'Coronavirus 2.0': NJ hospitals prepare for second surge as cases spike in rest of US

Hospitals are restocking their warehouses with N95 masks, protective gowns and surgical gloves. Their supply managers are hunting for hand-sanitizer refills and the chemicals used in coronavirus tests. Engineers are tuning up ventilators that breathed for thousands of patients.

New Jersey health leaders are keeping a wary eye on South Carolina, Florida, Texas and other states facing record spikes in coronavirus cases, especially after clusters of cases were reported this past weekend among travelers who had returned from hot-spot states. They know most of New Jersey’s 9 million residents remain vulnerable, if the virus starts to spread widely here again.

This time, hospitals want to be ready.

This time, they know more about what will be needed. An executive at Atlantic Health, the hospital system that includes Morristown and Chilton medical centers, says his six hospitals plan to stockpile enough personal protective equipment to last 90 days at a burn rate 20% higher than the worst day they've seen so far in the pandemic.

That would be more than 25 masks used by the various staff who go in and out of each COVID patient's room daily.  

Holy Name Medical Center in Teaneck, at the epicenter of the original outbreak this spring, now wants to have more than a year’s worth of supplies on hand.

But worrisome shortages and concerns about the supply chain persist, with no national strategy for the distribution of essential supplies.

“There’s a big shortage of disinfectant wipes,” said Kevin Lenahan, chief financial and administrative officer for Atlantic Health. There are not enough hand-sanitizer refills, and "even on the masks and gowns, we still get 70% of our orders.”

“Testing to me is a big, big concern,” said Michael Maron, president and chief executive officer of Holy Name. His hospital runs four different manufacturers’ tests, but he said the supplies for each of them are slow.

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Reagents — the chemicals used to extract virus particles from a human sample — are a daily challenge for all hospitals and labs.

And as other states flood commercial labs with samples to be tested, the turnaround time for those results is lengthening. That means more personal protective equipment is used, as patients with unknown COVID status are treated as positive until shown otherwise.

Hospitals also must allow for the uncertainties of planning for a disease that hadn’t even been identified seven months ago.

Treatments evolve daily. After the pressure for ventilators during the first surge, physicians now strive to avoid sticking tubes down patients’ throats and instead use high-flow oxygen delivered through a mask or nasal cannula.   

Last spring’s preferred medication — hydroxychloroquine — has been shown to be ineffective. Neither the antiviral remdesevir nor the steroid dexamethasone, the only approved treatments known to be effective, is a knockout. By the time the next wave crests, those therapies may be superseded.

Preparing for 'Coronavirus 2.0'

Nowadays, the “Coronavirus 2.0” playbook at Hackensack Meridian Health contains 30 chapters. They range from maintaining and acquiring supplies of gowns, gloves, masks and face shields to staffing needs in a crisis.

“This is a novel, never-before-seen virus,” said Cathleen Bennett, the president of the New Jersey Hospital Association, “and we learned a great deal about both challenges and solutions.” She hosts weekly conference calls with hospital executives to share best practices, as they regroup during the summer lull.

State Health Commissioner Judith Persichilli and State Police Superintendent Col. Pat Callahan, who oversees the Office of Emergency Management, expressed confidence that the state will be prepared for the fall, should the virus come back.

“Every day at 10 a.m., we review our hospital preparedness,” Persichilli said last week. Officials monitor the number of hospital beds and testing kits available, and how long it takes to get test results. They check the inventory of drugs, especially remdesevir, in both hospitals and the state stockpile.

And they check supplies of personal protective gear to see if they meet current and future anticipated demand. Gloves are the area of most concern now, as the state rebuilds its stockpile, said Laura Connolly, a spokeswoman for the Office of Emergency Management. A few weeks ago, it was gowns.

Connolly declined to specify how many days’ supply of personal protective equipment the state is seeking to have on hand or how close it is to achieving that goal, citing “homeland security concerns.”

Whenever the next surge arrives, it will be different from the first.

Younger patients?

If New Jersey follows the trend of current surges in Texas, Arizona and other states, a higher percentage of cases are expected to occur among younger age groups than in the first wave.

