At University Hospital in Newark, where one staff member has already died of COVID-19, the medical team is straining to adjust to the challenges of treating the capricious and fast-moving coronavirus.
Many of the cases seen are “quite severe,” said hospital president and CEO Shereef Elnahal in an exclusive telephone interview for New Jersey Monthly. “Our emergency room has anywhere between 10 and 15 ventilated patients now at any one time, waiting for a bed.”
When patients first get admitted and assessed, Elnahal explained, they may not require ventilation. However, he said, “All of a sudden [patients] crash, and they crash unexpectedly. Their oxygenation status is often not commensurate with the way they look—their general appearance—and so the speed at which folks with the disease end up getting worse is pretty profound.”
The crisis is “unprecedented,” Elnahal said. “We’ve never seen anything like this in terms of the demand for intensive care and critical care.”
Shereef Elnahal, president and CEO of Newark’s University Hospital
Indeed, hospitals across New Jersey are being flooded with patients who have tested positive for the virus. Elnahal, who served as New Jersey’s health commissioner from January 2018 through July 2019, says his hospital is no exception.
Prior to his work for the state, Elnahal served as a White House Fellow under President Barack Obama in 2015, then became the chief quality and safety officer of the Veterans Health Administration in the U.S. Department of Veterans Affairs. [Elnahal is a cousin of the author of this piece.]
As of Saturday, April 4, Elnahal said that University Hospital—a state-owned teaching hospital associated with Rutgers New Jersey Medical School—had more than 100 confirmed positive in-patients with an additional 60 to 70 patients waiting for test results.
“Most of them are likely to be positive,” Elnahal said, “and we’re getting more and more admissions every day. We’ve modeled this out for our hospital, and at peak—in terms of the case load and the surge—we’re expected to have about 100 new admissions per day in our hospital for people with coronavirus.”
In anticipation, the hospital has converted multiple units into critical care units. The mother-baby unit, where mothers go after they’ve delivered babies, has been transformed into a coronavirus unit, Elnahal said.
University Hospital also has had to make special accommodations for its morgue, which has filled up quickly. (Elnahal could not reveal the number of coronavirus-related fatalities.) Accordingly, the federal government has given all hospitals in North Jersey resources to create more morgue space.
Because coronavirus patients’ conditions can change so quickly, doctors are often hesitant to send home anyone who comes in with any level of labored breathing or shortness of breath. “You don’t know how bad they’re going to get,” Elnahal said, “so you have to admit them to the hospital at least to observe them and support them in any way.”
Typical stays for COVID-19 patients vary. Those who don’t need ventilation can go home within four to five days. However, Elnahal said, “For anybody who needs ventilation, you’re talking about at least a week’s course until we can either take them off the vent [or] transition them to a lower level of care, like a skilled nursing facility or a nursing home or rehab.” Overall, people who need ventilation to recover can end up staying between 7 and 10 days.
As of April 4, the hospital had enough equipment for the next week or two, but Elnahal said, “That’s a moving target. We’re always searching for more, and as we get more cases, we’re still on high alert for the possibility of shortage.”
University Hospital is a Level 1 Trauma Center, meaning it is connected to the state in many ways. As a result, according to Elnahal, the hospital has already received 15 ventilators from the Strategic National Stockpile, in addition to a good deal of personal protective equipment (PPE). However, Elnahal said, the state is not getting enough equipment from the stockpile.
The hospital also received $2.3 million from an anonymous benefactor to buy supplies, ventilators and other supports for employees—but, Elnahal said, the equipment isn’t there to buy. “All the suppliers domestically are now on backorder for so many things, so we’re having to go internationally for a lot of this equipment, including vents at this point.”
[RELATED: How Is NJ Responding to COVID-19?]
As for potential treatments, Elnahal said, “There’s a lot of talk about chloroquine and hydroxychloroquine,” drugs primarily used to treat malaria. But, he said, “There really isn’t great evidence for those things, although they’re being tried empirically by our medical staff, and we just don’t have data yet on whether that’s actually helping. But, you know, at this point, folks are willing to try it because there’s some preliminary evidence that it might work.”
Some patients, according to Elnahal, are also developing bacterial pneumonia as a secondary complication; those cases are being treated with antibiotics. Patients are usually sent home when they have been without a fever for at least 48 hours and are able to breathe without support.
“The whole goal is to get people back to their baseline,” Elnahal said.
He added that older patients are overwhelmingly more likely to be admitted. “Almost everyone in our hospital is over the age of 50, and almost everyone ventilated is over the age of 65.”
In addition, there are slightly more male patients than female. “We’re unclear on the reasons for that,” Elnahal said. As has been reported at other hospitals, University Hospital is also seeing patients with underlying medical conditions, “like heart failure, COPD [chronic obstructive pulmonary disease], poorly controlled diabetes, […] heart conditions. All that contributes to a worse outcome and the need for hospitalization.”
Patients admitted for coronavirus treatment also reflect the diverse population served by University Hospital, which Elnahal described as “overwhelmingly black, Hispanic, Portuguese [and] Creole-speaking populations.”
“Everybody is susceptible from what we know so far,” Elnahal said, from “statewide, countrywide, worldwide data. Although, I will say, densely populated areas are more at risk, obviously, and minority communities and communities of color tend to be in those areas, so I think as a secondary effect of that, you end up seeing a lot of people of color getting complications and suffering the consequences of this.”
Last week, Kim King-Smith, an EKG technician at University Hospital, died due to complications from COVID-19. Elnahal described her as “really beloved by anyone who worked with her,” adding that“her death really affected people and brought it home.”
“It’s really hard to keep up morale at a time like this,” Elnahal said. “It’s a time of crisis.”
King-Smith’s death, Elnahal said, “showed how much solidarity there is in the hospital. People are just more committed to the job in some ways because they know how important it is. But that really was a blow on morale for the hospital. And, unfortunately, I fear that we’re only going to see more of that as the spread continues.”
University Hospital is, however, taking preventative measures, according to Elnahal.
“Unfortunately,” he said, “a lot of our employees who are getting [COVID-19] are getting it from the community, [and] there’s not much we can do about that other than to encourage people to socially distance and stay home. But in the hospital, we’re taking everybody’s temperature at the door, and [staffers] with a fever [are] asked to go home and call their supervisor at Employee Health.”
Elnahal also told New Jersey Monthly that all employees must wear a mask in the hospital at all times, whether they’re seeing patients or not. Additionally, staffers have removed over half of the chairs from the cafeteria and are limiting the number of people in elevators in order to enforce social distancing.
Unfortunately, it’s unclear as of now when the curve will flatten or decline in New Jersey.
“We won’t know […] for at least another week,” Elnahal said on April 4, “because the real stay-at-home order wasn’t until the latter half of March, and so I think by the end of this week we’ll have a better idea of whether the social distancing measures are effective. But we can only hope they are. We’ve seen other countries do this effectively … and we hope to see it work here.”
Deena ElGenaidi is a freelance writer and editor currently sheltering in place at home in Brooklyn. She received her MFA in Creative Writing from Rutgers University–Camden in 2016, and her work has been published in Nylon, MTV News, Oprah Magazine, Bustle and elsewhere.