HOBOKEN, N.J. - At New Jersey's oldest hospital, the demands of fighting a pandemic threaten to overwhelm the city's medical resources - a frightening prospect confronting more communities as coronavirus burrows deeper into the United States.
With just 333 hospital beds for a commuter city of 55,000, Hoboken University Medical Center has less than a week before “we will not have the resources to save lives,” said Ravinder Bhalla, the city’s mayor.
Sometimes mocked as "Bro-boken" for its hordes of young professionals who cross the Hudson River every day to work in Manhattan, this town is bracing for the same onslaught of critically ill people now gripping New York.
So far, Hoboken has only 59 confirmed cases, but the mayor noted that many of those people are in their 20s and 30s, and he thinks it's only a matter of time before the figure jumps dramatically.
"In New York, in a span of two weeks, they've gone from about 50 cases to 25,000," Bhalla said. "So it feels like we are looking across the river at a wave, and what I'm trying to do is hold my hand out and push that wave back."
Like the rest of state, Hoboken's bars and restaurants and most businesses are closed. But even in a shutdown, many of the residents still commute to New York for jobs.
"I want people to know, even though we only have about 50 cases, this feels like the calm before the storm," Bhalla said.
John Rimmer, director of the hospital's emergency department, has been working from home since he contracted covid-19, the potentially lethal respiratory disease caused by coronavirus.
So far, the number of patients hasn't been overwhelming, he said, but the severity of their illness is straining resources. The hospital is using eight of its nine ventilators for critically ill patients, according to hospital officials. There is an emergency reserve of another 10 it can draw on if necessary, but those are designed for short-term emergency use, not longer-term recovery. The hospital is seeking another 13 respirators.
"We're trained for trauma, but shooting events, train crashes - things that end in a few hours," Rimmer said. "With this, there's no end in sight."
The hospital, which was founded during the Civil War, is now seeing about 130 patients a day, and 3 out of 4 of those are suspected of being infected with coronavirus.
The hospital's CEO, Ann Logan, said her staff has been "watching this, chasing this, planning this. This is our every day now."
As of midday Friday, New Jersey had nearly 9,000 confirmed coronavirus cases, and 108 deaths. The state is second only to neighboring New York in the number of cases, underscoring just how easily the disease leaps and spreads across state lines.
"These are not abstract numbers, these are our neighbors, our family, our friends, all of us, we are in this together and we mourn together," said New Jersey Gov. Phil Murphy, a Democrat. "But we have expected, with a heavy heart, that this would take an increasing toll on our state."
Unlike in New York, where Gov. Andrew Cuomo, a Democrat, has tried to make coronavirus tests widely available, Murphy and New Jersey health officials say they are trying to reserve their tests for only those showing flu symptoms.
"We need to know we are testing the right people, and not wasting tests," Murphy said.
Even with the strict limits on testing, New Jersey Health Commissioner Judith M. Persichilli said it currently is taking as long as seven days for tests to be completed. The lag time has unsettled state leaders, who say they remain unsure just how bad the pandemic will become in coming weeks.
"This is a war, and we all know what the ingredients are for winning a war," said Murphy, who noted that the most recent predictive models show the crisis may not peak until mid-April.
Amid widespread concern from hospital staff and first responders about a lack of personal protective equipment, Murphy took the extraordinary step of ordering all private businesses in the state to disclose to his office by Friday evening whether they had any stockpiles of protective supplies.
"This is not an ask, it's an order," the governor said.
In Lakewood Township in Ocean County, Mayor Raymond Coles feels as if the storm has already slammed into his community. Over the past week, the number of cases there doubled to more than 100.
Coles said the outbreak has been centered in the city's Orthodox Jewish and Hispanic communities, both of which have tightknit family structures and frequent contact through social and religious gatherings. The virus quickly spread through the Orthodox community, which makes up about 60 percent of Lakewood's population, before anyone even knew the contagion had made its way to the East Coast, Coles said.
"Folks just don't understand with the Orthodox community, just how central daily life is in synagogue and with schools," the mayor said. "People want to pray three times a day, and learning is paramount to life."
In the Latino community, Coles noted, the virus quickly spread through some households because it's not uncommon for more than one family to live together.
"And if one person gets it, it just spreads," he said, adding that local and state officials are now working to try to ensure that immigrant communities understand they will receive treatment for their illness even if they do not have health insurance.
Over the past two weeks, amid warnings from state and local officials about remaining indoors, Coles said most of Lakewood's residents now "understand" the virus and "are afraid of it and respect it."
But he wishes he had more guidance from government leaders and health experts.
"If we had been made aware a few weeks sooner, we would have locked down a lot sooner, because once people were aware of what was happening, this town has pretty much locked down," said Coles, noting that at least three Lakewood residents have died. "We really wish we could just push the self-isolation back in time."
The scale of the pandemic is bigger in New York, where more than 500 have died. But New Jersey is facing the same steep hill to climb.
"New Jersey is literally right behind [New York]," said Maria Refinski, president of the New Jersey Nurses Union CWA Local 1091 and a nurse at St. Barnabas Medical Center in Livingston, N.J. "As they start to peak, we are going to be right there also. We're behind, but not by much, in regards to timing."
Refinski said some hospital staff working in intensive-care units are already resorting to buying their own versions of hazmat suits to try to guard against getting sick, because protective equipment is "constantly running low."
A survey released Friday by the US Conference of Mayors found that 90 percent of mayors who responded think their communities lack the necessary gear to effectively fight the spread of the virus.
Taken together, the cities reported a need for 28.5 million face masks, 24.4 million items of personal protective equipment such as gowns and gloves, 7.9 million test kits and 139,000 ventilators.
In Paterson, New Jersey, the mayor and other city officials became so concerned about supplies at the local hospital that they raided the city's emergency stockpile, amassed in case of a natural disaster or terrorist attack.
On Thursday, officials went to a Passaic County warehouse and removed 15,000 surgical masks, 1,000 N95 masks, thousands of rubber gloves, 500 thermometers and 100 stethoscopes for delivery to St. Joseph's University Medical Center.
Stanley Trooskin, the chief medical officer at Robert Wood Johnson University Hospital in New Brunswick, said his facility has spent the month of March gearing up for what they fear will be a flood of coronavirus cases. The 600-bed facility has been devoting more of its beds to intensive-care work.
In canceling family visitors and other activity, the hospital is more quiet than usual, giving it a "very eerie feeling" as staff wait for the coming storm, Trooskin said.
"I've never seen this level of cooperation and people putting their petty issues aside," he said. "We think about a week ahead, five days and 10 days, this giant wave that's going to overwhelm us - we don't know that for sure."
Two tents were recently set up to direct incoming emergency patients. In the first tent, a health-care worker dressed in protective equipment asks about possible covid-19 symptoms. Patients who potentially have covid-19 are directed to a second tent, where a robot awaits to allow an emergency medicine physician to perform a remote physical.
Health-care workers at the hospital have protective equipment in line with Centers for Disease Control and Prevention and New Jersey guidelines, but "optimally we'd walk around in spacesuits taking care of these patients," Trooskin said.
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Guarino reported from New York. Craig and Barrett reported from Washington.