by Andrew S. Lewis, NJ Spotlight
This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com

Gov. Phil Murphy has called New Jersey’s lack of ventilators “dire,” and has increasingly called on the White House to deliver more from the federal stockpile. Why are there so few ventilators, and why are they key in the fight against COVID-19?

Does New Jersey have enough ventilators?

Murphy has requested 2,500 from the Strategic National Stockpile (SNS), a federal repository of pharmaceuticals and medical equipment that itself is now facing a shortage of masks, gowns, and especially ventilators as cases of COVID-19 soar across the United States.

As of Thursday morning, the state had received 850 from the stockpile. The governor has reiterated that he is still pressing for the outstanding 1,650 from the federal government. “That’s not theoretical,” he said. “We need them.”

Already, some New Jersey hospitals are nearing, or have hit, full ventilator capacity. And without a sufficient, centralized stockpile, states are now locked in a bidding war against each other and the Federal Emergency Management Agency for new Chinese-made ventilators. “It’s like being on eBay with fifty states, bidding on a ventilator,” New York Gov. Andrew Cuomo said in his daily briefing on Tuesday. “And now FEMA is bidding on top of the fifty, so FEMA is driving up the price. What sense does this make?”

In all the uncertainty surrounding effective treatment of COVID-19, there is one thing doctors and health care workers on the front lines are confident of: A mechanical ventilator will prolong the life of many infected patients, and oftentimes is the difference between survival and death.

Why does COVID-19 require mechanical ventilation?

 COVID-19 causes the respiratory tree of the lungs to become infected then inflamed, which in the most severe cases causes pneumonia and requires ventilation. Unfortunately, the severe pneumonia caused by COVID-19 is itself different from the more common, bacterial forms of the lung infection.

“In the setting of bacterial pneumonia, you give antibiotics to kill the bacteria,” said Dr. Andrew R. Berman, the Division Director of Pulmonary/Critical Care Medicine at University Hospital in Newark. “The problem with the COVID-19 virus is that there’s nothing really to give [patients].”

The combination of the infection and inflammation results in Acute Respiratory Distress Syndrome, an often fatal complication. “The COVID-19 virus is a problem,” Dr. Berman continued. “But the resultant inflammation is really where these patients end up requiring — and sometimes not necessarily responding to — the mechanical ventilation.”

What is a ventilator and how does it work?

“Ventilators are life support for the lungs,” Dr. Berman, who also serves on the American Lung Association’s New Jersey Leadership Board, said. Simply put, a ventilator is a machine that helps a patient breathe when they are unable to do so on their own.

A patient is sedated and intubated, a highly uncomfortable procedure that involves running a tube into the mouth or nose, and down into the windpipe. The tube is connected to the ventilator, which is then calibrated to deliver, or pump, air into the patient’s lungs that ranges from 21% oxygen content — “room air,” as Dr. Berman called it — all the way up to 100%, depending on the severity of the patient’s condition.

But the machines, which cost about $25,000 each (New York Gov. Andrew Cuomo said on Monday the price has now increased to “over $50,000” because of the bidding war), do much more than pump air into the lungs; in addition to precise percentages of oxygen, they deliver specific flows, volumes and pressures of air, as well as perform constant digital analysis.

Such complexity requires a team of highly skilled operators in the critical-care unit, keeping a round-the-clock watch over a patient whose condition, and oxygen need, is constantly changing. In general, a team of two specialists needs to be on-hand to keep a patient properly ventilated — a respiratory technician, who sets up and troubleshoots the ventilator, and a physician, who oversees the process. The ventilator’s computer then provides digital readouts of each tweak to oxygen, volume and pressure. “It’s a dynamic situation that’s frequently changing,” Dr. Berman said.

How many ventilators will New Jersey need?

In New Jersey there are approximately 2,000 critical-care beds most of which are ventilator-equipped, but the state has projected that it will need to double that number. In order to do that, the state is moving to make room for hundreds more by opening shuttered hospital wings, reopening at least one closed hospital, and building three temporary facilities.

