September was Alaska’s deadliest pandemic month. Here’s what that might tell us about the future of COVID-19 in the state.

In Alaska, at least one COVID-19 death — but usually two or more, and as many as 10 — was reported for each day in the month of September, state data shows.

It was the deadliest month of the pandemic so far, with 138 people dead.

September 2021 broke records on multiple other fronts, including the number of COVID-positive patients in Alaska’s hospitals and daily case counts. Elevated hospitalization and case numbers have carried on into October.

Health experts say the darkest, grimmest weeks of the pandemic can teach us that without more vaccinations and prevention measures, the potential for a continued surge or a new one remains, and the pandemic’s deadly toll will likely continue until cases decrease.

Vaccines — which are proven to decrease the likelihood of severe illness, hospitalization and death from the virus — have been widely available in the state for months. Clinics and local pharmacies have offered the preventive shot for free, every day, for much of this year.

But the state’s vaccination progress has slowed. On the first day of September, 61.3% of Alaskans older than 12 had their first dose of the vaccine. Currently, that number stands at 64.5%, rising only a little over three percentage points.

In a weekly report, state health officials said cases are plateauing in several communities. In Anchorage and the Matanuska-Susitna Borough, health officials wrote, there’s no clear evidence of an upward or downward trajectory.

“Regardless of the trajectories, intense community transmission is continuing to occur and is causing significant illness, death, and demand on the health care system,” they wrote.

Janet Johnston, former Anchorage Health Department epidemiologist, said that until more people get vaccinated, the coronavirus will continue to spread.

“We’re going to keep seeing high rates of cases and hospitalizations and deaths,” Johnston said. “In some ways, it feels like unfortunately, the story hasn’t changed the behavior of the virus. It’s more transmissible, but it’s still transmitted the same way.”

[Alaska reports 6 deaths, 877 cases Friday as COVID-19 hospitalizations remain near record level]

And while the virus continues to transmit at a high rate in Alaska and the rest of the world, there’s a chance it will mutate, she said. Given how much virus is being spread, Johnston said, it’s hard to believe there won’t be more serious mutations in the future beyond the current delta variant.

“Which, again, is the reason why we need to get people vaccinated and get the case counts down so we have less virus transmitting,” Johnston said.

Given how high case rates have been, it’s not a surprise that the state had so many deaths, said Dr. Benjamin Westley, who treats COVID-19 patients in Anchorage. Hospitalizations can lag for weeks after someone gets sick, and deaths can lag a month or two.

“September was a bad month, and unfortunately, I think people can expect to the next couple of months are going to have pretty high death numbers compared to what we’re used to,” Westley said.

There’s a lot of virus circulating in the state right now. And the virus is especially bad for those who are unvaccinated, he said.

“There’s no way to avoid death when this many people that are unvaccinated are getting COVID,” Westley said.

The state’s been able to mostly avoid a large number of deaths compared to other states because of its relatively younger population, hospitals that weren’t extremely full and a lack of large nursing homes. But that will likely change, Westley said.

“Clearly, our death rate amongst other states is going to rise,” he said. “You can’t have more COVID than any other state for three or four weeks on end without expecting the deaths to go up.”

Anchorage’s recently passed ordinance requiring masks in indoor public spaces could help push COVID-19 numbers down. With that type of mitigation occurring in the state’s biggest city, cases should start to decrease in the next week or so, according to Westley.

There are several exceptions to Anchorage’s emergency mask ordinance. Multiple businesses — as well as the city’s municipal manager — have highlighted those exclusions to employees and/or customers, and questions remain about how the ordinance will be enforced. Mayor Dave Bronson and his administration opposed the mask mandate, and the municipal manager’s office is in charge of handling complaints about mask ordinance violations.

In response to a question about the city health department’s plans for the approaching months of the pandemic, Bronson spokesman Corey Allen Young said in an email that the department would “continue to test, vaccinate and strongly encourage monoclonal antibody treatment, as well as strongly encourage non-pharmacological mitigations.”

“As we have seen, the Delta variant is too unpredictable,” Young said.

September’s COVID-19 cases overwhelmed hospitals, a situation the state had largely avoided for many months during previous surges, said Dr. Tom Hennessy, an affiliate faculty member with the University of Alaska Anchorage and previous director of the CDC’s Arctic Investigations Program.

“This has been a really tough stretch, and it’s pretty clear we’re not through it yet,” he said.

While it looks like cases may have plateaued, they’re plateauing at a really high level, which Hennessy said is discouraging given how effective vaccines are and how much we know about the virus. Alaskans could have done better at applying those tools earlier in the summer to help blunt the surge, he said.

The state didn’t meet its goal of high vaccination levels — at the start of the surge back in early July, only half of eligible Alaskans had been vaccinated.

“That just wasn’t enough. It left a large proportion of the population vulnerable to this new strain,” Hennessy said.

A lot of the proven pandemic prevention measures fell out of practice. People weren’t masking or social distancing the way they were earlier in the pandemic.

“It seemed like we forgot the lessons that we learned in the first year of the pandemic and just either got tired or people just got frustrated, or just ignored what we had learned,” he said.

That led Alaska to where we are now.

What does this all mean for the future? It’s hard to predict, Hennessy said, “but I think one of the things is pretty clear is that on a population level we are still vulnerable in Alaska.”

Vaccination levels aren’t high enough to stop the spread of the virus. This summer demonstrated that the state’s large portion of unvaccinated people spread the virus, he said.

“And we’re still in that position,” Hennessy said.

Even assuming that some of the unvaccinated people now have natural immunity from the recent surge, Hennessy said there are still enough people without immunity to continue the current surge or create another one if people don’t take actions to stop spread.

“I think it’s an important turning point opportunity for Alaska,” he said, “to see if we can get to the point where we can protect ourselves when we have the tools to do that.”