Life at the epicenter of N.J.’s coronavirus outbreak

Holy Name CEO Maron, with 11 current cases and six patients in the ICU, says state may not realize how serious this is: ‘There is absolute reason to be extremely cautious, to be very concerned’

By Tom Bergeron
Teaneck | Mar 14, 2020 at 4:19 pm
Editor’s Desk

(Editor’s Note: This story originally appeared on ROI-NJ.com on March 14. We interviewed Mike Maron again for a story that appeared April 1. Read it here.)

Eleven cases. Six of which are in the ICU. And 40 more patients under observation.

All at Holy Name Medical Center in Teaneck.

The numbers are growing by the day. So quickly that not all of them are included in the state’s official coronavirus count.

It’s why Holy Name CEO Mike Maron thinks all the attention the coronavirus has been getting in New Jersey — from the school closings, banning of public gatherings, suspensions of pro sports leagues and even the fights over toilet paper and bottled water — is not enough. Not even close.

“There is absolute reason to be extremely cautious, to be very concerned,” he said.

Holy Name Medical Center CEO Mike Maron.

Maron and his staff are working around the clock under the most trying of conditions. The vitally important single-use N95 masks that are needed to care for patients who have been identified — you know, the ones the state is running out of? Holy Name went through 795 of them. Just on Friday. By 7 p.m.

“They say we are getting more,” he said. “And we’ve asked (Gov. Phil Murphy) to get into the stockpile. We need them.”

The same goes for test results.

Maron said he has given up on the Centers for Disease Control and Prevention.

“They haven’t even confirmed our first case,” he said.

He knows the state lab is overloaded. And, while Maron praised the efforts of LabCorp — “they’ve really been great to work with” — he has seen firsthand, every day for a week, how quickly the disease can spread.

“The labs are very, very slow,” he said. “I’m still waiting to hear back on two of my cases that are in ICU. We’ve seen enough patients that our team feels it can make a diagnosis. We’re not taking any chances. We’re isolating people.

“Forget about all that ‘presumptive’ stuff.”

Maron is a widely respected health care executive because he has proven a single-entity hospital can compete in quality of care with the bigger systems that surround him. He now knows Holy Name has another distinction.

“Holy Name is at the epicenter of the outbreak in New Jersey,” he said.

Maron said the past week has been unlike any other in his more than four-decade career.

“I can fall back on my cholera experiences in Haiti, which was devastating, considering the lack of basic medical supplies after the earthquake — and then the other things that came here, everything from MERS and SARS, and even when we ramped up for Ebola — this is unprecedented,” he said.

“I can tell you, it’s real.”

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New York state is introducing drive-through testing, following the lead of Washington, California, Texas, Colorado and others. Seven states had introduced it going into the weekend. Plenty more — including New Jersey — are either considering it or getting ready to introduce it.

This concerns Maron. And it’s a concern he has shared with Murphy and Bergen County Executive Jim Tedesco.

Holy Name CEO Mike Maron compared the coronavirus outbreak to his work in Haiti and other extreme situations.

The tests are so new — and have so little history behind them — that Maron said he’s been told their sensitivity remains uncertain. And that’s for patients presenting with the known symptoms: fever, respiratory issues, gastrointestinal distress. For those who aren’t, Maron said, the accuracy is much lower.

“Here’s the concerns around lab testing that people need to know,” he said. “One, every sample has to be garnered under strict conditions. So, the sample taker has to be gowned in full PPE equipment. Precautions have got to be taken. You can’t just put up a test and have people show up. Gathering samples is not like swabbing for the flu. So, that slows down the number of people you can effectively swab.

“The second is that all these companies all use different assays to determine the RNA sensitivity to the test. And, because the (Food & Drug Administration) let people fast-track because we need to make more available, we don’t know for sure. I’ve had this conversation with the virologists at LabCorp, and they told me, ‘We don’t know the sensitivity of the test.’

“So, if you’re symptomatic, meaning you have a fever and cough, and I swab you and send that sample in, the accuracy (is uncertain). … This is opposed to the flu test, which is 9o-95% positive. We’ve had enough testing on those and they have refined that the processes that they know for sure.

“This is complicated. It’s complex science. And, the best we can tell, it’s (accuracy is uncertain). And there is no evidence whatsoever to indicate it’s otherwise.”

Maron said he’s explained this to elected officials.

“I said, ‘Governor, you do not want to do this,’” he said. “You’re going to give people a very false sense of security thinking they can drive through and get swabbed and say, ‘Oh, it’s negative. I’m clear.’

“That’s not good. That’s irresponsible.”

Expanding of testing appears to be coming anyway.

On the governor’s daily briefing call on Saturday, Murphy and Health Commissioner Judith Persichilli announced a testing center is coming to Bergen Community College soon. Details, however, were light.

“This plan is a work in progress,” Murphy said. “It’s a work in progress that will not last more than a couple of days, but the exact details of this are still under consideration and deliberation.”

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Maron wants to get the word out. He wants to let everyone in the state know how bad this can be. His team is living it. And his reality, he said, is not matching what he’s seeing in the media.

“I’ve seen a bunch of headlines. Some people are out there saying: ‘They’re overplaying this. It’s not that contagious. It’s a little bit like the flu.’ It’s not.

“What we’ve seen in the patients who ultimately are positive is that things can turn very rapidly. We had a patient that we were thinking about releasing — he seemingly was recovering — and then, two days later, he was put in the ICU. The flu isn’t like that. People need to know this.”

