Rural Alaska

The North Slope has some of the lowest vaccination rates in Alaska. Now, it’s seeing COVID-19 surge.

Over the summer, Daniel Thomas estimates he knocked on around 200 doors in communities on Alaska’s North Slope, trying to talk with every household about COVID-19 and vaccinations, “making sure that people get accurate information and stopping the spread of misinformation.”

Thomas works in Utqiagvik as deputy director of community health for the North Slope Borough, which organized the summer outreach effort. Unlike other rural regions of Alaska, the North Slope has some of the lowest vaccination rates in the state, and it’s seeing surges in places that appeared to be free of the virus until now.

As Thomas went door to door talking with residents about their hesitation to receive the vaccine, the biggest obstacle he encountered most frequently, he said, was misinformation.

“Maybe they read something that wasn’t true,” Thomas said. “That was a large majority. People just not having the facts, not having the science.”

Thomas spoke from his office in Utqiagvik, where the vaccination rate is 65.5% — on par with the rate in the Municipality of Anchorage but significantly lower than in other rural communities such as Nome, Kotzebue and Bethel, which are comparable hubs for transportation and medical services in each region’s web of small communities.

Other communities in the North Slope Borough have much lower vaccination rates.

Point Hope, on the Chukchi Sea coast, has some of the highest numbers of virus cases per capita in Alaska, and among the lowest rates of vaccination.

Just 31% of eligible Point Hope residents have received a dose of COVID-19 vaccine, and only 26% are considered fully vaccinated. Since Sept. 1, 199 residents have tested positive for the virus, according to the Kotzebue-based Maniilaq Association. That’s nearly a quarter of the town’s residents infected in a three-week period. (While Point Hope is part of the North Slope Borough, it has a health care compact with Maniilaq, in part because commercial air routes to the community pass through Kotzebue.)

Even that dramatic surge is almost certainly an undercount. Testing occurs mostly through the local clinic, and last week a health aide in Point Hope posted to a community social media page asking for patience from residents as the demand for testing exceeded the available staffing. The health aide had been swabbing and processing samples by herself until almost 9 p.m. on recent evenings.

[Alaska’s COVID-19 case rate is now the highest in the nation as state reports 6 deaths]

Overall, the North Slope has the second lowest vaccination rate among eligible residents of any region in the state, at just 41%. Only the Southeast Fairbanks Census Area, at 37%, has a smaller percentage of vaccine uptake, according to data from the state Department of Health and Social Services. Not only is the North Slope’s rate a good deal lower than Alaska’s overall vaccination rate of 62.5%, it’s an outlier when compared to regions in Western Alaska, which since the start of the year have had some of the best success administering vaccines.

A rise in cases

As of Tuesday, there were 304 active COVID-19 cases in the North Slope region, according to figures from Maniilaq and the Arctic Slope Native Association. (That number does not include cases in Anaktuvuk Pass, where health care is administered by the Tanana Chiefs Conference, which does not publicly report community-level data figures.)

State health department data on Tuesday showed that the North Slope Borough’s rate of new COVID-19 cases over the past seven days was by far the highest out of any region in the state, and about double that of its closest competitor — continuing a trend that started emerging just this month.

Many of the region’s cases involve youths under 18, and the vast majority are under 40. There is just one person hospitalized with COVID-19 in Utqiagvik’s Samuel Simmonds Memorial Hospital, though that does not include people sent out of the region for intensive care.

Rapid response teams from the hospital are offering vaccinations to village residents, and they’ve visited all villages within the Arctic Slope Native Association’s service area to offer vaccinations to those interested, wrote ASNA’s public information officer Tim Rowe, who did not respond to multiple messages requesting an interview.

“Some communities, they’re getting their first positive case since the start of the pandemic,” said Thomas, with the borough’s health department.

During earlier waves of the pandemic, even last winter when hospitals on the road system were nearing capacity, many towns in the North Slope successfully kept COVID-19 out through a mix of screenings and rigorous preventive measures, Thomas said. The sudden arrival and rapid spread of the delta variant caught many off guard.

“Anaktuvuk Pass, they got their first positive case two to three weeks ago,” Thomas said.

[Coronavirus Q&A: How many Alaskans who test positive are vaccinated? What about women’s fertility concerns?]

The region has a troubled history will federal initiatives purporting to help Indigenous communities in the name of health and scientific progress, including the proposed Project Chariot nuclear explosions near Point Hope and Cold War military experiments conducted on Alaska Native residents using Iodine-131.

Since the recent COVID-19 outbreaks began, many communities in the region are snapping back into lockdown mode, re-imposing quarantine requirements and social distancing protocols.

“We’re ‘condition red’ at the school, meaning that the doors are closed, homework is being sent home, left at the doorstep in some cases, because nobody wants to enter,” said Bill Tracey from Point Lay, which he represents on the North Slope Borough Assembly. The grocery store has limited hours, and mask requirements have returned. “We’ve got controls out there, but evidently we ... relaxed some of that stuff during the summer.”

As of last week, the vaccination rate in Point Lay is 36%, according to ASNA, although Tracey suspects the actual figure might be somewhat higher if there were more consistent resources locally for tracking and reporting data. There were 18 active cases on Tuesday. Tracey said it had been difficult to get clarity on the situation at times because most of the village’s leaders have been sick with COVID-19.

”We were able to keep it away during last year’s pandemic, we never had a positive case here, but that’s all changed now,” he said.

Regional challenges

The region’s lone hospital in Utqiagvik doesn’t have an intensive care unit, so residents warily watch what’s happening with health care capacity along the road system — the state’s largest hospital is currently rationing care under crisis standards and other major facilities are sounding the alarm over capacity and staffing — should someone need to be flown there for emergency care. An Utqiagvik elder and member of the North Slope Borough Assembly, Roy Maloney Nageak Sr., died at Mat-Su Regional Hospital on Thursday night. For 20 days he battled complications from COVID-19 in the hospital, according to a Facebook post by his wife.

[Impossible choices inside Alaska’s inundated hospitals]

The increase in cases is also posing many of the same challenges that other rural areas have had to contend with during the pandemic.

“The need is so high. We have residents without water and sewer,” said Caroline Cannon, a Point Hope resident who spoke at a North Slope Borough Assembly meeting recently.

Amid overcrowded homes with multiple generations often living in just a few rooms, the community has barely any spare space where people can quarantine as they wait for test results, or where they might isolate themselves after testing positive to keep from infecting family members.

“We know what it takes to reduce these numbers, and hygiene is the critical one,” she said. “I wish we could do more.” Cannon didn’t respond to multiple messages requesting an interview.

Another concern raised to the Assembly is how the current outbreaks might affect fall whaling, a vital opportunity for subsistence communities along the Arctic coast. The hunt not only involves crew members in close quarters on small boats, but brings dozens of community members into close contact as meat is butchered.

But Thomas, with the health department, wasn’t overly concerned.

“This is not the first time we’ve had to do this,” he said, noting that it’s the fourth whaling season since the start of the pandemic. Last year, Thomas said, whaling communities adapted to protect themselves without abandoning vital practices, like re-engineering holiday feasts and food sharing traditions as drive-thru distributions.

Now that parts of the region are grappling with their first major outbreaks and the current virus surge, Thomas said residents will need to trust and depend on one another to protect themselves.

“It’s gotta get back to grassroots and relying on your neighbor to get through tough times,” he said. “The real resilience of the people.”

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