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N.J. COVID-19 hospitalizations more than tripled in the past month. How bad could it get?
Updated Nov 27, 2020; Posted Nov 26, 2020
EMTs bring a patient to the emergency room at Hackensack University Medical Center in April.Ed Murray | NJ Advance Media for
By Brent Johnson | NJ Advance Media for NJ.com and Matt Arco | NJ Advance Media for NJ.com
The number of coronavirus patients in New Jersey's hospitals has more than tripled over the last month, and officials warn it could continue to rise in the coming months if COVID-19 cases keep surging during the second wave of the pandemic — especially after Thanksgiving.
There were 2,831 people hospitalized with confirmed or suspected COVID-19 cases across the state's 71 hospitals as of Wednesday night. That marked the first time in 27 days that the number didn't increase. And the total is still far below the more than 8,000 patients with the virus in April at the peak of the first wave. But it's more than 200% the nearly 900 patients hospitalized a month ago.
Hospitalizations typically increase after spikes in new cases, and new cases have been steadily rising this month. New Jersey's statewide seven-day average for new positive tests surpassed 4,000 for the first time this week, doubling the average in just 17 days — 14% higher than a week ago and more than 220% higher than a month ago.
Stephanie Silvera, an epidemiologist and public health professor at Montclair State University said she wouldn't be surprised to see hospitalizations double again by Christmas depending on how people act during and after Thanksgiving.
"If we see cases increase the way we think we may, we'll see really dramatic increases in hospitalizations," Silvera told NJ Advance Media.
While hospitalizations are a key real-time measure of the status of the outbreak, it is considered a trailing indicator because of the time between exposure, incubation, and illness serious enough to require hospital care can span several days or a week.
Silvera said the problem with the number rising is that it puts stress on health care workers, stress on the state's health care system, and increases the risk of people dying from the disease.
Deaths are also likely to increase noticeably by mid-December as hospitalizations rise, she said.
"There are people hospitalized weeks to months before they die from this disease," Silvera said.
New Jersey's 71 hospitals reported 2,902 patients as of Tuesday night, the 26th consecutive day of increases.N.J. Department of Health
Health experts do say hospitals have learned from the initial wave and are improved at treating patients. Plus, the people getting infected now tend to be younger and healthier overall, which should shorten hospital stays.
Dr. Daniel Varga, the chief physician executive for Hackensack Meridian Health, said the biggest concern over Thanksgiving is younger, asymptomatic residents passing the disease to older, more vulnerable friends and family members.
Varga also noted the state has seen outbreaks after major holidays and events.
"We're gonna be indoors instead of outdoors," he said. "There's the risk of a lot of people versus a few people, the risk of prolonged exposure. You could see where this could get us pretty quickly."
Still, Varga said he does not see hospitalizations approaching what they did in the spring.
"It's been fairly incremental," he said of hospitalizations in the second wave. "It was 0 to 100 in the spring. This has been a much slower, more gradual increase."
New Jersey's hospitals are "holding steady" at about 66% capacity statewide, said Kerry McKean Kelly, a spokeswoman for the New Jersey Hospital Association.
"Hospitals are monitoring the daily case counts very closely to ensure they're prepared with sufficient capacity," Kelly said. "During a public health emergency, hospitals are able to bring on additional surge capacity beds. Of course, we need healthcare personnel to staff those beds, and they are our most important resource as COVID activity intensifies in New Jersey."
During the state's initial coronavirus surge in the spring, New Jersey saw a peak of 8,224 people hospitalized on April 15, including 1,880 in critical or intensive care and 1,645 requiring ventilators to breathe.
Statistical models based in part on data from other countries predicted the demand for hospital beds could have climbed to 14,000. Anticipating the worst, state Health Commissioner Judith Persichilli asked hospitals to add beds in whatever space they had. Within five weeks of the state's first reported case of the coronavirus, the number of hospital beds grew from 23,000 to 37,000, including a doubling of intensive care beds from 2,000 to 4,000.
With the field hospitals long closed, and many temporary beds hastily created in the spring gone, it is hard to compare hospital occupancy levels then and now. But in mid-April, the overall hospital bed occupancy level was 76%, with 75% non-intensive care and 83% ICU, according to the state Department of Health.
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Varga said more people in the spring entered hospitals and never left. Now, the vast majority of COVID-19 patients stay for only three to five days, Varga said.
Still, new coronavirus patients seeking care at hospitals in New Jersey have outnumbered discharges and those who died while receiving care for every day of November, leading to the steady rise.
Varga said hospitals also have more space, equipment, and personal protective equipment this time.
"We've been stockpiling," Varga said. "We know how to convert space after the first trip around the sun."
The biggest issue, Varga said, is staff members getting sick. He also said the hospitalizations could multiply if cases continue to grow in the state.
The RWJBarnabas Health System is expecting cases to keep trending upwards in the winter, said Christopher Freer, the group's senior vice president for Emergency and Hospitalist Medicine.
But Freer also stressed "our facilities are well prepared to handle the influx."
If hospitals are overwhelmed, Silvera said, there could be less room and attention for patients with other issues, like heart attacks and strokes. Plus, treatment isn't as robust when there are more patients, the Montclair State professor said.
Hospitals are urging people to keep wearing face coverings, social distancing, and limiting gatherings to help control the spread and prevent hospitals from becoming overburdened.
Silvera said New Jersey might be able to avoid doubling hospitalizations by Christmas depending on how people behave on Thanksgiving and the subsequent reaction.
"If we see numbers double after Thanksgiving and people start to take it seriously," she said, "maybe we'll see enough of a change by Christmas that we could avoid that."
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NJ Advance Media staff writer Susan K. Livio contributed to this report.
Matt Arco may be reached at marco@njadvancemedia.com.
Brent Johnson may be reached at bjohnson@njadvancemedia.com.