State health officials have said about half the COVID-19 patients now in critical-care beds currently require ventilation, but they fear the need will rise and want every critical-care slot to have this capacity.

Since the federal government has delivered just 850 ventilators, the state is continuing to work on its own to acquire more, in case the outstanding SNS order falls through. “We have not been able to get a non-federal source for acquisition for ventilators successfully,” Murphy said in his Wednesday briefing.

At this point, it’s impossible to know exactly how great New Jersey’s ventilator shortage could become, if at all. Based on the projections for the spread of COVID-19 in New Jersey, Judith Persichilli, the Department of Health Commissioner, said in Wednesday’s briefing by state officials that, with the amount of ventilators the state received from the SNS, “we do believe we’re going to be okay, but we do believe we’re going to be moving ventilators around, from the south to the north, across regions.”

Before the pandemic, the SNS had a total of about 16,600 ventilators — 7,000 have since been distributed nationwide — though a portion of them are not working or require some maintenance and cannot be immediately deployed. This number will fall far short of the need in the coming weeks and months, in which top federal government officials now estimate that the U.S. will see between 100,000 and 240,000 COVID-19 deaths, even under the restrictive social-distancing measures that are being implemented across the country.

Aren’t U.S. companies stepping in to retrofit their factories for production?

On March 21, the U.S. Department of Health and Human Services issued a request for information to identify manufacturers who have current capability to produce ventilators, or who can quickly modify current capabilities to make them. But production will not happen overnight — equipment needs to be retrofitted, and additional engineers and experts employed.

Ford and General Electric have announced plans to manufacture a combined 50,000 ventilators over the next 100 days, and General Motors is also working to produce the machines. Elon Musk, the CEO of Tesla and SpaceX, also said that his factories have the capability to adapt and help. Last week, the U.K.-based company Dyson announced that it had created, in collaboration with The Technology Partnership, a new ventilator machine of which the U.K.’s National Health Service has already ordered 10,000, and Dyson plans on donating 5,000 of the machines “to the international effort” by this month, 1,000 of which will go to the U.K. (A Dyson spokesperson declined to comment on where the remaining 4,000 machines may go, though they said the company has received requests “from all around the globe.”)

Are there viable alternatives for the full-scale ventilators?

There are other options that can be used as alternatives should hospitals experience a shortage of the full-scale ventilators.

“We have what’s called transport ventilators, which are much smaller and more basic,” Dr. Berman said. Transport ventilators are used when a patient needs to be moved from the ICU to another room in the hospital for other short-term procedures, like, for example, a CAT scan. But these ventilators “only control a few of the many things that can be controlled” in the full-scale units. If the national supply does reach full capacity and there are no more full-scale ventilators available, using transport ventilators to treat COVID-19 patients is “definitely an approach” that should be considered, Dr. Berman said.

In Wednesday’s briefing by state officials, Persichilli reported that New Jersey hospitals have been successfully ventilating COVID-19 patients with anesthesia machines, which are essentially simplified ventilators that cannot perform all of the processes of a full-scale ventilator and are usually used only during surgery.

Dr. Berman also said there are non-invasive methods that are being considered, like “high flow” oxygen therapy, which doesn’t require a tube to be inserted into the patient’s lungs. “Every institution uses them,” he said. “It may be a way to take care of someone’s oxygen needs and stave off mechanical ventilation.”

The use of other non-invasive breathing technologies, like CPAP or BiPAP machines —electronic breathing devices most commonly used in the treatment of sleep apnea and chronic obstructive pulmonary disease — has been circulated in recent media reports, but there is some concern among experts that they may not be effective, and even may increase the risk of infectious transmission. “Almost all patients are requiring ventilators for both oxygenation and ventilation,” Dr. Berman said. “And CPAP and BiPAP cannot do these effectively in this population.”

Could hospitals resort to ‘co-venting’?

