Bethel Hospital sets standards of care in times of crisis; Alaska remains on COVID-19 upward trajectory as Lower 48 sees decline

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Large, rural Alaskan hospital promulgates Crisis Care Standards, the latest worst-case facility that provides support to physicians forced into deciding which patients to treat due to a shortage of staff, beds or d ‘equipment.

The Yukon-Kuskokwim Health Corp. on Wednesday announced a switch to crisis care mode, saying the Tribal Health Organization’s Bethel Hospital was operating at full capacity and struggled to maintain normal standards of care as COVID-19 cases continue to rise ‘increase in the region and around the state.

At least one other hospital, in Valdez, has also recently used crisis care guidelines to make treatment decisions involving oxygen, which is rare due to demand from COVID-positive patients.

Providence Alaska Medical Center began occasionally rationing patient care starting September 11, using state guidelines and an in-house triage team to make tough decisions if necessary.

Despite an apparent spike and decline in cases nationwide, Alaska continues on a steep upward trajectory, with more than 1,000 new COVID-19 infections reported on Wednesday.

State epidemiologist Dr Joe McLaughlin said Wednesday that Alaska has the highest seven-day case rate in the country – five times the national average and double the rate of State with the second highest rate, West Virginia.

“We’re definitely on a steep and steep upward trajectory,” McLaughlin said.

Several places around the country have shown declining case rates this week, appearing to show both peak and declining cases, McLaughlin said.

[Delayed shipments of monoclonal antibodies stress supply of time-dependent COVID-19 drug for some in Alaska]

Governor Mike Dunleavy and senior health officials activated crisis care standards last week, giving every hospital the choice to adopt standards and shield providers from liability. Authorities also announced a federal contract to bring up to 470 health workers, including many nurses and respiratory therapists, to Alaska starting this week.

The Yukon-Kuskokwim Health Corp. made the decision on crisis care because many hospitals that normally handle patient transfers in Anchorage and elsewhere continue to operate at full capacity, officials said on Wednesday. Hospitals in remote areas are already saying they have to treat more difficult patients internally because they can’t move them for higher levels of care.

The Yukon-Kuskokwim health organization developed crisis guidelines at the start of the pandemic, including activating a committee of doctors, to help providers make clinical decisions, officials said. The change in operations could mean delayed patient transfers, fewer nurses caring for patients, and longer wait times for elective procedures like cancer screening or pediatric dental procedures.

Wednesday’s decision was not triggered by specific shortages, and that doesn’t mean the kind of rationing of care that doctors from Providence described in Anchorage are happening in Bethel, the YKHC chief of staff said, Dr. Ellen Hodges.

That means those kinds of decisions are possible unless the pressure on the state’s hospital system eases, Hodges said.

“The nuances of that and how to explain it to the public is really difficult,” she said. “It sounds really dramatic, but it’s really about taking the best possible care for our patients. People in the hospital are doing well.

Hospital officials urged residents of Yukon-Kuskokwim to get vaccinated against COVID-19, wear masks in indoor public spaces, practice social distancing and take additional measures to avoid injuries that could land them in the emergency room.

Doctors at Providence Valdez Medical Center are already enforcing state crisis care guidelines for rationing oxygen, according to Dr. John Cullen, chief of staff at the 11-bed hospital. The hospital is operating at 50% of the workforce amid a local wave of COVID-19 that has triggered a wave of patients requiring large amounts of oxygen.

“We don’t give as much oxygen to get patients to what we consider normal,” Cullen said Wednesday. Normally, the hospital would like to see patients achieve oxygen saturation levels of 93%, he said. Currently, providers accept 90%, as recommended by standard state crisis guidelines.

The hospital is struggling with “really sick” COVID-19 patients, Cullen said. One of them recently died after being transferred to another hospital.

He wrote last week to the mayor and city council of Valdez, warning that the state’s limited hospital capacity could make transfers to Anchorage from their small hospital “difficult if not impossible” despite state programs to relieve pressure on staff, including more workers coming to town.

Cullen described the likelihood of a much higher death rate “similar to a battlefield scenario” until COVID-19 cases start to decline.

“When you get to a crisis standard of care, that’s what it means, is that you’re going to expect a higher standard,” he said Wednesday. “It really depends on the severity of this particular wave. I was really hoping we were going to see significant drops in numbers this past weekend. “

This week, the town of Valdez issued a declaration of disaster given the worsening situation in the community. A city council meeting on Wednesday will consider an extension of the disaster declaration as well as a mask mandate, said Allie Ferko, the city’s public information officer.

The statement includes specific requests for more hospital staff and continued testing and immunization support. The declaration must also be in place in order to enact an emergency warrant, such as a mask requirement, Ferko said.

Alaska reported 1,009 new cases and four more virus-related deaths on Wednesday. As of March 2020, 546 Alaskan residents and 21 non-residents infected with the virus have died.

The deaths reported Wednesday involved Anchorage residents: two men in their 40s, a woman in her 60s and another in her 60s.

Alaska reported 207 hospitalizations for the virus on Wednesday, and COVID-19 patients – mostly unvaccinated – made up more than a fifth of all people hospitalized in the state. Others who may still be hospitalized due to the virus but are no longer actively contagious are not counted in this overall number.

The percentage of positive tests over the past week in Alaska was 9.2%, which McLaughlin said is almost double the state’s 5% target.

As of Wednesday, 63% of Alaskans aged 12 and over had received their first dose of the vaccine while 60% were considered fully immunized.


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