Joyce Johnson-Albert watches as she receives an antibody infusion while lying on a bed in a dream room at Upper Tanana Health Center in Tok, Alaska on Wednesday, September 22, 2021.
Rick Bowmer | AP
Dr. Jeremy Gitomer of the Providence Alaska Medical Center in Anchorage noted last month that there weren’t enough dialysis machines to handle the flood of Covid patients with kidney damage.
An intubated 70-year-old woman who was also struggling with kidney failure and was on dialysis for six days was unlikely to make it, he recalled.
Gitomer and his medical team decided to stop their treatment to release the machine to a 48-year-old man who was also on a ventilator and had a higher chance of recovery if he was on dialysis. Both patients died in the end, he said, adding that up to 95% of intubated Covid patients in Alaska do not survive on dialysis.
“It’s horrible to be going through this because I’ve never seen people die in my career,” said Gitomer, a nephrologist who works for the Kidney and Hypertension Clinic of Alaska at three Anchorage hospitals. “I’ve been doing this for 25 years.”
Doctors in Providence have been forced to decide who could live and who is likely to die as a swarm of Covid patients push the hospital’s limited resources to capacity.
Angie Cleary, a registered nurse, takes care of Joyce Johnson-Albert while receiving an antibody infusion on a bed in a dream room at the Upper Tanana Health Center in Tok, Alaska on Wednesday, September 22, 2021.
Rick Bowmer | AP
Alaska is in the midst of a flood of cases fueled by the highly contagious Delta variant that devastated the continental United States this summer. To ease the burden on the state’s health care system, Alaskan officials activated “Emergency Care Standards” in 20 hospitals on October 2, which can save a patient’s life while giving up treatment for others who are less likely to survive.
Anchorage hospitals, which house almost all of the state’s dialysis machines, have been forced to refuse transfers of low-chance patients from other state medical centers, Gitomer said. Not only does it put Covid patients at higher risk. Hospitals are now struggling to treat non-Covid patients with a range of life-threatening conditions, including cancer, accidental injuries and organ failure. Patients with brain tumors face longer delays in the emergency room, which extends their ability to get an MRI and see a neurosurgeon, doctors say.
Mat-Su Regional Medical Center, located about 40 miles northeast of Anchorage, cannot simply move patients with kidney and heart failure to Anchorage, as it usually does. The hospital now needs to keep some of them overnight and “good enough to make it to outpatient dialysis the next day,” said Dr. Anne Zink, chief physician of the state and emergency doctor at Mat-Su.
“Instead of having one nurse care for four or five emergency room patients, they could care for ten emergency room patients,” said Zink of Mat-Su, where Covid patients occupy almost half of the hospital’s 100 beds. “Patients who have to go to the emergency room really wait a long time.”
Alaska, which has mastered dozens of Covid cases at any given time during most of the outbreak, had more than 1,200 new cases as of Wednesday – with a seven-day average of 1,317 new cases as of September 27, according to a CNBC analysis from data from Johns Hopkins University. Alaska is the third largest state in the nation, but it currently has the most Covid cases per person, with 120 new infections per 100,000 residents. And Covid patients overfill hospital beds almost twice as quickly as the national average, according to the Ministry of Health.
Alaska’s sheer geographic expanse further complicates the state’s ability to fight the outbreak: the health centers are spread out so widely that the average Alaskan has to travel about 250 miles one way for medical treatment, Zink said. The Mat-Su Regional Medical Center alone serves an area the size of West Virginia.
The state hired 400 medical workers outside of the state late last month to help with the surge, Zink said.
A combination of school resumption, snowfall, and people spending more time indoors made Alaska particularly vulnerable to the highly transmissible Delta variant this fall, Zink said. Many communities also lacked access to running water and sewage and faced high rates of respiratory illness before the pandemic started, she explained, which increased their risk of a Covid outbreak.
“We’re seeing far more deaths and dying with this surge,” said Dr. Angelique Ramirez, Chief Medical Officer at Foundation Health Partners in Fairbanks. “It happens every day, it happens to younger people, and it happens despite all we can.”
Vaccine reluctance is high in Alaska, making monoclonal antibodies a popular covid treatment, Ramirez said. But as the supply of antibodies dwindled with the surge, Ramirez said Foundation Health was forced to keep life-saving treatment available only to the most vulnerable patients.
Herbie Demit, president of Tanacross Village Council, walks through a cemetery in Tanacross, Alaska on Thursday, September 23, 2021. Alaska is experiencing one of the sharpest spikes in COVID-19 cases in the country, coupled with a limited statewide health system that relies almost entirely on hospitals in Anchorage.
Rick Bowmer | AP
“When it got tight we had to make a choice,” said Ramirez. “And our choice was that we could either use up and just use up everything we had, or we could look at who was using it and make community decisions about who would benefit most and limit it to those people. ”
Staff shortages at Foundation Health have reduced capacity, Ramirez said. The hospital has not postponed emergency surgeries, discharging pneumonia patients earlier than usual and providing them with home oxygen treatments as soon as doctors are comfortable with their recovery rather than holding them until they have fully recovered, she said.
Ramirez blamed the region’s low vaccination rates and public opposition to wearing masks for the rise in Fairbanks. And although Ramirez said the surge began before schools started for the year, she said she expected the return to face-to-face learning would exacerbate the outbreak.
Alaska has more than 51% of its population vaccinated against Covid and ranks 35th in the nation among all states and Washington, DC on Wednesday, according to the CDC. Misinformation and anti-vaccine sentiment have proven to be significant barriers to trying to vaccinate more people in Alaska, said Charlee Gribbon, a nurse and infection prevention expert at Bartlett Regional Hospital in Juneau.
“Viruses are difficult pathogens to control,” said Gribbon. “So if we pull out all the stops, we just need everyone to help us with whatever they can to keep the disease from spreading.”
– CNBC’s Nate Rattner contributed to this report.