Murphy and Cuomo have also mentioned “co-venting,” or connecting two patients to the same ventilator, to stretch resources. Dr. Berman acknowledged this is “being discussed by others” — mostly by doctors in New York City — but said that he wasn’t aware of the status of its application in COVID-19 patients. In Thursday’s briefing with state officials, Persichilli confirmed that, currently, no patients in New Jersey are being co-ventilated.

The practice, however, is rare and risky, given the severely weakened state of patients’ lungs and the unique nature of each case; one provider said it is “nearly impossible” to find two patients who are enough of a “match” to make co-venting a success.

Universities are also jumping in to help. Rutgers University, where Dr. Berman is a professor of medicine, has organized some of its engineers to look at how they can produce basic ventilators. At MIT, a “volunteer team of engineers, physicians, computer scientists, and others,” which calls itself MIT E-Vent, is also currently working on simpler, cheaper alternative that can be deployed for emergency use.

At this stage of the pandemic in New Jersey, and the U.S. in general, Dr. Berman said no one approach should be prioritized over another. “All different groups have to work on this from all different sides,” he said. “It’s a supply and demand race — the manufacturers are trying to ramp up supply, and the national stockpile is trying to increase supply, and the demand is created by the COVID virus. Assessing our needs, and how we can meet those needs, is a part of what we do every day.”

PARSIPPANY — Lake Hiawatha resident Brian Donlin continues to train and fundraise to help to find a cure for Type 1 Diabetes (T1D) with the Juvenile Diabetes Research Foundation (JDRF). Every year, hundreds of cyclists gather in different cities to ride in support of JDRF research at their “Ride to Cure T1D” events. Some are kids and adults with T1D, and some are the friends and family that support them. Brian has known many people in his life that live with T1D, but it really hit home when the diagnosis came to his nephew Zach.

“I remember being pretty young and at my cousin’s house for a party” recalls Brian, “at one point, we didn’t know where my cousin went”. Brian found his cousin in the living room, preparing to give himself a shot of insulin. “I thought it was a little weird but I really didn’t think much more of it at the time. Now watching my nephew live with T1D first hand, I understand what my cousin and my friends have been dealing with for all these years.”

When we last saw Brian, he was just starting his fundraising effort. He is now over a quarter of the way there but still needs more support. Along with personal donations through his JDRF page, click here, and his Facebook fundraiser, he is also seeking potential corporate and business support to help him reach his goal of $3,500. He has been canvasing some of the local businesses with flyers, as well as asking around some of the immediate Lake Hiawatha businesses for help.

He is training for the 100 mile route that takes place in Saratoga Springs, NY on September 12, 2020, along with hundreds of like minded people gathering for a day of fun, camaraderie, and of course, to support the JDRF. You can follow Brian’s progress on his personal site by clicking here and on Strava by clicking here.

In light of the current CoViD-19 health situation, the JDRF has published some great information for those with T1D and how you can keep yourself safe, and how to care for yourself in case you feel sick. While having T1D does not increase your chances of developing the disease, there are some things to stay on top of should you get it. These tips and a wealth of more information can be found by visiting their blog page by clicking here.

Every mile pedaled is a mile closer to a cure. We can’t make it to the finish line without you!

MORRIS COUNTY — Morris County has risen to 1105 and increase of 161 cases from yesterday. The figures reflect open COVID-19 positive cases as of the date and time indicated, not cases which have been closed, some cases which may be pending, or have yet to be entered into the system.

MORRIS COUNTY — More than 50 individual restaurant cooked meals were delivered to the staff at Saint Clare’s Hospital in Denville by Italian American Police Society of NJ President William Schievella and Rockaway Township Mayor Michael Puzio.

Chef Matt Pierone, of Gourmet Cafe, prepared chicken francese, pasta, salad and Italian bread for the Italian American Police Society of NJ to serve the hospital staff.

Thank you to the Rockaway Township Education Assoc. (public school union) for generously splitting the cost of the meals with us.

These brave medical personnel are doing amazing work and deserve a gourmet cooked meal. Italian American police officers know how to eat and so should they.

