Coronavirus Diary (26): New Jersey Under Siege

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.

From a story about the plight of north Jersey hospitals:

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.

The state’s health commissioner cites a Penn Medicine model that outlines the desperate need to expand hospital capacity in New Jersey:

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.

11 thoughts on “Coronavirus Diary (26): New Jersey Under Siege

  1. “universities, which have adopted what strikes me as a head-in-the-sand, business-as-usual posture during this crisis”

    Not sure what you mean here. Nearly every university I’m aware of has moved almost everything online. Things seem pretty far from business as usual.

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    • I regard the academy’s response to this as essentially a bad joke. My point is, setting aside the medical schools, they’ve done little or nothing to leave their comfort zones. Moving classes online strikes me as a triviality relative to the gravity of the crisis, especially in the New York/New Jersey area. For the most part, that’s made most academics’ jobs easier, not more difficult–no commute, fewer meetings, less administrative micro-management, fewer interruptions at the office. Most faculty that I know have some experience with online teaching; we’ve been transitioning to that for a decade. In New Jersey, we’re under a state mandate to minimize our reliance on textbooks and move to online readings, even for on-ground classes. So for many people, the “transition” to online teaching has been minimal. The academy has trumpeted it as though it were some grand accomplishment, and as though the disruption involved were something of overwhelming intensity and scale. It isn’t, and wasn’t.

      Here is what I mean by “business as usual.” Again, there are exceptions to this rule, and the medical schools (and various clinical programs within non-medical schools) have been a notable exception across the board. That said:

      1. The PR/messaging has been completely tone-deaf. The overriding imperative throughout the crisis has been: how do we pretend that it isn’t happening and continue with our efforts at enrollment management? When the crisis comes up at all, the tone of the messaging sounds like something out of a textbook of positive psychology: “don’t panic; this, too, shall pass.” I feel like adding, as a footnote to such messages: “Right, but you too may pass. We are staring mass death in the face. Try taking a look at it instead of averting your eyes and pretending that things will be OK.”

      2. They’ve made no serious effort to volunteer their resources–e.g., physical plant, materiel. The state (on behalf of the hospitals) issued an urgent call (really, a mandate) for any institution with medical supplies to declare them and prepare to hand them over. Have the universities done this? No. They’ve offered up complete silence. But it is common knowledge that they have these supplies in their science, nursing, and art departments. When one of my colleagues volunteered his supplies, I was tasked with retrieving them from his office and getting them to the hospital. The basic concern expressed to me was: yes, this is important, but aren’t we under an administrative edict to stay off campus? That I’m openly copping to have to flouted this edict online as an at-will employee testifies to my sense of the sheer insanity of those priorities.

      3. The “lockdown” has made collective action difficult, true. But ingenious and enterprising people have found ways to act despite that. And the lockdown in any case makes exceptions for collective action aimed at ameliorating the effects of the crisis. Have the universities issued any kind of clarion call for such action? Fuck no. That task has devolved on grass roots enterprises, mostly of the left. Here we have thousands upon thousands of “bored” students who could be organizing for the kind of action that university mission statements are always blathering on about. So where are they?

      I don’t mean to suggest that academia is unique, just that my criticism applies to academia. Despite the commendable efforts of some companies, business has in many respects been AWOL, too. I’ve already recounted here the story of the friend whose business insisted on a physical presence at their work site for appearances’ sake. Here’s a message I got from someone who works in healthcare administration:

      Are you seeing anything on social media about organizing to help healthcare? I just joined back on Facebook [for that purpose] but I see nothing of the sort. I appealed to the president of my company about mustering support for health care workers, PPE equipment or money or ancillary support [;] we serve hospitals after all but he didn’t even respond.

      “Didn’t even respond” is a nice summary of much of the institutional “response” I’m seeing, from academia and elsewhere.

      I’d continue, but I’m late for class.

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      • Here’s what I was going to say before I was so rudely interrupted by the imperatives of my job. Take a look at this viral video of an NYU Dean responding to students’ about whether they’re to receive a tuition refund for the semester:

        https://nypost.com/2020/03/27/tone-deaf-nyu-dean-sends-video-of-herself-dancing-to-students-seeking-tuition-refunds/

        Yes, this is a sample size of 1, but the tone-deafness of this video strikes me as just the most egregious and public manifestation of a widespread attitude within upper level academic bureaucracies: a willed, compulsive detachment from reality, and a desire to put a smiley face on everything, even mass death.

        Consider the fact that NYU operates three major medical centers, one of them just steps away from this dean’s office–Langone, Tisch, and NYU Medical. The faculty and staff working at these hospitals are engaged in a life-or-death struggle aimed at averting all-out catastrophe. And they are losing that battle. At the very least, the outcome of the battle is uncertain. Academic leaders with any sense of civic friendship and moral responsibility would, at the very least, be conducting themselves with a demeanor appropriate to that occasion. They might even explicitly bring up the struggles of their colleagues–not as PR or grandstanding, not as an insidious way of downgrading anyone else’s legitimate grievances, but in an authentic spirit of collegiality and solidarity. Are they doing so? No. Green’s dance is only the most visible and ridiculous manifestation of that fact. I’ve paid pretty close attention to the doings of major institutions in New Jersey, and some in New York City. On the whole, they have been AWOL.

