Not again

Holy Name Medical Center, a 361-bed hospital in Teaneck, was widely regarded as among New Jersey’s first epicenters of the COVID-19 pandemic last year. And so while Michael Maron, the hospital’s chief executive officer, contends that these latest surges in the delta variant are indeed worrisome, they’re by no means a reason to “create an alarmist narrative” which he’s seen circulating in public.  “This to me is one of the real concerns I have,” he said in an interview. “There’s a lot of misinformation.”

At the height of the pandemic last year, more than 8,000 COVID-19 patients were admitted into the state’s 71 acute-care hospitals. Many health care facilities turned cafeterias into new wards, emergency field hospitals were set up across the state, and Gov. Phil Murphy instituted a three-month ban on elective procedures to focus health care resources on the pandemic response.

“If you look at a collective trend line from March of 2020 through July of 2021, we are at all-time lows – not even remotely close to the highs that we saw last year,” Maron said. “At our height we had approximately 300 patients in the hospital, all COVID. Today, we have three.”

Nonetheless, caution may be warranted. The number of COVID-19 patients, while still down dramatically, is inching upward day by day. On July 29, the state Department of Health counted 480 patients, compared to an all-time record-low of 289 COVID-19 hospitalizations on June 25.

Hospitalizations typically lag behind daily cases, but public health officials often use the metric to more accurately gauge the severity of the pandemic’s spread.

According to New Jersey Health Commissioner Judith Persichilli, vaccination rates have been lagging in younger crowds. Just 44% of people aged 12 to 17 have gotten at least one dose, compared to 62% of the 18 to 29 age group. “We need that coverage to be higher,” she said during a July 26 COVID-19 press briefing. The Pfizer vaccine is approved for anyone above the age of 12, while Moderna and Johnson & Johnson shots are authorized for anyone over the age of 18.

“Those ages 12-29 have some of the lowest vaccination rates, but they are not invincible against this virus,” said Cathy Bennett, CEO of the New Jersey Hospital Association. “NJHA’s data shows that those hospitalized with COVID are skewing much younger because they simply haven’t been vaccinated.” By most scientific accounts, the existing vaccines are effective against the delta variant, despite its highly contagious nature.

Past is prologue

Hospital executives across the state learned painful lessons and many told NJBIZ they have no intention of repeating that history. With the delta variant driving new cases, especially in the millions of people not willing to get vaccinated, hospitals have a chance to put those lessons to the test.

For Holy Name, that means ramped up testing capacity to quickly discern COVID-19 from say, the flu or cold as both come back this fall. It also means having health care service on standby that an unvaccinated COVID-19 patient can immediately access once they come to the hospital.

There are specially designated COVID-units to handle the overflow of patients. And Maron said that there’s “no indication we’d have to open them,” but “when all of a sudden we see influxes to the emergency room, if that goes up markedly, then we need to.”

For places like University Hospital, the only publicly owned hospital in the state and one of New Jersey’s three Level One trauma centers, preparedness means a 90-day stockpile of personal protective equipment, consistent combing of COVID-19 data and other health metrics, and “surge plans” for where to admit COVID-19 patients should the need arise for more bed space, according to Dr. Shereef Elnahal, the hospital’s president and CEO.

Like Holy Name, University Hospital, and more broadly North Jersey urban centers like Newark, were devastated by the pandemic last year.  And communities of color have borne the brunt of hospitalization and fatalities from the virus. “The delta variant is going to cause another surge in the unvaccinated community … so we have to prepare for it” Elnahal said. “By no means are we done fighting this fight. We’re starting to see a trickle of more admissions.”

He added that the added $150 million in federal aid under the American Rescue Plan will go toward an entire new wing for new capacity to meet future public health crises. “Number one, it solves our capacity issue but number two, we finally have a chance to design the hospital of the future,” Elnahal said, one that’s “designed explicitly to serve the community and the community’s needs.”

“It’s a clean slate against which we can build a new structure that is innovative, that is thoughtful, that has community input.”

With the possibility of booster shots being necessary in the coming months, Elnahal suggested that hyperlocal points of care like those coming out of University Hospital would be the go-to place for area residents to get them, rather than, say, the vaccine mega-sites used during the winter and spring. “The good news is the country is better-prepared for boosters than they were for original shots,” he said.

Tough season ahead?

Last year, the combination of face coverings and social distancing meant that illnesses such as the cold and flu were practically absent. This year, the more common ailments might come back. Dr. Manish Trivedi, who heads the infectious disease division at AtlantiCare in South Jersey, said there’s already been an uptick in respiratory viruses “circulating this summer, which is highly unusual.”

“This fall and winter, we may see a situation where patients have less immunity to circulating viruses since they were not exposed the previous season,” Trivedi added. “This coupled with relaxing of virus prevention protocols will likely lead to an increase in people needing to seek care for typical respiratory viruses in addition to COVID-19.”

Daniel Varga, the chief physician officer at Hackensack Meridian Health, which operates 17 hospitals across North and Central Jersey, said he expects a “typical flu season,” hence the need for residents to get an annual flu shot on top of the COVID-19 vaccine.

Maron said Holy Name’s testing capacity makes the facility able to quickly discern illnesses like the flu or cold from COVID-19. And he expects rebound in the two. “What really mitigated the spread of the virus and flu and cold was the separation,” he said. “Giants Stadium hadn’t been open, large theaters hadn’t been open. People haven’t been going to concerts, people haven’t been going to Broadway.”

The concern, he said, is that those very likely become “spreader events” that lead to painful outbreaks. “Shutting down those events again would probably be the greatest mitigating intervention.”

James Matera, the chief medical officer for CentraState Medical Center in Freehold, cautioned that the current “hybrid status with situational masking” could very well allow the flu to become more prevalent in these colder months.

And Elnahal and Varga noted that many patients have been returning to the hospitals for elective procedures to finally get long-delayed care.  According to the NJHA, the most common elective procedures are bariatric surgery, pacemaker insertion, spinal fusion, knee replacement and hernia repair. These matters might not be life or death, but they could have a major impact on overall health and quality of life.

“Before this past little blip, we were really humming along,” Varga said in an interview. “A lot of folks wanted to get vaccinated before they came in for their elective procedure.” He estimated that “most of our elective procedures are back to pre-COVID levels.”

In addition, many patients are utilizing urgent care or telehealth services whereas before COVID-19, they might have made the emergency room their default choice. “Some folks are beginning to wonder whether [emergency department] volumes will ever come back,” Varga said.

Elnahal called it a “good sign that people are confident enough to get their health care again.” Substance use and mental health disorders “exploded” during the pandemic, and that needs to be addressed, he added.

Lauren Yedvab, head of lab services for the Atlantic Health System, which operates five hospitals, said that thanks to COVID-19 mitigation efforts, the health network has “been able to return our procedure schedule to near pre-pandemic levels in recent months.”

But other hospital executives have said patients are still anxious about coming back in because of the virus.  Maron said that while more patients are coming into Holy Name for elective procedures than they were last year, many are opting to live with “those higher levels of discomfort than they normally would, out of fear” of the variant.

“We’re not banking on it staying strong through the fall,” he said of elective procedures, “especially if there’s any kind of change with the variants.”

Matera agreed that a significant number of patients are still too worried about the pandemic to come back in for routine medical care. “While 2021 has shown promise in getting back toward normal … patients [are] still being reluctant to follow through with routine medical care, whether it is procedures like joint replacements
or general healthcare initiatives like management of diabetes and cardiovascular disease,” Matera said.