New Jersey, nation ‘collectively failed’ to prepare for pandemic, long-awaited report says

A mammoth report into New Jersey’s handling of COVID-19 found that repeated breakdowns in communication, infection controls, and oversight at nursing homes and state-run veterans homes contributed to the widespread death New Jersey saw during the pandemic’s first wave.

The 910-page report drafted by law firm Montgomery McCracken Walker & Rhoads paints a picture of a state that was unprepared to weather a pandemic when New Jersey identified its first case of the virus on March 3, 2020, and continued to fumble its handling of the crisis in congregate settings like nursing homes and prisons, leading to some of the highest death tolls seen nationally during the virus’s initial surge.

“We collectively failed as a nation and as a state to be adequately prepared,” Paul Zoubek, the firm partner who led the review, told reporters Monday. “At the beginning of the crisis, our federal government failed to provide critical guidance as to the true nature of the COVID threat, which, in turn, delayed New Jersey’s response to the crisis. New Jersey quickly found itself at the epicenter of the crisis and was hit with a tsunami of cases, suffering horrific losses.”

Even worse, the report says, New Jersey is not ready for the next big crisis.

“Despite the lessons of the last four years, New Jersey remains underprepared for the next emergency. We owe it to those who lost their lives, and the families who suffered, as well as the heroic State workers and healthcare professionals,” the report says.

The state launched the review of its pandemic response in late 2022, fulfilling a promise Gov. Phil Murphy made early into the crisis. According to Zoubek, the review has cost taxpayers at least $4.6 million, with some more bills outstanding.

The governor was not present when Zoubek and others briefed reporters on the document Monday. Zoubek said the report was done independently of the governor’s office.

“I am proud that New Jersey is the only state in the nation to have completed this type of independent and comprehensive review,” the governor said in a statement Monday morning. “The report both highlights numerous examples of New Jersey’s strong leadership during the crisis, and identifies gaps in preparedness and structural deficiencies that must be addressed.”

Among a host of other recommendations, the report urges New Jersey to update its pandemic response plan for the first time since 2015, noting it risks a loss of institutional knowledge that could help it weather the next pandemic, and work to ease civil service rules that place limits on hiring and pay in emergencies.

The long-awaited examination of New Jersey’s pandemic response found the greatest breakdowns in two state-run veterans homes, pointing to failures in leadership that left the North Jersey facilities without functional oversight of infection control plans, waning confidence among staff, and policies that repeatedly exposed vulnerable residents to the virus when it was most deadly.

It found top administrators at veterans homes in Paramus and Menlo Park, who had no experience in health care or long-term care and have since been replaced, repeatedly floundered when trying to implement infection control measures ranging from basic guidance on handwashing to an effort to segregate residents with COVID-19 that led to more virus exposures after the Menlo Park facility failed to timely relocate asymptomatic residents.

“Menlo Park and Paramus, at the beginning, had soldiers running those facilities. They did not have clinical health care backgrounds … Also the facilities were old, the spread was very easy,” Zoubek said.

The troubles were compounded by a loss of confidence in leadership among the facilities’ staff after administrators in the two homes backed discipline for workers who wore masks. At the time, health officials faced a nationwide shortage of personal protective equipment.

The loss of confidence and the spread of illness led to staggering increases in employee call-outs, which jumped 480% in Menlo Park and 100% in Paramus, during the earliest weeks of the pandemic, exacerbating staffing shortages that had harried the facilities even before the crisis.

At least 201 residents died at the state’s three veterans homes, according to statistics maintained by the Department of Military and Veterans Affairs, though a previous Department of Justice investigation and the report released Monday found those deaths were likely significantly underreported.

More than 90 residents died at each of the veterans homes in Paramus and Menlo Park in April 2020 alone, the report said. The state’s posted cumulative death toll for the Menlo Park homes lists only 80 resident deaths, and Paramus’s lists just 95.

Long-term care

New Jersey’s long-term care facilities, where more than 16,000 died of the virus, were sorely unprepared to handle even a moderate outbreak, the report found.

A lack of funds meant the facilities could not hire additional staff or purchase personal protective equipment to meet the pandemic, and a nationwide shortage of virus tests in the first weeks of the crisis raised virus exposures that compounded existing staffing shortages.

“The result was more infection and death,” the report says.

The deficiencies were so severe that deaths in New Jersey’s nursing homes and other long-term care facilities outnumbered deaths among other New Jerseyans aged 65 and older by a margin of 10 to 1.

