As the number of new COVID-19 cases continues to escalate in New Jersey, Gov. Phil Murphy on Monday put the focus on hospital capacity in announcing new restrictions on indoor sports and outdoor gatherings to help curb the spread of the virus.
The situation is truly worrisome.
Acute-care facilities are not facing the same level of patient surge they experienced in the spring, and care options have improved significantly since then, experts note. But according to some key indicators, New Jersey’s system is becoming more stressed as the case load swells. And one respected model predicts that by January hospitalizations could be 20% higher than experienced when the coronavirus first peaked in April.
“Our concern remains, overwhelmingly, the situation in our hospitals — even more than the increase in the raw numbers of cases,” Murphy said at a media briefing Monday. “And it comes down to this — maintaining the stability of our health care system and ensuring the ability of our frontline medical workers to treat patients starts with implementing restrictions that will keep fewer people from becoming hospital patients in the first place.”
Eventually, “some percentage” of the nearly 3,200 new COVID-19 cases the state announced Monday — part of nearly 11,000 it logged just since Friday — will need hospital care, Murphy warned. More than 337,000 cases have been reported since March and some 41,000 people have been hospitalized over the nine-month pandemic, according to state figures.
COVID-19 ‘cause and effect’
“At the end of the day, this is all a simple and direct matter of cause-and-effect,” Murphy said. “Stability in our health care system starts with carefully chosen steps to hamper the spread of this virus. And because of the data, we know how and where we can best meet this challenge.”
As a result, starting Saturday the state will suspend all indoor organized sports through Jan. 2, including practice and competitions for adults and kids, Murphy said. College and professional teams are exempt. And beginning Monday, outdoor gatherings would be further limited to 25 people, he said, down from 150. There will be exemptions for religious and political gatherings.
“Youth sports, in particular, has presented a challenge as we have seen a number of outbreaks related to these activities,” Dr. Ed Lifshitz, medical director of the state’s communicable disease services, said at the press conference Monday. At least 20 outbreaks, responsible for more than 100 cases, are tied to youth hockey alone, he said, an activity that has concerned state officials for weeks. “The pause in these activities will help slow the spread of the virus,” Lifshitz added.
No sitting on Santa’s lap
The state Department of Health also issued holiday guidelines Monday that urged residents to limit Christmas caroling, menorah lighting and other festivities to outdoor only, warned against visiting Santa in person and reiterated the need to avoid celebrating with those outside your immediate bubble. Additional restrictions — including suspending elective surgery in hospitals, which was done in the spring to create hospital space — are also on the table, Murphy noted.
At the peak in April, New Jersey’s 71 acute-care facilities were dealing with more than 8,000 coronavirus patients, with roughly one in five on a ventilator in critical care. Many things have changed since then, experts note, as clinicians have identified better COVID-19 treatment options, stockpiled protective gear and other critical resources and developed a highly effective vaccine likely to be distributed in the coming months.
“We have made strides throughout this pandemic,” said Dr. Shereef Elnahal, president and CEO of University Hospital, in Newark, which has been an epicenter for COVID-19 care several times since March.
There are more effective clinical protocols, a clear surge plan and other changes, he said, and patients now tend to be younger and healthier than they were in the spring.
“That said, our hospital census remains near-full overall, as other health care needs have escalated in light of the pandemic in our community,” Elnahal said, something clinicians did not experience in the spring, when fear of the virus kept many people from seeking routine or even emergency treatment and elective surgeries were suspended. In recent weeks, University Hospital has treated between 30 and 40 COVID-19 patients daily, he said, with five to 10 new admissions daily.
‘’Bah, humbug,’ COVID-19
As of Monday, there were nearly 3,000 COVID-19 patients hospitalized statewide, but mathematical modeling indicates these numbers will continue to escalate. Murphy pledged to share more of the state’s modeling predictions Wednesday, but noted that — like the character Scrooge in Charles Dickens’ “A Christmas Carol” — New Jersey residents have power to shape the outcome by wearing masks, maintaining distance and practicing other precautions.
According to calculations by the University of Washington’s Institute for Health Metrics and Evaluation, the stakes could be significant when it comes to hospital capacity in New Jersey. Highly accurate in its prediction of the April peak, IMHE’s most recent model — updated Nov. 19 — suggests COVID-19 admissions could continue to ramp up in the coming weeks, passing April’s peak level on Christmas Day and reaching a new high of 10,600 patients on Jan. 16, before descending again.
Currently New Jersey has roughly 8,000 hospital beds, so accommodating a higher patient census would require facilities to again convert lesser-used wings or set up field operations, as was done in the spring. Officials with the DOH have said these resources can be redeployed when needed, something New York State Gov. Andrew Cuomo said Monday might need to happen soon in that state.
As of late afternoon Monday, six of the New Jersey hospitals — located in Camden, Essex, Hudson, Gloucester and Union counties — were too full to accept any new patients for multiple hours, forcing ambulances to be temporarily diverted to other facilities, according to state data. Two other hospitals, in Mercer County, were forced to divert certain groups of patients.
With bed space still available, it is likely at least some of these diversions reflect gaps in staff, something Elnahal said remains the “biggest risk” at University Hospital. And, unlike in the spring, facilities will not be able to call in reserves from other states or the military to assist, since the pandemic is now active nationwide. “We are seeing increases in the number of our employees testing positive, commensurate with case increases in the community,” he said.
Department of Health officials are also tracking the impact of the rising COVID-19 case load on hospital staff statewide, a group that was particularly hard-hit during the first wave, but details on the current impact were not immediately available Monday. “We are aware and concerned that acute-care hospitals are showing more (staff) cases now than they were three or four months ago,” Lifshitz said at the briefing.