The coronavirus surge is coming: Racing for supplies, Pa. hopes to avoid disaster and New Jersey fears it's here

Apr. 4--As a public service, The Inquirer is making this article and other critical public health and safety coverage of the coronavirus available to all readers.

In the three weeks since Pennsylvania's first social distancing measures took effect, all schools and most businesses have closed indefinitely, the state's nearly 13 million residents have been ordered to stay home, and more than 10,000 people have been diagnosed with the coronavirus.

Gov. Tom Wolf has said officials are trying to keep the state's hospital system from "collapsing," and doctors and nurses tell of mask shortages while members of the military line up cots in empty schools. Some projections say the state can still avoid the disaster unfolding in neighboring states. There is a chance -- if residents stay home -- that "we actually nip this in the bud," Wolf said Friday.

New Jersey has confirmed more than 34,000 infections and over 840 deaths. Gov. Phil Murphy said Friday that the state may be only a week behind the nation's coronavirus epicenter, New York, where more than 3,000 have died.

Four weeks into the region's crisis, government data and interviews indicate that Pennsylvania, New Jersey, and some cities and towns within them have increased their equipment stockpile and taken precautionary steps recommended by experts -- but remain short of the medical equipment they need.

And with the pandemic's likely peak weeks away, the worst is yet to come. With no treatment and no vaccine -- and just days to prepare -- governmental and health officials are trying to amass the things they believe will give them a shot at slowing the coronavirus' grim toll: hospital beds to treat patients, ventilators to keep them breathing, and masks and supplies to protect the workers on the front lines.

The Federal Emergency Management Agency has provided only a fraction of the supplies requested by states including Pennsylvania, New Jersey, and Delaware, data and records released by the House of Representatives show. And efforts by domestic manufacturers to produce more are "not moving fast enough," FEMA told lawmakers.

Pennsylvania faces "drastic life-threatening circumstances" if it doesn't get more ventilators, state officials warned in one request for equipment in late March. New Jersey says it could run out of room in its intensive care units in less than two weeks. If 20% of the population catches the virus, both states' hospital-bed capacity will be overwhelmed in six months, one study said.

"It's unreal. It's like nothing we have ever seen before," said Alice Barden, a nurse at Englewood Hospital in Bergen County, New Jersey's hardest-hit region. "As a country, as a system, we were not prepared for this."

Pennsylvania needs a "significant number" more hospital beds than the 37,000 it has, said Department of Health spokesperson Nate Wardle. Officials are working with the Hospital and Healthsystem Association of Pennsylvania on a plan to increase capacity, which could include using ambulatory surgical facilities as hospitals and housing non-coronavirus patients in hotels.

The state has already allowed hospitals to add beds without needing the usual approval, and hospitals have begun adding beds to unused spaces.

Philadelphia hospitals, like others in the region, also freed space among their 6,200 hospital beds by canceling elective procedures. In late March, the Army Corps of Engineers began outfitting Temple University's Liacouras Center as a makeshift medical site.

"If we do all of those steps, we think it's unlikely we'll need more than that, but we're going to watch this closely," said the city's health commissioner, Thomas Farley.

Hospitals in the city and outside it have been reassigning staff, allocating equipment, and lining up volunteers.

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Doylestown Hospital, said chief medical officer Scott Levy, is prepared to handle anything "other than the most extreme surge." He estimated staff could stretch the hospital's capacity by an additional 30% to 35%.

"The [work] we've done ... even in advance ... of what happened in Washington state has given us the confidence that we can handle most increases other than the most extreme surge," Levy said.

New Jersey is more desperate. With about 20,000 beds total statewide, its 2,000 ICU beds could be filled by April 11 and hospitals could run out of space completely by May 8, Murphy's administration has said.

But 2,300 beds should be added to the state's capacity in the coming weeks as health officials reopen at least two hospitals and multiple hospital wings that were previously closed. Four temporary hospitals -- together providing up to 1,000 beds -- are also on their way from the Army Corps of Engineers; the first one, in Secaucus, will be operational in days.

Just as critical as finding spots for the infected is preventing doctors, medical personnel, and first responders from joining their ranks. Specialized masks, gloves, gowns, and other equipment enable responders to care for patients without contracting the highly contagious virus.

No Pennsylvania hospital has been overwhelmed yet, health officials say, and the state still has some stores of unused equipment. But officials are "scouring" the state and country for materials to purchase, and workers at hospitals across the region have sounded alarms since the start of the crisis of having to reuse masks, go without testing kits, or search desperately for supplies.

It remains unclear how many beds and masks are still needed statewide or exactly where, because health officials do not have "granular" data by region, state Health Secretary Rachel Levine said Tuesday.

The state Health Department could not even estimate whether it had received thousands or hundreds of thousands of masks from the federal government because the shipments weren't labeled, its spokesperson said. Philadelphia had to throw out nearly 10,000 masks in a federal shipment because they arrived ruined by dry rot.

