Op-Ed: Lessons learned for a potential second wave of COVID-19

After witnessing the devastating impact of the early months of the coronavirus pandemic, we are better prepared to tackle the next wave
Dr. Hamid Shaaban

As a leader and physician in Newark’s health care community, I’ve been watching with a cautious sense of trepidation as cases of new COVID-19 have continued to rise in the past month throughout the state.

New Jersey reported 478 newly confirmed cases and one death on Monday. The state was averaging 772 new daily cases over the last week, an increase of 14% compared with the week earlier and up 110% compared with this time last month, according to Inquirer data analysis.

The state also reported 662 people hospitalized with the virus, marking the sixth straight day above 600 and the highest level since August (though well below the highs earlier this year). The second wave is occurring in the face of the reopening of schools, restaurants and businesses. Also, winter is coming, which will force us to spend more time indoors at a time when other respiratory viruses will be resurfacing.

So, are we prepared for the second wave? We witnessed firsthand the devastating impact of the pandemic as it surged through the Garden State in the early months, and I believe that, months later, we have learned lessons on how to effectively tackle the next wave.

Lesson 1: We know more about the virus and how to prevent infection

Scientific evidence and clinical experience demonstrate that the virus is primarily spread by droplets. Airborne transmission occurs mainly through aerosol-generating procedures. It’s very important our planning involves stocking up personal protective equipment in preparation for the coming months.

I continue to advocate for people to wear face masks at all times when in public, socially distance from others by at least 6 feet, avoid large crowds and gatherings, practice good hand hygiene, and stay home and isolated if sick. It is integral for members of the community to adhere to these public health guidelines and to respect the public servants who enforce the emergency rules and regulations.

We also will need robust testing capacities in socially distanced clinics, churches and barbershops to effectively identify cases earlier, isolate and contact trace.

I strongly believe that every New Jerseyan who becomes sick, who is admitted into a hospital and who dies because we do not follow the infection control processes is an immense failure of the responsibility we all have toward one another.

Lesson 2: We must ameliorate health care systems and bed capacity to avoid another suspension of interventional or surgical procedures

As we battle the increasing COVID-19 cases, it is critical that the state’s hospitals have available resources and personnel to tackle the rising cases of a “twindemic.” In Essex County, many residents do not have access to medical care because of a wave of hospital closures over the past two decades.

Saint Michael’s Medical Center could have easily been one of those hospitals until the state approved its sale to Prime Healthcare, which resulted in its recovery. And now we are one of the top 20 safety net hospitals in the nation, according to Washington Monthly magazine. The neighborhood we serve is noted for its high incidence of diabetes, hypertension and obesity, which happen to also be significant risk factors for severity and mortality related to COVID-19.

The rise in COVID-19 cases has been stretching the limits of safety net hospitals by compounding the challenges of working with limited beds, thin operating margins and a lean workforce. The pandemic has highlighted what many of us working in urban hospitals have always known — that communities of color live in health care deserts where health care disparities are accentuated.

One way to tackle this dire issue is to increase the number of ambulatory and community-based services to focus on primary and preventative health care.

Lesson 3: Addressing racial and health care disparities should be a priority

I recognized early that this viral pandemic was intersecting with the ongoing pandemics of poverty, homelessness and systemic racism. Nationwide, people of color are two to three times more likely to die from COVID-19.

We should be setting up health centers in areas worst hit by the first wave where health disparities are most magnified, and aggressively focus on educating individuals about preventative infection control measures. These centers will also ideally need to have enhanced testing capacity.

By encouraging the poor and underprivileged in predominantly Black and Hispanic communities to take proactive steps to protect their health and the health of others through clearly outlined steps, we can potentially reduce the transmission of the coronavirus in our communities.

Lesson 4: We can treat severe infections better, but we need to act early

There’s a growing consensus in the medical community about how and when to use the two major therapeutic approaches — attacking the virus and modulating the immune system. There is now little support for hydroxychloroquine after negative results have been seen in five controlled studies.

We know now that antivirals like remdesivir are most effective early in disease, when viral replication is the primary driver, and that immunosuppressants are most effective later, when a hyperaggressive immune response is activated, often resulting in death. We also now have scientific data supporting the clinical safety and efficacy of the anti-inflammatory steroid dexamethasone in reducing mortality, particularly in patients on ventilators.

Timing is everything in the treatment of COVID-19, and the earlier the diagnosis and initiation of these therapeutic interventions, the better the chances of recovery and survival. Patients should seek early medical attention if serious COVID-19 symptoms, especially shortness of breath, begin or fail to resolve within five days of onset so treatment can be started immediately to curb the potentially fatal hyperimmune hyperinflammation phase from kicking in.

Lesson 5: We all need to work together. Communication is paramount

At a hospital level, we need a constant flow of information, insights and ideas among staff, patients and families to achieve the safest and most optimal delivery of care. At Saint Michael’s, in preparation for the rising cases, we have increased the frequency of our task force meetings led by our new dynamic CEO and even created a lessons-learned playbook with input from different departmental staff.

At a state level, the New Jersey Hospital Association and the state Department of Health do an exceptional job with transparent communication and dissemination of daily COVID-19 statistics and information updates, which is invaluable in preparing for a potential second wave.

Our response to a potential second wave will be heavily dependent on whether we learned these lessons and how well we adhere to the public health policies that develop as a result of these lessons. We have seen the results in other states when residents don’t give credence to these important warnings.

During the first wave, I warned members of our community to not fear the virus but to respect it by following the public health guidelines. Although the virus may be a serious and dangerous threat, we still shouldn’t fear it, we should very much respect it, but most important of all, we should not ignore it.

Together, we can get through this unprecedented pandemic. It is going to take all of us working together, following the science and educating each other to keep New Jerseyans healthy, reduce transmission and, ultimately, reduce serious illnesses and death in our community.