Alaska’s COVID-19 hospitalizations approached record territory Monday, just days after the state announced that crisis standards of care were activated for 20 health care facilities as the worst surge of the pandemic drags on.
A wave of new virus cases in the last several weeks — fueled by the ultra-contagious delta variant and stagnating vaccination rates statewide — has sickened enough people to put unprecedented stress on hospitals already contending with staffing shortages and limited resources.
On Monday, Alaska reported 2,235 new cases: 1,045 on Friday, 781 on Saturday and 409 on Sunday among residents, plus another 55 nonresident cases. Alaska’s per-capita case rate over the past seven days remains the highest in the country, according to CDC data.
A majority of the 31 health care facilities in the state (a total that includes hospitals and nursing homes) now have crisis standards of care activated, though the situation varies widely from place to place. The challenge of transferring patients from rural communities to outlying hospitals, and from those hospitals to busy Anchorage facilities, was a factor in the shift to crisis standards.
Crisis standards of care provide guidance and liability protection for health care workers operating with extremely scarce resources, and health officials continue to emphasize that people needing important care should still seek treatment at hospitals.
By Monday, 216 people were hospitalized with the virus statewide, just shy of the record set Sept. 24 when 217 COVID-19 hospitalizations were reported. Forty patients were on ventilators.
Roughly 22.5% of the state’s hospital patients had active cases of the virus, with likely more people still hospitalized but no longer infectious, and therefore not counted as COVID-19 patients.
The state also reported another COVID-19 death, involving a man from the Kusilvak Census Area in his 50s. Since January 2020, 558 Alaska residents and 21 nonresidents in the state have died with the virus. As of Monday, Alaska had the 13th highest seven-day per capita death rate in the country, according to CDC data.
Hospitals say they are near or at capacity due to short staffing and continued high numbers of COVID-19 patients who take longer to treat and, when severely ill, require unprecedented amounts of oxygen as well as dialysis equipment that can be hard to staff.
Alaska is one of the few states around the country to enable statewide crisis standards of care. Idaho did so last month. Crisis standards, when applied in a worst-case scenario, help doctors make difficult decisions to prioritize treatment for patients most likely to survive. They also provide legal liability protections for providers forced to adopt lower standards of care.
A number of hospitals implemented their own crisis standards prior to the state’s decision: Providence Alaska Medical Center, Alaska Native Medical Center, Fairbanks Memorial Hospital, Providence Kodiak Island Medical Center and the Bethel hospital operated by Yukon-Kuskokwim Health Corp.
Some hospitals are reporting that up to nearly half of their patients are COVID-positive.
A wide range of circumstances
The situation is fluid and changes from facility to facility and day by day, if not hour by hour, health care officials said this week.
• At the state’s largest hospital, Providence Alaska Medical Center in Anchorage, the intensive care unit is full. A triage team has consulted on roughly 10 decisions around how to prioritize care for patients, according to spokesperson Mikal Canfield.
• Bartlett Regional Hospital in Juneau, one of the 20 facilities on the state list, is “nowhere near re-allocating care for our patients” but the designation provides flexibility if that point comes, according to a statement Sunday night from chief nursing officer Kim McDowell.
Outpatient elective surgeries continue and surgeries that need a post-op hospital stay are assessed daily, hospital officials say. Bartlett has five infectious COVID-positive patients as well as recovered patients who still need “a large amount of resources and specialist care” for lingering effects of the virus, McDowell said.
• At Alaska Regional Hospital in Anchorage, the activation of crisis standards of care gives the facility flexibility in how to treat patients and use resources, according to spokesperson Kjerstin Lastufka.
Staff there have not had to start making decisions about how to allocate resources or treatment, Lastufka said in an email, and the hospital hasn’t made immediate changes to operations. The hospital’s 14-bed intensive care unit and six-bed ICU pod are near capacity, filled mostly with COVID-19 patients, Lastufka said.
• Mat-Su Regional Medical Center near Palmer is using 10 times as much oxygen as usual due to the demands of COVID-19 patients, according to emergency department director Dr. Thomas Quimby.
The hospital last week was running so short on ventilators that administrators had to request five from a state stockpile, and Mat-Su Regional is also struggling to obtain testing supplies, Quimby said.
But the hospital is “nowhere near having no resources for someone,” he said. “There is a plan in place.”
• At Kanakanak Hospital in Dillingham last week, several patients who needed high levels of oxygen were transferred out and a few lower-severity patients were transferred in, according to Jennifer De Winne, spokesperson for Bristol Bay Area Health Corp. A new state transfer center is helping coordinate patients moving between hospitals, De Winne said.
• Dr. Angelique Ramirez — chief medical officer for Foundation Health Partners, which operates Fairbanks Memorial Hospital — said the basis for last week’s decision to shift to crisis standards boiled down to an inability to transfer patients to other hospitals, which is stretching staff past their routine services, as well as the organization reaching capacity last week.
They’ve also had to restrict monoclonal antibody treatment, which has been shown to keep some people with COVID-19 out of the hospital, to those who are likely to benefit from the treatment most and are at highest risk for severe complications from the disease, she said.
While Ramirez said many patients may not see a change in care, some may now be denied access to monoclonal antibodies, have their treatment or surgery deferred, or be discharged from the hospital earlier than usual.
“This is not how any of us want to practice,” Ramirez said. “But at this particular point in time with the number of cases that we have in our community, and with the impact on our hospital capacity — the number of staffed beds, the number of staff we have, the resources that we have — this is what’s been required.”
Staff at the hospital are treating their youngest COVID-19 patient to date, who was just 14 days old on Monday and had pulmonary disease requiring steroid and antiviral treatment as well as oxygen, she said.
The state’s guidelines, a 40-page document called “Patient Care Strategies for Scarce Resource Situations,” includes instructions to help free up scarce equipment like ventilators or dialysis machines as well as recommendations to avoid crisis care in the first place.
Many larger hospitals also have their own guidelines as well as triage teams to help prioritize care if needed.
Capacity issues, and some relief
As of Monday, hospitals reported continued capacity issues, though only one was holding patients in the emergency department as they waited for beds to open up, according to Alaska State Hospital and Nursing Home Association senior vice president Jeannie Monk, who listened in on the daily hospital call with state health officials.
“Facilities are all continually evaluating, can they do surgeries that are non-emergent? That’s all being evaluated on a daily basis,” Monk said. “Some facilities are doing a few, some aren’t.”
Gov. Mike Dunleavy and Anchorage Mayor Dave Bronson have made it clear they will not enact new restrictions to curtail the spread of the virus.
Dunleavy last month announced several other measures intended to take pressure off the state’s strained health care system, including bringing in 470 federally contracted workers who began arriving last week to fill in for exhausted caregivers around the state.
“That will make a big difference in just the level of stress in the staffing,” Monk said.
On Monday, 9.5% of tests returned positive results based on a 7-day rolling average, which is nearly double the state’s target of a 5% positivity rate.
Of Alaskans ages 12 and older 63.4% had received their first dose of the vaccine Monday while 61.5% were considered fully vaccinated.
Correction: A previous version of this story misstated the number of new COVID-19 cases reported among residents on Friday in Alaska. There were 1,045, not 1,405.