        I don’t have a view on whether students should get a refund or not, but even the outrage of the disrespected students strikes me as a case of misplaced moral priorities. Yes, many students are suffering economic distress right now (as are many non-students). And yes, this video is disrespectful to them. But is it really plausible to think that the economic distress of NYU students is comparable to the distress of people at NYU who are being intubated without sedatives or painkillers, and face the prospect of death by the equivalent of suffocation for lack of ventilators or critical care? The economically disadvantaged students certainly have cause for complaint. But if they do, what about the patients who are being intubated without access to Tylenol?

        I singled out academia in the one sentence that you quoted, but the point I’m making isn’t just about academia, but about an entire class of administrators and bureaucrats–not just the ones in academia, but those in business and in government. Obviously, I don’t mean to be referring to every particular individual, and don’t mean to be arriving at some armchair estimate of how many of them there are. I just mean: there are enough of them, everywhere, to represent a recognizably recurrent phenomenon. When you encounter or deal with one, you think, “Jesus Christ, not another one.” But yeah, it’s another one. Their prevalence explains why we’re in the situation we’re in. The best account I’ve read is Anne Applebaum’s in The Atlantic, which should become required reading once we find our way out of this crisis.

        https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-showed-america-wasnt-task/608023/

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      • My claim about “business as usual” in academia may have been unfair or hasty. It is likely that confidential discussions were taking place about various proposals. I just learned that area institutions are seriously considering the possibility of loaning out some of their dorm facilities to house medical personnel. Slightly different from my proposal to use dorm facilities for quarantine purposes, but in the same ballpark.

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  2. The latest news glimpsed during a quick break in the day:

    Seven New Jersey hospitals on divert status, but the surge is only “beginning”:
    https://www.nj.com/coronavirus/2020/04/coronavirus-update-the-surge-is-beginning-7-nj-hospitals-temporarily-hit-capacity-in-1-day-official-says.html

    Holy Name Hospital, Teaneck stretched thin and pleading for help:
    https://patch.com/new-jersey/teaneck/nj-hospital-coronavirus-100-sick-1-night-too-few-ventilators

    ER doctor at East Orange General dies of COVID-19 after surviving cancer twice:
    https://www.nj.com/coronavirus/2020/04/nj-er-doctor-who-twice-survived-cancer-dies-a-week-after-developing-coronavirus-symptoms.html

    Florida Man blames New York and New Jersey for the problems of his state:
    https://www.nj.com/opinion/2020/04/hey-new-jersey-florida-is-trying-to-kill-you-with-coronavirus-stupidity.html

    Naturally, Florida Man blames us while belatedly enacting the policies that New York and New Jersey were among the first to put in place, but that’s only because Donald Trump has decided to endorse them:
    https://www.npr.org/sections/coronavirus-live-updates/2020/04/01/825383186/florida-governor-orders-statewide-lockdown

    Donald Trump, that paragon of prudence and probity, blames New York and New Jersey for the surge in cases:
    https://www.nj.com/coronavirus/2020/04/trump-says-nj-and-ny-got-off-to-a-very-late-start-fighting-coronavirus.html

    Yeah, that President Trump, the one with our blood on his hands:
    https://www.bostonglobe.com/2020/03/30/opinion/president-unfit-pandemic/

    But don’t worry, now that everyone is social distancing in New Jersey, the infection rates will definitely go down:
    https://www.nj.com/ocean/2020/04/10-charged-at-lakewood-engagement-party-in-violation-of-coronavirus-lockdown-cops-say.html

    We should merely remonstrate with people who act like this, especially after we discover that they’re utterly undeterred by the prospect of death:
    https://www.nj.com/coronavirus/2020/03/5-rabbis-from-lakewood-have-died-from-coronavirus-joining-growing-toll-of-nj-victims-reports-say.html

    Well, maybe New Jerseyans are uniquely stupid, but New Yorkers are way more sophisticated:
    https://www.usatoday.com/story/news/nation/2020/03/31/usns-comfort-crowds-watch-hospital-ship-arrive-new-york-city/5093608002/

    Good times.

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  3. A story from NJTV on the situation at Valley Hospital (Ridgewood, NJ):

    https://www.njtvonline.org/news/video/a-staggering-increase-in-coronavirus-cases-at-one-hospital/

    My brother on the situation there:

    Our hospital is rapidly approaching the tipping point between where disaster management is doable vs. not doable. I think the battlefield triage taking place in places like Elmhurst and Teaneck is upon us in the next several days. PPE is on tight rations and in constant re-use.

    On the brighter side, there’s a nice segment at about 5:48 about a North Bergen sewing company that’s now making PPE for Valley:
    https://www.njtvonline.org/news/video/april-1-2020-njtv-news-with-mary-alice-williams/

    Nurses mobilizing:
    https://www.njspotlight.com/2020/04/new-jerseys-nurses-mobilize-in-war-against-covid-19/

    A somewhat optimistic picture of the ethical decisions we face up ahead:
    https://www.njspotlight.com/2020/03/planning-for-the-unthinkable-what-if-covid-19-patients-overwhelm-medical-supplies

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  4. Pingback: Coronavirus Diary (30): Reporting from Brooklyn | Policy of Truth

  5. Pingback: Coronavirus Diary (38): Waiting for the Surge | Policy of Truth

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