New Jersey is moving to reopen a hospital and add health care staff but could be short by upward of 300,000 hospital beds in the coming months, and doctors may be forced to make the "agonizing" decision to deny care to victims of COVID-19 if the state doesn't get federal help, according to state officials.

And in the next two weeks, Gov. Phil Murphy said, New Jersey could need an additional 2,000 hospital beds, about 200 of which would need ventilators, which are in short supply nationwide.

In a letter to President Donald Trump, Murphy asked for the U.S. military and Army Corps of Engineers to help broaden the capacity of the state's health care system and "rapidly expand" supplies of personal protective equipment and ventilators, which are used to treat certain victims of the coronavirus.

"It is clear that our health care system will be severely overburdened very soon," Murphy wrote in the letter sent Tuesday but not released by his office until late Tuesday night. "We are doing everything we can in New Jersey," he went on, "but we need help from the federal government."

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As of Wednesday, there were 427 positive cases of the coronavirus in New Jersey, including five deaths. That was an addition of 162 new cases since Tuesday, the highest single-day increase since the state had its first positive case on March 4.

"This is increasing with a pretty steep curve, as we expected," Murphy said during a Wednesday briefing.

The number of cases is expected to rise over the next several weeks as testing becomes more widely available, though Murphy has taken measures to slow the spread of the virus, such as ordering bars, restaurants and malls closed and asking people to adhere to a curfew.

He has also activated the National Guard to support statewide efforts such as distributing food and helping to open hospitals for an expected rise in patients.

A surge would overwhelm the hospital system in New Jersey. More than half of the state's 23,000 hospital beds are now occupied, which "appears to be a fraction of the capacity that will be needed" as the outbreak spreads, Murphy said in the letter.

Citing estimates from the Senator Walter Rand Institute for Public Affairs at Rutgers-Camden, Murphy said New Jersey could face a "peak shortfall" of anywhere between 123,000 and 313,000 hospital beds sometime between May and October. The Department of Health projects that another 2,000 critical care beds may be needed in the next two weeks. About 10% of those beds would need ventilators, Murphy said.

New Jersey has 1,983 adult intensive care unit hospital beds, about 16,400 medical surgical beds and more than 700 negative pressure isolation rooms, according to the state health commissioner, Judith Persichilli.

New Jersey's problem is emblematic of a national shortage. The United States has 2.8 hospital beds per 1,000 people, one of the lowest rates in the world — and fewer than Italy, where people have been left to die because the health care system has become so overburdened.

"Should these projections materialize in the coming weeks and months, doctors and health care employees in New Jersey may be forced to make the agonizing decisions that the world has seen in Northern Italy — they will have no choice but to deny lifesaving care, including ventilators, to those in need of it," Murphy wrote.

The White House responded Tuesday night, Murphy said, and a representative from the Army Corps of Engineers planned to visit Trenton to determine how to help.

In the meantime, state officials have started to identify areas where it can treat patients. Persichilli said an additional 250 beds were being prepared Wednesday — 199 in North Jersey, 11 in the central part of the state and 50 in the south. And Inspira Medical Center Woodbury in Gloucester County will reopen with a 300-bed capacity for acute care, she said.

Even though New Jersey is adding several hundred hospital beds, "these actions alone will not be sufficient," Murphy said in his letter to Trump. The Health Department is also looking at college dormitories, empty nursing homes and spaces under construction that can be outfitted with medical gases to become a "ward-type facility," Persichilli said.

In a conference call with hospital CEOs Monday night, Persichilli said, their biggest concerns were "adequacy of their workforce [and] number of critical care beds, followed very closely by the number of ventilators." The Health Department is conducting a survey to find out how many ventilators there in the state, she said at a briefing Tuesday.

The department, working with the state nurse's association, has also put out an alert for nurses with active or inactive licenses to respond to a "call to action," Persichilli said. She also signed a directive to allow certified intensive care paramedics to work in hospitals "to enhance and supplement the existing medical and nursing staff."

Murphy's letter to Trump follows a similar one written by New York Gov. Andrew Cuomo, in which he said, "Can we slow the spread of the disease to a rate that our state health care systems can handle? The answer increasingly looks like no."

On Wednesday, Cuomo said the floating hospital USNS Comfort, which has 1,000 beds, was en route and will dock at New York Harbor. Cuomo said at a press briefing that Trump has been "fully engaged." Murphy also thanked the administration for its "swift response to our request."

Staff Writers Ashley Balcerzak and Lindy Washburn contributed to this article.

Dustin Racioppi is a reporter in the New Jersey Statehouse. For unlimited access to his work covering New Jersey’s governor and political power structure, please subscribe or activate your digital account today.

Email: racioppi@northjersey.com Twitter: @dracioppi