Alaska reports over 1,000 COVID cases Friday as ANMC shifts care standards, gets help from Outside workers

Alaska on Friday reported 1,044 new COVID-19 cases and one death as Alaska Native Medical Center shifted to crisis standards of care and received some relief in the form of health care workers from the Lower 48 who began arriving in Alaska this week.

The workers arrived at a critical time: Alaska is in the middle of one of the sharpest virus surges in the nation. Its case rate is higher than any other U.S. state and the number of patients hospitalized with the virus is at a near-record level, straining the state’s hospitals.

At ANMC, leadership voted Thursday evening to activate crisis standards, a sign of how the hospital in Anchorage is having to adapt to added pressure on its resources.

The hospital is one of the latest in the state to activate crisis standards — Providence Alaska Medical Center was the first to make the move last month. Other hospitals have had to less formally rely on state crisis standards to make decisions about patient care. As of Saturday, 20 health care facilities across the state are operating under crisis care standards, though circumstances vary widely from place to place.

For Providence, “crisis care” has meant an occasional rationing of treatment, and using state guidelines and an internal triage team to make difficult care decisions when necessary, which many health care workers consider to be a worst-case scenario.

At Alaska Native Medical Center, the reason for the activation has been less extreme: The decision was mainly made to “allow for more flexibility to maintain high levels of care,” said Dr. Bob Onders, the hospital’s administrator, during a Friday interview.

Specifically, challenges arose Thursday related to caring for patients requiring kidney dialysis although other areas of care were also at risk of being impacted, Onders said.

So far, no care has been rationed at ANMC, all patients have been able to receive the care they need, and the hospital is managing, he said.

But the move is a sign of a worsening situation at a hospital that for months has seen its emergency room and intensive care unit overwhelmed with extremely high volumes of COVID-19 patients who often require high levels of care.

As hospitalizations and deaths from the virus have continued to rise, ANMC also this week requested the use of a state-owned mobile morgue to have on standby, said Shirley Young, hospital spokeswoman. The morgue arrived Thursday, and hasn’t been needed yet, she said.

‘Happy to be here’

ANMC has long been plagued with staffing shortages, which were exacerbated by the latest virus surge.

To address these challenges, last week state officials announced a $87 million federal contract that would bring as many as 470 health workers, many of them nurses or respiratory therapists, to Alaska starting this week.

As part of that contract, ANMC received 30 nurses and certified nurse assistants who started this week, plus added support from a federal emergency response team.

That additional team includes 35 health care workers from Massachusetts who began their orientation Friday morning, and will stay for at least two weeks.

A Disaster Medical Assistance Team is typically deployed during natural disasters or emergencies — including the terrorist attack on 9/11, and Hurricane Katrina in 2005.

Onders said the hospital was selected to receive the added assistance because of their capacity issues and recent struggles to provide care.

“We’re operating at 100% capacity,” he said Friday. Patients have regularly had to be held in the emergency room to wait for a bed, and staff are exhausted, he said. “Today, we have every bed full, at two patients waiting for beds in the” Emergency Department.

“We see ourselves coming in when there’s a need, or a public health emergency,” explained Gina Smith, a registered nurse and a team lead with the group. “And this is a public health emergency.”

Smith’s team was on-call for the month of September, and she found out Wednesday evening that she was going to Alaska. She sees her role as collaborative.

“We support and augment what’s happening here, so we want to make sure we’re familiar with the practices that are here in Alaska and at (ANMC) so we can make a smooth transition in,” she said.

Many hospital staff are relieved about the arrival of the new workers, said Sadie Anderson, director of nursing at ANMC.

“A lot of nurses have been having to work five and six shifts a week,” she said, and the staff shortage has meant “we’re begging people to work extra. So this is going to help give those nurses a break,” she said.

The workers will also help decrease the nurse-to-patient ratio, she said.

Onders said he was thankful for the extra staff, but it wouldn’t entirely solve all of the hospital’s struggles.

“We have 600-700 nurses here, so 40 nurses is a help, but it’s a proportional response that still is challenging,” he said.

Friday morning, many of the nurses and support staff were finishing up their orientations or beginning work on the floor.

“We are happy to be here to help in whatever way we can,” said Tracy Williams, a certified nurse assistant hired by the state who started work at ANMC on Friday morning.

She said being a traveling health care worker can be exhausting — she finished up a stint in Michigan on Monday, returned home to Georgia for just a few days, and was in Alaska by Friday.

“That’s exhausting,” she said. “But it’s the motivation for what you love to do that give you that push to say, ‘Come on, girl. You can sleep on the plane.’”

Statewide COVID-19 numbers

As of Friday, at least 202 people were hospitalized with the virus across the state, including 35 people on ventilators.

Half of those patients were in Anchorage, the majority were unvaccinated, and many were younger and sicker than those treated during last winter’s surge.

The state also reported the virus-related death of an Anchorage man in his 50s. In total, 557 Alaskans and 21 nonresidents have died with COVID-19.

Alaska’s per capita case rate over the past week is higher than that of any country in the world, according to data from the Center for Systems Science and Engineering at Johns Hopkins University.

Alaska’s 170 average daily cases per 100,000 over the last seven days is nearly double the rate in West Virginia, which ranks second in the United States. Bermuda and Serbia, at the top of the global list, have case rates of 99 and 101.

Of all tests conducted in Alaska over the last week, 9.61% were positive.

About 63% of Alaskans 12 and older had received at least one dose of a COVID-19 vaccine.