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As of Thursday, Pennsylvania had received less than a quarter of the N95 masks it requested from FEMA and its requests for coveralls, gloves, and gowns had also been only partially fulfilled, according to agency documents released by the U.S. House Oversight and Reform Committee.

More N95 masks are on the way, but the amount will still leave the state with 260,000 fewer than it requested. By contrast, FEMA sent tens of thousands more face shields and surgical masks than Pennsylvania requested.

The FEMA records show similar shortfalls for other states in the region, and "confirm the urgent warnings we have been hearing from the nation's governors and health care professionals for weeks -- they do not have enough personal protective equipment and medical supplies, and the [Trump] Administration has provided only a tiny fraction of what they desperately need," Rep. Carolyn B. Maloney (D., N.Y.) said in a statement Thursday.

Pennsylvania has already distributed close to 900,000 masks to health-care workers and frontline responders, Wardle said, though he didn't have data for how well-supplied individual hospitals or counties are.

But even they are reusing masks and relying on donations. Nurses in Philadelphia say they don't have enough testing kits. Others at the 11 Pennsylvania Association of Staff Nurses and Allied Professionals hospitals in the region don't have enough personal protective equipment.

Because the amount of PPE supplies varies by facility and changes rapidly, the Hospital and Healthsystem Association of Pennsylvania can't estimate just how serious the current shortage might be, spokesperson Rachel Moore said. Its emergency management staff are tracking supply levels across the state and anticipate shortages "in part due to high demand and lags in the supply chain," she said in an email.

There is "a direct link between everyone staying home and our health-care system's ability to handle a surge," she said.

Philadelphia anticipates needing from 10,000 to 30,000 masks per day for health-care workers and emergency responders, Mayor Jim Kenney's administration has told City Council. City officials hope more will arrive from the federal stockpile.

The city also has tried to get supplies on its own, agreeing to spend $2.8 million for an order of 500,000 masks. But the shipment "never got out of Europe" and the order was canceled, City Managing Director Brian Abernathy said Friday.

"It is unfortunate that municipalities are being forced to try and find this PPE on [their] own," he said. "We don't have enough resources."

City officials are also concerned about the number of ventilators that might be needed, Farley said, and believe there are not enough virus tests available.

In New Jersey, Murphy took the dramatic step of using state dollars to order 10 million personal protective items from private suppliers, saying Monday there was "no price too high to save a life." Still, the state has only about half the protective equipment it needs.

And ventilators -- which are essential in keeping critically ill patients alive -- remain a major concern nationwide. Murphy tweeted this past week that "ventilators are our #1 need right now."

Pennsylvania needs at least 1,400 more ventilators. The state procured 400, which are on their way, and requested 1,000 from the Strategic National Stockpile but has not been told when or if it will get them. There are about 4,000 statewide, plus a few hundred in the Department of Health's storage, Wardle said. New Jersey has 2,500; it has received a few hundred from the federal government but is waiting for more.

An analysis by public health experts at Harvard University suggests both states' stockpiles aren't enough as the peak approaches: Pennsylvania may need at least 6,000 at the virus' peak; New Jersey will likely require more than 4,000.

"The hope is you'd get to a point where this is just over-preparation or over-training and we don't have to reach a point where we truly need to ration scarce resources," said Thomas Tsai, one of the Harvard researchers. "The hope is that the supply of ventilator production will catch up. But we can't count on that."

Predicting when the virus will peak is "not simple," said Levine, the state health secretary. Researchers at the University of Pittsburgh hope to soon have a projection, she said, but modeling the virus is like predicting the weather.

"If the wind changes direction or the temperature changes even a few degrees, it can make a difference between two feet of snow or some light flurries," she said.

Similarly, Philadelphia's health commissioner said varying models show different peaks for the city. He said it is still possible that the city could avoid its hospitals being overrun and short of medical equipment.

"We certainly want to flatten the curve [of rising infections] as much as we can, and it's absolutely still possible that we can do that to the point where every resource is available to everyone," Farley said.

Displaying his first cautious optimism in weeks, Wolf said his stay-at-home order, which he expanded to the entire state Wednesday, has already "done good things" to slow the virus' spread. Some models, he said, show the state will be overwhelmed, but others suggest a much higher death toll can be avoided if people continue social distancing.

"This is no time to relax," Montgomery County Commissioners Chair Val Arkoosh, a physician, said on Tuesday. "This is a time to hunker down [and] redouble your efforts."

Even amid some hopeful points in recent days, leaders in recent days cautioned that restrictions must stay in place at least until April 30 to continue giving Pennsylvania a fighting chance.

"This is what we do know," said Levine. "If we do not all stay home, then we will see the worst-case scenarios."

Staff writers Vinny Vella, Mike Newall, and Jonathan Tamari contributed to this article.

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