At Providence Alaska Medical Center, emergency room patients might typically wait an hour to see a doctor.
But right now, as the latest surge in COVID-19 coincides with a staffing shortage and an already busy summer season for the hospital, wait times for some patients can run four to five hours. As many as 15% of patients are leaving without being seen — far above the hospital’s target of 2%.
“I’ve been working at Providence for 22 years, and I can say that the capacity issues we’re having currently are unlike anything I’ve ever seen,” said Dr. Dan Safranek, the medical director for Providence’s emergency department. On some days, he said, the hospital can’t open the number of rooms that his department would typically use, “because we just don’t have the nurses to do it.”
Anchorage hospitals maintain roughly half of Alaska’s 120 intensive care unit beds, making the city the nerve center of the state’s health care infrastructure: Hospital patients in rural hub communities are often flown to Anchorage when they need higher levels of care.
Except right now, that infrastructure is stretched nearly to its limit. A new, variant-fueled surge in the coronavirus has arrived with hospitals already facing their usual, busy summer, which typically comes with an uptick in trauma cases and tourists who need emergency care.
Alaska has only experienced one other COVID-19 surge this intense. And last winter, as cases spiked, some of the state’s most powerful elected officials maintained tough mitigation measures as a kind of shield for Alaska’s health infrastructure. Anchorage’s city’s government had a mask mandate for indoor public spaces, and Republican Gov. Mike Dunleavy’s administration was requiring testing for passengers arriving at state-run airports.
But today, as the extra-contagious delta variant sweeps across Alaska, those defenses are gone, and both Dunleavy and Anchorage’s new mayor, Dave Bronson, have indicated they have no plans to bring them back. Instead, they’re counting on Alaska residents’ and business’ individual choices to limit the number of coronavirus cases and to protect the state’s health care infrastructure, which has left doctors, nurses and executives uncertain about how much more of a burden they’ll be asked to shoulder.
“I’m hoping that we’re close to the peak of this. But I honestly don’t know,” said Dr. Michael Bernstein, Providence’s chief medical officer. “Because a lot of it really does depend on people’s behavior.”
Earlier this week, 60 of Anchorage’s 63 ICU beds were occupied. And with the city’s hospitals nearly full, several patients from the Southwest Alaska hub town of Bethel were sent to the Mat-Su’s hospital for care.
While the state is continuing to record high case counts, with more than 1,000 between Friday and Sunday, it’s hard to know how much worse things could get, or when the numbers could start falling.
High vaccination rates among older residents have blunted the virus’ ability to hospitalize and kill Alaskans, and COVID-19 patients are only filling a little more than 10% of Anchorage beds. There’s also hope that the delta-fueled surge could burn out quickly, as it did in India.
Health care experts, meanwhile, point out that thousands of unvaccinated Alaska children are returning to classrooms this week — many in school districts where masks are optional.
“No one knows when or if it’s going to let up, and I think that is the hardest part,” said Jared Kosin, who heads a trade group of Alaska hospitals and nursing homes. “We are sprinting, and we’ve been sprinting for a while now. You can’t keep sprinting indefinitely.”
In Alaska, mitigation measures are ‘up to individuals‘
Hospital and health care executives, in their recent messaging, have not been expressly advocating for the re-adoption of politically polarizing measures like mask mandates, even as they’ve attested to masks’ effectiveness.
Instead, they’ve focused on COVID-19 vaccinations as the best long-term path out of the pandemic.
But mask mandates have also been shown to reduce the spread of COVID-19, and forgoing them will allow the coronavirus to do more damage, according to Dr. Tom Hennessy, a longtime Alaska epidemiologist.
“That lesson — it appears to have been forgotten or is not being applied by local governments,” Hennessy said. “If, collectively, as a society, we do nothing, we are choosing higher rates of transmission, more hospitalizations and more deaths.”
In response to the most recent surge in cases, elected leaders in other states and Outside cities have imposed new mandates and restrictions around masks and vaccines.
Last month, President Joe Biden announced that millions of federal workers must either swear they’ve been vaccinated or submit to mandatory coronavirus testing and masking. San Francisco has reinstated a mask mandate, and the mayor recently announced that businesses would be required to demand customers’ proof of vaccination.
Washington’s governor has mandated the vaccine for most state workers, who face a mid-October deadline.
All those elected officials, however, are Democrats. In Alaska, the mostly-conservative politicians who lead the state government and many of its largest communities have taken a far less aggressive response to the recent surge.
Dunleavy imposed strict travel restrictions early in the pandemic, and he’s endorsed the coronavirus vaccine amid the state’s stalling campaign to distribute the shots.
But he’s said the state will not mandate vaccines, and he and the leaders of his health department say that future actions to slow the virus’ spread will have to come from individuals, not the government.
“The idea of restrictions and masks and so forth, you can’t continue to live like this. You turn it into an existence as opposed to a life,” Dunleavy said in an interview last week. “We just have to use appropriate precautions: Whether it’s a helmet or it’s a life preserver, whether it’s a vaccine, it’s up to individuals to make those decisions.”
Bronson, Anchorage’s new mayor, was sworn in earlier this year after running on an anti-mandate platform. He has said he will not require mask-wearing, has declined to be vaccinated against the coronavirus and has hired public health officials who previously questioned the effectiveness of masks and vaccines — though they’ve since disavowed those comments.
The Anchorage School District and the state university system are requiring students to wear masks. But for now, two other large districts nearby, in the Mat-Su and on the Kenai Peninsula, are making masks optional, disregarding guidance from the Centers for Disease Control and Prevention.
The gap in additional government action will have to be filled by individuals, along with businesses and other organizations, said Hennessy, the epidemiologist.
A few of Alaska’s largest seafood companies and health care providers have instituted vaccine mandates. But widespread adoption of those requirements isn’t imminent.
Workforce shortage slows both admissions and discharges
Hospital leaders say that sustaining their workforce is one of the biggest challenges right now. Providence’s emergency department is facing “significant staffing constraints,” with a shortage of nurses, laboratory technicians and respiratory therapists, said Safranek, the department’s medical director.
Nursing homes and long-term care facilities, which care for many patients when they’re discharged from the hospital, are facing similar staffing problems. And that’s forcing hospitals to hold patients for longer, and making it harder for them to clear space for new patients.
In spite of state dashboards that show Anchorage’s ICUs with minimal space, hospital administrators say Alaskans shouldn’t be worried that people with the most urgent medical problems, like a gunshot wound, will be turned away.
Providence’s emergency department can provide ICU-type care if it can’t transfer patients into that unit, said Safranek. But supporting those types of patients, he added, takes a lot of work, leaving even less time for those with less acute problems, like a broken wrist.
“You come in expecting to have maybe eight or 10 rooms that you could start to see patients in, and maybe there’s no rooms at all. But there’s eight, 10, 15, 20 patients in the waiting room,” he said. “We feel a lot of pressure to see people quickly and make sure their needs are being attended to. But not having rooms to see them in makes it very challenging.”
One thing that’s improved since the earlier days of the pandemic is that, thanks to the vaccines, doctors and nurses are no longer facing the same acute stress about catching the virus themselves, or bringing it home to their families, Safranek said.
But the latest surge, he added, has still been demoralizing.
“I think we all were feeling encouraged that we were pulling through,” he said. “As this variant has come in and we’re seeing the rising cases, I think there’s a sense of dismay, like, ‘Oh, we’re going to have to face it again.’”