MORRIS COUNTY —The New Jersey Department of Labor and Workforce Development (NJDOL) is urging employers to keep employees on the payroll throughout the COVID-19 pandemic and to take advantage of a 100 percent, dollar for dollar, payroll tax credit provided under the Families First Coronavirus Response Act (FFCRA).

The federal law, which goes into effect on April 1, provides unprecedented support to employers to provide federal Emergency Paid Sick Leave and Emergency Paid Family and Medical Leave to workers affected by COVID-19.

The payroll tax credit immediately and fully reimburses employers with fewer than 500 employees (99.8 percent of all NJ employers) by allowing them to reduce their federal payroll taxes by the amount they spent on emergency leave. This tax credit enables businesses to keep workers on their payrolls and ensures that parents and caregivers do not have to make the impossible choice of earning a paycheck or staying at home to care for themselves or a family member.

“Gov. Murphy and his Administration is working around the clock to make sure that working families affected by the COVID-19 pandemic are supported, but we cannot do this job alone,” said Labor Commissioner Robert Asaro-Angelo. “That is why we are calling on the business community to join us in supporting working families as one New Jersey family.”

All but the state’s largest employers are eligible for the 100 percent federal payroll tax credit for all qualifying wages. Qualifying wages are those paid to an employee who takes leave under the act for a qualifying reason.

Under the act’s federal paid sick leave program, an employee is entitled to 80 hours (up to two weeks) of paid leave. Under the act’s expanded Family and Medical Leave program, an employee is entitled to 12 weeks of job-protected leave, the first two weeks of which are unpaid, and the remaining 10 weeks of which are paid.

• For general questions, please visit the US Department of Labor’s FAQs.
• For more information on which employers are covered under the law, please visit the US Department of Labor Employer Resource Guide.
• To understand how to access FFCRA Business Tax Credits, please visit the Internal Revenue Service resources page.
• For information on how these provisions apply New Jersey, please visit the NJ Labor Department.
• Business owners with questions about accessing the reimbursement from the federal government, please visit the New Jersey Business Action Center.
• Business owners with questions about grants and loans should visit the NJ Economic Development Authority.
• New Jersey workers with questions about eligibility for benefits should view these NJ-focused charts in English and Spanish or visit the US Department of Labor Employee Resource Guide.

MORRIS COUNTY — After over twenty years of service to Morris County, Lieutenant Evelyn Tasoulas has announced her retirement. Morris County Prosecutor Fredric Knapp, Acting Chief of Investigations Christoph Kimker and Captain Robert McNally honored Lt. Tasoulas for her exemplary service and the gratitude of the Morris County Prosecutor’s Office on her last day.

As lieutenant of the General Investigations Unit and Pretrial Services Unit, Lt. Tasoulas served in the Court & Administration Division of the Morris County Prosecutor’s Office. During her tenure, she mentored dozens of county investigators / detectives, primarily in the General Investigations Unit and the Pretrial Services Unit. Prior to joining the Morris County Prosecutor’s Office in 1999, Lt. Tasoulas served with the New Jersey Transit Police and as a Corrections Officer.

Prosecutor Fredric Knapp said, “It has been my privilege to have worked with her and to have promoted her twice during my tenure as Morris County Prosecutor. We all wish her well in her retirement and thank her for her steadfast dedication to duty.”

MORRIS COUNTY  — Administration officials with the New Jersey Departments of Children and Families (DCF) and Human Services (DHS) yesterday issued guidance for the Emergency Child Care Assistance Program for children of workers designated as ‘essential’ under Governor Murphy’s Executive Order 110.

Through this program, the state will help support child care costs for essential workers. In order to participate, essential employees who wish to utilize emergency care services must complete an online registration form available by clicking here. The State-supported, county-based Child Care Resource and Referral agencies will reach out to those who register to assist with enrollment and placement.

