As coronavirus infections surge across the state, Alaska finds itself at ‘a tipping point’

SEARHC personnel test a colleague for COVID-19 at the employee screening tent behind the hospital on April 28, 2020. (KCAW photo/Berett Wilber)

Alaska is in the grips of its highest number of coronavirus infections yet, and some health experts say the state has again reached “a tipping point” in the pandemic.

Either Alaskans get the spread of the virus under control, they say, or infections will continue to multiply and could overwhelm the state’s health care system.

“If anyone needs to know, ‘Should I be worried? Are the alarm bells going off?’ The answer is yes,” said Jared Kosin, president and chief executive of the Alaska State Hospital and Nursing Home Association. “We need to control the spread.”

Alaska recorded a record-high 526 new coronavirus infections on Sunday, followed by 348 cases on Monday and 381 on Tuesday. For more than a month, the state has reported 100 or more new cases a day, with the daily tally hitting at least 200 new infections for almost two weeks straight. 

The surge has prompted pleas from health officials that Alaskans avoid all activities with people outside of their households and, if they must be around others, to wear a mask and stay at least 6 feet apart. 

During the last spike, in July, the state and its largest city either had stricter measures in place or put them in place in response to rising cases. While some have suggested that tighter rules, including a statewide mask mandate, may help now, Gov. Mike Dunleavy maintains that he supports a more localized approach. Anchorage just seated a new acting mayor.

Meanwhile, the virus has exploded in parts of rural Alaska, and in more urban areas too. A top Anchorage health official said last week that “there’s virus everywhere in the community.” Efforts to trace the close contacts of those infected are strained. Some villages have gone into lockdown. Infections are also rapidly rising in other parts of the country. And, due to a national shortage, health care workers in Western Alaska say they’ve been forced to reuse gloves.

“We’re clearly into our third wave,” said Dr. Tom Hennessy, an Anchorage physician and infectious disease epidemiologist who used to work for the federal Centers for Disease Control and Prevention. 

“We probably have more people with COVID walking around in Alaska than we ever have.”

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By Tuesday, the state was reporting more than 7,500 known active coronavirus cases, and nearly every region in Alaska was in a “high-alert level,” meaning there’s widespread community transmission “with many undetected cases and frequent discrete outbreaks.” The state health department said cases are expected to continue to accelerate, and more testing is needed.

A chart shows that nearly every region in Anchorage is in a "high alert" level.
Pandemic alert levels on Wednesday, Oct. 28, 2020, according to data from Alaska DHSS (Chart by David Purdy/KTOO)

According to The New York Times, Alaska on Tuesday had the eighth highest number of new coronavirus infections per 100,000 residents over the past seven days, compared to other U.S. states. It still had one of the country’s lowest death rates from the virus.

Kosin said what he’s most concerned about now is the degree of community spread in Alaska, and also the impact that’s having on hospitals, and will continue to have. 

“This weekend, when we had over 500 positive cases statewide, the brunt of that is not going to hit our doors for a couple weeks,” he said. “So right now, we’re already strapped. I mean, definitely noticeable stress, in terms of staffing, in terms of just hospitalizations increasing, and the worst is yet to hit our doors.” 

Increasing case numbers are not only linked to more hospitalizations, Kosin said, but also to more hospital staff not coming into work, either because they have the virus or because they’ve been in contact with someone who does. That’s exacerbating existing staffing shortages, he said. Fewer staff means fewer available hospital beds.

Also, capacity is further stressed as the virus infiltrates other health care facilities, and those buildings push pause on accepting new patients, Kosin said. That includes assisted-living homes and the Alaska Psychiatric Institute, which announced Friday that it won’t take new patients for two weeks.

“That means any patients that otherwise would go to API essentially sit in a hospital emergency room, and it creates a backup and when we have a backup, you start creating basically choke points within the system,” Kosin said. 

The unpredictability of staffing shortages, facility closures and other variables makes it difficult to project precisely when the virus could overwhelm hospitals if the spread doesn’t slow, said Hennessy. One model, he said, shows Anchorage ICU beds filling up in about two months. The city has plans for surges, but concerns persist about staffing.

“We, with increased transmission, could threaten our hospital care system in December. Or we could, with a 10% decrease in transmission, get this under control,” Hennessy said. “We’re kind of in a fragile tipping point position right now.” 

The state health department reported that that the number of new coronavirus cases in Alaska last week was 56% higher than the week prior. And, it said, that many Alaskans diagnosed with the coronavirus said they went to social gatherings, community events, church services or other social venues while they were contagious, but before they knew they had the virus.

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Hennessy and Kosin questioned whether more should be done to try to control the spread of the virus, especially as temperatures drop and more Alaskans gather indoors.

“The methods that we’re using to try to convince people to change their behaviors do not appear to be working,” Hennessy said. “State public health is having a hard time keeping up with case contact investigations, data entry, even the simple things of reaching each positive case and giving them instructions about isolation.” 

While some local communities, including Anchorage, have mandatory mask orders, Hennessy said, a statewide rule would help.

“I think it would give enough coverage to enough communities that are suffering, and don’t have a mask order in place,” he said. “It would be cheap, it wouldn’t put anybody out of work, and it could have a huge impact on case numbers, hospitalizations, and it could save lives.”

Kosin said he’d support a statewide mask mandate too. 

“It sure seems like something more is necessary than what we’ve been doing, given the results we’re seeing right now,” he said.

In an email Monday, Lauren Giliam, deputy press secretary for Dunleavy, said when it comes to implementing new measures to reduce the spread of the virus, the governor “stands by his support of local control.” Dunleavy will continue to “assess and respond as needed,” she wrote.

Alaska’s chief medical officer Dr. Anne Zink said last week that “many communities have their own restrictions based on different case levels and alert levels.” 

“Mandates or no mandates, COVID really is determined by what we do individually,” she said. 

In Anchorage, the city is recently under new leadership after Ethan Berkowitz announced on Oct. 13 that he would resign from his job as mayor. Austin Quinn-Davidson was sworn in as acting mayor Friday evening.

A city spokeswoman wrote in an email Monday that Quinn-Davidson was not available for an interview early this week about whether she was considering new measures in response to the rise in cases, and said the administration was “prioritizing getting her acclimated with the status of many policy items – COVID-19 included.” 

The Anchorage School District is gearing up to resume in-person instruction for younger students next month, and city health leaders have asked residents to help lower the spread of infection to help more kids get safely back into classrooms.

At Tuesday night’s Anchorage Assembly meeting, Quinn-Davidson also called on Alaskans to “flatten to curve,” and said the economy will not fully recover as long as there’s widespread coronavirus transmission.

“Gatherings are not safe,” she said. “If you’re feeling even mild symptoms, please get tested, please stay home and wear a mask and stay at least 6 feet from others outside your home.”

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At the Providence Alaska Medical Center in Anchorage, the hospital has had plans in place for months to handle a surge in coronavirus patients, said chief medical officer Dr. Michael Bernstein. In the most dire case, he said, the hospital could fill the operating and recovery rooms with more beds. The Alaska Airlines Center could also be used.

The biggest challenge, Bernstein said, will be staffing. But the goal is to not get to a point where there’s that many Alaskans sick enough with the virus to get hospitalized.

To help bring the current rate of transmission down, Bernstein said, he’d support additional, government-led efforts, including a more sweeping requirement that people wear masks indoors, and an order limiting gatherings to about 10 people.

“That’s not a popular answer,” he said. “But if we flatten this again, and we start going down, I think you can relax it.”

Reach reporter Tegan Hanlon at thanlon@alaskapublic.org or 907-550-8447.