Most Alaska villages lack road access and hospitals. Here’s how they’ll fight the coronavirus.

Village health clinics, like this one in the Northwest Alaska village of Noorvik, will be at the front lines of fighting the novel coronavirus in rural parts of the state. (U.S. Air Force photo/Master Sgt. Jack Braden)

Even in cities with big hospitals, the novel coronavirus is testing the limits of the modern health care system. But fighting the virus in rural Alaska presents additional challenges: Some of Alaska’s remote villages can be 100 miles from the nearest hospital, and many are disconnected from the road system and only reachable by plane.

That isolation could make treatment more challenging, and epidemic disease has devastated rural Alaska before. But the remoteness of many of Alaska’s villages can also be an advantage, making it easier to control people moving in and out and to quarantine or isolate them if necessary.

“There’s potential for this to be contained and not to be catastrophic in rural Alaska. But if it’s mismanaged, it could be considerably worse,” said Kevin Berry, a University of Alaska Anchorage economist who’s studied epidemic disease and response.

Tribal health care providers have worked with state public officials to develop a basic framework for responding to cases of COVID-19, the disease caused by the coronavirus, if they’re discovered in rural Alaska.

Since most cases of COVID-19 don’t result in serious illness, officials hope that most sick people can stay at home and monitor their symptoms.

One important exception is if they live in a multi-generational home, as older people appear to be particularly vulnerable to the disease. The proportion of Alaska’s homes defined as “overcrowded” — with more than one person to a room — is roughly double the national average, and more than 10 times the national average in some communities.

For people who become sick in a home that also shelters elders, public health officials hope to be able to move them to another home in the same village, said Heidi Hedberg, Alaska’s public health director. If no alternative housing is available, then the person would have to move to either a regional hub community or, if that’s not an option, to an urban hub like Anchorage.

Officials are also exploring whether they could move modular trailers out to some villages to provide temporary housing, if necessary, but that idea is likely too logistically complicated to work on a large scale, according to Hedberg.

“We really want to figure out how we can leverage existing homes,” she said.

For people with COVID-19 who need to leave a rural village, Hedberg said the state can rely on three different types of air carriers. The least expensive option would be to have people fly in a regional commuter plane, if that can be done safely for the pilot and the patient, she said.

More expensive would be a medevac flight, in a plane with trained health-care professionals. And the state can turn to the National Guard as a last resort, Hedberg said.

Shelly Deering, an official at one medevac provider that works in Alaska, Airlift Northwest, said her service isn’t planning to add extra planes to its fleet but has protocols to protect workers against infectious illness. Those include basic protections like masks and gowns, she said.

“And then gloving and using a lot of hand sanitizer,” she said. “There’s nothing different from that.”

The center of the coronavirus response in rural Alaska will be the hundreds of community health aides that work for tribal clinics in more than 150 villages around the state — along with employees of other clinics known as Federally Qualified Health Centers.

The front-line community health aides are connected to other providers in regional hubs and at the tribal hospital in Anchorage, the Alaska Native Medical Center, who can be tapped when patients need more advanced care.

“The Alaska tribal health care system works from the ground up. So, our communities are our leaders — we’re responsible to them,” said Roald Helgesen, ANMC’s chief executive.

Tribal health care providers have developed what Helgesen described as a sort of flow chart or algorithm to help guide decisions about which rural patients could be treated in regional hospitals or in Anchorage.

The logistics of moving sick people between those locations can be significant, Helgesen acknowledged. Providers are preparing to deal with those logistics for patients who could have COVID-19, and there are pre-existing plans in the event that large numbers of people need to be moved, said Helgesen. But he declined to share many details, saying that need hasn’t developed.

“We want to encourage people to be calm, to be prepared if somebody does need to be asked to be quarantined in their home for a couple weeks,” Helgesen said.

People should make sure that they have two weeks worth of food and medicine in case they need to take care of themselves, along with another person who could check up on them and deliver food if necessary, he added.