The coronavirus appears to be surging in North Jersey, as the state saw its highest number of deaths in one day and began trying to secure refrigerated trucks to hold the dead, state officials said Wednesday.

The state recorded 91 new deaths related to COVID-19, the disease caused by the coronavirus, and 3,649 new positive tests, Gov. Phil Murphy said. A majority of those deaths and positive tests were concentrated in Bergen, Essex and Hudson counties, he said.

"It looks like the surge is beginning to occur in the northern part of the state," Health Commissioner Judith Persichilli said during a briefing in Trenton. "We’re beginning to feel the real stress and strain on the critical care complement."

That strain includes the shortage of medications used to sedate patients who require a ventilator. Persichilli said she heard from one hospital in the north that "the volume that they have on the shelves is going low."

Persichilli had expected a surge to hit New Jersey around the middle of April. But seven hospitals in North Jersey were diverting patients Tuesday night because of overcrowding in their emergency departments or a high number of patients, she said. One of those hospitals had 80 people waiting for beds, she said.

And two hospitals requested ventilators, which are in low supply nationwide, but the state was able to provide them, she said. She did not name the hospitals or their locations.

North Jersey hospitals had more than 1,000 COVID-19 patients as of late Wednesday afternoon: 400 at Hackensack University Medical Center, nearly 200 each at Englewood Health and Valley Health in Ridgewood, more than 150 at Holy Name Medical Center in Teaneck, and 114 at St. Joseph’s Health’s two campuses in Paterson and Wayne.

Information from Bergen New Bridge Medical Center in Paramus, Hackensack Meridian Health Pascack Valley Medical Center in Westwood and St. Mary’s General Hospital in Passaic was not immediately available.

Murphy has secured an additional 850 ventilators from the federal government, he said Wednesday, but has requested another 1,650. And those could be "imperative," Persichilli said, if the state is unable to flatten the curve and spread out the number of critical cases over time to ease the strain on the hospitals.

The Health Department projects that half of COVID-19 patients will require ventilators, but Persichilli said she expects that figure to increase.

"We're comfortable as of this moment in time, but we need every single one of the ventilators that we're asking for, plus all other sources we can find in order to withstand the peak ahead," Murphy said.

"We are not where we need to be or where we'll have to be" in terms of ventilators, beds, protective equipment and health care workers, he added.

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North Jersey, and Bergen County in particular, has been the epicenter of the state's coronavirus outbreak since the first positive case on March 4. Of the 91 new deaths, Bergen County had 23, Essex had 22 and Hudson had 13, Murphy said. Those three counties accounted for the most positive cases in the previous day, he said.

As of Wednesday, there were a total of 355 deaths statewide related to coronavirus and 22,255 positive cases.

NJ hospitals feeling the strain

Hospitals have been feeling the stress of the pathogen's spread. Persichilli said last week she learned of a couple of North Jersey hospitals that "went on divert," or turned away ambulances from their emergency rooms, because they did not have enough health care workers in the ERs. And the state has asked for people with medical experience to volunteer to supplement a strained workforce of nurses and doctors.

The Health Department has been trying to get hospitals to increase their critical care capacity, from 2,000 beds to 4,000, and many of them have, Persichilli said. Most of those beds would need ventilators to care for patients with severe symptoms.

The state is also working with the federal government to increase health care capacity by building field hospitals and looking to reopen shuttered wings of hospitals to handle patients. Murphy is expected to tour the first field hospital, at the Meadowlands Exposition Center, on Thursday.

Hackensack University Medical Center was caring for 400 patients who had tested positive or were presumed to have the virus, with 115 of them on ventilators in critical care, said Dr. Daniel Varga, chief physician executive for Hackensack Meridian Health system.

Throughout the system’s 14 hospitals, there were a total of 1,700 patients with coronavirus on Wednesday, with about 400 of them in critical care units.

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As the epidemic progresses, patients are arriving at the hospital much sicker. “These folks already have substantial lung injury when they get here,” Varga said. “The severity of illness we see is just overwhelming. They hit the ED [Emergency Department] and they’re intubated.”

So far, the hospital has not run out of ventilators. In addition to about 360 standard adult ventilators, it is using repurposed anesthesia machines and bipaps, or bi-level positive airway machines, which are typically used to maintain a stable air supply in people with sleep apnea or chronic obstructive pulmonary disease.

“We’re going to try to use everything we’ve got before we go to co-venting,” or two patients sharing a single ventilator, Varga said. “We're really hoping to not end up there.”

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Holy Name Medical Center in Teaneck has purchased the supplies needed to split a ventilator between two patients, but “we’re hoping it’s an absolute last resort,” Dr. Adam Jarrett, the chief medical officer, said Tuesday.

The Teaneck hospital was on “divert” status for ambulances during parts of the day Tuesday and Wednesday because its critical care unit was full. It expects to add 40 critical care beds on Thursday, through a renovation of storage space. Another 50 critical care beds are to be brought online next week as conference space is renovated, Jarrett said.

So far, it has had enough ventilators to meet its patients’ needs, and has added to its supply through purchase and state allocation. When the new units open, Jarrett said, the supply of “beds is OK, but vents and nursing may be tricky.”

The hospital had 151 patients in the hospital with confirmed or suspected COVID-19 on Tuesday afternoon, 38 of whom were in critical care and on ventilators, he said. “Patients who go on vents with this disease are not on it for a day or two, he said. “They are on it for days at a time.”

In Paterson, St. Joseph’s Health announced Wednesday that it was reopening the former Barnert Hospital to add 154 acute-care beds and free up space at the main hospital to treat critical care patients.

The Valley Hospital in Ridgewood had nearly 200 COVID-19 patients on Wednesday.

State officials have relentlessly promoted the importance of social distancing, or keeping at least 6 feet from others and avoiding crowds. They have seen some payoff, but Murphy still expects state residents to be "hunkered down" under his stay-at-home order until at least May.

Had the state done "absolutely nothing," Persichilli said, it would be experiencing the surge "exactly today."

"We know that it’s not here today because on a statewide basis we are not feeling the same capacity issues in the central to the south part of the state," Persichilli said.

But that is no reason to ease up on the restrictions, the officials said. The state's plan to get refrigerated trucks because morgues are running out of room reflects the severity of the crisis ahead, Murphy said.

"The fact that we’re having this conversation — folks, this is real," Murphy said.

Staff Writer Ashley Balcerzak 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