Alaska on Wednesday reported nearly 1,100 new cases of COVID-19, its highest-ever single day tally since the pandemic began, as hospitals under extreme stress struggle with difficult patient care decisions.
The new daily case record came a day after Providence Alaska Medical Center, the state’s largest hospital, announced that it was implementing crisis standards of care and rationing medical care — a worst-case scenario that forces providers to prioritize patients most likely to recover — in response to an overwhelming number of COVID-19 patients, a severe staff shortage, and limited resources.
And while Providence is the only hospital in the state so far to implement crisis standards, nearly all hospitals are struggling, and each is grappling with how best to respond to unsustainable patient levels, Dr. Anne Zink, Alaska’s chief medical officer, said Wednesday.
“They’re almost all at a crisis level right now,” she said. For smaller facilities, enacting crisis standards of care may not always make the most sense based on the types of resources and protocols already in place.
“Some (larger) hospitals have crisis standards of care committees that have already been set up, and they can kind of activate those, and other ones don’t, and they just make the best decisions they can,” she said.
Full hospitals affect all patients, not just those sickened with COVID-19.
“We’ve had increasing challenges accessing particularly things like (kidney) dialysis” and other similarly specialized care that is only available at a few hospitals in Anchorage, Zink said.
Zink heard from one clinician who spent nine hours trying to find a bed for a single patient.
Full hospitals in the Lower 48 have limited the state’s capacity to transfer patients to places like Seattle, as well.
While a national spike in cases driven by the delta variant has recently begun subsiding elsewhere in the country, Alaska’s case counts are still continuing on an upward trend and the state is currently recording some of the highest increases in both cases and hospitalizations in the country, Zink said. Over the last week, cases in Alaska increased by about 13%.
Alaska’s COVID-19 hospitalizations remained high, with 201 reported as of Wednesday afternoon, according to state data. Over half of those hospitalizations were concentrated in Anchorage, and included 34 people on ventilators.
Hospitals say those numbers are likely an undercount of the true impact of COVID-19, since they don’t include some long-term COVID-19 patients who no longer test positive but still need hospital care.
The majority of Alaska’s cases, hospitalizations and deaths have been among people who are unvaccinated. Between January and the first week of September, 81% of Alaska’s cases, 88% of all virus-related hospitalizations and 87% of deaths have involved people who were not fully vaccinated, according to state data.
Since July, hospitals across the state have described crisis-level staffing shortages and an overburdened system trying to provide care for higher numbers of COVID-19 patients and non-COVID patients alike. Smaller hospitals are struggling to transfer seriously ill people or scrambling to care for them in place.
Anchorage’s two other large hospitals are instituting new policies to address capacity problems.
As of Wednesday, Alaska Native Medical Center had not formally decided to implement crisis standards of care, spokesperson Shirley Young said. But the hospital’s resources are limited, prompting longer waits and delayed surgeries.
“The continued sharp increase of COVID-19 positive patients, mostly unvaccinated, require a higher level of care,” Young wrote in an email. “This means that patients who present for care at the hospital should expect a departure from the usual standard of care that we strive to deliver. This may include longer wait times, rescheduled elective surgeries and the use of alternate care sites.”
The hospital is “actively shifting staffing and resources” on a daily — sometimes hourly — basis to meet patient needs, she said.
Alaska Regional Hospital has also not shifted to critical-care mode, but the hospital decided Tuesday to prioritize the most critical cases for surgery, a spokesperson said. That will lead to postponed or rescheduled procedures for some patients.
Of the 1,095 new cases reported Wednesday, 1,068 involved residents and 27 involved nonresidents. The state’s previous record for the most COVID-19 cases reported in a single day was the 906 cases reported on Dec. 4, 2020. About half of Wednesday’s cases were from the Anchorage area, while Fairbanks, the Mat-Su and most of the Kenai Peninsula also reported high counts.
COVID-19 hospitalizations and deaths are considered lagging indicators, which means they typically follow a few weeks after surges in cases — signaling that hospitals aren’t likely to see relief anytime soon.
The state reported the COVID-19-related deaths of two men from Anchorage in their 60 and 70s on Wednesday. In an email, administrators from Fairbanks Memorial Hospital on Wednesday separately reported three new COVID-19 deaths, though it wasn’t clear how immediately those would be included in state-reported data.
Since March 2020, 453 Alaskans and 15 people from out of state who were in Alaska have died with COVID-19.
After assuming the title of most-vaccinated state earlier this year, Alaska on Wednesday ranked 35th per capita. By Wednesday, 62% of eligible Alaskans had received at least one dose of vaccine and 56.7% were fully vaccinated, according to state data.
State officials say continued high numbers of new cases are leading to backlogs in testing and contact tracing, both strategies used to limit the spread of the virus.
As of Wednesday, the state’s seven-day average test positivity rate — the number of positive tests out of total performed — was 9.6%, a new record high since the pandemic began. Health officials say anything over 5% indicates a need for more testing.
[Correction: A previous version of this story incorrectly reported the number of new cases Wednesday. There were 1,095, not 1,091.]