These recommendations could better prepare NJ for the next pandemic

Four years to the day since the World Health Organization officially declared the COVID-19 outbreak a global pandemic, the Murphy administration unveiled its much-anticipated review of New Jersey's response to the crisis.

That report, in the form of a 907-page the report dated March 7, was released Monday morning and focused on what the state had done to prepare for a potential public health emergency and the government’s efforts to manage the crisis as it unfolded.

Attorney Paul Zoubek, who was tasked with preparing the report, said that “we failed as a nation and as a state to be adequately prepared” but that the purpose of the report was to create a “playbook for future administrations.”

Zoubek, a partner at Montgomery, McCracken, Walker and Rhoads, led the investigation and the report. Zoubek worked in the state attorney general’s office during both the Whitman and DiFrancesco administrations as well as in the U.S. attorney’s office.

The review was conducted independently, with no interference and “unfettered access” to the administration.

Zoubek, who was personally impacted by the pandemic by the death of his father in a facility in California, said he understood what families had been through especially when it came to not being able to be with a loved one.

He noted that much like the Sept. 11 terrorist attacks, there were “total failures” in terms of intelligence and understanding because people were caught off guard and were “fundamentally not ready as a nation and as a state.”

“One comment we frequently heard in interviews was that ‘Nobody saw this coming,’” Zoubek said in the report's opening pages. “While it is true that COVID-19 was a never-before-seen disease, New Jersey — and the rest of the world — had been through pandemics and large-scale infectious diseases before and knew how vital it was to prepare for the next one.”

Zoubek said that the state relied on the CDC and the WHO for guidance and that after the first case the state was hit with a “tsunami” and that the “aggressive closures had an unprecedented impact on the economy.”

Weaknesses found by the report

The report noted that the impacts of the pandemic in the state “exposed areas where society or institutions were already weak,” and “perennial challenges for state governments, in New Jersey and beyond, such as operating flexibly, expediting bureaucratic processes and coordinating across agencies became likely failure points when COVID-19 upended regular operations and created a set of new demands which agencies needed to begin to fulfill on short notice.”

Though the state Health Department created a pandemic influenza plan in 2015 that was “extremely accurate in predicting what would eventually happen during the COVID-19 pandemic,” the plan was “not widely known within senior State leadership by the time COVID-19 hit.”

The report puts a great deal of emphasis on the lack of personal protective equipment, such as face masks, as well as changing advisories from the Centers for Disease Control and Prevention and other health organizations in the earliest days of the pandemic on how best to prevent COVID’s spread.

The Murphy administration was criticized for prioritizing the distribution of face masks and other equipment to hospitals over nursing homes and other long-term care facilities. The report said the administration “prioritized” long-term care facilities but the “amount distributed was not enough to prevent the high number of deaths in these high-risk settings, and New Jersey ultimately faced criticism and challenges for prioritizing hospitals over [long-term care facilities] for PPE distribution.”

More than 16,000 nursing home residents and staff members died in the pandemic, out of New Jersey’s 36,000 confirmed and probable victims.

Two weeks later, the Health Department issued an emergency order to stop nursing home readmissions and further ordered a stop to all admissions at facilities that were unable to meet safety protocols.

Recommendations for a future pandemic or crisis

Dozens of recommendations were made to ensure that the issues the state faced, especially in the early days of the pandemic, are not repeated in the event of another health emergency.

“In many respects, New Jersey was unprepared for an emergency of this magnitude. It is important to recognize that New Jersey learned a great deal from the experience, but this learning came at a steep human cost,” the report said. “However, if New Jersey does not act now to codify those lessons, it will lose the critical knowledge and skills developed during the pandemic.”

Though focused on a future pandemic, the recommendations are applicable to other crises, such as weather or terrorist-related activities.

The report noted that the working relationship among the governor’s office, the Health Department and the Office of Emergency Management "should be clearly defined in advance of a future pandemic” and that response plans should be developed and tested.

It also recommended preserving and codifying emergency orders that were put in place in order to streamline a future response.

Investments should be made in the public health system to address the weaknesses that were exposed during the pandemic, including investments in health equity and preparedness to the hospital system, the report said.

The report recommended doing more to enhance oversight, coordination and guidance capabilities for long-term care facilities and said collaboration should happen with partners outside state government to increase the speed, effectiveness and equitable distribution of services.

COVID response review process began in 2022

Zoubek was hired in November 2022 to conduct an independent review. The contract allowed for an hourly rate of more than $400 for lawyers at the firm. Boston Consulting Group was also hired.

There were 31 state agencies and entities that provided information to Zoubek and his team, as well as people outside government who “performed vital roles throughout the course of the pandemic.”

The administration confirmed that Murphy himself sat for hours of interviews and that no one refused to participate. The administration did not edit the report.

There were more than 3 million COVID-19 cases and 33,000 deaths in New Jersey between March 2020 and May 2023.

A "rapid review" of the administration's pandemic response by Manatt Health cost about $500,000 and did not focus on nursing and veterans homes, where the virus ripped through and killed hundreds of elderly residents.

Murphy said multiple times throughout the years that the report would be a “full accounting” of how his administration handled the pandemic and that those involved are “willing to hold a mirror up to ourselves.”

More than 190 lawsuits worth about $69 million have been settled with victims' families, but veterans home employees still have lawsuits pending.

Murphy promised "a full accounting to get to the bottom of what happened" in October 2020, days after he fired four top officials in charge of veterans homes that housed hundreds, including many veterans of the Korean and Vietnam wars.

Long COVID:NJ residents enduring long COVID weighed down by headaches, brain fog, fatigue and stigma

'Inconsistencies and confusion' in long-term care facilities

The report took a detailed look at one of the biggest criticisms leveled at the Murphy administration: the Health Department’s March 31, 2020, order for nursing homes to readmit COVID-positive patients. Critics said this allowed the virus to spread rapidly among the most vulnerable and was a key cause of the massive death toll.

Although the order by then-Health Commissioner Judy Persichilli was meant to avoid overcrowding at hospitals, the report said, “too few long-term care facilities could readmit such patients while following infection control guidance and maintaining safety protocols.”

The report said nursing home operators were confused by several of the Health Department’s directives, including the March 31 readmission order. Health officials struggled with devising clear orders in part because guidance from the CDC and other health organizations on how to deal with the virus kept changing.

The department’s “communication strategy led to notable inconsistencies and confusion among [nursing home] administrators,” the report said.

Two days before the readmission order, the American Health Care Association and the National Center for Assisted Living raised concerns over New York’s order that mandated nursing homes to accept patients discharged from hospitals, regardless of their COVID-19 status.

At the time, New Jersey nursing homes were “often hesitant or outright refused to readmit residents” after they went to the hospital to be treated for COVID, the report said.

The March 31 order told nursing homes to readmit patients that were deemed “medically stable” by a doctor. Persichilli held a teleconference that same day with some nursing home administrators and said the order “was contingent upon facilities having adequate PPE, sufficient staffing, and the capability to isolate COVID-19 positive patients,” the report said.

But some administrators “interpreted the directive as a mandate” to allow all residents back.

On April 13, the Health Department issued a directive rescinding the prior order and directed nursing homes to take back COVID-positive residents only when they were able to “effectively cohort residents,” the report said.

The situation “underscores the need for clear communication strategies and strong coordination among healthcare facilities during public health emergencies,” the report concluded.