For the first time since the coronavirus pandemic began, Alaska health care officials are publicly estimating the number of ventilators and ICU beds in the state. They caution the numbers are in flux and estimates are incomplete as hospitals work to increase capacity.
The virus that causes COVID-19 attacks the lungs and airways, and ventilators can be used to keep the most seriously ill patients alive and breathing. Intensive-care unit beds have sophisticated equipment and more health care workers per room to treat dangerously sick patients.
Alaska chief medical officer Dr. Anne Zink said on Thursday that there are about 200 ventilators in Alaska. That includes machines used primarily or exclusively on children, those designed for travel and some in surgical centers that could be adapted for coronavirus patients. Zink did not say and the state health department has not officially provided estimates for the portion of ventilators that would be immediately available for use by COVID-19 patients, if known.
At least 122 of Alaska’s available ventilators are in Anchorage, said Municipality of Anchorage spokeswoman Audrey Gray.
The number of ICU beds is similarly low, about 160 statewide according to the state and an Alaska hospital association, but is expected to grow as more hospitals report their numbers or convert beds for emergency use. At Alaska Regional, for example, the hospital is converting the ambulance bay into a room that could be used to treat coronavirus patients without contaminating others. Zink said Thursday that there are about 2,000 hospital beds overall across Alaska.
Meantime, the ongoing disruption to everyday life — lost wages, village travel bans, self-quarantines — is meant to slow the spread of the virus and avoid overwhelming these limited health care resources across Alaska.
“We can’t get enough beds, enough vents, enough people if we don’t socially distance,” Zink said, emphasizing that the state is working with hospitals and tribal health organizations to increase capacity for patients.
“All of the predictions show that the current infrastructure in Alaska, alone, is not going to be enough to handle this disease,” Zink said. “That’s why we are actively looking at our resources, our federal resources and creating additional resources here.”
The Alaska Department of Health and Social Services is working to count the ventilators, relying on reports from hospitals around the state, Zink said. That reporting has not been mandatory, making it difficult to create a snapshot of health care capacity on any given day.
In Anchorage, Alaska Regional Hospital has 39 ventilators and 17 “negative pressure rooms” with plans to convert a unit of the hospital to add five or six more, said spokeswoman Kjerstin Lastufka.
Negative pressure rooms have air circulation systems designed to isolate the room’s air from other parts of the hospital and prevent the spread of illness. Alaska Regional transformed the ambulance bay into one large such room, capable of treating up to 18 patients, Lastufka said.
“We have been focusing heavily on our surge plans,” she said. “We are in the process of transforming our Rehabilitation Unit into an area that will accommodate 15 patients with a combination of private rooms that were previously offices, and turning our rehab gym into an area for up to seven patients.”
It was unclear Friday how many trained ventilator operators are available statewide to meet a potential rise in demand. Also unknown as of Friday: How many ventilators are off the road system, including rural hubs that serve incoming patients from surrounding clusters of villages?
Norton Sound Regional Hospital in Nome has 11 ventilators on hand to serve the city and 15 villages with a combined population of 9,700, said spokeswoman Reba Lean.
The Yukon-Kuskokwim Health Corp., one of the largest rural health care providers, has five ventilators with “a few on order,” said spokesman Mitchell Forbes. The Bethel-based provider serves about 23,000 people in dozens of villages in Western Alaska but has no ICU beds.
Some regional health care providers such as Arctic Slope Native Association, based in Utqiagvik, and Kotzebue-based Maniilaq have not responded to Daily News requests for the number of ventilators and intensive-care beds in their regions.
Zink had previously declined to quantify the estimated or minimum number of ventilators in Alaska, saying on Wednesday that many ventilators were currently in use at hospitals. In Oregon, population 4.2 million, the state health authority reports 684 available ventilators statewide.
Alaska’s vast geography heightens the challenge here. Many villages cannot be reached by road. On Friday Gov. Mike Dunleavy said that in some cases the National Guard might be used to fly village patients to treatment by helicopter.
In Western Alaska, an outbreak of respiratory syncytial virus (RSV) could add another degree of difficulty.
“Sometimes when there are high levels of respiratory syncytial virus in children the number of ventilators for children can run very low,” said Clinton Bennett, Alaska Department of Health and Social Services spokesman. “If this can happen in years when the world is not battling a pandemic, then add COVID-19 and this turns into another reason for why we need to flatten the curve and take other measures to prevent/mitigate this virus.”
The state health department earlier this month would not quantify the number of ICU beds in Alaska, saying that number is also in flux and can be expanded during emergencies. But the most recent count by the Alaska State Hospital and Nursing Home Association estimated 160 ICU beds in Alaska. Association president Jared Kosin said that is a “rough” count and does not include one military hospital.
Bennett on Friday said the state health department agrees with that estimate for ICU beds but emphasized it does not tell the full story of bed capacity statewide: “That does not accurately reflect how many places would be able to care for ICU patients in the case of a surge in COVID-19 cases. Also, as mentioned, you need people to be able to staff ICU beds.”
Kosin said countless factors influence the true capacity of the health care system on any given day.
The hospital association, which represents more than 65 hospitals, nursing homes and health care organizations, is working on a more precise count of ICU beds and other available hospital beds across the state, Kosin said. The association plans to provide that information on a daily basis to the Alaska Department of Health and Social Services to assist in statewide coronavirus planning and response.
“You’re gonna see beds open, beds occupied (in the coming data),” he said. “But in terms of understanding what each hospital can actually handle, that report comes up short because you are not factoring in variables like available staffing and patient acuity. For example, only each hospital knows if there will be holes in staffing schedules for shifts later that day.”
If the virus were to spread quickly, Alaska would not currently have the staffing and equipment to handle demand to treat the most serious cases, he said. “If it hits all at once, we are going to have a major problem.”
Daily News reporter Morgan Krakow contributed to this story.
The Daily News has sought information on surge plans at individual hospitals -- how they would increase capacity for ICU patients for example, if necessary -- and on where testing for COVID-19 is occurring in rural Alaska. If you have information you would like to share confidentially with a reporter, email firstname.lastname@example.org.