COVID-19 cases in Anchorage and Alaska are on the decline. Is the ‘hunker down’ responsible?

For the third time since March, Anchorage has closed bars and restaurants for indoor service. And for the third time, daily COVID-19 case numbers have dropped.

“The big question is what’s driving that, and have these emergency orders, in particular in Anchorage, have they made a difference?” said Dr. Tom Hennessy, University of Alaska Anchorage epidemiologist.

Case numbers in Anchorage soared in November, leading to Acting Mayor Austin Quinn-Davidson’s consideration of business closures that she ultimately enacted for the month of December. But the decision elicited an outcry from vocal detractors, especially in the hospitality industry, who said the move was too heavy-handed.

On Dec. 5, the state recorded its highest-ever single day case count at 933. Nearly 300 of the cases involved Anchorage residents. Since then, case counts have steadily dropped. Hennessy said the data indicates the drop is due to Emergency Order 16, similar to what happened during emergency orders in the spring and late summer.

“Those all had an impact very similar to this,” Hennessy said.

What’s leading the decrease?

During Tuesday night’s Anchorage Assembly meeting, Quinn-Davidson and the city’s epidemiologist, Janet Johnston, also said the emergency order is responsible for lower case rates.

Johnston said the city went from an average of 370 new cases per day in mid-November to under 200 cases per day. The percent positivity rate for tests is also down, and hospital capacity is on the rise.

“Without EO-16, I think the COVID story in Anchorage would be more like other communities across the country, running out of ICU and inpatient capacity,” she said. “When that happens, you start to see mortality rates creep up.”

[Most Alaskans are wearing masks and believe they work, survey shows]

Johnston said while the numbers are better, Anchorage’s daily case rate is still about 12 times higher than the federal high alert level for reopening schools.

Since Nov. 9, when Anchorage had its peak reproductive number between 1.2 and 1.7, the number has come down to 0.85. Anything over one means virus transmission is increasing, and anything under one means it’s dropping.

“That’s about a 27-30% decline in the reproductive number, and that’s remarkably similar to what happened in August,” Hennessy said.

On Nov. 6, Quinn-Davidson announced a tightening of the mask mandate and gathering sizes. On Nov. 12, Gov. Mike Dunleavy used the state’s emergency alert system to broadcast a plea to Alaskans to stay socially distant, wear masks and avoid people from other households over the Thanksgiving holiday.

Hennessy said that messaging also likely impacted Alaskans’ behavior.

“Teasing apart the individual effects is very difficult,” he said.

[As groups clamor for vaccine, here’s how Alaska will decide who’s next in line]

During a Wednesday videoconference, an epidemiologist with the Alaska Department of Health and Social Services, Dr. Louisa Castrodale, said a number of factors were likely at play. She said due to a backlog in processing test results in mid-November, cases in Alaska likely spiked weeks before the data shows.

“I think (the emergency order) helped to tamp down those numbers, but in hindsight it does look like we peaked a little earlier than we thought,” she said.

Castrodale said she doesn’t think lower case numbers can be conclusively attributed to any one thing, but that all actions collectively appear to have had an impact. She also noted that cases dropped in December across the state — not just in Anchorage, where there was a restaurant and bar closure.

On the same videoconference, Dr. Anne Zink referenced Dunleavy’s emergency alert in November.

“What happened in Anchorage is a part of it, but we also saw many other communities as well as many Alaskans without emergency orders choosing to reduce their interactions, wear more masks and interact differently,” said Zink, Alaska’s chief medical officer.

Restaurants struggle as the economy shutters

The benefits of the emergency order come at a severe cost to the economy. Nearly 10 months into the pandemic, many businesses are struggling to hang on. Some, such as Table 6 in Midtown, have closed down.

Table 6 owner Alex Perez testified at Tuesday’s Anchorage Assembly meeting, starting by telling city officials that his restaurant closed due to their failed leadership. He ended by reading a list of dozens of former employees who are out of a job.