Executive Order 110 directed the closure of all childcare centers except for those on federal property or military bases, family-based centers caring for five or fewer children, and any centers that register to exclusively provide emergency child care services to essential personnel. Following a registration process last week, nearly 600 childcare agencies statewide have been certified by DCF to provide emergency child care services.

“Our essential workers are keeping our state running every day and every night,” said Governor Phil Murphy. “We are establishing this new Emergency Child Care Program to support them and their families as they continue to serve the residents of New Jersey.”
“Safe, dependable and affordable childcare is vital to working families, particularly now, as so many parents are being called to serve their state in critical roles during a pandemic,” said DCF Commissioner Christine Norbut Beyer. “These childcare centers are fulfilling a necessary function and giving parents across the state the peace of mind to go to work knowing their child is with licensed, reliable and skilled professionals.”

“Child care providers and staff who care for the children of essential workers are vitally important to our children and to the state’s response during this ongoing emergency,” Human Services Commissioner Carole Johnson said. “We thank child care workers for their hard work and commitment, especially during this difficult time. We urge essential workers who need child care click here. ”

For the month of April, under this program, the state will pay the following rates per week. Once final details are available on federal funds available through the CARES Act, this information will be updated for future months.

State Rate for Emergency Care (Full-time weekly rate for one child)
INFANT – $450.35
TODDLER – $415.70
PRESCHOOL – $415.70
SCHOOL-AGE – $336.00

Families choosing a childcare center with higher rates will need to pay the balance directly to the provider, but such rates cannot exceed up to a limit of 110 percent of the rate the center charged in February 2020.

Governor Murphy’s Executive Order 110 defines ‘essential’ workers as:
Health care workers, including staff working in health care facilities and in community-based services including home health and behavioral health; Law enforcement personnel, fire and emergency services personnel, and correctional facility staff; Individuals employed at emergency child care centers operating on or after April 1, 2020; Staff working for entities that provide essential social services, including, but not limited to, group home and shelter staff; Essential government employees who are unable to work from home, including child protection services workers, child welfare workers, foster care workers, unemployment compensation processing staff, and public health employees; and,
Certain critical workers, as defined by the Commissioner of DCF, at essential retail businesses, as defined in Executive Order No. 107 (2020) and subsequent Administrative Orders, which includes, for example, grocery store and gas station employees.

More information can be found on the ChildcareNJ website.

MORRIS COUNTY — The New Jersey Economic Development Authority (NJEDA) will launch the application for its Small Business Emergency Assistance Grant Program on Friday, April 3, at 9:00 a.m. A link to the grant program application will be posted on the State’s COVID-19 Business Information Hub. The grant program is part of a package of initiatives announced last week to support businesses and workers facing economic hardship due to the outbreak of the novel coronavirus COVID-19.

“The launch of the grant program application marks a critical step in the State’s support of the small and mid-sized businesses that are feeling the impact of the novel coronavirus outbreak,” said NJEDA Chief Executive Officer Tim Sullivan. “The livelihood of business owners and their employees hinges on how successfully businesses can withstand this ongoing challenge. Under Governor Phil Murphy’s leadership, the State is committed to advancing resources that will help businesses recover.”

The NJEDA’s COVID-19 initiatives focus on businesses that have been hit hardest by the novel coronavirus outbreak: local small businesses, mid-size businesses that have had to close or drastically reconfigure operations, and new businesses that were just getting on their feet before the crisis hit. The programs provide a suite of compatible offerings that address these businesses’ varied needs and include mechanisms to provide funding and assistance as quickly as possible.

The NJEDA developed these relief programs using the results of an online survey of small and mid-sized businesses conducted over March 20 and 21.

The survey, which was conducted in both English and Spanish, received more than 2,000 responses. Key findings that informed the NJEDA’s new programs include:

COVID-19 has had a significant impact on New Jersey’s business community, with 73 percent of organizations surveyed reporting a significant loss of revenue and/or contract commitments. The accommodation & food services and arts & entertainment sectors have been hit particularly hard.

