With surging COVID-19 cases taxing capacity at Anchorage’s hospitals, one has opened an overflow unit and delayed some procedures and another has a temporary morgue at the ready.
Hundreds of medical workers are home sick from the virus or exposed to it, causing “major staffing issues” at hospitals in Anchorage where the state’s sickest patients usually end up, according to the state hospital association.
The risk of overwhelming the city’s hospitals and ICU beds prompted Anchorage Acting Mayor Austin Quinn-Davidson on Wednesday to announce a hunker down order limiting gatherings and business capacity and closing bars and restaurants to dine-in services for the month of December.
A number of physicians on a media briefing to announce the order described physically and emotionally drained medical workers contending with significant upticks in the numbers of COVID-positive patients.
Doctors said those patients are among the sickest in hospitals and can require care for weeks. Dr. Ryan Webb, with The Alaska Hospitalist Group, said staffing is the biggest problem facing Alaska’s “brittle” health care system right now.
Unlike counterparts in the Lower 48, Anchorage hospitals can’t call in temporary nurses from nearby cities or load patients into ambulances for trips to other large hospitals, Webb said. He described nurses pulling double shifts because the “pool of qualified nurses is so small.”
The number of COVID-19 patients coming to Alaska Native Medical Center increased by 30% last week and is averaging 30 a day, according to Dr. Bob Onders, the hospital’s interim administrator. Patients in critical care are up significantly. Alaska Native people are experiencing disproportionate rates of hospitalization, ICU care and death with the virus.
Increasing patient loads in Anchorage hospitals are delaying medevacs from rural Alaska and prompting unusual transfers from the Yukon-Kuskokwim region to Fairbanks instead of Anchorage.
ANMC has established a second COVID-19 unit, spokeswoman Fiona Brosnan said. It has also established an off-hospital care site for non-COVID patients: Quyana House, connected to the hospital and previously used as rooms for patients and escorts traveling into Anchorage for medical care from rural communities.
Providence, the state’s largest hospital, has increased capacity for COVID-19 patients and is prepared to increase it again in the future, according to spokesman Mikal Canfield.
Providence recently acquired a refrigerated trailer to use as a temporary morgue if necessary. The move came “in response to the recent rise in cases, hospitalizations and deaths statewide,” the hospital said in a statement. The existing morgue at Providence only accommodates two bodies at a time.
The hospital now has two units dedicated to COVID-19 patients, with a total of about 40 beds, in addition to an area within the ICU for treating patients with the virus who need more care.
Alaska Regional Hospital as of Tuesday had enough COVID-19 capacity at current patient levels and has plans to expand into other areas if necessary, a spokeswoman said.
There is no “bright line” that will indicate the state’s hospitals are overwhelmed, Jared Kosin, president and CEO of the Alaska State Hospital and Nursing Home Association, said in an interview Wednesday. He’d just spent nearly an hour on the phone with Dr. Anne Zink, the state’s chief medical officer, who was trying to gauge the pressure facing hospitals now.
Kosin said parts of the state’s medical system are in “dire” condition now and cracks are emerging in staffing, patient medevacs and pressure on the long-term care system.
A recent survey revealed more than 530 medical employees out of work due to the virus. There’s no indication those numbers have changed significantly. At Providence, for example, there are roughly 90 employees out on any given day.
Delaying non-emergency, elective procedures is one way hospitals relieve pressure when capacity becomes limited.
As of this week, however, only Alaska Native Medical Center was delaying some elective procedures. The other two hospitals -- Providence Alaska Medical Center and Alaska Regional Hospital -- are not putting off procedures at this point.
“We have not reduced elective surgeries, but we do review hospital capacity and planned surgeries on a daily basis to assess our capacity to accommodate planned surgeries,” Canfield, the Providence spokesman, said in an email.
At Alaska Regional, the surgery schedule is actually “a little lighter than it would be otherwise” because some patients are choosing to delay procedures, according to spokeswoman Kjerstin Lastufka. Others had to cancel because they tested positive for the virus or have been exposed in the community and had to quarantine.
“In general, we are not reducing planned procedures, but we do closely review the surgery schedule on a daily basis and may delay, with the surgeon and patient’s approval, based on bed availability,” Lastufka said in an email.
No hospital is operating normally at this point, Kosin said. It’s difficult to plan too far ahead because patient levels could change quickly.
“This is really a moment by moment deal with the positive cases were seeing every day,” he said. “There’s no sign that is slowing down. I think that is the biggest concern.”