COVID-19 has already ravaged long-term-care facilities, so fewer elderly casualties or cases would be expected. Many of the remaining residents have been exposed to the coronavirus and survived. Although it’s not known how long their antibodies may protect them, the hope is that they will not be reinfected. And officials still limit visitation to nursing homes and have testing protocols in place for residents and staff that didn’t exist before.

On the other hand, young people appear to be more likely to behave in ways that potentially expose them. All of the 13 cases reported in Hoboken over the weekend were among people younger than 45, with the majority among those under 35, Mayor Ravi Bhalla said. Young people have been more likely to gather or take advantage of reopened shopping, dining and entertainment possibilities, heightening their risk. 

Yet young patients also are less likely to develop critical complications from COVID-19, or to require intensive care or a ventilator. On average, they spend less time in the hospital.

More care at home

It may seem surprising, but the foremost goal of most hospitals facing a renewed threat is to treat patients at home, so they don’t need to be admitted, said Dr. Daniel Varga, the chief physician executive at Hackensack Meridian Health. That is the simplest way to prevent hospitals from being overwhelmed.

That will require deploying nurses and materials in the community. Patients may need home oxygen supplies, via oxygen tanks or a machine that concentrates room oxygen. They need oxygen-saturation monitors and other devices that connect electronically to a central hub, where a nurse or doctor can respond to any alarms. And they need visits from home health nurses.

Holy Name is investing in an expanded inventory of home telemonitoring equipment, Maron said. “We want to make sure if the virus returns, we’ll be more effective at managing them at home as long as possible, in real time with clinical connectedness, regular videoconferencing and monitoring of all vital signs.”

Separate wards for hospitals

Rather than isolate coronavirus patients in individual rooms around the hospital, whole wings or sections will be dedicated to those patients, with staff who won’t switch into other areas. Other patients won’t pass through the COVID wards. This approach, known as cohorting, cuts down on the amount of personal protective equipment used.

More importantly, it protects the uninfected. Hospitals must be able to treat both COVID and non-COVID patients without risk of contagion. Executives want to avoid any repeat of the state ban on elective and non-urgent procedures, which cut deeply into their revenues. They want non-COVID patients to feel confident about returning for regular treatment.

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During the current lull, some of the negative-pressure rooms and intensive care units that were constructed specifically for coronavirus patients are being fixed up and made permanent. Strategies that helped conserve protective gear, like running IV tubes into the hallway, so a nurse didn’t have to suit up to change a bag of intravenous medication, will be incorporated.

More ventilators, but try not to use them

New Jersey has more ventilators now than it did before the pandemic. But doctors learned from the first surge that intubation — the process of inserting a tube down a person's airway — carries grave risks. They want to use alternative ways of supplementing oxygen in severely ill patients if they can, Varga said.

Hundreds of machines the state Office of Emergency Management received from the Strategic National Stockpile are still on hand at the state warehouse, and have not been returned, Connolly said. Individual hospitals also bought hundreds of units, which range in price from $20,000 to $60,000.

Atlantic Health now has 50% more ventilators than it did before the pandemic — even after returning those it borrowed from out-of-state hospitals or received on loan from the state stockpile, Lenahan said. It has another 90 machines on order.

The ventilators are stored at Atlantic’s hospitals, where they will remain at least through the end of the year, he said.

Holy Name, which acquired five different models during the crisis, now is working to standardize its ventilators, Maron said. “We’re going through, maintaining them, making sure they’re in good shape,” he said.

Avoid complacency

The number of coronavirus patients in New Jersey hospitals has dropped by 89%, as of Sunday night, since the peak of the pandemic in mid-April. Last week, The Valley Hospital in Ridgewood, which has treated 1,200 COVID-19 patients since March, listed only four with the disease.

Nevertheless, it’s no time to ease up on preventive steps. Although hospital executives strive to project confidence in their preparations for a future surge, they know all too well that, at least for now, there is no cure and no vaccine.

“You have to assume anybody you come in contact with, whether symptomatic or not, whether they’ve traveled abroad or not, could potentially be a carrier,” said Maron, who came down with a moderate case of the disease himself.

Science takes time, he said: “There will not be an anti-viral and there won’t be a vaccine any time soon.”

Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in the medical world affect the health of you and your family, please subscribe or activate your digital account today.

Email: washburn@northjersey.com Twitter: @lindywa