For months, the Mat-Su avoided the COVID-19 spikes hitting other regions of Alaska. Now it’s a hotspot.

PALMER — For much of the coronavirus pandemic, the Mat-Su region largely escaped the rising case counts and testing shortfalls despite a lack of mask mandates or any other restrictions.

Not anymore.

As of this week, cases in the Matanuska-Susitna Borough were doubling every seven to eight days — the state’s fastest growth rate, along with the Kenai Peninsula, according to Dr. Anne Zink, Alaska’s chief medical officer. State data shows that Mat-Su residents have Alaska’s highest test positivity rate for a region on the road system.

There have been 78 COVID-19 cases reported at Mat-Su schools in the last two weeks, according to the Mat-Su Borough School District.

But schools don’t appear to be a source of transmission, health officials say. Instead, students are picking up the virus at home.

Many of the Mat-Su cases are coming from people not wearing masks and getting too close together at work, social gatherings and sporting events, they say.

“The place that we’re seeing the most transmission is at work in lunchrooms and whenever there are small group dinners, social gatherings,” said state public health nurse Rene Dillow, who is based in Wasilla. “It’s our friends and family. Everyone worries about the grocery store but that’s not where it’s passing.”

At more than 106,000 residents, the Mat-Su Borough is the second largest municipality in the state. But it’s likely that the borough’s general lack of population density — in a place the size of West Virginia, most residents are concentrated around the cities of Palmer and Wasilla — helped keep cases down until the recent arrival of winter weather sent people inside to socialize.

Now Mat-Su seems to be mirroring trends happening around rural America. The Dakotas, Wisconsin, Montana and Wyoming are experiencing the country’s highest coronavirus case levels. Alaska is sixth in the nation for the number of weekly new cases per capita.

“Places where people could spread out more bought us more time,” said Elizabeth Ripley, CEO of the Mat-Su Health Foundation. “But unfortunately over time with sufficient community spread, it eventually increases.”

[Tracking COVID-19 in Alaska: 1 death, 447 new cases reported Saturday]

Ripley recently did a public service announcement with Gov. Mike Dunleavy urging residents to wear masks, practice social distancing and wash their hands. She said she has friends now who drive to Anchorage to do their shopping. They feel safer there.

Open for business

Anchorage and Mat-Su share a common boundary at the Knik River and, to some extent, a workforce. The borough boundary starts about 35 miles north of Anchorage, and historically about a third of adults commute to jobs in the city.

But the two split sharply when it comes to government reach. Mat-Su, where both Zink and Dunleavy live, stayed open for business once state mandates lifted in May even as the Municipality of Anchorage enacted mask mandates and capacity limits.

Concerts canceled by capacity restrictions enacted in Anchorage over the summer relocated here. Bars and restaurants stayed open. The Mat-Su Borough School District became the largest in the state to open for in-school learning in August.

Now, even with the rising case counts, it’s fairly common to walk into a business that doesn’t require masks, like a convenience store, and see nobody wearing one.

Palmer’s mayor recently shared a social media post advertising a weekend rally for President Donald Trump that ends with Halloween festivities at a restaurant — the kind of indoor gathering that health authorities are asking people to avoid.

Like many Alaskans, people in Mat-Su pride themselves on self-reliance. That independent streak doesn’t always help in a slow-motion crisis like this one, health advocates say.

Nor does the crazy-quilt of government jurisdictions at play here: three small cities; numerous unincorporated areas, some with a few thousand residents; a borough overseeing it all that, as a second-class government, lacks any health or policing authority; and a state that, as Dunleavy has repeatedly put it, wants any COVID-19 restrictions to come from the local level.

During the 1918 influenza epidemic, the regions with the least amount of viral spread and deaths were the ones that collaborated on public health messaging as well as response, Ripley said.

“We have so many different jurisdictions," she said. “We didn’t have a unified approach to fighting the virus.”

Yet even as Anchorage’s daily COVID-19 case counts climbed into triple digits, Mat-Su stayed low: an average daily report into early fall might show two new cases in Palmer, six in Wasilla, one in other communities like Big Lake or Willow.

That all changed about a week ago.

Sudden spike

COVID-19 counts in Mat-Su suddenly rose from single digits to daily tallies above 25 or 30, then topped 70 and hit 80 at the start of the week, a day after Alaska hit a new daily case high of 526. The state reported a total of 64 new cases in the borough on Friday, including 39 in Wasilla and 22 in Palmer. Saturday’s borough-wide total was 21.

Twenty-five of the borough’s 46 schools reported at least one or more COVID-19 cases in the past two weeks, including two high schools with nine. Seven schools closed for in-person learning through the week.

The district late Thursday announced that all school operational zones will shift to “medium risk” on Nov. 4 “to increase mitigation strategies and counteract the trend of increasing positivity rates in the Mat-Su Borough.” Medium risk means “low to moderate” level of community transmission and a “minimal” number of lab-confirmed cases as determined by community.

The borough’s test positivity rate topped 18% as of Friday. Alaska health officials say they’ve tried to keep positivity rates below 2% given the state’s fragile health care system and generally, health experts recommend keeping it under 5%. The national average is just over 6%.

Fairbanks got a visit from Zink and a state COVID-19 strike team when cases took off amid outbreaks at Fairbanks Correctional Center and the Fairbanks Pioneer Home, where two residents have died. Fairbanks got to about 12% positivity before dropping down to 6%.

The state is working on expanding testing and turnaround time throughout the state, but with so many cases, the testing is becoming strained, officials say.

“This pandemic does not happen to us. This virus can only spread when we give it a chance to spread from person to person. It can’t actually replicate without human cells," she said. "And so really the work that we all do collectively to slow the spread makes a gigantic difference.”

'Take a step back’

State public health workers in Mat-Su are fielding lots of calls from the public, asking about what to do if someone they know tests positive or if they’re identified as a close contact of someone who did, Dillow said.

The state is working to identify clusters in the rising numbers, she said. One was found among students engaged in sports between different schools, leading to a change in district policy that limits activities to within schools only.

Cases pop up in schools and day cares, Dillow said, but that doesn’t seem to be where the infections are starting and the state isn’t seeing entire classrooms with COVID-19 that’s spread among students. Rather, it’s people having social gatherings who then pass the virus to their children who then attend school before they know they’re infected.

Businesses with workers who test positive tend to be doing the right things most of the time, she said. The problem is when employees sit down together for lunch, close together, and take off their masks.

Generally, the rising positivity rate can indicate a jump in the amount of virus moving around the community plus not enough people getting tested.

There is ample testing available, Dillow said. Capstone Clinic operates a busy drive-up site in Wasilla that also offers rapid tests and just reopened a Palmer site. Mat-Su Health Services also offers drive-up testing at no charge. Several urgent care clinics provide testing, as do individual providers.

“The most important thing is that six-foot spacing, limiting time (near others), and wearing masks. That just can’t be said enough,” she said. “I want to start a campaign: Take a step back. Because it’s so counterintuitive. We want to draw close to people.”