Many businesses anticipate needing to lay off workers if support is not available, with 52 percent of respondents suggesting temporary lay-offs may be necessary if they do not receive support within the next three months.

Businesses need financial support, but are not requesting large sums. 96 percent of respondents predicted they would need financial assistance within the next three months, with the average amount of funding needed falling between $50,000 and $75,000.

Applications for other NJEDA COVID-19 programs, including no/low interest loans, entrepreneurship support, and technical assistance for those applying for U.S. Small Business Administration loans will be available in the coming weeks. Businesses and nonprofits can find eligibility requirements for all programs on the COVID-19 Business Information Hub or use the Eligibility Wizard to identify which emergency assistance programs they may want to consider for their business’s specific needs. Comprehensive information about New Jersey’s response to the novel coronavirus outbreak is available by clicking here.

Eligibility Guidelines for Small Business Emergency Assistance Grant Program
Businesses applying for the Small Business Emergency Assistance Grant Program must provide:

A contact who is authorized to speak on behalf of the company.

Basic information about the company:
Registered legal name and “Doing Business As” name (available here: https://www.njportal.com/DOR/BusinessNameSearch/Search/BusinessName;
Federal Employer Identification Number (EIN);
Year your company was established;
Full-time employees as of December 31, 2019 and Part-Time Employees as of December 31, 2019.
Industry as defined by your NAICS code (Click here).
Answers to the State’s basic debarment questions (Click here for application here).
Certification that the business:
Is not a home-based business;
Is not a prohibited business;
Has been impacted by the COVID-19 outbreak;
Has a material financial need that cannot be overcome without the grant funds;
Will make a best effort not to lay off any additional employees and re-hire any whom have already been laid off;

The NJEDA may check your entries against other State sources of data.
NJEDA has developed an online Grant Award Size Estimate Calculator to help eligible businesses understand what their potential grant size might be.

About the New Jersey Economic Development Authority
The New Jersey Economic Development Authority (NJEDA) serves as the State’s principal agency for driving economic growth. The NJEDA is committed to making New Jersey a national model for inclusive and sustainable economic development by focusing on key strategies to help build strong and dynamic communities, create good jobs for New Jersey residents, and provide pathways to a stronger and fairer economy. Through partnerships with a diverse range of stakeholders, the NJEDA creates and implements initiatives to enhance the economic vitality and quality of life in the State and strengthen New Jersey’s long-term economic competitiveness.

PARSIPPANY — Representative Mikie Sherrill (NJ-11) announced today that counties and municipalities in the 11th Congressional District will receive more than $7.9 million in COVID-19 Recovery Grants as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Essex, Morris, and Passaic Counties will receive a combined $7 million dollars in COVID Recovery Community Development Block Grants (CDBG) and Emergency Solutions Grants (ESG), and Parsippany, Bloomfield, and Wayne will receive hundreds of thousands in funding from the CDBG Program.

These U.S. Department of Housing and Urban Development grants were funded through the CARES Act, the third piece of coronavirus response legislation, which Sherrill helped pass last week. The CDBG and ESG grants will help states and municipalities build capacity to address the COVID-19 crisis, spur economic development, address homelessness and support transitional housing, and secure housing assistance for low-income individuals.

“Our counties and towns are working around the clock to provide support for our residents as we face the unprecedented challenges of COVID-19,” said Representative Sherrill. “I fought to get increased, direct, and rapid support for New Jersey and our community into the CARES Act. These grants will help our local governments in their ongoing response efforts, and I will continue to work with our local elected officials to respond to their needs.”

Essex County:
$3.22M CDBG20-COVID Recovery; $1.57M ESG20-COVID Recovery

Morris County:
$1.16M CDBG20-COVID Recovery; $587K ESG20-COVID Recovery

Passaic County:
$537K CDBG20-COVID Recovery

Parsippany:
$127K CDBG20-COVID Recovery

Bloomfield:
$615K CDBG20-COVID Recovery

Wayne:
$115K CDBG20-COVID Recovery