The cases have been rising again.
More people are testing positive for COVID-19 after a seemingly summer-long hiatus that gave hope that the virus might be ebbing in New Jersey.
But as the pandemic now grows across the nation and New Jersey is once again finding itself a hotspot, it has not seen a corresponding spike in one critical statistic: Fewer people are dying from the coronavirus than did in the spring.
Although there is still no vaccine or cure for the coronavirus, medical experts say they now far know more about the still uncontrolled pandemic that has killed more than 230,000 Americans to date. And since the outbreak began, new therapies have been deployed that have had a significant impact at earlier stages in the disease — therapies that have lowered the death rate in older patients as well as younger patients, who always faced less risk of dying.
“We’re able to treat this better and more efficiently,” said Shereef Elnahal, president and CEO of University Hospital in Newark and New Jersey’s former health commissioner. “As the evidence accumulates for these new regimens, the death rate is falling.”
Some of the reasons, say he and others, are the expanding treatment options and the experience doctors have gained since the first cases began showing up. Another factor is that those now getting hit with COVID-19 are younger and more able to fight the virus.
“When you look at deaths in hospitals, a fair number are older people who are dying,” said Daniel Varga, the chief physician executive for Hackensack Meridian Health, a network that operates 17 hospitals in New Jersey.
In the early days of the pandemic, funeral homes were forced to rent refrigerated trucks to temporarily store bodies, and nursing homes with their medically fragile populations were devastated by the deadly virus. Shortages of ventilators had health officials drawing up guidelines to allocate scarce resources, with directives that would literally decide who might live and who would die.
That grim reality began to ease as the outbreak seemed to peak and the number of cases fell. By May, Gov. Phil Murphy began loosening the stay-at-home and business-closing restrictions he had put in place to keep the virus at bay.
But in recent months, there has been a resurgence as more people have been testing positive for COVID-19. New Jersey on Friday reported another 2,199 coronavirus cases, pushing the state’s cumulative total to 249,380, with 13 new confirmed deaths — a graphic reminder that the coronavirus remains a killer. The Department of Health statistics marked the third day of more than 2,000 new cases, as the state continues to battle a second wave of the pandemic.
Murphy said Thursday he’s “close” to ordering new coronavirus restrictions, but has not disclosed any specifics.
Yet despite the increase in the total number of daily cases, the numbers do not show a similar big jump in the death toll here. Indeed, a number of high-profile individuals hospitalized with COVID-19 notably recovered in recent weeks, including the president and former New Jersey Gov. Chris Christie — underscoring how much still remains unknown about the coronavirus.
A DIFFERENT POPULATON
Are we better situated to fight SARS-CoV-2, the virus that causes COVID-19?
State officials are under no illusion that the virus is any less virulent than it was in the spring. But for now, they say it is hitting a different demographic. Those now getting infected are younger, and healthier with fewer underlying conditions that would make them more vulnerable.
Elnahal said his hospital and others are also in a better position than in March and April to help patients with COVID-19.
“We’re seeing a slower trickle of cases,” he explained. “The rapidity of the cases in the spring were very difficult to deal with.”
The sheer number of patients in the spring and rapid spread of the virus led to staffing issues in many hospitals. There weren’t enough doctors and nurses and medical technicians on the front lines.
While cases are again rising, they are not on the steep slope seen at the beginning of the pandemic, allowing hospitals to give patients the attention they need.
“That’s really helping to detect problems before they get worse,” Elnahal said.
It’s not just in New Jersey.
A recent study by researchers at NYU Grossman School of Medicine in New York showed that by mid-August, the death rate in those hospitalized with coronavirus-related illness had dropped significantly, from a 25.6% chance of dying at the start of the pandemic to a a 7.6% chance. It also noted that a younger, healthier group of people were getting infected and were arriving at the hospital with less severe symptoms than those infected in the spring.
The study analyzed 5,121 patient records of those treated for COVID-19 at NYU Langone hospitals in New York between March 1 and August 31.
