In the Yukon-Kuskokwim Delta, where coronavirus cases are surging and health care capacity is limited, villages are contending with life in lockdown and how best to control the spread of virus.
Over the last three days, the regional tribal health organization, Yukon-Kuskokwim Health Corp., identified 237 cases across the region: 67 on Thursday, 92 on Wednesday and 78 on Tuesday. Before Tuesday, daily case counts reported by YKHC numbered in the single digits and teens.
Particularly hard hit is the village of Chevak, where a total of 148 people had tested positive by Thursday evening.
Chevak residents accounted for 38 of the 67 cases announced Thursday, but there were also 15 cases in Quinhagak, 10 cases in Bethel and four cases other villages in the region. Around six COVID-19 patients were taken to Anchorage by medevac to receive “more advanced care" earlier this week, according to Tiffany Zulkosky, vice president of communications at YKHC.
The Yukon-Kuskokwim cases amounted to half the total cases reported statewide on Thursday, a striking statistic given the relatively low population numbers in the region compared to urban centers. The region currently has the highest daily average case rate over the last two week with 62.17 cases per 100,000 people. For comparison, the northwest region of the state has an average of 35.41 per 100,000 and Anchorage follows with 34.88.
The outbreaks in rural parts of the state are concerning because of limited access to health care along with multi-generational homes where the virus spreads more easily and limited testing supplies, according to state epidemiologist Dr. Joe McLaughlin.
There’s no intensive care unit at the hospital in Bethel, so people with more severe illness or injury must be medevaced to another part of the state.
Since health care resources in rural Alaska are “pretty thin" to begin with, it could get difficult to transfer patients for care if rising case numbers translate to more hospitalizations, according to Jared Kosin, president and CEO of the Alaska State Hospital and Nursing Homes Association.
“It’s very concerning and we’re all trying to constantly coordinate with each other,” Kosin said during a Thursday media briefing.
Generally, the state’s hospitalization rates have been holding fairly steady and mortality rates declining, Dr. Anne Zink, the state’s chief medical officer, said at the briefing.
Despite the number of cases in the Yukon-Kuskokwim region, there “hasn’t been a significant need for hospitalization at this time,” Zink said, even though some smaller communities have been experiencing outbreaks since August.
The Alaska Department of Health and Social Services is sending a strike team to one of three villages in the region experiencing a COVID-19 outbreak, officials said. They didn’t identify which one.
An ongoing public health crisis
Bethel is the main hub community in the Y-K Delta, a sprawling region in Western Alaska dotted with dozens of villages not connected by roads. The population of the region is largely Yup’ik.
Roughly 60% of households in the Y-K Delta do not have running water or sewer, according to the Yukon-Kuskokwim Health Corp. chief of staff, Dr. Ellen Hodges, who is overseeing the region’s response to the pandemic. That presents challenges when it comes to sanitation, Hodges testified at a state House Health and Social Services Committee hearing this week.
“You might imagine that if you had to pack every single ounce of water into your home to use it for hand washing, it might decrease the number of times you wash your hands," Hodges said.
The lack of running water was a public health crisis even before the pandemic, she said, but with the added burden of quarantine, it can be hard to go out to get water. Many villages have used CARES Act funds to hire workers who can help those who need it.
YKHC has also given villages instructions for using industrial chlorine, typically used in water treatment plants, to safely help people sanitize at home.
Tribal health officials urged people to avoid gatherings, maintain proper social distancing, wear a mask in public and regularly wash their hands — among other public health recommendations — as a “dramatic surge in COVID-19” continues within the region.
Life in Chevak: Continued testing, remote learning and a community mindset
In Chevak, where nearly 14% of a population of just over 1,000 people tested positive this week, community leaders held an emergency meeting recently to address the recent rise in cases.
“We’re getting help from our health officials and from the state to help us go over what needs to be done in our community,” said Richard Tuluk, mayor of Chevak.
More than 700 tests have been completed in the village so far, he said, and the plan is to continue testing throughout the week.
“The information we got (then) was that our cases might not have been travel related, which meant (the virus) might have been here a long time,” Tuluk said, explaining that this information was what prompted the decision to conduct widespread testing.
The school in Chevak has been conducting distance learning since Oct. 7, said David Lougee, Kashunamiut School District superintendent in Chevak. Remote learning began a day after a student reported showing symptoms of the illness.
The student later tested positive, he said.
Only a few of Chevak’s 329 students have internet access at home. So, teachers are using Facebook to reach them. One math teacher is sending out word problems on the platform and even parents are helping to answer them, Lougee said.
“They’re kind of fun to do and then she gives you feedback if you’re getting it done right,” he said.
Some teachers are videotaping their lessons as they would in class. And teachers are also following up with phone calls to students.
But they’ve temporarily stopped sending homework packets home until they can figure out a safer way to do it, he said.
Nonetheless, Lougee said they’re improving and haven’t been very affected by the lockdown.
“We haven’t missed a beat for educating kids,” Lougee said.
For locals who are quarantining or isolating right now due to positive test results, the village is providing free delivery of food and water from the village store, Tuluk said.
“Right now we’re developing how to keep providing those services,” he said.
Tuluk said that felt hopeful that Chevak would be able to get through the outbreak, just as others have.
“There’s been other cases in other villages,” he said. “And they’ve gone through their protocols, and to my understanding, they’re coming out (of this).”
He had a message for others contending with the virus: “They need to respect their communities and listen to their leaders on these mandates,” he said. “Take this seriously.”
Rapid response and villages on lockdown
As of Thursday, there were at least five villages in the region — including Chevak— currently on lockdown, said Zulkosky, with the health corporation.
The decision on whether to go into lockdown is always made on the local level, she said.
While every village clinic in the Y-K Delta has the resources to do COVID-19 testing, “it’s not necessarily on the level of being able to do a community-wide sweep,” she said.
That’s where the health corporation’s village rapid response team comes in, Zulkosky said.
Typically made up of a provider, contact tracers and lab techs, the small teams are deployed to affected villages to do community testing. The decision on whether to send out a team is based on current risk level within the community, whether the timing makes sense, and where there’s most need.
The rapid response team has been sent out to multiple villages in the region in recent weeks. Zulkosky said that on average, when the corporation does community-wide testing with its rapid response teams, “we’re seeing 50-60% of the community opting to be tested.”
There have been a couple of outliers like Chevak and Toksook Bay, where a higher percentage of people have opted in for testing. In Chevak, over 70% of the community has been tested so far.
There’s another team flying out on Sunday to Chevak to do some additional testing, Zulkosky said.
Earl Atchak, 55, a longtime resident of Chevak, says ultimately life hasn’t changed too much nearly a month into the community’s lockdown.
“The sun is still out there, the moon,” he said. “Everything is still the same.”
With socializing limited, the evenings do seem quieter, Atchak said.
“It’s bringing us back to the 1970s,” he said. “To simpler times.”
Overall, one of the most challenging parts of the pandemic has been the limitations on travel outside the village, Atchak said. He’s only been able to communicate electronically with his grandchildren, who live in Hooper Bay.
“It’s not the same as when you can you see them breathe,” he said.
Zulkosky emphasized that while health corporations like YKHC can do everything they can to help with the community response, “it’s really up to individuals in our communities, all of our residents, doing their part every day to help stop transmission of the virus."
“So we really just encourage everyone to hunker down for the next couple of weeks," she said, “to try to help turn the tide and spread of this really pernicious virus.”