Why is Alaska’s COVID-19 death rate among nation’s lowest, even as cases surge and hospitalizations keep rising?

For more than a month, coronavirus cases across Alaska have surged, with rising hospitalizations and a climbing test positivity rate. By most indicators, the pandemic here shows no signs of slowing.

But despite these alarming trends, there’s one metric that has so far stayed steady: Alaska’s per capita COVID-19 death rate has remained among the lowest in the nation, currently tied with Vermont at nine deaths per 100,000 people. Data from a report released by the state this week shows that the national COVID-19 death rate is about seven times higher than Alaska’s.

As of Thursday, a total of 77 Alaskans had died with the virus.

When asked this week why Alaska has so far avoided a much worse fate than other places — New York City’s per capita death rate from the virus, for example, is nearly 32 times higher than Alaska’s — health officials said there are many reasons, including Alaska’s early pandemic response, a relatively low nursing home population and an overall population that skews younger.

But state health officials said a low death rate is a precarious metric, and it can change quickly.

More than 20% of the state’s deaths have occurred in the last month.

“When you get a lot of cases in a short period of time, you can overwhelm the health care system quickly, and you get a lot more excess deaths,” said Dr. Anne Zink, Alaska’s chief medical officer. “And I think that’s what we’re on the threat of."

An early start

Alaska’s early successes with its mandates and community participation in social distancing, masking and avoiding gatherings played a major part in keeping overall numbers down, said Joe McLaughlin, a state epidemiologist, on a call this week.

“That effort early on in the pandemic basically translated to very low case counts in Alaska,” he said. “And that basically bought us time to learn more about how to best care for COVID patients.”

By the time Alaska saw a surge in July, he said, health care workers were prepared.

“By that time, we had some medications that were available and a much better understanding of how to care for patients," McLaughlin said.

Alaska’s early and aggressive testing strategy, a key tool for keeping outbreaks constrained and preventing community spread, is also “likely affecting our numbers,” Zink said on the same call.

[New report reveals stark disparities by race, age and gender in COVID-19 deaths and hospitalizations in Alaska]

The mortality rate is calculated by dividing total deaths by total infections.

Over the summer, the state tested a large swath of healthy people, including out-of-state seafood industry workers and travelers who were offered free tests in many airports, which allowed the public health team to detect many more cases and helped bring the overall mortality rate down.

Young people are driving the surge in cases

Alaska’s mortality rate is also low in part because younger people are less likely to die with the illness, and in Alaska, they make a disproportionate share of the state’s virus cases, health officials say.

That’s because young people — particularly those in their 20s and 30s — are more likely to be essential workers or work outside the home. They also tend to be more likely to go to bars and gatherings, and over the summer, they largely made up the seafood industry workforce that was extensively tested.

Many of them also have young children who may be carrying the virus and mixing with others, and may be less likely to follow mandates.

The U.S. Centers for Disease Control and Prevention has said that while all people are equally likely to become infected by the virus, the risk for severe illness, hospitalization and death from COVID-19 increases with age.

Eight out of 10 U.S. coronavirus deaths have involved adults over the age of 65.

In Alaska, people over 60 make up just 15% of virus cases, but about 80% of total deaths.

What also helps with the state’s low mortality rate is that Alaska has largely been able to avoid large outbreaks in nursing homes, in part because the state has the lowest rate of nursing home beds per capita of any other state, Zink said.

“A lot of our nursing homes are very spread out, or people are being cared for in a home or in a family,” she said. “So we don’t have nursing homes with a thousand people, where it could get going quickly and affect a lot of people.”

Nationwide, more than a third of U.S. coronavirus deaths are linked to nursing homes, according to The New York Times.

According to the CDC, nursing home populations are at a higher risk of dying from the virus, because they are older and have underlying health conditions, plus the virus can spread more easily in congregate settings.

But while Alaska for months largely avoided the scale of outbreaks in nursing homes seen in other states, when case counts started rising, outbreaks at senior living facilities — including the state-run Pioneer Homes — started popping up too.

Two residents died at the Anchorage Pioneer Home, part of an outbreak that began in early August. And an outbreak identified in late September at the Fairbanks Pioneer Home has now grown to more than 60 staff and residents, with two virus-related deaths reported as of this week.

And in Anchorage, there have been outbreaks tied to multiple assisted-living facilities, said Dr. Bruce Chandler, a medical officer with the Anchorage Health Department.

Ultimately, more cases in the general community have translated to more cases in these more vulnerable populations, more hospitalizations, and more deaths.

A lagging indicator

Alaska has been fortunate so far to keep its death rate low. But health officials say that deaths, like hospitalizations, are a lagging indicator, and with case counts surging and hospitalizations rising, the death toll will continue to rise too.

On Thursday the state reported six deaths tied to COVID-19, matching the highest number of deaths reported by the state on a single day since the pandemic began. On both occasions, officials said several of the cases had not occurred recently and were identified through a standard review of death certificates.

“There is a lot of hope," said Zink. “And there is a lot to do. We still have the lowest fatality rate in the country."

Had Alaska followed national trends, there would have been nearly 500 deaths by now, she said.

“We made a difference in Alaska in the beginning because of Alaskans taking care of each other,” she said, stressing that taking personal steps to mitigate the virus does actually work.

“We really need people to hang in there,” she said.