Alaska Governor Dunleavy Activates Statewide Crisis Care Standards to Help Hospitals Overwhelmed by COVID

Alaska Activates Statewide Crisis Care Standards, Employs Contracted Health Workers As Staff Shortages and Influx of COVID-19 Patients Make Normal Hospitals Operational Difficult .

Gov. Mike Dunleavy and senior health officials announced hospital support on Wednesday, the same day new single-day cases in Alaska hit another record as the highly infectious delta variant leads to infections .

A combination of reduced staff and high numbers of COVID-19 patients is overwhelming medical facilities in Anchorage, Mat-Su and Fairbanks. Rural hospitals say they are struggling to transfer patients to urban centers for further care. At least one patient recently died when a bed in Anchorage was not available.

The Alaska Department of Health and Human Services enabled crisis care standards on Wednesday with a new addendum to the state’s existing COVID-19 public health order, officials said.

Hundreds of medical staff are also coming to Alaska to help alleviate staffing shortages at many healthcare facilities: nearly 300 registered nurses and more than 100 certified practical nurses or patient care technicians, funded by a $ 87 million contract. of dollars between the state and federal general services. Administration.

[Alaska hits another daily record with over 1,200 COVID-19 cases reported as hospitalizations tick up]

Along with crisis standards and more workers, the state is tackling a shortage of certified nursing assistants with more training flexibility, officials say.

Five communities – Anchorage, Juneau, Kenai, Fairbanks, Mat-Su – will use “integrated mobile health care” to take the strain off hospitals, state public health director Heidi Hedberg said. Juneau is stepping up his program this week using telemedicine with a doctor at Bartlett Regional Hospital. The other four communities are still developing plans.

The state’s health department has also ordered $ 2 million worth of rapid home test kits for schools, officials said.

This week, the state reached the highest rate of new COVID-19 cases per capita in the country. State data shows that one of five Alaskans hospitalized this week had the virus.

[Alaska will bring nearly 500 health care workers from the Lower 48 to support strained hospitals]

Alaskan hospital administrators have warned of an impending health disaster in late July. Dunleavy earlier this month ruled out a statewide COVID-19 disaster declaration. The legislation he proposed instead of supporting hospitals through telemedicine and streamlined background checks has died at State House.

The Alaska State Hospital and Nursing Home Association said in a statement on Wednesday that the state’s announcement of staff support “and recognition that standards of care are rapidly escalating into crisis” were welcome developments.

Dunleavy, pressed by reporters on a vaccination mandate to relieve pressure on the health system, said that “although vaccinations remain the most important tool” he will not need them.

“The number of cases is much higher than what we want. The pressure on our hospitals is increasing every day. We’re going to get help. But that doesn’t mean the people of Alaska don’t or can’t help themselves, ”Dunleavy said, urging people to“ be extra careful ”over the next month. “The Delta variant causes a lot of infections, it forces a number of people to go to the hospital and it kills people. These are facts.

[Hospitals overwhelmed by COVID are turning to ‘crisis standards of care.’ What does that mean?]

Alaska, once the most vaccinated state in the country, has fallen into the bottom third. The state ranked 18th for the seven-day death rate per capita.

“Active disinformation campaigns”

The briefing for state officials came amid a politically charged climate where some Alaskans, including elected officials, dispute the public health messages as bogus.

Viewers on a Facebook livestream of Wednesday’s briefing peaked at around 1,350 people. Several have responded to statements by Dunleavy and others with unfounded misinformation about unproven COVID-19 treatments, the vaccine and the state of the pandemic. Others simply said “bogus numbers,” “lies” and “propaganda,” as health officials described the dire situation unfolding across the state.

Vaccination remains the best way to prevent serious illness and hospitalizations from the virus, said Chief Medical Officer Dr Anne Zink. Two-thirds of the new cases reported Wednesday will get sick, miss work, may need emergency treatment or worse.

Zink urged Alaskans not to be “distracted by other treatment options such as ivermectin which has not shown any benefit for COVID-19 yet” and instead get proven treatment like antibodies monoclonal.

“Epidemics are going to happen, and they’re going to go away, but we collectively control how quickly this happens and how many Alaskans we’re going to lose along the way,” she said, her voice seeming to crack. when she said swift action was needed. to relieve hospital pressure.

“Kindness and compassion are important to everyone, especially our healthcare workers who are committed to providing care to all Alaskans,” Zink continued. “There are active disinformation campaigns on health … and treatment options, so please speak to your health care provider if you have any questions.”

Many hospitals around Alaska say that while staff shortages have been a long-standing problem, the recent surge in the number of mostly unvaccinated COVID-positive patients has pushed their capacity over the edge. Hospitals say they are already postponing elective surgeries and keeping patients in emergency departments for days.

“Care has changed”

On September 11, the state’s largest hospital, Providence Alaska Medical Center, declared crisis standards when doctors said they had started deciding which critically ill patients had scarce resources like intensive care beds.

Alaska does not have a crisis standards law, Zink said. Instead, the state may offer guidelines to help clinicians make decisions when resources such as ventilators are scarce. Many facilities are already making changes, such as nurses caring for more patients or creating other areas of intensive care or COVID-positive treatment.

“Care has changed in Alaskan hospitals,” she said. “The same standard of care that was previously there can no longer be provided on a regular basis. “

Typically, a declaration of crisis standards is considered a last resort, which means that the number of patients requiring care is more than hospitals can handle due to a shortage of staff, beds or staff. ‘equipment. Providers can prioritize patients largely based on their likelihood of survival or even decline treatment.

Adopting crisis care standards ensures provider accountability as well as support for hospitals, health facilities and local health authorities, said Health and Social Services Commissioner Adam Crum.

“We want to make sure that Alaskans always have access to a very high standard of care,” said Crum. But for healthcare providers, if they can’t deliver that golden standard of care, it really hurts. “

State health officials developed statewide crisis care guidelines at the onset of the pandemic in March 2020, 37 pages based on Minnesota protocols.

Enactment of crisis care allows the state to share ethical guidelines with healthcare providers when they have too many patients and not enough resources to care for them all, state reports show . A committee of 15 can help provide advice on alternative strategies and other tools that may be available.

The state holds daily calls with state hospitals about capacity. Health officials say it is still up to each hospital and health facility to make decisions.

Many hospitals and a few states are turning to crisis protocols. Idaho activated statewide crisis care standards in early September. Some Montana hospitals have also turned to crisis standards. The governor of Hawaii this month cleared health workers of any responsibility if they have to ration care.

The Soldotna Central Peninsula Hospital was operating at 122% capacity on Wednesday. About a third of his patients – 21 out of 60 – tested positive for COVID, including three fully vaccinated.

There were 31 employees in 16 departments sick with the virus or quarantined at home after coming into contact with an infected person, spokesman Bruce Richards said Wednesday morning.

The Central Peninsula canceled elective inpatient surgeries on Tuesday and Wednesday, although staff were eventually able to transfer a few patients to Anchorage after being unable to move anyone for several weeks.

The hospital assesses patient loads and needs “on a 24-hour basis,” but is not currently in crisis care mode, Richards said. “Weren’t there. Sometimes it feels like we are.

– Reporters James Brooks and Morgan Krakow contributed to this story.