Many of the facilities faced the same problems as the veterans homes: A vulnerable population — cared for by too small a staff and under lacking infection controls and initially lax oversight — saw widespread death as the virus tore through high-density housing, all while a shortage of tests left the scale of the virus’s role unclear.

In part, some of the missteps were fueled by a nationwide lack of knowledge about the novel coronavirus in the early weeks of the pandemic, including officials’ rapidly shifting understanding of virus transmission and preventative measures, the report found.

A much-discussed March 31, 2020, state Department of Health directive ordered nursing homes to readmit residents who had tested positive for COVID-19 but physicians deemed stable enough to return. This caused confusion among long-term care operators who believed it was a mandate to admit COVID-positive patients, the report says.

The same order, which was paused two weeks after being issued, exposed a lack of capacity at the state’s nursing homes after more than 300 in late April reported they could not admit any more patients.

The report notes that the Department of Health’s efforts to expand capacity by adding more than 1,000 beds helped combat virus transmission within overburdened facilities.

School closures

The report found that New Jersey’s school closures and permissive attitude toward remote learning contributed to learning loss, and material conditions in poorer districts compounded existing disadvantages, thereby delaying a return to in-person schooling.

Like many states, New Jersey ordered its school facilities shuttered early in the pandemic, but its choice to let local school boards decide when schools would reopen for in-person instruction likely contributed to the expansion of its pre-existing achievement gap between urban and suburban schools, the report says.

Though New Jersey ordered all schools to move to remote settings for the final months of the 2019-2020 school year, the state allowed districts to determine their own format for the following school year.

Districts could return students to the classroom so long as they could seat them 6 feet apart, screen for the virus, disinfect surfaces, and add hand sanitizing stations, but not all schools could meet those bars.

“Schools were essentially given the green light to open if they could open and observe social distancing and other policies in the fall of 2020,” Ethan Hougah, a partner at the law firm, told reporters. “Some schools did, but you have a challenge in that certain school districts — particularly schools with older infrastructure, urban schools — they were not able to observe those social distancing measures.”

Students who attended remote classes fell behind those who could learn in person, and the material conditions in urban districts meant already disadvantaged students got the short end of the stick.

“Like many states, New Jersey entered the pandemic already struggling with an achievement gap between low-income students of color and wealthier white students,” the report says. “This gap became a chasm during the pandemic.”

Most schools stuck with virtual instruction at the start of the 2020-2021 school year, and the state lacked a method for accurately determining how the shift was affecting student achievement statewide.

Returning students to pre-pandemic achievement levels is expected to take years, the report says

“We should have given greater weight to the devastating impact of school closures and perhaps pressed harder for school districts to reopen in the fall of 2020,” Zoubek said.

Bright spots

Despite stumbles in its early pandemic response, New Jersey received plaudits for its vaccination campaign, which reached its target of immunizing 70% of eligible residents weeks ahead of schedule.

The report praises the state’s vaccine appointment tool and the coordination with vaccine manufacturers that helped it secure doses when shots were in short supply.

It notes the state had slashed vaccine hesitancy to among the lowest levels in the nation, from 10% in May 2021 to just 2% in December 2022.

The report notes New Jersey employed state and federal funds to create expansive rental, mortgage, and utility assistance programs, adding that state efforts to bring the services to residents who needed them most were largely successful.

Despite great focus paid to stumbles in paying out unemployment benefits, New Jersey actually filled such requests in a more timely manner than most comparable states, the report found.

In the second quarter of 2020, 79% of New Jerseyans who made a claim saw their first unemployment payment within 21 days, despite the incredible age of the state’s unemployment system, according to the report.

For comparison, New York paid 55% of its unemployment claims during that time period. Virginia, the only state that saw high mortality early in the pandemic to outpace New Jersey on timely unemployment benefits, paid 89% within 21 days.

Recommendations

In addition to updating its pandemic response plan and loosening hiring and pay restrictions, the state should mandate regular training for public health officials and ensure the pandemic response plan is regularly updated, the report says, adding regular training and drills would improve infection controls in New Jersey’s long-term care centers.

The authors recommended the Department of Health boost funding for survey teams that inspect long-term care centers to ensure quality and expand the teams that help operators of ailing nursing homes improve facility conditions.

Other recommendations call for the state to draft a roster of contractors that could provide personal protective equipment, staffing, and other services while loosening emergency procurement rules to allow larger no-bid contracts in a crisis.

The authors added that the state should shift more crisis decision-making to lower-ranking public health workers, noting that New Jersey’s top-down decision-making delayed some aspects of its pandemic response.