Joyce Johnson-Albert watches as she receives an antibody infusion while lying on a bed in the trauma ward at Upper Tanana Health Center on Wednesday, September 22, 2021 in Tok, Alaska.
Rick Boumer | AP
Dr. Jeremy Gitomer, of Providence Medical Center in Alaska in Anchorage, realized that there were not enough dialysis machines in the past month to treat a large number of coronavirus patients suffering from renal impairment.
He recalled that one intubated 70-year-old woman who also struggled with kidney failure and was on dialysis for six days is unlikely to survive.
Gitomer and his medical team decided to discontinue treatment in order to free the machine for a 48-year-old man who was also mechanically ventilated and had a better chance of recovery on dialysis. Both patients eventually died, he said, adding that up to 95% of intubated Covid dialysis patients do not survive in Alaska.
“It’s awful that I’m going through this because I’ve never seen more people die in my entire career,” said Gitomer, a nephrologist who works at three hospitals at the Anchorage Kidney and Hypertension Clinic in Alaska. “I’ve been doing this for 25 years.”
Doctors in Providence have been forced to choose who will live and who is most likely to die, as the hospital’s limited resources are being depleted due to the large number of coronavirus patients.
Angie Cleary, a registered nurse, looks after Joyce Johnson-Albert as she receives an antibody infusion while lying on a bed in the trauma ward at Upper Tanana Medical Center on Wednesday, September 22, 2021 in Tok, Alaska.
Rick Boumer | AP
Fueled by a highly contagious species of the delta, Alaska is at the epicenter of a wave of disease that devastated the continental United States over the summer. To ease the burden on the state’s health care system, Alaska authorities activated “crisis treatment standards” in 20 hospitals on Oct. 2, which gives them some legal protection if they have to choose who gets a bed or ventilator. can save their lives by refusing to treat others who are less likely to survive.
Anchorage hospitals, where nearly all of the state’s dialysis machines are located, have been forced to refuse transfers of patients with low survival rates from other public health centers, Gitomer said. It doesn’t just 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 injury and organ failure. According to doctors, patients with brain tumors face long delays in the emergency room, which prolongs their ability to get an MRI and seek neurosurgeon’s attention.
The Mat-Su Regional Medical Center, located about 40 miles northeast of Anchorage, cannot simply transport patients with kidney and heart failure to Anchorage as it usually does. The hospital is currently required to keep some of them overnight and “in such a condition that they can be performed on an outpatient basis on dialysis the next day,” said Dr. Ann Zink, chief state physician and emergency department physician at Mat-Su. …
“Instead of one nurse being able to care for four or five patients in the emergency department, they could look after 10 patients in the emergency department,” Zink said of Mat-Su, where Covid patients occupy nearly half of the hospital’s 100 beds. “Patients who need to get to the emergency room have a really long wait.”
Alaska, which has had dozens of Covid cases at any time during most of the outbreak, recorded more than 1,200 new cases on Wednesday – 1,317 new cases on Sept 27, an average of seven days, according to an analysis of CNBC data. Johns Hopkins University. Alaska is the third least populated state in the country, but it currently has the most Covid cases per person – 120 new infections per 100,000 inhabitants as of Wednesday. Covid patients fill hospital beds almost twice as fast as the national average, according to the Department of Health and Human Services.
Alaska’s geographic reach further complicates the state’s ability to deal with the outbreak, Zink said: medical centers are so scattered that the average Alaskan has to travel about 150 miles one way to receive medical attention. The Mat-Su Regional Medical Center alone serves an area the size of West Virginia.
At the end of last month, the state brought in 400 out-of-state health workers to help them do just that, Zink said.
The combination of school resumption, snowfall and people spending more time indoors has made Alaska particularly vulnerable to a highly infectious variant of the delta this fall, Zink said. Many communities also lacked access to plumbing and sanitation and faced high rates of respiratory illness even before the pandemic, she said, raising their risk of a Covid outbreak.
“We are seeing many more deaths and dying from this surge,” said Dr. Angelica Ramirez, chief medical officer of Foundation Health Partners in Fairbanks. “It happens every day, it happens to young people, and it happens in spite of everything we can do.”
Vaccination hesitancy is high in Alaska, Ramirez said, making monoclonal antibodies a popular treatment for Covid. But as the supply of antibodies dwindled due to the surge, Ramirez said the Health Foundation was forced to reserve vital treatment for only the most vulnerable patients.
Herbie Demit, President of the Tanacross Village Council, walks through the cemetery on Thursday, September 23, 2021 in Tanacross, Alaska. Alaska has seen one of the sharpest spikes in COVID-19 incidence in the country, combined with a limited statewide healthcare system that relies almost entirely on Anchorage hospitals.
Rick Boumer | AP
“When that wasn’t enough, we had a choice,” Ramirez said. “And our choice was that we could either use up everything we had and just run out, or we could choose to see who was using it and based on that community decision on who it was. will bring the greatest benefit, and limit it. to these individuals. ”
Staffing constraints at Foundation Health have reduced opportunities, Ramirez said. The hospital is postponing non-emergency surgeries and discharging pneumonia patients earlier than usual, giving them home oxygen therapy as soon as doctors are happy with their recovery, rather than delaying them until they are fully recovered, she said.
Ramirez blamed the surge in Fairbanks for low vaccination rates in the region and popular resistance to wearing masks. And while Ramirez said the surge started before the start of the school year in schools, she said she expects a return to full-time education to exacerbate the outbreak.
More than 51% of Alaska’s population is vaccinated against Covid, ranking 35th.th in the country among all states and Washington, DC, as of Wednesday, according to the CDC. Misinformation and anti-vaccination sentiment have proven to be major barriers to immunizing more Alaskans, said Charlie Gribbon, a nurse and infection prevention specialist at Bartlett Regional Hospital in Juneau.
“Viruses are a pathogen that is difficult to control,” said Gribbon. “So when we do our best, we just need everyone to help us all, what they can do to avoid the spread of the disease.”
CNBC Nate Rattner contributed to this report.