Some businesses participated in an organized defiance of Emergency Order 16 on Saturday. Jackie’s Place in Spenard was fined $300 on Tuesday for opening over the weekend, and code enforcement planned to fine the downtown White Spot Cafe later in the day. Both restaurants opened for part of Saturday, violating the order.

City spokeswoman Carolyn Hall said the businesses are now ineligible to receive any current or future hospitality grants aimed at helping businesses impacted by the pandemic.

On Tuesday morning, the city held a standing, twice-monthly meeting with industry representatives. Usually, about 10 to 15 total people participate, ORSO and Glacier Brewhouse owner Chris Anderson said. On Tuesday’s call, there were about 45 people, he said, with at least 30 from the hospitality industry.

The first half-hour involved Quinn-Davidson and Anchorage Health Department personnel giving a recount of case numbers and other public health information. Then, Anderson said, the meeting turned to “raw emotion.”

“It just kind of broke down, it got crazy,” he said.

Anderson said the hospitality industry’s position is that restaurants must reopen, even if at half capacity. They’re dying, he said, and the little financial assistance the city is able to provide just postpones their death ever so slightly.

[Anchorage restaurant coalition pitches plan to reopen, but officials say better sanitizing won’t make dining-in safe]

Anderson himself has pitched the city on what he calls the “North Star plan,” which includes protocols like enhanced sanitization and temperature screenings for guests, though city officials said that is not enough. He said Quinn-Davidson and her team are doing their best in a terrible situation, and restaurants just happen to be a site of transmission they can control.

“There is no good decision,” he said. “Both decisions are bad.”

What does the data not show?

Hennessy said the data has clearly shown a decline in transmission after an emergency order, such as one closing businesses, is imposed. There’s also been an increase after such an order is lifted. But there are still gaps in the data.

“We would love to know exactly where transmission is occurring,” he said.

Early in the pandemic, the city was able to sufficiently trace where people who tested positive had been over the past handful of days. They were able to identify locations of outbreaks, most being bars and restaurants. But as cases rose, they became overwhelmed and have since been unable to conduct such detailed contact tracing. Hennessy said most states around the country are in the same situation.

A couple weeks ago, New York Gov. Andrew Cuomo made headlines by releasing data showing where cases were coming from in the state. Almost three-quarters of the cases were attributed to household/social gatherings while bars and restaurants accounted for 1.4% of the cases.

That low figure has been used by restaurant owners in Anchorage, arguing that not only can restaurants be safe, but closing them would push people to less regulated indoor gatherings.

Hennessy said states like Colorado and Louisiana are still able to contact trace, and have found 10% to 20% of cases come from bars and restaurants.

“Any outlier that’s in the 1% range doesn’t make sense to me,” Hennessy said.

While cases have dropped in Anchorage during the shutdown, they’ve also dropped in the Matanuska-Susitna Borough, where there are no such business restrictions, or a mask mandate. But Hennessy said that doesn’t mean such mandates aren’t actually impactful.

“This is one of the things about the pandemic that’s hard to explain,” he said. “These things do ebb and flow.”

He said in the long term, cases in Mat-Su have been much lower than in Anchorage, though they did spike in November. He said such a spike, and subsequent messaging about hospital capacity decreasing, can cause people to change their behavior. He also said that while Mat-Su rates have dropped recently, they’ve been higher than Anchorage’s overall when looking at the past six weeks.

“I don’t think you can argue and say, ‘Oh look, Mat-Su didn’t have a restaurant closure and a mask order, Anchorage did, our rates are similar right now therefore these things don’t work,’” Hennessy said. “I think that’s a totally false way of looking at it.”

Hennessy said the goal now is to avoid the pattern of becoming more comfortable after cases decline and businesses reopen.

“The key for us, really, is to get rates low enough, and keep them low enough, for as long as we can until the vaccine becomes widely available,” he said.