Most of the national media reporting on the COVID-19 pandemic has focused, understandably, on the catastrophe taking place in New York City, the epicenter of the pandemic. A student in one of my classes, with friends and family in Queens, told me that he knew personally of fifteen COVID-19 deaths in Queens alone (Elmhurst). New York City essentially leads the world right now in COVID-19 cases.
Somewhat lost in the shuffle as it always is, is the second-place case of New Jersey, where, apart from graduate school, I’ve lived all my life. You can turn on the TV to see what things are like in New York, but whether you see it there or not, things aren’t much different in Jersey: like New York, New Jersey is under siege. And “siege” is no metaphor. COVID-19 is an invading army–much more so than the Japanese, the Nazis, the Soviets, Al Qaeda, Saddam, or ISIS ever were–and we’re losing the battle to it.
I’ve lived through 9/11 and lived through Hurricane Sandy. I’ve often sat in Fort Tryon Park in Washington Heights musing on the carnage of the Revolutionary Army’s retreat across the Hudson and through New Jersey after the Battle of Brooklyn Heights (August 1776). And the misery at Jockey Hollow during the Revolutionary Army’s winter encampment there (1779-80) has permanently been ingrained on my memory since childhood.
This is worse. We have no precedent, no historical referent, for what is happening to us now. As Anne Applebaum presciently argued in The Atlantic a few weeks ago, COVID-19 has called this country’s bluff. Eventually, the odds get even with a nation addicted to hubris, brutality, and lies. As now they have.
There’s no human way for anyone to keep track of what is going on in our hospitals right now, whether in New York or New Jersey. No matter how close we are to them in spirit or sympathy, those of us not on the front lines are too far from the action to know what’s going on there, even in the most abstract or intellectual terms, much less in terms more immediate and engaged than that. We aren’t even the rearguard of the army. We’re bewildered semi-spectators watching the carnage unfold from the distance of a deathly silent hinterland.
In lieu of any better way of capturing this, let me just list the handful of articles published online in the last twenty-four hours or so, as gleaned from a single search of “New Jersey hospitals” via the “News” function on Google.
COVID-19 patients continued to descend on hospitals throughout the state Monday, forcing some facilities to divert admissions from their critical care units or emergency departments.
The deluge comes as health care workers themselves are being exposed, whether at work or in the community, further straining medical staffs.
A bioethics committee is being put together to figure out how to make triage decisions regarding who gets ventilators or not, who lives and who dies:
“I’ve never witnessed anything like this,” said Nir Eyal, a bioethics professor and director of the Center for Population–Level Bioethics at Rutgers University.
Eyal, who has written about healthcare triage and scarcity of resources in responses to Ebola and the 2010 Haitian earthquake, said that the “level of scarcity of the most important medical resources is going to be quite unprecedented” for the United States.
“The difference between ordinary times and what we are going to see is going to be absolutely staggering,” he said.
Wouldn’t you love to have his job? If you think grade complaints are bad, what about death-decision complaints?
This article suggests that New Jersey hospitals will run out of beds in two weeks unless we intensify social distancing (that the demands for social distancing are still regularly being flouted is a blog post of its own):
New Jersey will run out of ICU beds to care for coronavirus patients within the next two weeks unless the public increases the practice of social distancing to historically unprecedented levels, Gov. Phil Murphy said Monday.
At the same time, dramatic measures are being taken to repurpose hospitals as critical care COVID-19 facilities while non-critical patients are transferred to field hospitals, nursing homes and even dormitories and hotels.
Dormitories? I fantasize that my efforts had something to do with the inclusion of those on the list, but that’s just my vanity speaking. Whether my advocacy of the idea played a role or not, I’m happy to see the dormitory idea taken seriously. Let’s just see whether universities, which have adopted what strikes me as a head-in-the-sand, business-as-usual posture during this crisis, manage to step up and do the right thing for the people and institutions that subsidize them.
Three New Jersey hospitals have stopped accepting any more patients, diverting new patients to other hospitals:
Three New Jersey hospitals — one in Bergen County, one in Morris and one in Monmouth — alerted the state Health Department on Saturday afternoon they were going on “divert” status, giving themselves a four-hour break from accepting new patients.
Diverting patients is not cause for alarm, experts say. But it is the latest sign that acute-care hospitals in New Jersey are being pushed to their limits as the number of patients infected by and dying from the coronavirus quickly mounts.
