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Dr. Nizar Kifaieh wanted the public to see how the hospital he leads, Hudson Regional, has become a COVID-19 ward.
During a tour of its ICU and another patient floor, he showed how the Secaucus medical center is treating 80 patients, almost all of them afflicted with the novel coronavirus. Every patient in the ICU breathes with a ventilator. IV drips hang outside rooms, so nurses can adjust them with minimal patient contact.
“We can’t add any more patients in the actual ICU, which is why we have a spillover on the floor,” said Kifaieh, Hudson Regional’s CEO and president. “We’re expecting the floor is going to turn into an intensive care unit. Right now, we have about eight patients on the floor that are ICU-type patients, and I also have a few patients in the Emergency Department that are ICU-type patients.”
Currently the hospital’s handling double its usual number of patients needing intensive care. Meanwhile, nurses worked to admit three more COVID-19 patients on the spillover floor — cases that could go either way, the staff says.
“Every single patient on this unit that’s not on a ventilator is a potentially a ticking time bomb,” he said. “Any of them can deteriorate so rapidly. It’s not a gradual process. We’ve seen it happen like this. That’s why we always have to make sure we have enough ventilators in-house.”
To be sure, the team here is notching its share of victories.
“We’ve had a number of discharges, patients that were here four or five days and are doing really well, their symptoms have improved, and we send them home with instructions,” said Felicia Karsos, chief nursing officer at the facility.
Hudson Regional’s coping for now. But with state officials warning that the expected surge in COVID-19 infections is still to come, what support and help it and other hospitals get from government to overcome shortages in supplies and medical staff will be critical, officials say.
Like most hospitals in New Jersey, Hudson Regional is scrounging for protective gear, ventilators and — especially — nurses. Sometimes they must divert patients to other hospitals. Nurse-to-patient ratios here have jumped from 5:1 up to 12:1.
Karsos says she needs 15 more RNs.
“The impact on nursing is the tremendous workload,” Karsos said. “The patients just keep coming, the ER is overcrowded. We try to get the patients up to the floor. We’ve opened up additional beds to accommodate, but that’s with staff I don’t really have.”
That’s one reason Hudson Regional would like to send less critically-ill, COVID-19 patients to the federally-sponsored field hospital at the Meadowlands Expo Center, which on-boarded its staff today. It was originally intended by the Federal Emergency Management Agency to take only non-COVID patients, but state Health Commissioner Judith Persichilli has said it might end up accepting both.
During the state’s daily COVID-19 briefing, Persichilli said the Secaucus popup — its 250 beds the first of a 1,000 FEMA-sponsored beds planned in the state — would see its first patients on Tuesday.
Meanwhile, Murphy reported at the briefing that President Donald Trump had told him that a certain number of the beds aboard the USNS Comfort, a Navy hospital ship currently docked on Manhattan’s Westside waterfront, would be available to patients from New Jersey. Murphy said it was too early to say how many beds would be devoted to Garden State residents.
“I literally just got off the call with the president and the vice president as I was coming here,” he said. “But he did say affirmatively that [New York] Gov. Andrew Cuomo was aware, and that I should work it out both with the White House on the federal side, as well as Gov. Cuomo’s team.”
Meanwhile, Murphy and his team on Monday unveiled revised estimates based on statistical modeling of both the timing and the magnitude of the expected surge hitting the state’s hospitals.
Murphy said that the analysis showed that, with steps already taken, the state had sidestepped a “runaway freight train” with a total of 3 million infections. The current modeling shows a range of scenarios, from a new worst case of over 500,000 infections peaking in mid-May to a “batting 1.000” projection of 86,000 total infections peaking on April 19.
The difference, he stressed, was compliance with the stay-at-home social distancing orders.
“There’s good news and bad news here,” Murphy said. “The good news is the worst case is a lot better than a runaway freight train. The bad news is the worst still swamps the health care system, and still too many people get sick and too many people pass.”
He noted that millions of New Jerseyans are abiding by social distancing rules.
“I would conclude here by saying again to everybody, thank you for everything you are doing,” he said.
“But secondly, you have to continue to do it,” he said, adding, “We’ve got to make sure we’re staying home. We’re keeping social distance. We’re doing the right things, because it is making a difference. But we can’t take our foot off the gas.”
Persichilli has said that officials believe the surge had already begun among hospitals in the northern part of the state, and is showing signs of spreading to Middlesex and Somerset Counties.
She added that officials monitor where hospitals have gone on divert status, and noted that six had done so Sunday night — five in Hudson and one in Somerset.
“Hudson particularly was getting hit pretty hard,” she said.
Kifaieh at Hudson Regional further explained the case for devoting at least part of the Secaucus field hospital to COVID-19 patients.
“A lot of hospitals like ours have a significant number of infected patients, and not that many patients that are not infected,” he said. “So if they’re really banking on the fact that they’re going to have a lot of non-COVID patients, they’re going to have empty beds.”
But there could be push back from alarmed Secaucus residents, if the popup at the Meadowlands Exposition Center becomes a COVID-19 ward.
“Would you like to live right across the street, knowing all these folks have coronavirus?” asked Mayor Michael Gonnelli. “I don’t think so. There’re plenty of hotels in this area we could do it in.”
