The nurse was holding up. Then her 3 close relatives were brought in.
Twelve doctors at her hospital and the chief executive were sickened with the coronavirus. A colleague had died. Patients as young as 19 were being placed on ventilators.
But Michele Acito, director of nursing at Holy Name Medical Center, in the hardest-hit town in New Jersey’s hardest-hit county, felt like she was holding up.
Then her mother-in-law, sister-in-law and brother-in-law arrived.
The disease that has crippled New York City is now enveloping New Jersey’s densely packed cities and suburbs. The state’s governor said on Friday that New Jersey was about a week behind New York, where scenes of panicked doctors have gripped the nation.
Hospitals in the state are scrambling to convert cafeterias and pediatric wings into intensive care units. Ventilators are running low. One in three nursing homes has at least one resident with the virus.
At Holy Name in Teaneck, just across the Hudson River from Manhattan, two doctors are among the 150 patients being treated for the virus.
The ages of the 41 people on ventilators one day last week ranged from 19 to 90.
Twenty patients died in 72 hours.
One of them was Edna Acito, Michele Acito’s mother-in-law.
She had turned 89 on Thursday. It was a bittersweet day with a team of medical workers singing “Happy Birthday” from the hallway, just outside a modified door made from plastic sheathing and a zipper.
No visitors were allowed in. But the older woman’s nine children expressed their love through an iPad as Michele Acito held her hand. She died early Saturday.
“You compartmentalize,” Acito, 57, said. “You go home. You shower it off. But when you have a family member here, you can’t scrub that off.”
As of Sunday, at least 917 people in New Jersey had died of the virus, and 37,505 had been infected. New Jersey has the nation’s second-highest number of cases after New York.
“We’re eyeball deep inside the surge,” said Dr. Dan Varga, the chief physician executive at Hackensack Meridian Health, which runs Hackensack University Medical Center and 16 other hospitals in New Jersey.
On Friday, Gov. Philip Murphy ordered that all flags be flown at half-staff.
“Behave as though you’ve got it,” he said, adding, “It’s going to get worse before it gets better.”
Two hospitals notified state officials last week that they had run out of ventilators, the lifesaving devices that do the lungs’ work. One reported that it was nearly out of a medicine used to sedate patients on ventilators.
That same day, Murphy and New Jersey’s health commissioner explained the state’s provisional plans to move refrigerated trucks to some hospitals where the morgues were quickly filling with bodies.
“The fact that we’re having this conversation, folks — this is real,” said Murphy, who enacted a statewide stay-at-home order just over two weeks ago.
New Jersey’s fatality and infection rates are still dwarfed by New York’s, where, as of Sunday, more than 122,000 people had been infected and more than 4,100 had died. The virus appeared to be spreading fastest in Nassau and Suffolk counties on Long Island, where there were more than 27,000 cases, only about 10,000 fewer than in all of New Jersey.
The outbreak in New Jersey is most serious in Bergen County, the state’s most populous county. It has recorded 6,187 confirmed virus cases and at least 189 deaths.
Teaneck, one of the county’s biggest townships, has reported 421 cases.
Acito said she expected her sister-in-law and brother-in-law, who were not on ventilators, to fully recover.
She said that she considered it a blessing to be able to visit with her relatives in person. “We know how fortunate we, as a family, are to have me on the inside,” she said on Thursday.
With hospitals closed to most visitors, nurses are the lifelines connecting patients and their families. At Holy Name, iPads wrapped in clear plastic to shield germs offer some patients the ability to communicate face-to-face with loved ones.
“Our role is not only to provide all this care, under these circumstances,” Acito said. “It’s to be their advocate, their family member, their provider.”
She added, “There’s so much to do, but we don’t ever want to lose sight that it’s a person in that bed and, yes, they happen to be sick.”
Hackensack University Medical Center, about 6 miles to the west, reported the first virus-related death in the Northeast, on March 10. The man who died, John Brennan, is believed to have passed the virus to a relative of the Fusco family in Freehold, in Monmouth County.
The virus soon claimed the lives of four members of the large Italian American family: Grace Fusco, the 73-year-old matriarch, and three of her children.
Doctors at Hackensack University Medical Center are bracing for a surge in patients that is expected to last for weeks. The hospital’s cafeteria has been outfitted as a makeshift intensive care unit for 74 noncritical virus patients.
