Alaska’s rate of COVID-19 hospitalization and death in 2020 was far below national averages

Alaska’s rates of death and hospitalization among people with COVID-19 in 2020 fell far below national averages, statistics that reflect the state’s younger overall population and lower number of nursing homes.

The state’s death rate was less than one-third the national rate, or 34 per 100,000 residents compared to 104 nationally, according to a bulletin from the epidemiology section of the state Division of Public Health released Friday summarizing COVID-19 deaths from January through December.

But the overall death rate nearly quadrupled after mid-October, state epidemiologists found, “and rates increased in all geographic areas, all age ranges, and all racial and ethnic categories.”

The disparity between national and state rates for hospitalizations last year also was striking: Alaska’s rate was less than half the national rate, at 140.6 per 100,000 residents compared to 343.4 nationally, according to a bulletin summarizing COVID-19 hospitalizations last year.

Preliminary state data shows that possibly up to 20% of the 245 Alaskans who died with the virus last year were not hospitalized, state epidemiologists say.

There’s a chance that information could change, especially for those who died in late December and whose hospital status still needs to be confirmed, according to Dr. Louisa Castrodale, an epidemiologist with the state’s infectious disease program. It’s also possible some died at the hospital but they had been receiving care for something else, so COVID-19 was noted later as a contributing factor on their death certificate.

Those who did die at home may have been in hospice care and chosen not to go to the hospital, Castrodale said.

Some people in rural Alaska have also described loved ones dying at home because of medevac flights grounded by bad weather or reluctance to leave family behind to fly to larger communities with hospitals.

[The death and burial of our dearest mother and grandmother]

Generally, about two-thirds of the Alaskans who died with COVID-19 were men and death rates were highest in people over 80, the bulletin says. Of 200 people with known medical histories, only 10 people had no pre-existing conditions associated with increased risk for more severe infection, including two people in their 30s and one in their 50s.

Two-thirds of Alaska adults have one or more of these underlying conditions including include cancer, smoking, diabetes, obesity, chronic kidney disease and chronic heart disease.

Of the nearly 200 people who died after being hospitalized at some point during their illness, almost half were admitted to an intensive care unit, according to the bulletin. Most deaths occurred in November and December, when the state’s monthly counts of new confirmed cases also peaked.

Mortality rates were highest among Native Hawaiian and Pacific Islands people as well as American Indian and Alaska Native people, with “notable increases” in rural Alaska Native people late in the year, according to the bulletin.

As of Friday, 260 Alaskans with COVID-19 had died along with two nonresidents since the pandemic reached the state in March. Alaska’s death rate per capita is still among the lowest in the country, but the state’s size and vulnerable health care system complicate national comparisons.

Public health officials have said the high numbers of younger people contracting COVID-19 in Alaska could be a factor in the state’s relatively low numbers of hospitalizations and deaths compared to others. Alaska ranks second among all states in terms of lowest median age.

National data shows that the rate of people hospitalized with the illness per 100,000 population is lower for younger people.

Alaska also has fewer nursing home beds per capita than any other state.

[Young people make up most of Alaska’s new COVID-19 cases. Health authorities want their help.]

The state bulletin on hospitalizations attributed the relatively low numbers to several factors including “successful community mitigation, Alaska’s younger population age distribution, and successful preservation of hospital capacity.”

Dr. Joe McLaughlin, an epidemiologist with the state, said by email Friday that Alaska’s hospitals were largely kept from being overwhelmed and noted that in other communities, “when hospitals become overwhelmed, death rates rise considerably.” He also said that Alaska’s aggressive virus mitigation efforts early on in the pandemic helped delay a rise in case counts, which “bought us time to glean from other’s experience on how best to care for COVID-19 patients in the hospital setting.”

Regional rates are further influenced by factors including local adherence to mitigation measures like masks, testing rates, localized outbreaks, hospital referral patterns, health care availability and population density.

The hospital statistics referenced in the state bulletin only include patients where COVID-19 either contributed to or caused their hospitalization; people who tested positive while getting care for something else, like injuries from a car accident, weren’t included.