Maron praises the move to shut down public gatherings. He feels it will slow the spread, but he worries about an unintended consequence of overconfidence.

He doesn’t want to incite hysteria. Just caution. Maron feels people need to take this very seriously.

“People have to take an element of self-responsibility and say: ‘I’m going to do my part. I’m going to stay home. I’m going to limit my group activities. I’m not going out to the theater or the mall or doing this stuff anymore.’

“We need to sort of hunker down at home. Go outside when the weather’s nice in your backyard. That’s healthy and good. But we shouldn’t be out and about.”

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Maron said he is willing to don personal protection equipment himself.

“I tell everybody, ‘I’m not going to ever ask anybody to do something I wouldn’t do myself,’” he said. “So, if people are concerned about, you know, donning PPE equipment and going in a room, I’ll do it. I’ll help the physician in there if you’re concerned.”

But here’s the deal with COVID-19: Those caring for patients can get it, too. Three of the 11 identified cases have been staff members, though Maron said they all contracted it in the local community, not at the hospital.

That shows, he said, the seriousness of the disease. And the randomness of the disease.

Holy Name sits in an area with a large Asian population. Considering the virus began in China, one would assume …

Don’t, Maron said.

“Not one of my patients is Asian,” he said. “Not one. And, even though the outbreak in New Rochelle (New York) started in a Jewish community, only two of the 51 are Jewish.”

Maron said this point needs to be emphasized.

“We were on a call with all the rabbis here in Teaneck, and I said, ‘Let me be very clear: This is not a Jewish disease, this not an Asian disease.’”

Holy Name’s 11 positives are all males — and all between the ages of 28 and 48.

“From what we’ve seen, it’s not impacting children at all — or pretty much anybody under 20,” he said. “That doesn’t mean they don’t have it. They may just process it in a better way, a faster way. That’s the beauty of being young.

“And we have not seen it among seniors, either, because the nursing homes are doing a great job of keeping people out and seniors are taking the news seriously enough and they’re self-isolating.”

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Telehealth is playing a bigger role, as self-isolating and social distancing are being employed to help reduce the burden on health facilities like Holy Name.

“If you call, we do a video conference with a physician — and, depending on your condition, we may tell you (to) self-quarantine at home,” he said. “We’ll have someone come and drop off a home monitoring system, which can take your temperature and take your oxygen saturation rate, your sb02. It gets automatically reported to us and we’ll monitor you.”

If it gets bad, Maron said, hospital personnel will come get you and bring you in — and isolate you. The hope is that treatment will help you recover enough to go home. He knows that’s not always the case. And he’s not taking any chances.

Maron has ordered ‘isolettes,’ akin to adult-sized versions of neonatal incubators.

Maron said he’s put in an order for isolettes — a mini bed-based isolation chamber. He’s after a larger version of what you would see in a NICU unit for newborns in distress.

“It’s clear plastic and it’s got glove entries so a caregiver can touch the patient and do things,” he said. “No one has them. Bergen County has one for the entire county. I placed an order for 50 of them. And I think we’re going to need more than that.”

Things are progressing that quickly, he said.

And Maron needs to only look at one of his colleagues to see it.

“One of my employees, who is a beloved guy here, got it in the community and came in,” he said. “We had him in our ER in isolation. We were monitoring him, and the decision was: ‘He seems to be doing a little bit better. We think we’re going to discharge him home under self-isolation and monitor him from there.’ But we wanted to wait another hour or two because we were just seeing a little indication that something’s not right.

“In that two hours, he decompensated so fast. He is one of the ones in the ICU on a ventilator. He’s fighting for his life. It goes that quick.

“That’s what people aren’t seeing. The flu doesn’t do that to you. These people are going from being moderately OK to being on a vent. And the next thing that happens is they start to decompensate, and then you get into organ failure.”

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Maron knows the situation is going to get worse before it gets better.

“I know that there are epidemiological models that are being circulated right now that are saying, given the data that they’re seeing and the metrics they’re using, we’re still two weeks away from the inflection point of peak,” he said. “So, if we’re seeing this now and the inflection point of peak is two weeks away, that’s a concern.”

The good news: It is not spreading that far outside of Teaneck. At least right now.

Maron said the two other area hospitals, Englewood Health in Englewood and the Valley Hospital in Ridgewood, have only one patient on a ventilator between them. But he worries that other hospitals in Bergen County and around the state soon will be going through what Holy Name is going through.

“Once it gets into a local community, it takes no prisoners,” he said.

Persichilli shared Maron’s concern on the state’s briefing call. She said she worries that state residents base their actions on whether there are any cases in their town or county. That, Persichilli said, would be a mistake.

“Everyone should assume that the coronavirus will be expected in their community,” she said. “So, whether they have one case right now, they need to make an assumption that they may have 10 next week. They need to take care of themselves. They need to take personal responsibilities.”

On Saturday night, Teaneck Mayor Mohammed Hameeduddin asked residents to do more than take personal responsibility.

Teaneck became the first municipality in New Jersey to call for citizens to self-quarantine in an attempt to slow the spread of coronavirus in the town, which has 18 of the state’s 69 confirmed cases.

Hameeduddin said residents should only go out if they have to — and asked residents to go out only to get food or medicine. The request is voluntary.

“There are people that don’t understand that this is something we haven’t seen since World War II,” he said. “We don’t have enough test kits — every day more and more people will be getting sick.”

Read the follow-up interview with Mike Maron (April 1):

Read more from ROI-NJ on coronavirus: