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Alaskan doctors ration life-saving care as Covid cases clog hospitals


Joyce Johnson-Albert watches as she receives an antibody infusion as she lies on a bed in a trauma room at Upper Tanana Health Center on Wednesday, September 22, 2021 in Tok, Alaska.

Rick Bowmer | PA

Dr Jeremy Gitomer of Providence Alaska Medical Center in Anchorage realized last month that there weren’t enough dialysis machines to handle the flood of Covid patients with kidney damage.

An intubated 70-year-old woman, who also struggled with kidney failure and on dialysis for six days, was unlikely to be okay, he recalls.

Gitomer and his medical team decided to end his treatment to free the machine from a 48-year-old man who was also on a ventilator and had a better chance of recovering if he was on dialysis. Both patients ultimately died, he said, adding that up to 95% of intubated Covid patients on dialysis do not survive in Alaska.

“It’s terrible going through this because I’ve never seen so many people die in my career,” said Gitomer, a nephrologist who works at the three Anchorage hospitals for the Kidney and Hypertension Clinic. in Alaska. “I’ve been doing this for 25 years.”

Doctors in Providence have been forced to choose who could live and who will likely die as the crush on Covid patients puts a strain on the hospital’s limited resources.

Angie Cleary, a registered nurse, looks after Joyce Johnson-Albert as she receives an antibody infusion while lying on a bed in a trauma room at Upper Tanana Health Center on Wednesday, September 22, 2021 , in Tok, Alaska.

Rick Bowmer | PA

Fueled by the highly contagious delta variant, Alaska is at the heart of a wave of cases that devastated the Americas over the summer. To ease the burden on the state’s health care system, officials in Alaska activated “crisis care standards” on October 2 in 20 hospitals, a move that gives them some legal protection if they have to choose. who will get a bed or ventilator that can save their life while forgoing treatment for others who are less likely to survive.

Anchor hospitals, where almost all of the state’s dialysis machines are located, have been forced to reject transfers of patients with low chances of survival from other medical centers in the state, 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 illnesses, including cancer, accidental injury and organ failure. Patients with brain tumors face extended delays in the emergency room, which prolongs their ability to have an MRI and see a neurosurgeon, doctors say.

The Mat-Su Regional Medical Center, located about 40 miles northeast of Anchorage, can’t just transfer kidney and heart failure patients to Anchorage like it usually does. The hospital now has to keep some of them overnight and “well enough to go on outpatient dialysis the next day,” said Dr Anne Zink, chief medical officer and emergency doctor in Mat-Su.

“Instead of one nurse looking after four or five ER patients, she could look after 10 ER patients,” Zink said of Mat-Su, where Covid patients occupy near the hospital. half of the 100 hospital beds. “Patients who have to get into the emergency department wait a very long time. ”

Alaska, which has handled dozens of Covid cases at any time during most of the outbreak, recorded more than 1,200 new cases on Wednesday – peaking at a seven-day average of 1,317 new cases on September 27 , according to a CNBC analysis of data from Johns Hopkins University. Alaska is the third least populated state in the country, but it currently has the most Covid cases per person with 120 new infections per 100,000 population on Wednesday. And Covid patients are cramming into hospital beds at a rate almost twice the national average, according to data from the Department of Health and Human Services.

Alaska’s geographic vastness further complicates the state’s ability to fight the epidemic: Health centers are so scattered that the average Alaskan has to travel about 150 miles one way to get medical care, a Zink said. The Mat-Su Regional Medical Center alone serves an area the size of West Virginia.

The state brought 400 medical staff out of state at the end of last month to help with the increase, Zink said.

A combination of resumption of school, snowfall and people spending more time indoors has made Alaska particularly vulnerable to the highly transmissible delta variant this fall, Zink said. Many communities also lacked access to running water and sewers and faced high rates of respiratory illnesses even before the pandemic began, she explained, increasing their risk of an outbreak of the disease. Covid.

“We are seeing a lot more deaths and deaths with this wave,” said Dr. Angelique Ramirez, chief medical officer of Foundation Health Partners in Fairbanks. “It happens every day, it happens in younger people and it happens despite everything we know how to do.”

Reluctance to vaccination is high in Alaska, making monoclonal antibodies a popular Covid treatment, Ramirez said. But as the supply of antibodies dwindled with the outbreak, Ramirez said Foundation Health was forced to reserve life-saving treatment only for the most vulnerable patients.

Herbie Demit, chairman of the Tanacross Village Council, walks through a cemetery Thursday, September 23, 2021 in Tanacross, Alaska. Alaska is experiencing one of the largest increases in COVID-19 cases in the country, associated with a limited statewide health system that is almost entirely dependent on Anchorage hospitals.

Rick Bowmer | PA

“When it got scarce, we had a choice to make,” Ramirez said. “And our choice was that we could either use whatever we had and just run out of it, or choose to look at who was using it and make decisions at the community level as to who would benefit the most and limit it to those. people.”

Staff shortages at Foundation Health have reduced capacity, Ramirez said. The hospital has postponed elective surgeries and discharged pneumonia patients earlier than usual, equipping them with home oxygen treatments once doctors are comfortable with their recovery rather than Withhold them until they are fully recovered, she said.

Ramirez blamed the Fairbanks outbreak on the region’s low vaccination rates and public resistance to wearing masks. And although Ramirez said the wave started before schools started for the year, she said she expected the return to in-person learning to exacerbate the outbreak.

Alaska has vaccinated over 51% of its population against Covid, ranking 35e in the country among all states and in Washington, DC on Wednesday, according to the CDC. Misinformation and anti-vaccine sentiment have proven to be significant obstacles in the campaign to immunize more Alaskans, said Charlee Gribbon, nurse and infection prevention specialist at Bartlett Regional Hospital in Juneau.

“Viruses are a difficult pathogen to control,” Gribbon said. “So when we do everything we can, we just need everyone to help us with whatever they can do to avoid spreading the disease.”

CNBC Nate rattner contributed to this report.

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