamo said years of collaborative training enabled RWJBarnabas staff to continue to provide high quality care even amid “crisis conditions.”

“We were extremely happy that our staff had the tools to work together and get each other and their patients safely through the pandemic,” he said.

RWJBarnabas is also working with other hospital systems — including longtime competitors — to share clinical and operational knowledge, Bonamo said.

“There is no question (that) those were things that never happened in the past. That is a good thing that came from COVID,” he said. When several chief medical officers from competing systems collaborate in this way, “it’s all about the patient,” he said.

At the peak, the system was caring for 1,750 COVID-19 patients; by Sept. 20 that had dipped to fewer than three dozen, Bonamo said. On Monday, RWJBarnabas hospitals had 128 coronavirus patients.

“We’re not in a danger zone or worry zone yet,” he said. “But we look at the numbers every single day, so it’s not going to sneak up on us.”

Lessons learned

The caseload has been much the same at HMH hospitals, Varga said. On April 20 — just six weeks after the first coronavirus diagnosis in New Jersey — the network was caring for some 2,000 cases. By late September the census was down to 50 cases daily; now the system has around 150 coronavirus patients, he said.

“It’s just a bump, but it’s a three(fold) bump in a month,” Varga noted.

The Hackensack system has also stockpiled PPE and some medications and is participating in clinical trials for other treatments, Varga explained. HMH also created a 30-chapter playbook for the second wave, based on lessons learned from the initial surge, he said.

In addition to diagnostic and clinical protocols, the playbook offers guidance on how to better manage COVID-19 patients within a hospital in order to reduce the risk of spread, Varga said. However, that effort is complicated by delays in coronavirus testing, another area he said HMH is working to address.

“There’s still no ‘quote unquote’ cure here. It’s still (about) mitigating the effects” of the disease,” Varga noted, underscoring the need for face masks, hand-washing and social distancing.