Editor’s note: This is the fourth in a series of year-end stories looking at key issues facing New Jersey in 2021 and 2022. This entry focuses on the state’s public health during this unprecedented time of COVID-19 and lessons going forward for the health care system.

As if 2021 weren’t momentous enough, the list of immediate priorities for New Jersey’s health care leaders in 2022 could be even more daunting.

The state starts the new year facing off-the-chart numbers in new COVID cases, and the first task will be responding to the still-evolving coronavirus variants, hopefully without shutting down much of society again. There will be the huge task of reinforcing the battered and bruised health care workforce. And a fundamental challenge will be helping people deal with the unimaginable levels of stress and grief, especially in the face of staggering racial gaps exposed by the pandemic.

Woven into all these issues, experts say, is the fact that it is time rethink how health care is delivered and shift in earnest to a more sustainable approach that promotes better health while protecting residents from the worst of the coronavirus, which could continue to circulate for years.

“We need to rebuild a lot of our health-care delivery system in light of the COVID pandemic,” said Gregory Paulson, executive director of the Trenton Health Team, a regional multisector partnership focused on health equity that has taken on new roles during the pandemic.

Untreated conditions

In addition to an increase in mental health and addiction issues, Paulson worries about complications from chronic physical conditions, which may have gone untreated during much of the past two years. “Diabetes hasn’t gone away. Hypertension hasn’t gone away. All these other conditions are still here and likely neglected,” he said.

“We have built the plane while we were flying it,” Paulson said of the current health care system, referencing a frequent statement from Gov. Phil Murphy.

“But now we need to try and learn the lessons of COVID while we are still in flight,” Paulson said. “It’s not going to be easy, but we have to try and figure out how to live with (coronavirus).”

The new year begins with record-high numbers of daily COVID-19 diagnoses, growing concern about hospital capacity and a rising sense of dread about the destructive powers of omicron, the coronavirus variant now sweeping the nation.

Nearly 1.5 million cases of COVID-19 have been reported in New Jersey since the outbreak began in March 2020, including more than 26,000 likely positive diagnoses last Wednesday alone. It was a new peak that was 74% higher than Tuesday’s case count and well over twice the previous high point recorded early this year. Hospitalizations and deaths are also rising, although at a somewhat slower pace.

New Jersey’s health officials have been closely monitoring the impact of new, more transmissible variants — first delta, now omicron — over the past six months and promoting COVID-19 vaccinations and booster shots as a primary offense.

More than 6.4 million New Jerseyans have now been vaccinated and nearly 2.2 million have been boosted. The state took steps during 2021 to improve care at nursing homes, which were particularly hard-hit by the coronavirus, and is working to reduce racial disparities within maternal health, a mission led by first lady Tammy Murphy.

Dealing with variants

But variants will continue to be a challenge, experts agree, and dealing with them requires a global response. Stephanie Silvera, an epidemiologist and public health professor at Montclair State University, said that means encouraging vaccination around the world — to help prevent mutations before they can develop new strains — in addition to promoting shots and boosters in New Jersey.

“We (also) need to remember that while vaccines reduce hospitalization and mortality rates, other public health prevention measures, including mask wearing and adequate ventilation, that reduce transmission are effective regardless of the variant,” Silvera added. “We need to layer all of these actions in order to be prepared no matter what comes next.”

Policy experts began to explore the impact of the pandemic last year, with multiple organizations calling for greater investment and coordination within New Jersey’s public health sector and better integration of mental and physical care statewide.

A report released in April by BioNJ, the life sciences trade association, and the nonprofit New Jersey Health Care Quality Institute, included more than two dozen recommendations for improving the state’s health system, several that focused on the need to develop a more sustainable health care workforce.

Staffing worries

While shortages of nurses and other aides have long plagued hospitals and nursing homes in New Jersey and nationwide, the deficiencies have become more critical recently as frontline workers face burnout, sickness and coronavirus-exposure threats, which can keep them home for a week, regardless of symptoms.

“I am very worried about staffing going into the holidays, and it’s the biggest systemic health-care risk right now, when it comes to quality and patient safety,” said Dr. Shereef Elnahal, president and CEO of Newark’s University Hospital and a former state health commissioner.

Elnahal is also concerned about the pandemic’s effect on mental health and substance abuse and the multifaceted impact of the ongoing crisis on communities of color, like Newark, which was hard-hit by the virus. He also fears the impact of long-COVID, a confluence of symptoms that can affect patients for months or longer and is not well understood.

To meet some of these needs, Elnahal said the state should consider expanding inpatient treatment options for behavioral health issues, even on a temporary basis, and enhancing community-based programs. Drug overdoses have been on the rise the past two years — in New Jersey and other states — in part because of the growing presence of fentanyl, a deadly synthetic opioid.

“This will resurface as among the more important public health crises,” he said of the rising rates of addiction, particularly to opioids.

Mental health is also a concern for many in New Jersey, given the ongoing toll of the pandemic. Stress and anxiety are rising, and the state was receiving record numbers of calls to a children’s health hotline in September, when kids were heading back to schools and parents were struggling with the emotional and logistical toll.

“Much like racial and ethnic health disparities, this pandemic has highlighted the need to look at mental health as part of our overall health,” Montclair’s Silvera said, calling for more comprehensive health insurance coverage for behavioral health services.

“While the pandemic has created new stressors, I think it is also allowing more people to acknowledge their anxiety and depression and seek help. That is good and it means that we need to create better access and ensure that that access is equitable,” she added.

Racial, economic disparities

Many agree the pandemic underscored the importance of addressing racial and economic disparities, which can translate into higher risk for Black and Hispanic residents. In New Jersey, and nationwide, people of color are more likely to hold frontline jobs that expose them to COVID-19 and less likely to have access to quality care. As a result, Black and brown people experienced higher rates of infection, hospitalization and death, when compared with white people.

“COVID has highlighted the very deep, structural and institutionalized inequalities that foster health disparities,” Silvera said. Rapid tests are expensive for individuals making minimum wage, she explained, and transportation challenges can keep people from accessing care. “We cannot unsee these disparities and we cannot afford to continue to look away,” she said.

Paulson, with the Trenton Health Team, said effectively addressing racial gaps may require us to move away from crisis-response mode and examine New Jersey’s health care system more comprehensively.

“When any system is stressed, the flaws in that system become more obvious,” he said. “And when a system is flawed, we always have to ask if each step (in reform) is addressing inequality, or making it worse.”