Bethel hospital enacts crisis standards as Alaska stays on upward COVID-19 trajectory

A major rural Alaska hospital is enacting crisis standards of care, the latest facility to employ the worst-case scenario that provides support for doctors forced to decide which patients to treat due to shortages of staff, beds or equipment.

Yukon-Kuskokwim Health Corp. announced a shift to crisis-care mode on Wednesday, saying the tribal health organization’s Bethel hospital is operating at capacity and struggling to maintain normal standards of care as COVID-19 cases continue to mount in the region and around the state.

At least one other hospital, in Valdez, is also newly using crisis-care guidelines to make treatment decisions involving oxygen, which is in short supply because of demand from COVID-positive patients.

Providence Alaska Medical Center began occasionally rationing care for patients starting Sept. 11, using state guidelines and an internal triage team to make difficult decisions when necessary.

Despite an apparent peak and decline in cases nationally, Alaska is continuing on a steep upward trajectory, with more than 1,000 new COVID-19 infections reported Wednesday.

State epidemiologist Dr. Joe McLaughlin said Wednesday that Alaska has the highest seven-day case rate in the nation — five times higher than the national average and double the rate of the state with the second-highest rate, West Virginia.

“We are definitely in a steep, steep upward trajectory,” McLaughlin said.

Several places in the nation showed declining cases rates this week, appearing to show peaking and falling cases, McLaughlin said.

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Gov. Mike Dunleavy and top health officials enabled crisis standards of care last week, offering each hospital the choice to enact standards as well as protect providers from liability. Officials also announced a federal contract to bring as many as 470 health workers, many of them nurses or respiratory therapists, to Alaska starting this week.

Yukon-Kuskokwim Health Corp. made the crisis-care decision as many of the hospitals that normally take patient transfers in Anchorage and elsewhere continue to operate at capacity, officials there said Wednesday. Hospitals in outlying areas already says they’re having to treat more challenging patients in-house because they can’t move them out for higher levels of care.

The Yukon-Kuskokwim health organization developed crisis guidelines at the start of the pandemic, including the activation of a committee of physicians, to support providers making clinical decisions, officials say. The change in operations could mean delayed patient transfers, fewer nurses caring for patients and longer wait times for elective procedures like cancer screening or pediatric dental procedures.

The decision Wednesday wasn’t triggered by any specific shortages, and it doesn’t mean the kind of care rationing that Providence doctors have described in Anchorage is happening in Bethel, said YKHC chief of staff Dr. Ellen Hodges.

It does mean those kinds of decisions are possible unless the strain on the state’s hospital system eases, Hodges said.

“The nuances of this and how to explain it to the public is really hard,” she said. “It does sound and feel really dramatic but it really is about taking the best possible care we can of our patients. The people in the hospital are OK.”

Hospital executives urged Yukon-Kuskokwim residents to get vaccinated for COVID-19, wear a mask in indoor public areas, practice social distancing and take extra steps to avoid injuries that could land them in the ER.

Doctors at the Providence Valdez Medical Center are already applying the state’s crisis-care guidelines to ration oxygen, according to Dr. John Cullen, the 11-bed hospital’s chief of staff. The hospital is operating at 50% staffing amid a local COVID-19 surge that’s triggered a wave of patients who require high quantities of oxygen.

“We’re not giving as much oxygen to get patients up to what we’d consider normal,” Cullen said Wednesday. Normally, the hospital would want to see patients hit 93% oxygen saturation levels, he said. Right now, providers are accepting 90% as recommended by state crisis standard guidelines.

The hospital has been contending with “really sick” COVID-19 patients, Cullen said. One died recently after they were transferred to another hospital.

He wrote a letter to the Valdez mayor and city council last week warning the state’s limited hospital capacity could make transfers to Anchorage from their small hospital “difficult to impossible” despite state programs to relieve staffing pressure, including more workers coming to town.

Cullen described the likelihood of a much higher mortality rate “similar to a battlefield scenario” until COVID-19 cases start to drop.

“When you get to a crisis standard of care, that’s what that means, is that you’re going to expect a higher level,” he said Wednesday. “It really depends on how bad this particular wave is. I was really hoping we were going to see some significant decreases in numbers over last weekend.”

This week, the city of Valdez enacted a disaster declaration given the worsening situation in the community. A Thursday city council meeting is going to consider an extension of the disaster declaration as well as a mask mandate, said Allie Ferko, public information officer for the city.

The declaration includes specific requests for more hospital personnel and continuation of testing and vaccination support. The declaration also has to be in place in order to enact an emergency mandate, like a mask requirement, Ferko said.

On Wednesday, Alaska reported 1,009 new cases and four more virus-related deaths. Since March 2020, 546 Alaska residents and 21 nonresidents with the virus have died.

The deaths reported Wednesday involved Anchorage residents: two men in their 40s, a woman in her 60s and another in her 70s.

Alaska reported 207 virus hospitalizations Wednesday, and COVID-19 patients — mostly unvaccinated — made up more than a fifth of all people hospitalized in the state. Others who may still be hospitalized due to the virus but are no longer actively infectious aren’t counted in that overall number.

The percentage of tests coming back positive over the past week in Alaska was 9.2%, which McLaughlin noted is almost double the state’s target of 5%.

By Wednesday, 63% of Alaskans ages 12 and older had received their first dose of the vaccine while 60% were considered fully vaccinated.

Correction: A previous version of this story incorrectly reported when the Valdez city council meeting was set to occur. It is scheduled for Thursday.