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Alaska once had the highest vaccination rate.  Now it is in a COVID-19 crisis.

The reluctance to vaccinate and the delta variant pushed the state’s fragile and limited hospital system to the breaking point.

Providence Alaska Medical Center, the state’s largest hospital, released a letter to the public on Tuesday saying more than 30% of its patients have COVID-19 and the hospital is rationing treatment.

“As we do our best, we are no longer able to provide quality care to every patient who needs our help,” wrote Chief of Staff Kristen Solana Walkinshaw on behalf of the Executive Medical Committee of the hospital. “The acuity and number of patients is now beyond our resources and our ability to staff beds with qualified caregivers, such as nurses and respiratory therapists.”

Of Alaska’s 120 intensive care beds, 106 were occupied as of Thursday, leaving just 14 beds available statewide.

Alaska has had a strong initial vaccine deployment, delivering doses to remote areas of the state by helicopters, planes, dog sleds, and ferries, with additional support from the Indian Health Service and the Tribal Health System of the state to vaccinate the natives of Alaska. Due to the challenges posed by the large size of the state, he received vaccine allocations monthly rather than weekly, giving him the ability to plan ahead and deliver many doses early on.

But, like the rest of the country, vaccination rates slowly began to decline over the summer, stagnating with 56.7% of Alaskans fully vaccinated on Thursday, according to the state’s coronavirus dashboard.

“As for why things have stagnated, it seems reluctance is the main factor behind this,” said Jared Kosin, CEO and President of the Alaska State Hospital and Nursing Home Association. “It’s not a problem of access. The vaccine is widely available in Alaska anywhere.”

Governor Mike Dunleavy ended Alaska’s COVID-19 emergency declaration in the spring, and the state legislature and Dunleavy administration have yet to reinstate one, even at the request of the hospitals and doctors.

In a mayoral race this spring, Anchorage voters elected Dave Bronson, who has repeatedly said his administration will not enact city-wide masks or vaccines.

Bronson reiterated that commitment Tuesday after an assembly meeting where hospital workers pleaded for action.

Cases in Alaska have risen sharply since August, and the state broke its new daily record for cases with 1,068 infections reported on Wednesday. As a result, hospitalizations have skyrocketed, reaching all-time highs.

And health care experts warn that this is just the start of a wave that could last for weeks.

“It got us to the breaking point, and to be totally blunt, in a lot of ways we’re broken,” Kosin said. “The situation is extremely grim.

Alaska operates on a “star model” of health care, according to Kosin. “If you are in a more rural area, you will go to clinics, rural hospitals,” he told ABC News. “The idea is that as you need a higher level of care or (have) more needs, you will ultimately be transferred to our larger hub, which is Anchorage.”

Anchorage, the most populous city in the state, is home to the state’s three largest hospitals, some of which offer the state’s only advanced neurological and cardiovascular care. While many people live in rural and geographically isolated areas, these communities still depend on specialized medical care that can only be found in cities.

As the city’s hospitals have reached capacity and residents of Anchorage are forced to stay in their cars or in emergency waiting rooms until they can receive care, health workers must refuse to transfer patients from rural communities, leaving them without what can be life-saving treatment, said Solana Walkinshaw. .

The next closest option are hospitals in contiguous United States like Seattle, Washington – more than a three-hour flight away. Seattle is also seeing an influx of COVID-19 patients and is trying to help by taking patients from neighboring states like Idaho, which is facing its most severe increase in cases since the start of the pandemic. This leaves very limited options.

Because the city’s hospitals are inundated with COVID-19 cases, they are struggling to provide routine care and emergency services to patients who do not have the virus.

As of Tuesday evening, Providence Alaska Medical Center only had one bed available with 10 admitted patients who needed it, as well as emergency room patients waiting to be opened, Solana Walkinshaw said. Three of these patients needed an intensive care bed, but the hospital did not have one available.

Between 80 and 85 percent of COVID-19 patients in hospital are unvaccinated and the same is true of COVID-19 patients who die, according to Providence Alaska Medical Center spokesperson Mikal Canfield.

The hospital began rationing care on Saturday, leaving health workers to decide which patients receive care and which should wait. The staff are demoralized, Solana Walkinshaw said, some bursting into tears, sad and frustrated with the situation they find themselves in.

“People struggle, work as hard as they can and having to make these decisions is probably one of the hardest things people have done in their careers,” she said.

While rural Alaska has seen a sharp increase in coronavirus cases, with some communities experiencing the worst outbreaks on record, rural health providers are not as hard hit by COVID-19 patients, Kosin said.

This is due to the smaller populations outside the city, the fact that COVID-19 patients in the most severe condition are being sent to Anchorage and because some villages have very high vaccination rates.

The biggest problem for rural institutions is that they are responsible for caring for non-COVID-19 patients that they would typically transfer to Anchorage.

At Tuesday’s town hall meeting, a group of healthcare workers from Anchorage hospitals advocated for residents to wear masks and get vaccinated.

Leslie Gonsette, an internal medicine hospital attendant at Providence Alaska Medical Center, testified at the meeting while on shift at the hospital. One of her patients, who does not have COVID-19 and is vaccinated, was in critical condition and needed an intensive care bed, she said.

“I called my colleagues in the intensive care unit and explained to them, ‘My patient is probably going to die. I need an intensive care bed, “” she said. “And the response I got was, ‘We’re doing our best. We don’t have a bed.'”

Bronson’s office released a statement after the meeting.

However, Alaskan healthcare providers are concerned about what kind of choice will be left to them.

“Rationing care will take on a whole new meaning than it does today,” Kosin said. “I think it’s going to lead to the types of decisions that you can’t imagine a person having to make.”