Statewide public health emergency brings new restrictions

Last Thursday, Governor Mike Dunleavy issued a statewide emergency alert beseeching Alaskans to change their behavior and slow the spread of COVID-19 as case numbers continue to reach unprecedented heights and state hospitals approach capacity. The message came in the wake of a new statewide emergency declaration and a number of new health orders at the state and local level.
Alaska continues to see its COVID-19 case numbers climb at an increasing rate, with 745 new cases on Saturday and 654 on Sunday marking the highest and second-highest daily case totals since the start of the pandemic.
Healthcare leaders across the state have warned that if cases continue to rise at their current trajectory, some healthcare systems could reach maximum capacity within the month. The issue isn’t necessarily about the number of beds – only about 25 percent of Alaskan hospital beds are currently occupied, said Megan Mackiernan, who stood in for Norton Sound Health Corporation Medical Director Dr. Mark Peterson on a conference call on Monday. She added that about 13 percent of hospitalized people in the state are there with COVID-19.
 “But staffed beds show very low capacity,” she explained. “We have a lot of nursing staff out due to quarantine and isolation – not in Norton Sound, but around the state. That really limits the number of available beds for sick individuals.”
The staffing issue is especially dire in Anchorage. Providence Alaska Medical Center reported double the number of staff out of work in recent days, and the majority of those absences were related to COVID-19 isolation and quarantine.
Alaska Native Medical Center has already had to convert housing space into treatment facilities and is receiving out-of-state healthcare workers from the Indian Health Service to deal with staffing issues.
The crunch in Anchorage has ripple effects in rural communities that rely on the bigger hospitals. Last week, the Yukon-Kuskokwim Health Corporation, which is currently dealing with the highest per capita case numbers in the state, had four patients needing urgent care that couldn’t travel to Anchorage because of a lack of staffed ICU beds there.
NSHC’s Dr. Mark Peterson said that so far, capacity in the Bering Strait/Norton Sound region has been adequate. Norton Sound Regional Hospital has 11 ventilators and the ability to create up to 50 hospital beds in case of an emergency, but staffing is much more limited.
Ventilators, for example, require about two nurses and a trained respiratory therapist to operate, and Norton Sound doesn’t currently have the staff to run all its ventilators at once. “We can have lots of ventilators, but if we don’t have anybody to run them, they’re not much use,” Mackiernan said.
“We could quickly get in a situation where we’re more overwhelmed,” Dr. Peterson said last week. “If everything goes poorly, we can expect to see the same thing as Bethel in eight weeks or so.”
This public health crisis is what prompted the governor to issue a new emergency declaration, which went into effect on Monday and is valid for the next 30 days. The governor also issued a new series of “health orders” on Monday to replace the mandates laid out by the first emergency order in March.
Many of the health orders extend the mandates of the previous emergency declaration, including increased flexibility for telehealth and remote operations. They also more clearly lay out the rules concerning critical infrastructure workers, which had previously been contained in a number of separate mandates.
The new health orders also reinforce rules for out-of-state travel, requiring anyone entering the state to have proof of a negative COVID-19 test taken 72 hours before departure for Alaska, or purchase a COVID-19 test in the airport upon arrival.
The biggest change is a new set of rules governing intrastate travel between rural communities and the road system. Under the new health orders, anyone traveling from the road system to a rural community or vice versa is required to test negative for COVID-19 72 hours before departure.
In a Monday press conference, Division of Public Health Director Heidi Hedberg said the new rules were included after some rural communities called for tighter state mandates between the road system and rural Alaska.
She said the rules were not meant to conflict with existing travel restrictions, such as the City of Nome’s travel mandate, and that the state would work with municipalities to ensure that state and local mandates don’t conflict.
The new emergency declaration has also prompted some changes in Nome and the surrounding region. NSHC has announced that it will be postponing all medical travel to Anchorage for the next three weeks except for in emergency cases, in order to prevent people from bringing the virus back into the region.
It will also postpone medical travel from regional villages to Nome, partially to limit the spread of the virus but also to free up housing facilities in case of a Nome outbreak. “Right now, we need housing available for people who are quarantining and positives in Nome,” Dr. Peterson said. “That’s taking precedence on the housing side.”
Medical visits to villages deemed nonessential, like optometry visits, will also be postponed for the rest of November and early December, he said.
The City of Nome has also issued a number of closures for the next two-week period. City Hall will reduce its hours to 10 a.m. to 12 p.m. and 1 p.m. to 3 p.m. on weekdays, and City Manager Glenn Steckman said he encouraged residents to pay bills through the City’s website instead of coming to City Hall. Nome Joint Utility System will also reduce its public hours to 12 p.m. to 3 p.m. and recommends paying bills online as well.
The Visitor Center and Rec Center will both close to the public with a tentative reopening date of November 30. Steckman said this was mostly in response to the handful of cases recently identified in Nome, and that those facilities can reopen in two weeks as long as the city’s case count remains low.
The City is keeping the Mini Convention Center open for the day shelter and NEST, but recommending that masks be required at all times except for designated mealtimes.
The custodian of the building housing the Nome Post Office announced that masks are required for all visitors to the building. St. Joseph’s Catholic Church will close to public worship for the next three weeks. Nome Public Schools will remain open and in-person but are prepared to go remote if Nome experiences high case numbers.
The combined efforts from the public and private sectors alike are meant to get a cap on the virus before it gets out of control. The coming month will tell if the stricter measures succeed.