COVID-19 hospitalizations in New Jersey have hit a four-month high, as the virus spreads from younger infected people to older and more vulnerable residents.

But as the state enters the second wave of the pandemic, hospital leaders tell Gothamist/WNYC they’re much better prepared this time around: They have better treatment options, can recognize symptoms earlier to intervene, and have more access to testing.

“We know that this is a sneaky disease,” said John Ganter, president and CEO of Robert Wood Johnson University Hospital New Brunswick. “At this point, it's a different response because we know it better. What we don't know is -- is it all of a sudden going to overwhelm us?”

New cases have surged to levels not seen since May and statewide hospitalizations have more than doubled in the last month, averaging over 1,200 a day. On Monday, Governor Phil Murphy announced that over 1,300 people were currently hospitalized for COVID-19. Similar to the spring wave of the pandemic, hospitalizations are growing in the northern end of the state fastest.

The death rate, however, remains much lower than during the worst of the pandemic. For the last week, the state has recorded an average of 10 deaths a day, compared to more than 170 a day in the early days of May, when the hospitalization rate hovered around 4,000. At the peak of the pandemic, the state’s 71 hospitals reported more than 8,000 patients.

Health experts attribute an overall decline in the COVID-19 mortality rate to a variety of factors, including earlier detection and standardized treatment.

State data show hospitals in the north, which includes the state’s denser counties of Bergen, Essex and Hudson, have been hardest hit, with patient rates tripling since October. In the central and southern region, hospitalizations have doubled in the last month.

Gantner said at the peak of the pandemic, the hospital, which is located in Middlesex County close to Rutgers University, was treating about 250 COVID-19 patients at a time. Now, those numbers have hovered around 25, and they haven’t changed despite the rising cases in the surrounding community.

“Right now, it's still manageable,” Gantner said, adding that the hospital has treated more than 1,600 patients to date. “We have to understand that we can impact that surge, reinforcing messages of good behavior that will keep that surge down.”

Newark, the state’s largest city, is a different story. The city’s positive testing rate is around 12 percent -- and new infections account for more than half the cases in Essex County.

Dr. Shereef Elnahal, president and CEO of University Hospital in Newark, said the number of patients have tripled in the last two weeks. There are currently 30 COVID patients in the hospital.

“There are certain parts of Newark where spread is happening at particularly high rates,” Elnahal said, citing a 20 percent positivity rate in the city’s Ironbound section.

Elnahal said the hospital spent the quieter summer months stocking up on personal protective equipment, building their ventilator supply (from 40 to 100), training clinical staff and providing mental health services to their workers.

“A lot of staff have post-traumatic stress and some of them, in fact, are being triggered now because they're starting to see more cases in the emergency room,” he said.

Staffing remains his biggest concern. While University Hospital and other hard hit hospitals received help from the U.S. Army Reserve, traveling nurses and a volunteer medical corps, Elnahal worries whether those options will be as readily available when the second wave peaks.

“Staffing agencies were able to get folks who are willing to travel and come to New Jersey, including our hospital. That risk is much higher now that they won't be able to do that since the virus is surging pretty much everywhere,” he said.

And with several other states seeing a surge, “the entire country may be requesting the limited group of heroes who helped us, and so we're going to be competing with hospitals across the country for staffing.”

Listen to reporter Karen Yi's radio story for WNYC: