New Jersey Gov. Phil Murphy on Saturday announced a statewide “stay at home” order, closing nonessential retail businesses and asking residents to stay home until further notice. The order prohibits gatherings and asks individuals to practice social distancing.
“We know the virus spreads through person-to person contact,” the governor said in a news release, “and the best way to prevent further exposure is to limit our public interactions to only the most essential purposes.”
Each state provides for certain exceptions, such as visiting grocery stores, pharmacies or healthcare facilities, among others.
“Every state will head this way,” CNN national security analyst Juliette Kayyem said Friday. “People need to prepare themselves that this gets harder before this gets easier.”
President Donald Trump did not anticipate issuing any nationwide stay-at-home orders, he said. Days earlier, the federal government issued “15-day pause” guidelines asking Americans to avoid public gatherings with more than 10 people, among other suggestions.
The “pause” may last longer than 15 days, the US Centers for Disease Control and Prevention, or CDC, said in its own guidelines.
One federal plan obtained by CNN includes preparations for a pandemic that could last 18 months or longer and include “multiple waves of illnesses.”
Cases climb as more are tested
There were at least 22,397 confirmed cases as of Saturday in the United States — a number that has soared as testing became more available. At least 278 people have died.
Nearly half are in New York state, where there are 10,356 confirmed cases, Gov. Andrew Cuomo said. A majority, 54%, were people between the ages of 18 and 49, the governor said.
More than 195,000 Americans have been tested, Vice President Mike Pence told reporters in a White House briefing. That total does not include county hospitals or health care labs, the vice president said.
The White House doctor determined there was no reason to believe Pence was exposed, but Pence will be tested “given the unique position that I have as the vice president and as leader of the White House coronavirus task force,” the vice president said.
In a strategic shift, New York City and Los Angeles County health authorities recommended this week that health care providers avoid testing patients except in cases in which a test result would significantly change the course of treatment.
Guidance from the Los Angeles County Department of Health, dated Thursday, said testing at public health labs would prioritize patients with symptoms, health care workers, residents of long-term care facilities, paramedics and other high-risk patients. Others were encouraged to simply stay at home.
The recommendation reflects a “shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” the guidance said.
Guidance from the New York Department of Health directed health care facilities to stop testing non-hospitalized patients in an effort to preserve dwindling medical supplies.
“At this point in the pandemic, demand for unnecessary testing is contributing to the rapidly diminishing supply of PPE and leading to a decreasing supply of swabs and viral transport media used to collect diagnostic specimens for COVID-19 testing,” the guidance read. “Testing may play a more significant role after the pandemic has peaked.”
Makeshift masks and hospitals
But as numbers climb, health care workers and state leaders have sounded the alarm on medical supplies beginning to run short.
In New York City, now the epicenter of the outbreak in the US, Mayor Bill de Blasio called on Trump for help and said supplies may only last for the next few weeks.
“I said very clearly that for the month of March, we have the supplies that we need, the city has very strong reserves of the kind of supplies that I talked about,” he said. “It is going into April that I’m worried about. I don’t have the perfect day for you. We’re assessing all the time, but it is a day — two weeks from now or three weeks from now — where we must, by then, have had a very substantial resupply.”
That includes reusing masks, as well as using “homemade ones” from materials like bandanas and scarves.
Hospitals have already reported they’ve had to get creative with how to make more masks and make them last longer.
Some have moved to makeshift hospital facilities, too, with one Washington state community getting ready to open a 200-bed hospital on a soccer field. And de Blasio said his city will use “every building we can … to become essentially annexes to hospitals.”
“Supplies are a major issue — (personal protective equipment), gloves, gowns, mask suppliers,” Cuomo said Friday. “I am now asking all product providers, all companies who are in this business, we will pay a premium for these products.”
Some facilities, including in New York, also have drastically upped their orders for ventilators. Michael Dowling, president and CEO of the Northwell Health, was picked by New York’s governor to lead a hospital surge team. He said he wants to purchase as many as 500 ventilators, which can cost $20,000 to $40,000 a machine.
US is unprepared, experts say
The coronavirus outbreak in Italy — where there are more hospital beds per 1,000 people than the United States — could signal a lack of preparedness in the US, according to commentary published this week in the New England Journal of Medicine.
“Though Italy’s health system is highly regarded and has 3.2 hospital beds per 1,000 people (as compared with 2.8 in the United States), it has been impossible to meet the needs of so many critically ill patients simultaneously,” Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital in Boston, wrote in the piece.
The US is “two months too late” in preparing, one expert told CNN earlier this week.
“I really think this is a fundamental responsibility of government to have acted on this a long time ago,” said Dr. Eric Toner, who studies hospital preparedness at the Johns Hopkins Center for Health Security.
Staffing shortages will likely come even before equipment starts to run out, said Dr. David Hill, a pulmonary critical care physician and a spokesman for the American Lung Association.
“Part of it is just exhausting our personnel. Health care is complicated and people make mistakes when they’re overworked,” Hill said.
If health care workers get sick, “everything can fall apart very quickly,” says Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.
Hotez is “especially worried now about our health care providers because we’re starting to see those individuals become sick as well and be taken out of the workforce, or in some cases become seriously ill. So here’s where everything can fall apart very quickly,” he said.
To combat a possible shortage, Georgia officials are moving to expedite licensing for nursing professionals who come in from other states to help stem the spread of the virus, Secretary of State Brad Raffensperger said.
“Fighting, defeating, and overcoming coronavirus in Georgia and across the country will require enlisting the help of the best and brightest medical professionals available,” Raffensperger said in a news release.
And in New York and Connecticut, state leaders reached out to retired doctors and nurses to request help.
CORRECTION: A previous version of this story incorrectly stated Connecticut residents could be fined for choosing to ignore Gov. Ned Lamont’s executive order asking nonessential workers to stay home.
CNN’s Dianne Gallagher, Ben Tinker, Athena Jones, Mark Morales and Michael Nedelman contributed to this report.