I’m not an expert, so I can’t authoritatively say that diversion is an objective cause for alarm. But I certainly feel alarm.
Shore Hospital in Somers Point is asking for voluntary layoffs to deal with its financial difficulties:
A New Jersey hospital is asking volunteer employees to accept layoffs in order to help deal with its financial issues amid the novel coronavirus pandemic.
Shore Medical Center, located in Somers Point, New Jersey, sent a letter to employees stating they had invested “significant resources” on equipment to protect their staff who are treating COVID-19 patients. They also said they were experiencing a “dramatic decrease in revenues” after they canceled elective surgeries and other scheduled services while protecting staff and patients.
A dramatic decrease in revenue is, of course, highly problematic for the hospital, but it’s the least of the problems caused by the cancellation of elective procedures and services.
New Jersey health officials said the state is continuing to take steps to increase hospital bed capacity to deal with the expected surge in coronavirus patients, but said the number of beds needed will diminish if people step up their efforts to adhere to social distancing measures.
“The only tool we have in our tool kit is social distancing,” said N.J. Department of Health Commissioner Judy Persichilli, during a press briefing Monday afternoon.
Persichilli said New Jersey went into the COVID-19 outbreak with 18,000 medical surgical beds and 2,000 critical care beds at hospitals statewide.
Citing an epidemic hospital impact model developed by Penn Medicine, she said had the state done nothing to increase its bed capacity — and assuming a social distance compliance rate of 31% to match historical averages during an epidemic — New Jersey would reach its intensive care unit bed capacity by April 11 and its overall bed capacity by May 8.
The model projects a need for 30,000 to 35,000 hospital beds, with a 31% compliance rate of citizens staying 6-feet away from each other.
“That (model) assumes we had done nothing,” Persichilli said. “We have asked all hospitals to double their ICU capacity. If they had 10, we asked them to move it to 20. If they had 40, move it to 80.”
The comforting thing about this particular model (and who knows which one is right?) is that since we did do something–since the relevant people moved heaven and earth–we shouldn’t reach ICU bed capacity by April 11 or overall bed capacity by May 8. Nor should we need 30-35,000 beds. But that’s only because people have (to whatever degree) practiced social distancing, because those who didn’t practice it were forced to by the police or other legal action, because elective procedures were canceled, and because hospitals here took early, drastic measures to clear space for new beds.
My brother tells me that all of his colleagues’ office space (and his own) at Valley Hospital was repurposed for critical care purposes. What’s sad is that the Penn model on which Persichilli is relying assumes a mere 31% compliance rate–which makes you wonder what’s going on in the minds of the other 69%. And what’s even more frightening is that we don’t know whether the compliance rate is as high (or low) as 31%. We can’t know what it is, except by indirect inferences from the actual rate of infection and mortality. Which is a hell of a way to find out.
And finally, to end on a bit of good news, FEMA has set up a 250-bed field hospital in Secaucus for non-COVID patients, in addition to some others at the Meadowlands:
New Jersey’s emergency command center, a complex outside Trenton referred to as “the rock,” is playing a key role in the state’s battle with COVID-19, coordinating the distribution of critical supplies and preparing for the opening of a new, 250-bed, pop-up field hospital in Secaucus that will start hosting patients next week.
Col. Patrick Callahan, the superintendent of the State Police, is in charge of the nerve center, which sits in Ewing Township, five miles to the northwest of the State House.
First opened in 2006, the complex formally known as the Regional Operational and Intelligence Center, or ROIC, has played key roles in the wake of tropical cyclones like Superstorm Sandy, as well as domestic security threats. It’s never had to handle a pandemic before.
“To say it’s a little surreal, I think, would be appropriate,” said Callahan, who’s been a constant presence at the daily COVID-19 press briefings conducted by Gov. Phil Murphy, alongside Health Commissioner Judith Persichilli and others.
Actually, it’s a little too real.
No recitation of dry facts can really convey the anguish, the uncertainty, the terror, the misery, or for that matter the grandeur of our moment. But it’s all of those things, and more. We’ll be different people–a different people–when we get to the other side of this, whenever that happens to be. The gnawing uncertainty is when it will be. And of course, for some–for far too many, however the curves fit and the calculations go–the greater uncertainty is whether it will happen at all.