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Rural Alaska

As a different respiratory illness hits rural Alaska, RavnAir’s policy to disallow Alaskans with symptoms from flights leads to challenges

An aerial view of Bethel, Alaska on Saturday, Jan. 21, 2017. (Loren Holmes / ADN)

Update, 3 p.m. Friday: In a statement Friday, RavnAir spokeswoman Debbie Reinwand said the air carrier’s “number one priority is the safety and health of all of our passengers and employees, and that will will continue to be the case as we serve all Alaskans and the communities where they live.”

The company’s policy, enacted on March 16 based on federal Centers for Disease Control guidelines, is that “if any passenger — infant, child or adult — is presenting symptoms associated with COVID-19, and the passenger does not have a doctor’s note, they are not allowed to fly on our planes,” Reinwand said.

Reinwand said that was why the two infants “who were exhibiting COVID-19 type symptoms” were not allowed to fly to Bethel.

According to Reinwand, the carrier had notified the Yukon-Kuskokwim Health Corp. that if the agency could assess patients using telemedicine and provide them with doctors’ notes saying the patients are believed to have RSV and not COVID-19, then the patient would be allowed on a RavnAir aircraft “as long as they put a mask on and did not fly on a normally scheduled flight with other passengers – because they would not be able to keep a six foot distance away from others, and a telemedicine diagnosis is not a definitive means of confirming the absence of COVID-19.”

Dr. Ellen Hodges, medical chief of staff for the YKHC, said she did not agree to put patients on charter flights with RavnAir because that is not workable for her organization.

Hodges said many of their patients are Medicaid recipients. Medicaid will reimburse for commercial flights, but not charter flights.

Hodges said RavnAir executives said they were willing to negotiate price on charter flights, but no numbers were discussed.

So far, RavnAir’s screening program has prevented almost 40 passengers seen as being at risk or showing signs of illness from flying, Reinwand said.

“During this global pandemic, RavnAir Group has focused on the safety and health of the Alaskans we carry and the communities we serve,” she said.

Original story: Amid the global coronavirus pandemic, some rural Alaska villages are coping with an outbreak of a different respiratory illness called respiratory syncytial virus, or RSV. But as a precaution due to the coronavirus crisis, the airline RavnAir Alaska has stopped transporting patients showing signs of respiratory illness on their commercial flights.

Dr. Ellen Hodges, medical chief of staff for the Yukon-Kuskokwim Health Corp., said that decision could be “disastrous.”

Hodges said the Yukon-Kuskokwim Delta is enduring one of the largest RSV outbreaks in a decade. RSV is a common respiratory infection among infants and toddlers. Hodges’ hospital in Bethel serves as the medical hub for the Y-K Delta, a 55,000-square-mile expanse where 25,000 Alaskans live in 48 communities.

“We average over 300 ambulatory patients per month from 50 different villages, and they all commercially fly to Bethel and Anchorage for urgent treatment that doesn’t require a medevac,” said Dan Winkelman, the Yukon-Kuskokwim Health Corp.'s president.

Winkelman said there are only two options: “Commercial flights either continue to operate with ambulatory patients throughout rural Alaska, or two, the governor has to order the National Guard to activate aircraft and station them in every hub from Dutch (Harbor), Bethel, Dillingham, Nome, Kotzebue and Utqiagvik.”

On Wednesday, two infants with suspected RSV were denied seats on a RavnAir flight bound for Bethel, according to Winkelman and Hodges. RavnAir told the health corporation they would no longer fly patients with respiratory illness, Hodges said.

A spokeswoman for RavnAir did not comment for this story, but pointed to a March 17 policy on its website, saying it was implementing “verbal screening” of all passengers and employees in an attempt to keep people infected with the coronavirus from traveling on its planes.

Winkelman said they have patients fly on RavnAir daily, so he didn’t understand why none were stopped until Wednesday.

Over the course of the day Wednesday, Hodges had phone conversations with RavnAir, Winkelman said. On Thursday morning, the airline said they had a compromise: Patients suspected of having RSV or another respiratory illness could charter a plane to get to Bethel.

“We’d go broke by summertime trying to pay for charter flights that would cost $1,000 to $5,000 each,” he said.

The Yukon-Kuskokwim Health Corp. uses three air carriers; RavnAir, Grant Aviation and Yute Commuter Service. There are only a few places where all three carriers fly, so the Y-K Delta medical infrastructure is heavily reliant on all three to get patients to the regional hospital in Bethel.

Hodges said RSV causes inflammation in the airways, which for adults isn’t a big deal. In infants, the airways “narrow too much, and they can’t breathe well,” she said. "That’s why RSV is such serious illness among infants.”

This year, there were so many extreme cases of RSV that infants from the Y-K Delta filled intensive care unit beds at Alaska Native Medical Center in Anchorage. Infants had to be placed in the ICU at Providence Alaska Medical Center, which also filled up, Hodges said.

Winkelman said a round-trip ticket from a nearby village to Bethel costs a couple hundred dollars, and can be as much as $800 for a far-flung village.

Winkelman said he’s worried that Grant Aviation and Yute Commuter Service will follow RavnAir’s policy change. Spokesmen for the two air carriers said at this time, there’s no change.

Cliff Bergeron at Grant Aviation said as of Thursday, Grant would have flown the two babies to Bethel.

Any patients flown in would have to be tested for and cleared of COVID-19 before being flown back to their village, Bergeron said.

“That’s not really us, that’s mandated by the villages," he said.

Winkelman and Hodges said transporting ambulatory patients in commercial flights is critical. There are not enough resources to medevac patients.

“That’s not possible,” Hodges said. “There aren’t enough medevac planes probably in a five-state area to do this.”

Winkelman said he and his staff have not responded to RavnAir since hearing they would only allow chartered flights for respiratory patients.

On Wednesday, Winkelman joined the Lower Kuskokwim School District, Yuut Elitnaurviat, the Association of Village Council Presidents and the Bethel Native Corp. in penning a letter to Gov. Mike Dunleavy, asking him to help rural Alaska deal with the COVID-19 outbreak.

They called on Dunleavy to impose a statewide shelter-in-place order, and asked that he work with Alaska’s congressional delegation to secure as much as possible from the $2 trillion stimulus package moving through Congress for Alaska’s air carriers.

Winkelman said the inability to transport RSV patients to a hospital is a problem that needs to be fixed quickly. Others are on the horizon, and they will also need National Guard resources, he said.

“Once COVID arrives, we will need the Guard here, for sure,” Winkelman said.

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