Overwhelmed by Covid-19 patients, Alaskan doctors make life or death decisions

Recently, the team had to decide which of the two critically ill patients with Covid-19 should use a single specialized dialysis machine. The team saw little hope for one patient and chose the other to start dialysis. The patient who had to wait died.

“We have the most sophisticated medicine and advanced training in the world, and we need to ration care,” said Javid Kamali, intensive care physician at Providence. “We didn’t sign up for this.”

Hospitals across the country have been preparing for such a scenario since the start of the pandemic, as surges in Covid-19 patients have pushed the limits of their resources. Some facilities across the country have approached a similar stage in previous waves of the pandemic, although not all states have required them to disclose when they need to activate crisis teams.

Idaho government officials recently said its overwhelmed hospitals have reached a critical point, but the Idaho Hospital Association said late last month that none had yet used a triage team.

After initially registering an immunization rate above the national average, Alaska began to fall behind in April. It is now one of many states with a vaccination rate below the national average where hospitals are overwhelmed by Covid-19 cases caused by the rapidly spreading Delta variant.

In the seven days to Saturday, Alaska’s statistic for Covid-19 cases per 100,000 people made it number 1 in the country, and it was nearly double that of West Virginia , the next closest state, according to data from the Centers for Disease Control and Prevention show. About 58% of Alaskans aged 12 and over are fully immunized, compared to 65% nationally.

Increased stress on its hospitals: Alaska, with a population of 733,391, has 1.8 intensive care beds per 10,000 people, according to the Kaiser Family Foundation. Only Hawaii and Vermont have fewer intensive care beds for their populations.

The Anchorage Hospital Triage Committee was formed at the start of the pandemic in March 2020 but was first activated around September 10 this year, shortly after Michael Bernstein, chief medical officer of the Providence hospitals in Alaska, noticed the worsening of the state’s Covid -19 trends.

The team has been asked to intervene in at least eight cases, said Dr Bernstein, who oversees the group.

There is no way to know for sure whether patients forced to wait for care who died would otherwise have survived, hospital officials said. But such decisions at Providence weighed so heavily on the staff, in addition to the burden of caring for so many sick patients, that the president of the hospital’s psychiatry department began to tour the hospital. intensive care unit to check their mental health. .

Doctors of Providence also make difficult choices about whether and when to accept more critically ill patients. The largest state in the country by geography, Alaska is dotted with rural communities with limited health facilities that regularly have to transport patients to hospitals like Providence for specialist care.

When a remote hospital wanted to transfer a patient with severe heart disease last month, Providence told the small facility there was no room. This patient has died, hospital officials said.

Dr Kamali said he had to inform in recent weeks many rural Alaskan doctors requesting transfers that there were no intensive care beds available. One case involved a patient with sepsis, who was on a ventilator and needed 24-hour care from a respiratory therapist that the small facility did not have, he said.

“The supplier was speechless,” he said.

Norton Sound Regional Hospital in Nome regularly sends patients to Anchorage hospitals that have more technology or specialists that critical patients need, said Tim Lemaire, one of the doctors at the remote hospital.

But in recent weeks, patients have waited hours or days to be transferred to major hospitals.

“Our job is normally to support someone until the other guys can take over,” said Dr. Lemaire. “For the moment, we must use all the means necessary.”

The 11-bed Providence Valdez Medical Center in Southeast Alaska, which often sends patients to its company central hospital in Anchorage, has started to conserve oxygen in accordance with state crisis standards in limiting the amount of doctors injecting patients who have trouble breathing, said chief of staff John Cullen.

“I don’t think anyone has experienced anything like this in their life,” said Dr. Cullen.

—Jon Kamp contributed to this article.

Write to Dan Frosch at [email protected] and Melanie Evans at [email protected]