Varga and others noted that treatment protocols have changed, including a number of pre-emptive medical measures now taken as a matter of course.
“We’re a lot better at treating this disease than we were in March and April,” said the Hackensack Meridian Health physician.
For example, Varga said physicians today recognize the importance of monitoring oxygen saturation. In the past, patients without any symptoms would nevertheless have significant lung issues that would only turn up on X-ray, and ultimately end up on a ventilator after their condition deteriorated suddenly.
“You have to be very aggressive on monitoring oxygen saturation,” explained Varga. “We’re also aggressive on the application of oxygen and use of high-flow oxygen that delivers much higher levels of oxygen without putting them on a ventilator.”
They have also turned to so-called “proning” to alleviate severe acute respiratory distress.
Placing patients in the prone position, on their stomach, is thought to distribute oxygen more evenly throughout the lungs and improve overall oxygenation. While often used for patients under sedation and already on mechanical ventilation, proning is not standard practice for awake patients breathing on their own.
“It improves oxygen exchange,” said Varga.
The FDA has also approved the use of remdesivir to treat COVID-19 in hospitalized adults and children who are age 12 and older in the hospital. The jury, though, is still out whether it works, said Varga. There has been no evidence so far that it significantly lowers death rates, according to a recent study sponsored by the World Health Organization, although a trial by the National Institutes of Health found that it modestly reduced the recovery time in hospitalized patients.
The U.S. National Institutes of Health recently recommended dexamethasone for people with severe COVID-19 who require supplemental oxygen or mechanical ventilation, which Varga said seems to have a value in blunting the body’s inflammatory response that comes with COVID infection.
The vast majority of hospitalized patients now receive dexamethasone, he said.
Hackensack Meridian is also participating in clinical trials of Regeneron Pharmaceuticals’ cocktail of monoclonal antibodies, an experimental therapeutic for coronavirus, that is still undergoing testing and is not FDA approved. It also doing clinical trials of convalescent plasma, the liquid part of blood that is collected from patients who have recovered from the novel coronavirus disease.
Varga, though, also echoed the assessments on the current demographic of those now getting sick from the virus.
“It’s a different scenario than we had at the peak,” he said, when thousands of new cases were being diagnosed, 700 were in intensive care, and 25 percent of them were on mechanical ventilators.
“The numbers are clearly different this time around. It is a somewhat younger and less chronically ill group,” he said. The vast majority of the cases now being seen are among those from 18 to 40-years-old, and they have less compromised immune systems.
And pointing to the recovery of Gov. Christie and the president, who both had the virus in October, he noted that even during the height of the pandemic, 80% of all patients had minimal to no symptoms.
Despite the new ways of treating hospitalized patients, though, Varga said the elderly and those in nursing homes remain just as high risk today as they were during the peak of the pandemic. He suggested the reason there are not more nursing home deaths with the growing number of cases is because the rules isolating those in long-term care now are so stringent.
“We don’t see it because we’re seeing a good job of sequestering them,” he said.
Jan Siegal, director of Quality, Clinical and Regulatory Services for the Health Care Association of New Jersey, which represents long-term care facilities in the state, said, there have been no changes in health care protocols in most long-term care settings, other than weekly staff testing to prevent spread, which were implemented in the spring.
“Any medical interventions in our centers would be driven by the individual physician via prescription,” she said. “COVID-19 continues to be a risk to our elderly and the goal of our members is to protect them from contracting the virus. That means that screening visitors, residents and staff, use of PPE, and social distancing continue to be the protocols used in nursing centers to minimize the risk of introducing COVID-19 into their homes, potentially infecting residents who have the highest mortality rates.”
Meanwhile, Varga, the growing concern is that of secondary infections passing from the young to the old — especially at family get-togethers as the holidays approach.
“That’s why a lot of people are holding their breath about what happens during Thanksgiving and Christmas,” he said.
With no vaccine or cure, public intervention remains focused on prevention.
“You still have people dying,” Elnahal said. “The fact is, people are still dying from this disease and we have to be vigilant.”
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