Rural Alaska in jeopardy as COVID flood floods remote hospitals

TANACROSS, Alaska- A village in Alaska knew what to do to keep COVID-19 out. They set up a gate on the only road into the city and guarded it around the clock. It was the same idea that was used a century ago in some isolated indigenous villages to protect people from outsiders during another deadly pandemic – the Spanish flu.

It worked pretty much. Only one person died of COVID-19, and 20 people fell ill in Tanacross, a 140-strong Athabascan village whose rustic wooden huts and other homes lie between the Alaska Highway and the Tanana River.

The COVID-19 increase is exacerbated by Alaska’s limited health care system, which is heavily dependent on hospitals in Anchorage, the largest city. This is where the state’s largest hospital, Providence Alaska Medical Center, is overwhelmed by patients and was the first weeks ago to declare crisis-of-care protocols, meaning doctors sometimes prioritize care based on who has the best odds of survival.

Since then, 19 other health facilities in Alaska, including Anchorage’s two other hospitals and the Fairbanks Memorial, have also entered a state of emergency, something overtaxed facilities in other states have had to do, including Idaho and Wyoming.

“Even though we live here, we are concerned about Anchorage and Fairbanks,” said Alfred Jonathan, a senior at Tanacross. “If anyone gets sick out there, there’s no place to take them.”

While Alaska has agreed with nearly 500 physicians to help over the next few months, the consequences are severe for those in rural Alaska if they need higher care — for COVID-19 or otherwise — but there are no beds available.

Sometimes these patients are lucky and are transferred to Fairbanks or Anchorage. Other times, healthcare professionals are on the phone – in some cases for hours – looking for a bed or facility that can provide special treatments such as dialysis.

A patient who could not get dialysis at Providence died, hospital spokesman Mikal Canfield said. Dr. Kristen Solana Walkinshaw, the hospital’s chief of staff, said she knew a patient in an outlying area who needed cardiac catheterization and died and was waiting.

The options in Seattle and Portland, Oregon, are also overloaded. A rural clinic finally found a place for a patient from Inner Alaska, Colorado.

Health officials blame the hospital crisis on limited staff, rising COVID-19 infections and low vaccination rates in Alaska, where 61% of eligible residents of the Conservative state are fully vaccinated. According to data collected by Johns Hopkins University, one in 84 people in Alaska was diagnosed with COVID-19 from September 22 to September 29, the country’s worst diagnosis rate in recent days.

Officials say doctors are exhausted and frustrated at what feels like a no-win effort to combat misinformation that COVID-19 is overblown and vaccines are unsafe. Some say it can have long-term effects — further shaking confidence in vaccines and treatments for other diseases and making the long-standing pre-pandemic challenge of recruiting health workers to the remote state more difficult.

Medical workers “describe the feelings of, ‘You hear a code is happening, someone’s dying,'” said Jared Kosin, president and CEO of the Alaska State Hospital and Nursing Home Association. “It’s devastating. You will never lose a patient. But in the back of your mind you think, ‘OK, another bed is now available that is critically needed.’ And how do you balance those feelings? It’s insane. “

In Tanacross, the elders are urging people to get vaccinated, especially with strained facilities. The village is located in a scattered, sparsely populated region of eastern Alaska, where the vaccination rate is below 50%.

Jonathan, 78, tells villagers that COVID-19 is here and just like the delta variant will evolve in other ways.

Those who “were not vaccinated? Gosh, we’re scared of them, ”said Jonathan, who recently led a crew clearing dead and dying trees to reduce fuel for firewood and supply wood for heating homes.

His wife, Mildred, helped guard the gate into the community this year. These restrictions ended this summer as the pandemic seemed to get better. Now she says she is tired of outsiders calling their friends in Tanacross to scare them, claiming there are problems with the vaccines.

“I got both of my shots, I’m alive and there’s nothing wrong with me,” she said before putting bags of disinfectant, masks and nitrile gloves in her Prius to deliver throughout the city.

Alaska, which paid tribute early in the pandemic to working with tribal health organizations to distribute vaccines widely and rapidly, was 25th in the U.S. for the percentage of its total population inoculated, according to the Centers for Disease Control and Prevention data.

In hospitals, care has “changed,” said Dr. Anne Zink, Alaska’s Chief Physician.

“The same standard of care that was there before can no longer be given regularly,” she said. “This has been going on for weeks.”

In rural Alaska, six indigenous villages, including Tanacross, rely on the new Upper Tanana Health Center in the hub community of Tok, about a two-hour drive from the Canadian border. The staff treat whoever they can and move them with more serious needs to Anchorage or Fairbanks, said Jacoline Bergstrom, executive director of health services for the Tanana Chiefs Conference, a consortium of 42 Athabascan villages spread across an area of ​​Alaska that is almost on size with Texas.

Emergency plans are in place to house people overnight if hospital beds are not available immediately, said clinic director Joni Young. They are usually flown because it is a three hour drive from Tok to Fairbanks and about seven to Anchorage.

“If for some reason we are unable to get out, we have been prepared since the beginning to help our patients if we need to,” Young said. “We have former cots tucked away here, and we have another building that we rent that we could use to separate COVID patients.”

Staff work overtime, where nurses take COVID-19 questions from callers and work weekends. They have to hire two emergency nurses registered nurses, but few have applied.

Joyce Johnson-Albert was lying on a bed at the health center with an IV in her arm. She was vaccinated but got a breakthrough infection, she suspects from a hunting camp.

“I just hope I get a little better over the next few days than I do now,” Johnson-Albert said when she received a monoclonal antibody infusion given at the start of COVID-19 to reduce symptoms. “It simply came to our notice then. You can go both ways. ”

Registered nurse Angie Cleary is grateful that the clinic offers the infusion treatment.

“However, I feel worried some days where we are not sure when we will get more,” Cleary said. “For example, we’re down to, I think, five doses right now, and we could get more tomorrow or it might not be until next week. That’s one of the concerns we have out here, like, when should we get our next shipment? ”

They are also struggling with misinformation about the pandemic.

Republican Gov. Mike Dunleavy has been criticized for not imposing masks and not approving vaccines as fully as some would like. He has encouraged people to get shots, but said it is a personal choice. Others have accused him of pushing vaccines and playing fear.

Employees at Providence hospital are having a hard time with the harsh rhetoric, Solana Walkinshaw said. An employee was spat at by leaving work, the chief of staff said.

“We still have people who deny COVID when they are intubated, or family members who deny COVID when they say on an iPad and say goodbye to their loved one,” she said.

Daisy Northway of the Tok Native Association knows how hard it is to go in for vaccinations and says she “has talked until I am blue in the face” and tries to convince one of her sons.

The elder in Athabascan said she encourages people to get the shots, but in a way that lowers the political glow.

“We have to say, ‘Get vaccinated’ in such a way that it is helpful and not being criticized for their beliefs,” she said.

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