Alaska's COVID-19 surge has overwhelmed its limited hospital system, forcing 20 hospitals to enact crisis-of-care protocols where doctors sometimes prioritize treatment based on which patients have the best chance of surviving.
The largest hospital in the state, Providence Alaska Medical Center, was the first to ration health care as the hospital in Anchorage struggles to keep up with the pandemic. Anchorage's two other hospitals and Fairbanks Memorial, as well as 16 others, have entered crisis care mode.
"Even though we live here, we're concerned about Anchorage and Fairbanks," said Alfred Jonathan, an elder in the Athabascan village Tanacross. "If somebody gets sick around there, there's no place to take them."
For more reporting from the Associated Press, see below.
One Alaska Native village knew what to do to keep out COVID-19. They put up a gate on the only road into town and guarded it round the clock. It was the same idea used a century ago in some isolated Indigenous villages to protect people from outsiders during another deadly pandemic — the Spanish flu.
It largely worked. Only one person died of COVID-19 and 20 people got sick in Tanacross, an Athabascan village of 140 whose rustic wood cabins and other homes are nestled between the Alaska Highway and Tanana River.
But the battle against the coronavirus isn't over. The highly contagious delta variant is spreading across Alaska, driving one of the nation's sharpest upticks in infections and posing risks for remote outposts like Tanacross where the closest hospital is hours away.
While Alaska has contracted with nearly 500 medical professionals to help over the next few months, the ramifications are dire for those in rural Alaska if they need higher levels of care — for COVID-19 or otherwise — but no beds are available.
Sometimes those patients get lucky and get transferred to Fairbanks or Anchorage. Other times, health care staff are on the phones — in some cases, for hours — looking for a bed or facility that can provide specialty treatments like dialysis.
One patient who couldn't get dialysis at Providence died, hospital spokesperson Mikal Canfield said. Dr. Kristen Solana Walkinshaw, the hospital's chief of staff, said she knew a patient in an outlying community who needed cardiac catheterization and died waiting.
Options in Seattle and Portland, Oregon, also are being overloaded. One rural clinic finally found a spot for a patient from interior Alaska in Colorado.
Health officials blame the hospital crunch on limited staffing, rising COVID-19 infections and low vaccination rates in Alaska, where 61 percent of eligible residents in the conservative state are fully vaccinated.
Officials say medical workers are exhausted and frustrated with what feels like a no-win effort to combat misinformation about COVID-19 being overblown and vaccines being unsafe. Some say it could have long-term effects — further shaking confidence in vaccines and treatments for other illnesses and making the longstanding pre-pandemic challenge of recruiting health care workers to the remote state more difficult.
Medical workers "describe the emotions of: 'You hear a code is happening, someone is passing away,'" said Jared Kosin, president and CEO of the Alaska State Hospital and Nursing Home Association. "That is devastating. You never want to lose a patient. But in the back of your mind, you're thinking, 'OK, another bed is now available that is critically needed.' And how do you balance those emotions? It's gut-wrenching."
In Tanacross, elders are encouraging people to get vaccinated, especially with facilities strained. The village is in a sprawling, sparsely populated region of eastern Alaska where the vaccination rate is under 50 percent.
Jonathan, 78, tells villagers that COVID-19 is here, and like the Delta variant, is going to develop in other ways.
Those who "didn't get vaccinated? Gosh, we're afraid for them," said Jonathan, who recently led a crew clearing dead and dying trees to reduce wildfire fuel and provide wood to heat homes.
His wife, Mildred, helped guard the gate into the community this year. Those restrictions ended this summer as the pandemic seemed to be improving. Now, she says she's tired of outsiders calling their friends in Tanacross to scare them, claiming there are problems with the vaccines.
"I got both my shots, I'm alive and nothing's wrong with me," she said before piling bags of sanitizer, masks and nitrile gloves into her Prius to deliver throughout town.
Alaska, hailed early in the pandemic for working with tribal health organizations to distribute vaccines widely and quickly, was 25th in the U.S. for the percentage of its total population inoculated, according to Centers for Disease Control and Prevention data.
At hospitals, care "has shifted," said Dr. Anne Zink, Alaska's chief medical officer.
"The same standard of care that was previously there is no longer able to be given on a regular basis," she said. "This has been happening for weeks."
