Alaska tribal health groups brace for COVID surge

"COVID-19 testing site" sign at the Alaska Native Medical Center in Anchorage, Alaska (Photo by Joaqlin Estus, Indian Country Today)

Joaqlin Estus

‘We may be forced to make difficult choices when it comes to … allocating scarce patient care resources’

Joaqlin Estus

Indian Country Today

Tribal health organizations that serve dozens of remote Alaska Native villages are struggling to prepare for a crush of coronavirus cases.

COVID came late to Alaska, and it crept in slowly. Even now, the Centers for Disease Control and Prevention report Alaska’s infection rate is 3,152 cases per 100,000 people, less than half that of North Dakota’s. That’s good because Alaska has fewer doctors, nurses and respiratory therapists than a lot of states. But the spread of the disease is picking up speed. 

Alaska Chief Medical Officer Dr. Anne Zink Monday said Alaska’s infection rate has been rising for six weeks, and the state is now on red alert, the highest level.

“We've seen an 18 percent increase over the last week,” Zink said.

Plus, the state released study results on Tuesday that show 2 out of 3 Alaskans have one or more ongoing health concerns that increase the risk of serious illness due to the coronavirus.

The hardest-hit area is the predominantly Yup’ik and Athabascan Yukon-Kuskokwim Delta, a region about the size of Oregon. Its one hospital can handle seven critically ill patients, at most. There were 50 new COVID-19 cases there on Nov. 16. As the disease progresses in a week or two, some of those people are going to be showing up in the ER.

Tiffany Zulkosky, Yup’ik/Orutsararmiut Native Council, is vice president of communications for the Yukon-Kuskokwim tribal health organization, which provides medical services to 58 villages, none of them linked by road. The health corporation serves American Indians, Alaska Natives and non-Natives through dozens of village clinics, a handful of subregional clinics, and the hospital in Bethel.

The hospital has five high-flow oxygen machines, or vapotherms, and four ventilators. However, its lack of specialized expertise limits their use, Zulkosky said.

“Operation of ventilators requires oversight of a physician, respiratory therapist and nurses. COVID-positive patients requiring ventilators can be a complicated care dynamic, and YKHC is not set up to keep long-term ventilator patients in Bethel,” Zulkosky wrote in an email.

Yukon-Kuskokwim Delta Regional Hospital in Bethel, Alaska (Photo by Tiffany Beardslee, courtesy of Wikimedia)
Yukon-Kuskokwim Delta Regional Hospital in Bethel, Alaska (Photo by Tiffany Beardslee, courtesy of Wikimedia)

Ordinarily the health corporation would divert critically ill patients to Anchorage hospitals, but Zulkosky said all Anchorage intensive care units were “on divert,” or turning patients away, on Monday and Tuesday of last week.

Four patients from the delta went elsewhere in Alaska. Health professionals are concerned there soon will be nowhere to send patients who need the specialized equipment and expert staff provided in an intensive care unit. 

“While all of these individuals may not have been COVID-positive patients, the delay for access to intensive care remains concerning — particularly as we see growing numbers of serious COVID infections presenting to our hospital system,” Zulkosky said.

She added it’s not unusual for Anchorage hospitals to divert patients in the wintertime, “but this is certainly much earlier than we’ve experienced and impacting a higher volume of our patients.”

Health professionals concerned about limited resources have been sending increasingly urgent messages asking the public to take steps to avoid catching or spreading COVID-19.

On Monday, the Yukon-Kuskokwim Health Corporation recommended a monthlong lockdown for the region.

“With continued exponential transmission of COVID-19 across the region, a growing number of YK Delta residents requiring hospitalization, and increased unavailability of ICU beds in Anchorage, YKHC is forced to prepare for providing care using the state of Alaska’s guidance for crisis capacity,” the health corporation’s President and CEO Dan Winkelman, Athabascan, said in a statement.

“We may be forced to make difficult choices when it comes to activating medevacs, providing care and allocating scarce patient care resources,” Hodges said.

The state has strategies and guidelines for times when resources — whether people, supplies, equipment or space — are scarce. 

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They tell care providers the main criteria for determining which patients get limited resources are factors that affect the likelihood of survival. Those may include pre-existing conditions such as heart disease, high blood pressure, severe lung disease and cancer. Care providers are advised to leave judgements about patients’ quality of life or relative social “value” out of such deliberations.

“Unfortunately, we are appropriately preparing for a crisis in the next one to two weeks,” said Dr. Elizabeth Bates, the health corporation’s infection prevention physician. “I cannot stress enough the importance for communities and individuals to take action now to slow the spread of COVID-19, to help limit broad use of these crisis capacity measures.”

Across Alaska, patients of tribal health organizations who need specialty care are sent to the Alaska Native Medical Center in Anchorage. The Alaska Native Tribal Health Consortium runs the medical center’s statewide services. It said in a statement that staffing levels are being affected by essential health care workers having to quarantine or isolate after infection or exposure.

“If this trend continues, our hospital will not have the physical bed space or staff available to provide the level of care our community will likely need,” it said.

Last week, Gov. Mike Dunleavy sent an emergency alert to all Alaskans via their cellphones. In a video, he said health care workers and first responders are being infected at unprecedented rates.

“My job as governor is not to tell you how to live your life. My job is to ensure the security and safety of Alaska. I can’t do that without your help,” Dunleavy said. “I’m asking you to reach deep for the next three weeks. If we can buy time for our critical workers – if we can keep our systems operational – we can avoid being forced to take further action.” 

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Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a long-time Alaska journalist.

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