Coronavirus: Lack of key medical data hampers New Jersey’s plan of attack against pandemic
Original Article can be found here: https://www.northjersey.com/story/news/coronavirus/2020/03/24/coronavirus-nj-state-lacks-key-data-plan-attack-against-pandemic/2901155001/
Gov. Phil Murphy likes to say he takes a “Moneyball” approach to state government. Like Billy Beane, the Oakland A’s executive vice president who used statistics over gut instinct to assemble a winning baseball team, Murphy wants to get the most from public dollars by using evidence to make a wide array of policy decisions — from tracking gun sales to fighting opioid addiction.
But when it comes to attacking the epidemic of coronavirus in New Jersey, the state has been hampered as if it has blinders on, lacking the most basic data to guide its decisions. That gap has been most clear in two crucial areas: testing for COVID-19, the disease caused by the coronavirus, and the availability of hospital beds.
State health officials don’t know how many people have been tested for COVID-19. And they have no “dashboard” with real-time data to show how many hospital beds are occupied by coronavirus patients, and how many are available — critical data in the push to open up new beds.
The governor on Monday announced a nearly 50 percent single-day leap in the number of patients testing positive for COVID-19 — to 2,844. So far, 27 people have died.
Much of that spike has been spurred by increased testing for the pathogen. But Murphy was unable to say how many people have been tested, or the rate of positive results.
Health Commissioner Judith Persichilli described plans to reopen shuttered hospitals and hospital wings and bring four “pop-up” Army field hospitals to New Jersey. But when she was asked on Monday how many coronavirus patients in the state are currently hospitalized, she cited numbers that were 2½ days old — some 600 patients suspected of coronavirus infection awaiting test results, and another 100 confirmed.
As she spoke, a single hospital system — Hackensack Meridian Health — was caring for close to 700 patients either confirmed with or being tested for coronavirus in its 17 hospitals on Monday afternoon, not even counting the other 50-plus hospitals in the state. And the demand for hospital care, at least in northern New Jersey, was growing by the hour.
“It’s like fighting a war blind” when data to describe the problem isn’t available, said Harry Glorikian, author of “Moneyball Medicine: Thriving in the New Data-Driven Healthcare Market.” In most businesses, “having sensors, having data, knowing what’s going on,” is basic.
But health care is not like that, especially when information from multiple hospitals or independent test companies must be aggregated at the state level. And the infrastructure of public health has been underfunded for years.
“If you don’t know where the fires are,” said Glorikian, “you don’t know where to send the firefighters, you don’t know what equipment to send, and you don’t know what you have to put out.” The increase in testing statewide has even caused delays in test results for hospitalized patients — slowing doctors’ ability to decide how to allocate limited resources.
Data-based evidence is vital not only to guide policy decisions and assess their impact on public health but to defuse public panic.
“The more data we have at our disposal, the better and more equipped we are to be able to break the back of this virus,” Murphy said Monday. “Knowing what the total denominator is, the total positives and the total negatives” for people tested, “is not just good for our ability to manage this challenge,” he said. It’s “a step toward lessening anxiety.”
A nurse holds a swabs-and-test-tube kit to test people for COVID-19, the disease that is caused by the novel coronavirus, at a drive-thru station set up in the parking lot of the Beaumont Hospital in Royal Oak, Michigan, on March 16, 2020. (Photo: Paul Sancya/AP)
Each day, the number of people with confirmed cases of coronavirus illness announced by the governor climbs. And each day there is little context to understand how bad the situation is.
The escalation mostly reflects the expansion of testing: when only 20 to 40 people a day were being tested, the numbers were naturally smaller. Now that thousands are being tested, they’re higher.
But the virus is also spreading across the community. That rate of spread — and the percentage of people in the population who have it, even with mild or asymptomatic cases — is completely unknown. No part of the United States has that information, because there are so few tests and they were rolled out so slowly.
And while Persichilli said last week that about 55% percent of confirmed coronavirus patients had been hospitalized in New Jersey, that likely overstates how severe the virus is affecting people, since until the past few days most of those tested have been people in the hospital, not those with mild cases or who carry the disease but have no symptoms.
New Jersey took steps Monday to nail down a different number: how many people, in total, have actually been tested.
Aside from three large companies — LabCorp, Quest Diagnostics, and BioReference Laboratories — more than 60 commercial laboratories are processing tests, according to state officials. Their reporting is inconsistent; not all report the negative test results. They also provide little information to assist local health officials in contact tracing, to notify and monitor those exposed to the positive person.
Centralizing the data is “critical for us to get testing results in real-time so we can make further decisions on mitigation in real-time,” Murphy said. “There is that gap that exists. … It can’t go on. We need that information.”
The directive issued Monday by Jared Maples, the state’s homeland security director, requires all commercial laboratories to provide all their test results — “positive, negative and inconclusive” — daily by 8 p.m., starting Monday. LabCorp, BioReference, and Quest already are providing that information, their spokespersons told NorthJersey.com.
While LabCorp and BioReference officials have said they are doing 20,000 tests a day nationwide, none of the companies would provide specific information about how many tests they have processed in New Jersey.
That information will show more clearly how the virus is spreading geographically, likely from northeastern New Jersey to the south and west. It will enable comparisons to other states and show trends.
Hospital chiefs in heavily hit Bergen County track how many COVID-19 patients they have with real-time dashboards.
They can give a minute-by-minute readout of the number of patients waiting for evaluation in the Emergency Department, the number of confirmed cases in the medical-surgical areas, and the number awaiting test results. They know how full their ICUs are, and how many patients are on ventilators.
But this information is not fed into a central statewide hub. That makes it hard to compile useful statewide data.
Systems like Hackensack Meridian Health and RWJBarnabas can convey the picture across many different hospitals. Others, like Holy Name Medical Center in Teaneck, stand-alone.
So it’s difficult to get an overall picture of how bad the surge is — or how many beds and ventilators are left.
More than half of the state’s 23,000 hospital beds were occupied last week when Murphy asked President Trump for help from the Army Corps of Engineers to reopen old hospitals and expand unused hospital wings.
But that was before the cancellation of elective surgery and non-urgent care at many facilities freed up a lot of space. Many health systems had already done so; everyone was ordered on Monday to complete the process by 5 p.m. Friday. And on Monday, Murphy ordered all non-emergency medical and dental surgeries and procedures to be canceled statewide.
When asked if the state’s hospitals could handle a surge in patients in need of care, Persichilli said Monday she didn’t know yet.
The former state epidemiologist, Dr. Eddy Bresnitz, has come out of retirement to help develop a predictive model, in conjunction with the state hospital association. More information, expected soon, is needed about the average length of stay for coronavirus patients before it will work, he said.
But Persichilli does know that the state has a deficit of 300 ventilators, used to help patients breathe in the most severe cases of COVID-19. Each of the 2,000 critical care beds in the state should have a ventilator available, she said.
She has asked the federal government to supply 400 of the machines.
Even that won’t be enough, she predicted.
“We do expect with the coming surge in patients,” Persichilli said, “we will have to increase our volume of critical care beds and ventilators.”
Lindy Washburn is a senior healthcare reporter for NorthJersey.com.