On the front lines of the pandemic stand three Hudson County hospitals: Christ Hospital in Jersey City, Bayonne Medical Center (BMC), and Hoboken University Medical Center (HUMC).
These CarePoint Health hospitals have admitted one of the highest rates of COVID-19 cases, approximately one out of every 82 positive cases in the country, according to CarePoint Health. Out of the more than 95,000 positive cases in New Jersey, the three hospitals had nearly 1,200 admissions through April 18.
Dr. Tucker Woods, Chief Medical Officer at Christ Hospital, said that the hospital was the busiest of the three.
“The situation was overwhelming, I think, for all of northern New Jersey and New York City, including Christ Hospital,” Woods said. “But luckily because of a lot of the measures we put in place we were able to deal with it.”
BMC was hit almost as hard but also managed to cope during the peak of the pandemic. Dr. Vijay Singh, Chief of Hospitalist Medicine at BMC, said that the hospital overcame unforeseen hardships through staffing, triage, and employee virus screening.
HUMC struggled as well, with city officials pleading in late March for 13 ventilators. But it survived and continues to treat patients.
Initiatives to treat virus patients included launching advanced critical teams (ACT), repurposing palliative care nurses, providing innovative therapies and treatments, and forming proning teams. Proning is turning patients on their stomachs to improve breathing.
Repurposed to be “COVID-19 warriors”
The hospitals repurposed nursing staff, recruited additional staff, and repurposed physicians to care for critical care patients.
Nurses from other floors were repurposed, and additional nurses were hired, but few were available due to the high demand for nurses.
After three weeks, Singh said BMC finally got much-needed relief in the form of nurses and other staff.
Woods said that illness among staff led to the repurposing of some staff to become COVID-19 “warriors.”
At Christ Hospital, Gastroenterology (GI) Fellowship members who were training to graduate from a residency quickly became COVID-19 warriors, rotating in periods of seven days on and seven days off.
“If one of our doctors got sick we repurposed staff,” Woods said. “Because we had some manpower issues, we repurposed our GI fellows.”
Coping with sick staff
Dozens of staff, nurses, and physicians at the three hospitals have tested positive, further straining an increasingly stressed system. But the three hospitals met these challenges through clinical collaboration, anticipation, and new initiatives.
At BMC, Singh said the hospital had its fair share of sick employees but not too many considering the 1100-person staff. The hospital has been providing mandatory temperature checks to screen all employees, keeping the number of sick staff down to 14 or 15.
If an employees with high temperatures were immediately taken for testing and sent home with a mask and instructions to follow the proper protocol for self-quarantine.
Each hospital created a surge tent outside the ER for triage, which required additional staffing. The triage center assessed COVID-19 patients based on their need for or likely benefit from immediate medical treatment.
Some patients would show stable vitals at 11 p.m., but would then take a turn for the worse only a few hours later, also known as a “code blue.” Because of this, a rotation of critical care nurses checks on patients every hour or so and has reduced instances of “code blue.”
Proning teams were created to help cope with the influx of patients on ventilators. The hospitals formed teams to move patients onto their stomachs in order to improve oxygenation. The difficult task requires several team members and is made harder by the sheer number of patients on ventilators.
Staff also offered emotional support to patients and famllies.
Ventilator video calls
Palliative care nurses help patients stay in touch with family members. Visitors were prohibited, except in certain circumstances.
“All hospitals have a no visitor policy during the COVID pandemic,” Woods said. “That’s the cruelest part of this disease in my opinion.”
Nurses connected patients to their loved ones through electronic means even while the caseload continued to increase.
“It really, really helps the family,” Woods said. “I think it’s nice they get to see their loved one, even on a ventilator.”
Woods shared the story of a man who stopped him outside of Christ Hospital during his lunch break.
The man saw Woods was in a lab coat and pleaded with him for any information about his wife who had the virus.
“Give me five minutes,” Woods told the man.
Woods gave the palliative care nurses the man’s info and a video conference was arranged.
The man’s wife was on a ventilator and couldn’t talk but was able to listen to her husband. When the nurse held up the iPad to the patient, she began to cry in response to her husband’s words.
Woods said she could understand everything she heard. Not only was it a powerfully touching moment, Woods said it also showed that her brain was working perfectly fine, which was a very good sign.
Hospitals in recovery
According to Singh, the number of virus patients at BMC has been declining.
As of May 7, there were 37 patients who tested positive admitted to the hospital, including seven people under investigation for the virus. Two weeks ago, there were 70 such patients.
The dramatic decrease in COVID-19 patients is a testament to the flattening of the curve in Bayonne.
Singh said that more than 70 percent of in-patient admissions at BMC used to be COVID-19 patients, with 30 percent non-virus patients. Now, the numbers have swapped.
“I think social distancing is helping, and the Bayonne community is doing its job,” Singh said.
Woods said the volume of COVID-19 patients is on the decline, but Christ Hospital is still in crisis.
As of May 7, there were 25 patients on ventilators. Before the pandemic, there were only four or so patients on ventilators.
The Intensive Care Unit is still full with all 18 beds occupied. The secondary ICU set up in the converted recovery room still has seven patients on ventilators.
Woods said up to 141 patients were admitted for COVID-19 during the peak. The number stayed in that range for two weeks, fluctuating between 130 and 140.
As of May 7, only 80 COVID-19 patients remain at Christ Hospital.
In Hoboken, Mayor Ravi Bhalla announced in late April that HUMC began seeing a decrease in virus cases. The hospital has also seen a reduction in ventilator use, a promising sign.
For updates on this and other stories, check www.hudsonreporter.com and follow us on Twitter @hudson_reporter. Daniel Israel can be reached at firstname.lastname@example.org.