COVID case numbers rise, DHSS activates crisis standards of care

By Julia Lerner
As hospitals across the state continue to ration care and turn away patients, COVID-19 cases are on the rise in Nome, Norton Sound and the Bering Strait region.
The Norton Sound Health Corporation has identified 62 new cases in the last week, bringing the total number of active cases to 74 as of Tuesday, Oct. 5.
On Tuesday, September 28, 13 individuals tested positive for COVID-19, including nine people in Nome, two in Gambell and two in Koyuk. Of the 13 cases, one was a NSHC employee.
Seven individuals tested positive on Wednesday. Four of the new cases were in Brevig Mission and the remaining three were in Nome, including one NSHC employee.
The following day, 20 individuals tested positive for the virus. Eight of the cases were in Brevig Mission, seven were in Nome and five were in Koyuk. Of the 20, three were NSHC employees, though none had exposure to patients.
Between Friday and Sunday, 22 individuals were diagnosed, including 15 in Nome, five in Brevig, one in Koyuk and one in Shaktoolik.
 On Monday, October 4, three COVID-19 cases were identified in Nome. All three cases were close contacts to previously identified cases. One individual is an NSHC employee, but there was no exposure to any patients.
 “Of the 15 new cases in Nome over the weekend, 12 of them were close contacts who were already in quarantine,” explained NSHC medical director Dr. Mark Peterson. “Only three were unknown to us.”
Of the 74 active cases in the region, 42 are in Nome, 18 are in Brevig Mission, 11 are in Koyuk, one in Shaktoolik and two are in Gambell.
Also on Monday, Alaska reported the second highest COVID-19 hospitalization tally. Over the weekend, the State of Alaska Dept. of Health and Social Services announced the activation of crisis standards of care for 20 Alaska healthcare facilities including NSHC, though the situation varies widely between each facility and doesn’t always mean rationing care.
Following the rise of COVID-19 cases in Nome, the city implemented a face mask mandate for indoor public places beginning October 2 at midnight.
“We applaud the City of Nome for issuing a face mask mandate for all indoor public spaces,” NSHC CEO Angie Gorn told tribal leadership during Monday’s COVID-19 conference call. “For the next two weeks here in Nome, face masks are required in indoor public spaces, and that’s a good thing with the surge of cases. We’re really happy to see that here at Norton Sound Health Corporation.”
Peterson also recommends maintaining social distance practices and limiting visits to other households to help stem the spread.
The Nome Public School District also implemented precautions and moved the school district’s sports classification to Red on Monday.  “No sports travel is permitted while in RED, mask wearing is required of all students in high-risk sports, and unvaccinated students must test weekly,” according to an announcement from the school district. “We will monitor the situation closely and adjust as needed.”
Currently, about 30 percent of all positive cases in Nome are in children still too young to receive their vaccines.
“We have also had a small number of student cases at both Nome Elementary and Nome-Beltz Middle/High School,” the school’s announcement said. “We are hopeful that a pediatric version of the COVID-19 vaccine will be available soon. Vaccination, masking and other mitigation measures provide the most protection for individuals and our communities. Safety of our students is paramount and we are also committed to keeping our schools open.”
Nomeites seeking rapid COVID-19 testing, particularly following exposure to an active case, are out of luck for the time being, though. The rapid COVID-19 tests Alaska’s hospitals were using are running out, forcing hospitals to use tests that take much longer to process.
“It’s going to take 24 hours, sometimes 48 hours to get results to people,” Peterson said.
Most hospitals in the state, including NSHC facilities, are adopting the state’s Crisis Standards of Care following significant stress on the hospital system.
“We’re stressed like every community, every hospital is, but we’re doing okay,” Peterson said. “We’re hanging in there and doing okay. This is just the ability for facilities to provide care in a more streamlined fashion, whether it’s hiring staff with licenses from different states, or getting some funding for staffing or sharing staffing with other hospitals.”
Peterson says other hospitals in the state, including Alaska Native Medical Center and Providence Alaska Medical Center, will rely on crisis standards significantly more than NSHC will.
“We’re not in a desperate situation where we’re going to have to utilize [emergency care precautions] but I’m sure there will be some of those standards that we may utilize, like recruitment,” he said. “It’s probably something ANMC will take more advantage of because their situation is significantly more dire.”
Peterson encouraged COVID-19 conference call participants to get vaccinated if they aren’t yet, and to push their community members to do the same. Several call participants pushed back, though, telling Peterson the lack of consistent medical staff in their villages makes it significantly harder to get vaccinated.
“Health aides can give the Moderna vaccine, and the mid-levels can give the Pfizer shots,” Peterson said. “You should be able to get Pfizer and Moderna just about every day or every week.”
Part of the problem, Peterson said, is that each vial of vaccine contains several doses, but once the bottle is open, it spoils within just a few hours.
“The bottle of Moderna, for example, can be used for 10 people, but once you tap the vial, it’s only good for a couple of hours,” he said. “I know [health aides] are trying to get a number of people to come in all at once [for their vaccines]. I know the health aides and the midlevel are trying to save supply and batch people together so they can do a lot.”
Across Alaska, there have been a total of 117,941 COVID-19 cases since the pandemic began, including 6,285 in just the last week. In the state, there have been 2,769 hospitalizations, including 216 individuals currently hospitalized with the virus and 40 on ventilators. Around the state only 22 ICU beds remain available, and 579 individuals have died of COVID-19 since the pandemic began in March, 2020.
In Nome, Norton Sound and the Bering Strait region, there have been 1,104 cases of COVID-19, 12 hospitalizations and zero deaths.


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