A patient walks into Holy Name Medical Center for a routine colonoscopy. He has no symptoms associated with COVID-19, but takes the test as a matter of procedure.
He had no idea he was infected.
The patient is now one of the roughly 1,000 new coronavirus cases New Jersey is seeing daily — a far cry from the peak of the pandemic, but still a concerning spike for health officials.
At Holy Name, a Teaneck hospital once teeming with COVID-19 patients, doctors have witnessed a recent uptick in similar situations, signaling that the lethal virus is once again spreading through the community undetected.
“Up until a couple of weeks ago, it was very, very rare we’d have a positive test,” said Dr. Adam Jarrett, the chief medical officer at Holy Name. “Now, we’re seeing three or four positives a day in that group of people.”
State Health Commissioner Judith Persichilli put residents on notice earlier this month when she said New Jersey officials are anticipating a second wave of coronavirus cases.
“This wave has the potential to become a surge,” she proclaimed Oct. 8 at a state coronavirus briefing.
While New Jersey hospitals are better positioned to handle a deluge of cases thanks to improved treatment options and large stockpiles of personal protective equipment and drugs, staffing remains a major concern.
The state continues to see at least 1,000 new cases a day. Nearly 2,000 positive test results were reported Saturday, the most since May 6. Hospitals also reported 886 patients who were confirmed to have COVID-19 or were suspected cases, the highest number of hospitalizations since July 14. New Jersey now averages 800-plus hospitalizations a day, compared to 400 in September.
In interviews with NJ Advance Media, doctors, nurses and other health care officials were hesitant to declare that the second wave has arrived. Although they are seeing an uptick in hospitalizations, it pales in comparison to the peak of 8,293 patients on April 14. The patients they are seeing now are younger — in the 18 to 45 range — less vulnerable and their symptoms aren’t as severe, doctors said.
But hospitals are still preparing for a surge similar to the one they experienced in the spring. The colder weather continues to bring people inside, and families will soon gather to celebrate the holidays, potentially accelerating the spread. The state has already lost 16,285 residents to the virus.
“We put in place what we call a COVID 2.0 playbook,” explained Dr. Daniel Varga, the chief physician executive for Hackensack Meridian Health, a network that operates 17 hospitals in New Jersey. “Right now we haven’t had to invoke it. We’re at a place where we can reasonably manage a full-service hospital while still taking care of the COVID population we have.”
The prolonged pandemic and the decrease in hospitalizations during the summer have given medical professionals time to study the virus, make advances and prepare for another wave. There are stockpiles of PPE. Pop-up spaces for extra beds. And new treatments, such as remdesivir, an antiviral medicine that was the first drug approved to treat COVID-19.
The result is improved outcomes and lower mortality rates.
“We built five pop-up ICUs back in March and April,” said Jarrett, the Holy Name doctor. “They’re all ready to go in case we need them.”
The hospital also has nine investigational studies it can enroll coronavirus patients in, Jarrett said. One of those trials includes the Regeneron antibody cocktail, the same treatment given to President Donald Trump when he was hospitalized with COVID-19.
“That word is on the street,” Jarrett said. “Some of our positives are coming from outside the region. The correct word on the street is we have access to a fair number of trial drugs.”
Other drugs, such as steroids and blood-thinner medications, have also shown promise as therapeutics. While some treatments are effective, Jarrett cautioned, none of them are “silver bullets.”
New Jersey has gone through hell and back fighting this virus. The Northeast region, especially New York and the Garden State, quickly became the epicenter of the pandemic in the U.S. That means the doctors and nurses here have learned how to handle a surge — having been sent into battle with no armor and no ammunition.
“With the treatment protocols in the spring, clinicians were pretty much writing the treatment playbook as they went along,” said Kerry McKean Kelly, vice president of communications for the New Jersey Hospital Association, which represents the state’s 71 acute-care facilities. “New Jersey and New York were among the very first hotspots, so they were really the lead on this. Since then, they’ve learned so much.”
McKean Kelly pointed to simple maneuvers like proning, the act of turning a COVID-19 patient on their stomach to relieve pressure on the lungs and make it easier to breathe.
“It’s not a high-tech intervention, but it’s something they learned from experience in the spring,” she said.
Doctors also have something else going for them: Patients now admitted to the hospital don’t have symptoms as severe as those who arrived in the first wave, officials said.
At RWJBarnabas Health, Dr. Christopher Freer says they have only about 20 patients on ventilators in the entire network. At the peak of the outbreak, one hospital alone had 100 ventilators in use, he said. The population was also much older, while the patients coming in now are younger and aren’t as sick.
“You’re definitely seeing much more milder cases,” Freer said. “Whereas before… everyone who came in was critical. Hopefully, we’ll never see anything like that again.”
The scarcity of PPE was an issue for health care workers in the early days of the pandemic. Masks were in such high demand that some nurses pleaded with the public for donations on social media.
New Jersey hospitals are now in a good position when it comes to PPE, doctors said. Hackensack Meridian, for example, has a combined stockpile of about 90 to 180 days, Varga said.
The state is also stockpiling masks, gowns, gloves and medications, including remdesivir. The New Jersey Department of Health — which requires hospitals keep a 90-day supply of PPE in stock — also created a database for critical care centers to report their supply levels.
Still, some officials fear a lack of PPE if another wave occurs. Deborah White, the president of the Health Professionals and Allied Employees, a union representing 14,000 nurses and front-line caregivers statewide, said PPE shortages remain a concern.
“When we’re talking about PPE stockpiles,” White said, “I don’t think we’re factoring in the normalized usage.”
Nurses are still using N95 masks — which offer more protection against COVID-19 than surgical and cloth masks — for a full day, she said.
“They were not created to do that,” White said. (The Centers for Disease Control and Prevention says N95 masks should be discarded after each patient encounter, but it has created guidelines for extended use.)
Holy Name is in a much better position with PPE than it was this spring, Jarrett said. But more is always welcome, he emphasized.
“If there’s a big second wave,” Jarrett said, “the amount of PPE (needed) is so overwhelming. We’re never good enough.”
And there’s a new challenge that awaits hospitals during a potential second surge: staffing. During the first wave, hospitals were able to recruit nurses and doctors from outside the state. Now, the rest of the country is dealing with its own avalanche of cases.
“Our biggest concern will be staffing,” Persichilli said at a recent coronavirus briefing. “If health care workers fall ill like in the prior surge, we will have a problem.”
One out of five nurses and other front-line health care workers tested positive for COVID-19, according to an HPAE survey returned by 1,100 members. Fifty-four percent were exposed to the virus, the survey found.
“There’s no question I’m still concerned about our members,” said White, the HPAE president. “I’m not convinced that all of our employers are really prepared.”
But health care workers are resilient. They are built to adapt to whatever situations confront them.
Pamela Flynn, a registered nurse and the clinical leader of the emergency department at CentraState Medical Center in Freehold, said she doesn’t fear a second wave of the coronavirus.
“Working in the emergency department, we don’t know what’s coming in at any time, not just during a pandemic,” Flynn said. “We are always prepared.”
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