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Alaska’s isolation and the challenges of recruiting during a pandemic are hamstringing the ability of the state’s largest hospitals to staff intensive-care units as the state’s COVID-19 cases start to swell.
Hospital administrators here say that while they’re concerned about steep community spread, they’re not seeing unusual crowding in Anchorage ICUs — at least so far. The state’s sickest patients tend to end up at Providence Alaska Medical Center, Alaska Native Medical Center, and Alaska Regional Hospital.
There are about 75 beds for critically ill people in the city’s three hospitals, plus separate COVID-19 space and “surge” plans to create additional room if patient numbers spike. About 65 beds were full as of Thursday, according to municipal health officials.
Despite record resident daily case counts and high-alert levels in Anchorage, Fairbanks and Northwest Alaska, the statewide hospitalization and fatality rate remain relatively low. Many new cases are in younger people in their 20s and 30s who generally weather COVID-19 infections better than older people.
But the virus is already cutting into staffing and capacity levels in other ways that could leave the system vulnerable if the virus moves into older or more medically compromised people who end up in the hospital, needing critical care.
[Tracking COVID-19 in Alaska: 232 new cases of COVID-19 reported Saturday, no new deaths]
ICU recruiting is always challenging due to the specialized training required to care for critically ill patients, said Mikal Canfield, a Providence spokesman. It’s become particularly challenging during the pandemic due to supply and geography.
“The need for ICU nurses nationally in response to the pandemic has increased, which has made recruitment much more competitive,” Canfield wrote in an email. “This challenge is compounded here due to our distance from families outside Alaska, which is a disincentive for both travelers and permanent positions.”
‘The potential to really compound the problem’
Alaska’s unique health-care setting makes for unique issues staffing hospitals.
Under state recommendations to slow the spread of the virus from other places, nurses and other health-care workers must quarantine if they travel out of state. They also face potential exposures to the virus that force them out of work and into isolation.
[Hundreds of health care workers in Alaska have tested positive for COVID-19]
And the pandemic is making it harder to staff ICU beds for another reason: hospitals here say it’s a challenge recruiting ICU and critical care traveling nurses who fill in short-term staffing gaps around the country.
Instead of coming to Alaska, nurses staying in the Lower 48 where significant COVID-19 surges mean plenty of work. They’re also put off by Alaska’s travel-testing mandates that complicate any plans to visit with family Outside while working here, administrators say.
Hospitals can make internal adjustments including delaying non-essential surgeries, to move staff around, officials say. But that could fall short if the state’s surging coronavirus numbers translate into more illness.
“What’s different is that the pandemic has the potential to really compound the problem if we get a significant surge of hospitalizations,” Alaska Regional spokeswoman Kjerstin Lastufka said. “We are carefully managing our resources, and we strongly ask the community to help by continuing to do the things we know will slow the pandemic: wear a mask in public, wash your hands and keep circles very small."
Pressure mounting
COVID-19 patients tend to stay in ICU beds longer as they struggle to recover, health officials say. They can also require time-consuming levels of care.
Donna Phillips, an Anchorage critical care nurse with decades of experience, described the current ICU challenge as a combination of pre-existing staffing issues and new pressure from COVID-19 in terms of patients, travel restrictions and personal stress.
Nurses must don multiple layers of protection -- head cover, gown, masks, two pairs of gloves -- every time they enter a patient’s room, said Phillips, an RN who chairs the labor council at the Alaska Nurses Association. Often, patients must be rolled onto their stomachs to help their lungs recover, a maneuver that can require a team of health-care workers to make sure IV lines or breathing tubs aren’t yanked out.
The complications of Alaska’s geographic isolation also play into current staffing levels.
Phillips has aging parents and sometimes travels to help them. To go back to work after a visit, she needs a COVID-19 test at the airport, seven days off, then another test and negative results. Rapid tests at the hospital aren’t available for nurses, she said. The post-travel delay back to work is “absolutely” leading to staffing shortages.
Asked for her perspective on ICU capacity in the coming weeks, Phillips paused.
“I get asked nearly every day to work extra. That has gone on for weeks,” she said. “These nurses are trying to juggle children at home ... coming to work having all this pressure at work, maybe having to go in that COVID unit and work. At some point, people are like, you could pay me millions of dollars and it’s not worth it.”
Shifting numbers
The fall season tends to bring more hospital traffic and Anchorage ICUs are busy now, according to data from the Alaska State Hospital and Nursing Home Association. But ICU’s are not seeing a sudden spike in COVID-19 cases yet: the number of coronavirus-infected patients sick enough to need that level of care has at least so far stayed relatively constant in recent weeks.
The number of current overall hospitalizations for COVID-positive patients actually dropped slightly going into October, according to association president and CEO Jared Kosin. While hospitals and ICUs are busy right now, that’s only in part due to the added rigors of treating people with coronavirus, Kosin said. “COVID is an added pressure but just based on the numbers, it is not driving what we’re seeing today."
As of the second week in October, Anchorage hospitals were averaging 57 ICU patients per day, according to Kosin. There were 54 patients a day on average in September, 53 in August, and 56 in July. COVID-19 patients in ICU also stayed steady, he said: 9.6 so far this month and 9.1 in September.
Hospitals also tend to operate near capacity as much as possible, so it’s not unusual to have most of the unit in use, he said.
Providence has 37 beds in the ICU, according to Canfield. The hospital staffs beds based on planned procedures and projected emergency needs, he said. Providence has a surge plan if COVID-19 patients rise to the point they begin to threaten capacity.
Regional has 14 regular ICU beds, but COVID-positive patients are treated in a separate area with 19 additional beds, Lustafka said. That number isn’t concrete, she said, because if there’s a surge in the community and more beds are needed, the hospital has plans for that.
ANMC has 22 ICU beds, according to public records. Hospital representatives declined to specifically confirm that number. The capacity throughout the hospital, including in the critical-care unit, changes every shift, spokeswoman Shirley Young said. ANMC also has surge capacities.
The challenge right now, hospital representatives say, is making sure the public follows protocols to slow the spread of the virus as hospitals grapple with staffing challenges that can limit capacity.
“More hospital beds and more hospital staffing is not a solution that will stop the spread of COVID-19,” Young said.
It’s just not clear what’s to come, hospital and health officials say. Hospitalization rates don’t immediately show that people are starting to get sicker.
Municipal health officials have warned that models show COVID-19 cases could threaten ICU capacity by early next month if record case counts start translating to sicker patients.
“We remain concerned about hospitalizations and the ensuing need for ICU beds," Anchorage Health Department epidemiologist Janet Johnston said at a briefing Friday. “Keep in mind this is a lagging indicator, and something we need to watch.”