Alaska’s COVID-19 hospitalizations are at pandemic highs. Here’s what that number really reflects.

As Alaska’s hospitals grapple with short staffing, limited capacity and a health care system under serious strain, the state has reported ever-rising record numbers for COVID-19 hospitalizations.

But those tallies are complicated. They include people who may have been admitted for something else and test positive for the virus, but they also omit others who have been hospitalized for COVID-19 for so long that they’re not infectious anymore.

That all makes it harder to discern the true burden placed on health care facilities using a single number, Dr. Anne Zink, Alaska’s chief medical officer, said in an interview Friday.

“I don’t think from a state perspective we can say it’s like really overcounting, we can’t really say it’s undercounting,” Zink said. “We can say this is the only data that we can report out because it’s the only data that we have.”

State hospitalization data also doesn’t include emergency room visits, another way to quantify the burden on hospitals, since those are considered outpatient visits, Zink said.

The virus hospitalizations number recorded on the state’s online dashboard comes from hospitals that report into a federal database, and that information is then extracted by state public health officials.

While testifying before the House Health and Social Services Committee last week, Zink told legislators that the total number of hospitalizations reported on the state’s COVID-19 dashboard likely didn’t represent everyone ill from the virus in Alaska’s hospitals.

“For someone, say, who’s in their 30s who gets hospitalized, they might be infectious for the first 10, 15 days,” Zink said. “But they might require a monthlong or two-month-long hospital stay. And so that is a continued burden on the hospital that is not reflected in the overall dashboard numbers.”

There may also be other patients who aren’t reflected in the dashboard, Zink said. Some patients might begin to recover and then experience a complication, like a heart attack or stroke, and are admitted and treated instead for that complication, according to Zink. That wouldn’t always show up in state data.

When asymptomatic individuals who are COVID-positive are admitted to hospitals for other reasons, like labor, those patients still incur more work for hospital staff and require more resources. Staff have to gown up and patients need single rooms.

Asymptomatic patients also might get sicker while in the hospital, Zink said, and go from seeing no symptoms when they test positive to experiencing complications later.

Generally speaking, health officials say, once a patient is no longer positive for COVID-19, they’re no longer counted in the overall hospitalizations number. They might, however, still be in a hospital bed while symptoms persist, needing acute care and impacting capacity.

But there is some variety in how COVID-19 hospitalizations get reported.

Based on responses from various Alaska hospitals this week, some report all COVID-19-related hospitalizations while others only report active cases.

Alaska’s largest hospital, Providence Alaska Medical Center, only reports active COVID-19 cases in their hospitalization numbers. That doesn’t include others who are no longer infectious with the illness but still need hospital care, according to Providence Alaska spokesman Mikal Canfield.

On Wednesday, 50 people were considered active COVID-19 patients at Providence, while 22 others were not included in the case count since they weren’t infectious and were considered “recovered,” Canfield wrote in an email.

“This does not necessarily indicate the patients are doing well, it just indicates these patients are no longer considered infectious,” he wrote.

Similarly, Fairbanks Memorial Hospital only reports active COVID-19 cases, which as of this week was 24 cases, while there were no patients who were hospitalized past their infectious period.

The COVID-19 hospitalizations number of the state’s dashboard isn’t necessarily an accurate portrayal of who may be hospitalized with the illness at Mat-Su Regional Hospital either, according to spokesman Alan Craft. That’s because, similar to other facilities, patients who are at the hospital for longer stays due to COVID-19 may not show up in those numbers after being reclassified.

At Alaska Native Medical Center, generally any patient that tests positive for COVID-19 is reported as hospitalization but may be pulled out of that tally based on symptoms and other Centers for Disease Control and Prevention guidelines even though they may still be hospitalized, said Dr. Robert Onders, of the Alaska Native Tribal Health Consortium.

However, at Alaska Regional in Anchorage, spokeswoman Kjerstin Lastufka said that their COVID-positive numbers include all patients who need care related to the virus until discharge.

“The number that is reported to the state includes both patients in the acute phase of COVID-19 care as well as patients still recovering from COVID-19 — those who are past the infectious period — but are still hospitalized,” Lastufka said in an email.

Officials at Bartlett Regional Hospital in Juneau said that they report new COVID-19 admissions within their infectious window and in some cases, depending how severe a case might be when they’re admitted, that infectious window can be extended to 20 days.