Inside Saint Barnabas Medical Center, a line of patients had formed at the triage nurse’s station.
Dr. Christopher Freer noticed the 10 or so people Tuesday morning, standing near the entrance of the emergency room in Livingston. They hadn’t been examined yet. But it was already clear to Freer and the nurse why some had come.
Flu season has arrived in New Jersey.
“The volume of patients is high,” said Freer, chairman of emergency medicine for Saint Barnabas and system director of RWJBarnabas Health Emergency Services. He added: “The goal is to move these patients away from the rest of the patients coming through.”
The number of flu cases is ramping up, and emergency rooms around New Jersey are beginning to feel the strain as patient volume rises.
There have been 2,119 cases of influenza B reported statewide, according to the New Jersey Department of Health’s latest flu surveillance report, a rise from the 1,455 cases reported last week.
There has also been one flu-related pediatric death so far this season.
Emergency room visits and admissions statewide are climbing at an alarming rate. They are outpacing the three highest flu seasons ever recorded at this point in the year, according to the state Health Department’s latest flu surveillance report.
“We’re starting to feel it,” said Dr. Catherine McGinty, medical director of the emergency department at Cooper University Hospital in Camden.
New Jersey hospitals are bracing for a surge in patients in the coming weeks, as this flu season is on track to be one of the worst in years.
It also could be one of the worst across the country, according to a recent report by CNN.com, citing the director of the National Institute of Allergy and Infectious Diseases.
The situation remains under control, but experts and doctors around the state are preparing for what is expected to be a trying few months.
Dr. David Cennimo, an infectious disease expert at Rutgers New Jersey Medical School, believes the number of flu cases this season “will very likely be higher than average.” The state is seeing more cases each day than in past seasons with high flu activity, he noted.
“I think it’s safe to say this year could be one (of) the worst by the end,” Cennimo said via text message.
The next few weeks will be the test for hospitals as the state approaches peak flu season.
They are ramping up their protocols in preparation.
Identifying and isolating flu patients might sound simple. But a surge in cases can overrun emergency rooms, as it did both statewide and nationally during the record-breaking flu outbreak two years ago.
There were more than 22,000 flu cases and five flu-related pediatric deaths in New Jersey that season, making it one of the worst in decades. Patients flooded emergency rooms, stretching many facilities to full capacity. Hospitals began urging patients to visit only if extremely ill.
Such a surge can happen suddenly. Just a few weeks ago, only 422 New Jersey cases were reported. They have increased by 500% in less than a month.
And flu activity continues to escalate.
“We’re just starting to see an uptick, but we’re not in the thick of it,” said Dr. Matt Warner, chair of emergency medicine for Inspira Medical Center Vineland and Elmer and Inspira Health Center Bridgeton.
Emergency rooms prepare for the annual rise in patient volume by implementing simple but important protocols: masking patients, segregating them into separate areas of the hospital, ensuring there are plenty of hand sanitizer dispensers.
But the most important factor is getting patients in and out as quickly as possible.
However, emergency rooms are naturally crowded. Treating each patient, from admission to discharge, takes time — often hours.
“So we have to figure out how to see all the other patients we’ve been seeing all year,” Freer said.
It strains resources and taxes medical personnel, especially when there’s little they can do to help in many cases.
Most people who visit the hospital with the flu are only slightly sick, doctors say. They can prescribe Tamiflu, give a rapid flu test and provide some peace of mind — but all of that can be done by a primary care physician or at an urgent care center.
Multiply this scenario over and over again each day and week during flu season, and it adds up to overstretched medical facilities, especially in abnormally busy periods such as two years ago.
“With the flu, you have a high fever. You have a cough. All sorts of symptoms that you have when you have sepsis, and patients get freaked out,” said Dr. Robert Sweeney, chair of the department of emergency medicine at Jersey Shore University Medical Center. “For the patient, the attitude for them is to be safe than sorry.
“They rather go in and get checked and told that it’s just a virus. So it’s very, very hard to keep people from coming to the hospital.”
Sweeney said these are the situations in which urgent care centers, in particular, can play a pivotal role in reducing patient volume in emergency rooms.
“It’s very difficult to isolate patients in a crowded emergency department,” he said.
But urgent care centers in the state are also feeling the impact of flu season.
Summit Medical Group Urgent Care said it has seen a 40% rise in flu-related cases.
“There’s definitely been an uptick in flu patients in the last couple of weeks,” said Carlos Tronza, regional director of urgent care for MedExcel, which operates four locations in New Jersey. “The percentages of flu cases are higher than past years.
“It’s definitely across all centers, not just us,” he said.
And the worst is yet to come, Tronza warned.
“We’re not expecting it to die down,” he said.
Complicating matters is the flu, while usually not serious, can be deadly in rare cases, especially for young children, older adults and the immunocompromised. This is why each emergency room case must be thoroughly assessed.
But overcrowding from flu patients stretches resources and poses the risk of exposure to staff and others. Slightly sick flu patients present a serious threat to those with severe chronic illnesses who are already in a hospital.
Some hospitals don’t have separate areas for flu patients. Those patients can mix with others in waiting rooms until they are moved to an examination room.
This year, hospitals throughout the state have already imposed visitor restrictions, a preemptive move to reduce the volume and risk of exposure. Saint Barnabas Medical Center, for example, has requested that people who feel ill or have been near someone sick refrain from coming to the facility.
When flu season ramps up, hospitals often take such measures.
Two years ago, flu patients flooded New Jersey emergency rooms. Some hospitals around the country went as far as setting up military-style hospital tents, or “surge tents,” to triage the massive influx of flu patients.
Despite the forecasts, it’s unclear how bad this season will eventually unfold.
There have been at least 9.7 million cases, 87,000 hospitalizations and 4,800 deaths nationwide from flu so far this season, according to the Centers for Disease Control and Prevention.
There are four different types of flu viruses: A, B, C and D. Each season, one strain ends up causing the bulk of illnesses. The predominant flu strain this year is influenza B, which presents some good news.
Cennimo said illnesses from influenza B are typically less severe than influenza A strains like H1N1 (swine flu) and H3N2. Those are the only viruses known to cause flu pandemics.
So even if the number of cases this year is high, the CDC said there will likely be fewer flu-related deaths and hospitalizations than in past seasons.
This doesn’t mean emergency rooms won’t experience a surge in patients. Hospitalizations and deaths from the flu usually occur among people 65 and older. Influenza B mostly affects children and younger adults.
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