NJ Outlines Field Hospital Plan to Prepare for Surge of COVID-19 Patients
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By Lilo H. Stainton
New Jersey Gov. Phil Murphy pledged Wednesday to spare no expense in saving lives from the coronavirus and promised to leave no patients “on the battlefield” in the state’s fight to win the war on the pandemic.
Critical to the state’s response are the four temporary “field hospitals” being planned by U.S. Army officials, the first of which Murphy said would be open within a week at the Meadowlands convention center in Secaucus. Three other units will follow within roughly a month, he added, with two located at the massive convention complex in Edison and another at the Atlantic City Convention Center. Each will have roughly 250 beds.
While some hospitals — especially in hard-hit Bergen County — have reported being inundated, Murphy said most of the state’s acute-care facilities are “currently meeting the needs” of patients diagnosed with COVID-19 or other medical conditions. Nearly 4,500 New Jersey residents have now tested positive for the disease caused by the novel coronavirus and 62 have died.
Making more beds available
But with COVID-19 diagnoses growing daily — a result of both wider testing and the disease’s spread — state health officials want to add some 2,360 hospital beds in the coming weeks. Reopening hospitals or hospital wings that were recently closed will satisfy just over half this need, they estimate, and the field hospitals should add another 1,000 beds.
“We must be ready for the time when the surge comes” and the state’s existing 72 acute-care hospitals can no longer accommodate those who need treatment, Murphy said at his daily media briefing Wednesday. “We have been working rapidly to expand hospital capacity. Make no mistake, we are in this fight to save lives.”
“We will leave nothing on the battlefield in that effort. There is no cost too high to save one precious life,” the governor continued, recounting how in the United States, soldiers are trained to never abandon their fellow fighters in war. “That is America. And that is New Jersey. We will fight to save every single life,” Murphy said.
New Jersey — where the positive COVID-19 case count has grown by as much as one-third overnight — has instituted strict social-distancing measures to reduce contact among residents and slow the spread of the disease to reduce the impact on health care. Murphy has required hospitals to cancel elective surgeries and public health officials have encouraged individuals with mild symptoms to avoid visiting the doctor or local emergency room to further spare the medical system.
U.S. Army Corps to the rescue
The field hospitals will be set up by the U.S. Army Corps of Engineers, which has a long history of creating pop-up medical facilities in times of public-health disaster or war. The Corps is also working with New York State to retrofit the enormous Javits Center convention space in New York City so it can host hospital overflow; it has templates for space configuration, security and operations guidelines, work orders and more on its website.
“We will not be left scrambling. We will be ready to act decisively to protect our residents,” Murphy said. “We hope this all remains measures of preparedness,” he added, saying no one would be happier than he would if it turns out New Jersey doesn’t need the extra hospital capacity.
Nurse Suzanne Willard, associate dean for global health and a professor at Rutgers School of Nursing, said that the U.S. military has vast experience worldwide in quickly creating these facilities to care for victims of war, natural disasters or pandemics.
“They are well attuned to setting these up,” Willard said. “And things need to move rapidly,” she added, noting that while China was able to build new, permanent hospitals in several weeks to treat COVID-19 patients, that would be near impossible in this country.
Existing Garden State hospitals provide nearly 23,000 beds in total, including nearly 2,000 designated for critical care — considered vitally important for patients with serious respiratory issues. COVID-19 can cause mild cold-like symptoms and fever in most healthy people but can be deadly to older individuals or those with underlying conditions like diabetes or heart disease.
While the state does not have an automated system to monitor hospital bed availability in real time — or track the number of COVID-19 patients now getting treatment (either inpatient or outpatient) — State Department of Health Commissioner Judith Persichilli is working with experts to model the surge and its impact on individual hospitals. A separate study, by Rutgers University Camden, suggests the need could top 122,000 beds at some point, even with strict social-distancing measures.
Keeping an eye on COVID-19 in NYC
Persichilli is also closely watching the progress in New York State — now the national epicenter for the outbreak — where Gov. Andrew Cuomo said the case load is expected to peak in two or three weeks. “The algorithms are good, but the boots on the ground are what we are monitoring carefully,” she said Wednesday. “When we see this peak in New York, I think we can expect Bergen, Essex and Hudson (counties) will follow this trend.”
Bed space is only one worry, as Persichilli has made clear. Doctors, nurses and other staff are already in short supply — a growing concern as more caregivers are infected with COVID-19 — and stocks of masks, gowns and other protective items are dwindling fast, health care providers warn. The state is also short at least 300 ventilators, Persichilli said.
On Tuesday, Persichilli indicated that health officials have identified the staff needs for the field hospitals and are working with professional organizations to draft the clinicians needed. The state also plans to use nursing students in their final semester and may contract with a staffing agency for additional workers.
The hope is to coordinate both staffing and medical supplies — for the field hospitals and other COVID-19 response efforts — through central, government-run programs that can track and distribute resources statewide. Murphy said New Jersey has received some — but not nearly all — of the supplies it has requested from a federal stockpile. It is also collecting donations of medical equipment from corporate partners, closed ambulatory surgery centers and members of the public.
Persichilli said she is working closely with the New Jersey Hospital Association to coordinate a plan for these temporary facilities, which will be used for patients with less serious medical needs — regardless of their diagnoses. As demand for critical-care beds rises, so-called step-down rooms will be upgraded to also handle severe cases, and patients from these units will be moved to beds traditionally used for patients with limited medical needs.
The commissioner said this approach allows hospitals to serve as larger, critical-care complexes; some have offered to transfer out certain patients and exclusively treat individuals with COVID-19. The field hospitals will provide for those with COVID-19 and other conditions that require less medical intervention. The three regional Level 1 Trauma Centers will coordinate patient assignments at each field site, she said.
“We’ve looked at the whole continuum, and the hospitals are right now aggressively opening up every single bed that they have,” Persichilli said Tuesday.
While it is not yet clear exactly what treatments the state’s field hospitals will be able to provide, Rutgers’ Willard said these facilities can be outfitted to handle everything from basic to more critical care, or even surgery. But they are often used to triage people with certain symptoms and provide essential clinical support, like oxygen and fluids, in an effort to stabilize patients and prevent them from requiring more intensive treatment.
“This is really a time for mitigation,” Willard said, “to keep the bulk of the population in the state healthy and to isolate those who have the virus and also be able to provide care” for patients who need hospital treatment. “If you’re not treating people, they’re going to get sick and die on you,” she said.