Alaska on Saturday activated emergency crisis protocols that allow 20 medical facilities to ration care if needed as the state recorded the nation’s worst COVID-19 diagnosis rates in recent days, straining the state’s limited health care system.

The declaration covers three facilities that had already announced emergency protocols, including the state’s largest hospital, Providence Alaska Medical Center in Anchorage. The state’s declaration also includes the other two hospitals in Anchorage and facilities across the nation’s largest but sparsely populated state.

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“Today’s action recognizes that Alaska has an interconnected and interdependent health care system, requiring the need for activation of the state’s decision-making framework. That framework includes a progression of conventional, contingency and crisis standards,” the state health department said in a statement announcing the activation.

“I want to stress that our health care facilities in Alaska remain open and able to care for patients. Alaskans who need medical care should not delay seeking it, even during these difficult times,” said Adam Crum, the state’s health commissioner. 

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Factors that led the state to activate the crisis of care standards include scarce medical resources at some facilities, limited staff and difficulty transferring patients because of limited bed availability. Other factors include limited renal replacement therapy and oxygen supplies.

According to data collected by Johns Hopkins University Center for Systems Science and Engineering, one in every 84 people in Alaska was diagnosed with COVID-19 from Sept. 22 to Sept. 29. The next highest rate was one in every 164 people in West Virginia. 

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Fairbanks Memorial Hospital, which was covered by the state’s announcement, on Friday activated its own policy because of a shortage of beds, staff and monoclonal antibody treatments, along with the inability to transfer patients.

“The move to Crisis Standards of Care is not something we take lightly,” Fairbanks Chief Medical Officer Dr. Angelique Ramirez said in a statement. “This is in response to a very serious surge of COVID in our community.”

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The move came the same day the state reported 1,044 new cases, 108 of them in the Fairbanks area. The hospital says 35% of its patients on Saturday were being treated for COVID-19.

Since March 2020, there have been 110,850 total COVID-19 cases in Alaska, which has a population of about 731,000. More than 24,000 new cases were reported in September as the delta variant drove a spike in cases in Alaska, which has never had a statewide mask mandate.

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The state health department said in all, 2,432 people have been hospitalized, and 557 Alaska residents have died.

Statewide, 60% of eligible residents are fully vaccinated. The Fairbanks North Star Borough is the third worst region for vaccination rates in Alaska, with just under 52% of eligible residents vaccinated.

Ramirez said the decision to move to crisis standards was because of many factors, including community spread caused by the low vaccination rates and a high number of patients waiting to be admitted.

“This impacts all patient care, those with broken bones, traumas, heart attacks, strokes, COVID, anyone needing medical care,” Ramirez said. “The care we are able to provide is highly fluid and can change day by day and even hour by hour depending on the availability of resources within our system and stateside.”

Heidi Hedberg, director of the state Division of Public Health, encouraged all residents to wear masks and get vaccinated.

“Every action you take helps prevent COVID-19 from spreading and protects you, your family, other Alaskans and our health care system. No one wants to use crisis standards of care guidelines,” she said.