Murphy, a Democrat who has spoken frequently of his willingness to work with President Donald Trump to get supplies and funding needed to save lives during the outbreak, has stressed the state’s pressing need for more ventilators and personal protective equipment.
About 650 ventilators have been sent to New Jersey from the national stockpile, but many more are needed if hospitalization rates in the state continue to climb. Fourteen of the devices had either missing or nonfunctioning parts, state officials said on Friday.
Murphy has authorized the superintendent of the State Police to “commandeer” all available protective supplies — masks, ventilators, gowns and face shields — from private companies that may have stockpiles.
Hackensack and Holy Name officials said they had enough ventilators for now, but that could change rapidly.
Within Hackensack’s network of hospitals, anesthesia machines have been retrofitted to operate as ventilators for patients who do not need the highest levels of care, Varga said.
Still, both Hackensack and Holy Name vitally need medical professionals who are trained in critical care.
“We have beds,” Varga said, “but you have to be able to manage critically ill patients in those beds.”
Dr. Adam D. Jarrett, Holy Name’s chief medical officer, said he had been calling medical personnel he knows around the country to come help. The hospital has begun preparing to treat as many as 100 critically ill patients at once in one of four new intensive-care areas it created in the past few weeks.
New Jersey officials have also issued a plea for volunteers with medical training; as of Friday, 7,539 people had offered to help.
“Whenever you go to a busy hospital, the emergency department can go from busy to OK to frenetic,” said Jarrett. “We’re frenetic all the time now.”
Before last month, Holy Name had 14 negative-pressure rooms — areas designed so that air is not released into common areas, protecting patients and caregivers. It quickly built 136 more with material bought at home-supply stores.
Nursing homes throughout New Jersey are under their own particular strain.
More than a third of the state’s long-term health facilities have had at least one patient infected with the virus, and 83 deaths have been linked to the homes.
So many staff members and patients at St. Joseph’s Senior Home in Woodbridge got sick that the state temporarily closed it and moved nearly 100 patients to another long-term care center about a half-hour away.
Judith Persichilli, the state’s health commissioner, has announced new rules that require nursing home staff members to wear surgical masks at all times. Patients with fevers or coughs must be outfitted with masks during direct care and kept isolated on separate wings or floors.
Lisa Crowley, whose mother and stepfather live at the Paramus Veterans Memorial Home, said staff members had previously been told not to wear masks, to minimize fear among patients.
Almost all of her parents’ regular caregivers, she said, were home sick.
“Everyone we know isn’t here,” her mother, who is 82 and has Alzheimer’s, tells her each day, Crowley said.
All long-term care facilities in New Jersey have been closed to visitors for more than two weeks. The exception is final farewells to patients as the end of life nears.
The lockdown, the lack of information and the fear of the virus have made families feel helpless, said Laurie Facciarossa Brewer, who runs an organization that investigates claims of elder abuse and neglect in long-term care homes.
“We’re getting calls from them saying, ‘I feed my mom every day, and she won’t eat unless I’m there,’” Facciarossa Brewer said.
There are rays of hope.
Varga said the rate of hospitalizations had shown signs of slowing. During the week that began March 22, the number of patients at Hackensack Meridian hospitals went from 550 patients to 1,400. Last week, it climbed by only 400, to 1,800.
At Holy Name, Ashley Fitzpatrick, 32, was transferred from her regular nursing assignment, in the cardiac-catheterization unit, to assist with ICU patients. She has two small children, and she is self-distancing when she is not at work.
“My 2-year-old, he doesn’t understand why Mommy can’t pick him up,” she said.
Death surrounds the Holy Name nursing staff — as of Saturday morning, 48 patients had died since the hospital had its first confirmed case — but the crisis has also deepened the sense of camaraderie.
“We’re leaning on each other — hard,” Fitzpatrick said. Local restaurants and Girl Scout troops have continued to send meals and snacks.
On Friday, three patients had been deemed healthy enough to be removed from ventilators, Jarrett said.
“When there’s a victory, it’s incredible,” he said. “But it also means when someone doesn’t make it, it’s just devastating.”
Get Boston.com’s e-mail alerts:
Sign up and receive coronavirus news and breaking updates, from our newsroom to your inbox.