Alaska is activating crisis standards of care for the entire state and bringing in contracted health workers as staff shortages and influx of COVID-19 patients make it difficult for hospitals to operate normally.
Gov. Mike Dunleavy and top health officials announced the hospital support on Wednesday, the same day Alaska’s new single-day cases hit another record as the highly infectious delta variant drives infections.
A combination of short staffing and high numbers of COVID-19 patients is overwhelming medical facilities in Anchorage, Mat-Su and Fairbanks. Rural hospitals say they struggle to transfer patients to urban centers for higher care. At least one patient died recently when a bed in Anchorage wasn’t available.
The Alaska Department of Health and Social Services enabled crisis standards of care Wednesday through a new addendum to the state’s existing COVID-19 public health order, officials announced.
Hundreds of medical personnel are also coming to Alaska to help offset staff shortages at numerous health care facilities: Almost 300 registered nurses and more than 100 certified nursing assistants or patient care technicians, funded through an $87 million contract between the state and the federal General Services Administration.
Along with crisis standards and more workers, the state is addressing a shortage of certified nurse assistants with more training flexibility, officials say.
Five communities — Anchorage, Juneau, Kenai, Fairbanks, Mat-Su — will make use of “mobile integrated health care” to take pressure off hospitals, state public health director Heidi Hedberg said. Juneau is ramping up their program this week using telemedicine with a Bartlett Regional Hospital doctor. The other four communities are still developing plans.
The state health department also ordered $2 million in rapid at-home testing kits for schools, officials say.
This week, the state hit the highest new COVID-19 case rate per capita in the country. State data shows one of five Alaskans hospitalized this week had the virus.
Alaska’s hospital administrators warned of a pending health-care catastrophe in late July. Dunleavy early this month ruled out a statewide COVID-19 disaster declaration. Legislation he proposed instead to support hospitals through telemedicine and streamlined background checks died in the state House.
On Wednesday, the Alaska State Hospital and Nursing Home Association in a statement said the state’s announcement of staffing support “and the recognition that care standards are rapidly escalating to crisis” were welcome developments.
Dunleavy, pressed by reporters on a vaccine mandate to relieve pressure on the health care system, said “while vaccinations remain the most important tool,” he will not require them.
“The case numbers are much higher than any of us want. The pressure on our hospitals grow greater every day. We’re going to get assistance. But that doesn’t mean that individual Alaskans should not or cannot help themselves,” Dunleavy said, urging people to “be very careful” over the next month. “The delta variant is causing a lot of infection, it’s causing a number of folks to go to the hospital, and it is causing people to die. These are facts.”
Alaska, once the most vaccinated state in the nation, has dropped into the bottom third. The state ranked 18th for seven-day death rate per capita.
‘Active misinformation campaigns’
The briefing from state officials came amid a politically charged climate where some Alaskans, including elected officials, challenge public health messaging as false.
Viewers on a Facebook livestream of Wednesday’s briefing peaked at about 1,350 people. Several responded to the statements from Dunleavy and others with unsubstantiated misinformation about unproven COVID-19 treatments, the vaccine and the state of the pandemic. Others simply said “fake numbers,” “lies,” and “propaganda,” as health officials outlined the dire situation playing out across the state.
Vaccination remains the single best way to prevent severe illness and hospitalization from the virus, said the state’s chief medical officer, Dr. Anne Zink. Two-thirds of the new cases reported Wednesday are going to get sick, miss work, maybe need treatment at the emergency room or worse.
Zink urged Alaskans to not be “distracted by other treatment options such as ivermectin that has not shown benefit for COVID-19 at this time” and instead get proven treatment like monoclonal antibodies.
“Epidemics will come, and they will go, but we collectively control how quickly this will happen, and how many Alaskans we’re going to lose along the way,” she said, her voice appearing to break as she said prompt action is necessary to relieve hospital pressure.
“Kindness and compassion are important to all, especially to our health care workers who are committed to providing care to all Alaskans,” Zink continued. “There’s active misinformation campaigns about health … and about treatment options, so please speak to your health care provider if you have questions.”
Numerous hospitals around Alaska say that, while staffing shortages are a longstanding problem, the recent surge in mostly unvaccinated COVID-positive patients has pushed their capacity over the edge. Hospitals say they are already postponing non-urgent surgeries and holding patients in emergency departments for days.
‘Care has shifted’
The state’s largest hospital, Providence Alaska Medical Center, declared crisis standards on Sept. 11 when doctors say they started deciding which severely ill patients got scarce resources like ICU beds.
Alaska lacks a crisis standards statute, Zink said. Instead, the state can offer guidelines to help clinicians make decisions when resources like ventilators are in short supply. Many facilities are already making changes like nurses caring for more patients or creating alternate ICU or COVID-positive treatment areas.
“Care has shifted in Alaska’s hospitals,” she said. “The same standard of care that was previously there is no longer able to be given on a regular basis.”
Generally, a crisis standards declaration is seen as a last resort that means the number of patients needing care is more than hospitals can handle because of staff, bed or equipment shortages. Providers can prioritize patients based largely on their likelihood of survival or even deny treatment.
Enacting crisis care standards provides liability for providers as well as support to hospitals, health care facilities and local health authorities, Commissioner of Health and Social Services Adam Crum said.
“We want to make sure that Alaskans always have access to a very high level of care,” Crum said. But for health care providers, if they’re not able to provide this golden standard of care, it actually hurts.”
State health officials developed statewide crisis-care guidelines at the start of the pandemic in March 2020, the 37-page “Patient Care Strategies for Scarce Resource Situations” based on Minnesota protocols.
Crisis-care enactment lets the state share ethical guidelines to health-care providers when they have too many patients and not enough resources to care for them all, according to information from the state. A 15-person committee can help provide guidance on alternative strategies and other tools that may be available.
The state holds daily calls with hospitals around the state about capacity. Health officials say its still up to each hospital and health-care facility to make any decisions.
Numerous hospitals and a few states are turning to crisis protocols. Idaho in early September activated statewide crisis standards of care. Some hospitals in Montana have turned to crisis standards as well. Hawaii’s governor this month released health workers from liability if they have to ration care.
Soldotna’s Central Peninsula Hospital was operating at 122% capacity Wednesday. About a third of its patients — 21 out of 60 — were COVID-positive, three of them fully vaccinated.
There were 31 employees across 16 departments out sick with the virus or quarantined at home after coming in contact with an infected person, spokesman Bruce Richards said Wednesday morning.
Central Peninsula canceled elective inpatient surgeries for Tuesday and Wednesday, though staff was finally able to transfer a few patients to Anchorage after being unable to move anyone for several weeks.
The hospital is assessing patient loads and needs on “a 24-hour basis” but currently isn’t at crisis-care mode, Richards said. “We’re not there. Sometimes it feels like we are.”