‘It's awful. It's exhausting': Alaska rations care as it hits Covid nadir

Photograph: Nathan Howard/Reuters

Health systems in Alaska are at a breaking point, and the Republican governor, Mike Dunleavy, has activated crisis standards of care for the entire state, joining all of Idaho and part of Montana in rationing medical care.

Alaska now has the highest rate of Covid in America. On Wednesday the state hit its record number of cases and hospitalizations in the entire pandemic, and the numbers continue rising as its rolling seven-day average of daily cases tops 800.

Related: US public health workers leaving ‘in droves’ amid pandemic burnout

For Dr Anne Zink, Alaska’s chief medical officer and a practicing ER physician, this is the worst part of the pandemic.

“It’s awful. It’s exhausting,” she told the Guardian. “We went in this to care for patients, and it’s heartbreaking to not be able to give the care that you know could potentially save their life.” And, she said, it’s only going to get worse.

Crisis standards of care, or triage, mean overwhelmed providers may prioritize the patients more likely to survive over others for treatment, and they may not be able to provide care to some people at all. At least one patient in Anchorage, the state’s largest city, died while waiting for care.

Soldotna’s Central Peninsula hospital, about 150 miles from Anchorage, is operating at 133% capacity, said spokesperson Bruce Richards. And he’s worried about what will come next. “We all know that hospitalizations lag following these high-case days, so I don’t know what’s in store for us.”

Central Peninsula serves about 38,000 people, but it doesn’t usually offer higher levels of care. For that, patients are typically transferred to nearby hospitals in Anchorage. But with those hospitals also over capacity, Central Peninsula is caring for sicker patients than ever before.

Alaska showed initial promise with one of the best vaccination rates in the country. But, like West Virginia, its early promise soon stalled as vaccination rates slowed. That has been a phenomenon repeated across the US, though the slowing of vaccination rates has been most pronounced in conservative, usually Republican-run states.

Earlier this month, Dunleavy declined to declare a statewide disaster, and he has opposed mask and vaccination requirements. When asked directly by reporters on Wednesday, Dunleavy said “vaccinations remain the most important tool” but he will not mandate them.

With less than half of the population fully vaccinated, Zink finds herself wondering what she could have done differently to protect her neighbors, her family, her state – what else she could have done to convince them to get vaccinated and take precautions to halt the virus.

“It’s heartbreaking to feel like you’ve been running a marathon sprint for almost two years now, and this point of the pandemic is what I’ve always been trying to avoid,” she said.

Health workers report burnout and frustration with the ongoing crisis, particularly because it was preventable. “The evidence speaks for itself,” Richards said. “It’s very clear that a vaccine will help keep you out of the hospital.”

Governor Mike Dunleavy has declined to declare a state of emergency, and he has opposed mask and vaccination requirements. Photograph: Becky Bohrer/AP

About 85% of Alaskans hospitalized with Covid have not been vaccinated, and they tend to get sicker than those who are hospitalized despite vaccination, Richards said: “They’re requiring higher levels of care.”

Unvaccinated hospitalized Alaskans also tend to be much younger, Zink said. “Seeing such young people coming in, getting so sick, has also been really devastating.” She also sees patients, fearful of seeking medical treatment, who could have received lifesaving care earlier in their illness but waited too long.

There are no life-support machines, known as ECMO, in the entire state of Alaska, which means very sick patients need to be transferred to hospitals in western states, which are also facing pressure from the surge in cases. “As we’ve seen decreased beds across the country, including Seattle and Portland, we’ve been unable to, or seen significant delays, in transferring people to the lower 48,” Zink said.

“Geography really is a huge challenge,” Zink said. The average Alaskan travels 147 miles each way to access care, and many communities are only accessible by plane, where weather delays can present yet another hurdle.

Central Peninsula recently had a patient who needed a high level of care, but all of the facilities in Alaska that would have provided it were full. Health administrators started calling west coast hospitals, eventually finding a bed in Portland.

Overwhelmed health systems across the US have been a major concern, particularly for states like Alaska facing a massive shortage in care. “Everybody’s concerned about that,” Richards said. “Everybody’s watching across the country as this wave has gone through.” It’s not just providers and beds; some hospitals are also facing shortages of life-support machines and other key equipment for saving lives.

To cope with provider shortages, Alaska is now bringing in almost 500 health workers, including nurses, nurse assistants, respiratory therapists and others.

The state has also focused on distributing monoclonal antibodies, a treatment that can greatly reduce hospitalizations and deaths if administered early in the course of Covid-19. But, Zink said, there are significant geographic challenges to offering the treatment, which must be given as an infusion or as four shots under the skin.

Alaska has gotten creative with bringing the antibodies to remote communities with cruise ships and fishing boats. But that can take up to four days to deliver. And, with the Biden administration’s new distribution system for the antibodies based in part on how many doses have been administered, delivery delays may mean Alaska faces challenges receiving new shipments of the treatment.

For now, cases appear to be leveling off in other states, Richards said, making him hopeful that other states may be able to care for some Alaskans. “But it’s still very difficult to send the patients out of state,” he said. “It’s hard to find a place.”

And there are “no signs yet” of cases in Alaska slowing down, Zink said.

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