While Governor Dunleavy and Doctor Zink are being praised for their clear and open communication throughout the development of the COVID-19, their plan for Alaska’s rural communities is vague and under-developed. After a careful analysis of the daily press briefings, I have been able to compile what is likely their vision. Below I will discuss their plan and why it is dangerous.
Stopping the Virus “Upstream”
State officials are putting heavy emphasis keeping the virus out of the villages. They emphasize the need for personal protective equipment, isolation, testing, and medevac services.
Why this is dangerous:
Every Alaskan agree that our ultimate goal should be to keep the virus out of our vulnerable communities. However, the state must prepare for the inevitable spread into at least some villages. A well-rounded plan would be to fight the spread while developing medical teams that are ready to deploy to any infected communities.
Isolation
First, communities are encouraged to close their borders to nonresidents. However, any community that has a state-owned road, hospital and other infrastructure will not be permitted to prevent people from coming into town. As a result, cities like Wrangell and Petersburg are not free to develop stringent precautions to prepare for the influx of seasonal workers. Instead, these limited communities are encouraged to require the incoming workers to submit to prescreening by doing temperature checks before boarding a plane to town, then to stay out of town during the duration of their work.
Why this is dangerous:
First, the effectiveness of temperature checks has been called into question. For example, it is estimated that 60% of the positive cases of the Theodore Roosevelt aircraft carrier were asymptomatic. Unfortunately, temperature checks are the best defense we can employ: Alaska still does not have the capacity to test people who are asymptomatic. Finally, rural Alaskans are already reporting that incoming seasonal workers are not respecting the boundaries of the mandated quarantine.
Testing
The state has sent a number of ID Now rapid testing machines to various communities across the state. With a mind to the realities of rural living, their intention is to make testing available to communities as quickly as possible.
Why this is dangerous:
First, the ID NOW machines are not equipped to process the dozens of tests that would need to be administered if a hot spot were to develop. Second, we have seen varying reports of the distribution of only 20 to 40 machines. Whatever the number, when there are over 250 communities in Alaska, this small number is the equivalent of a band aid. Third, due to geographic limitations, these machines remain inaccessible for more than two hundred remote communities. For example, if a grandmother in Nightmute was concerned about whether she was exposed to COVID-19, she would still have to wait to ship her testing materials to Bethel.
Positive Cases
The Alaskan government plans to send most people who test positive out of the village and into a hub city. This means that only people with no pre-existing conditions and who live alone can stay in their hometown. In other words, whether or not they develop severe symptoms, any person with pre-existing conditions and/or who lives in a multigenerational home will be sent to a hub city.
Why this is dangerous:
First, by the time someone tests positive they will have already infected anybody who lives in their multigenerational homes due to the 2-week incubation period. Second, hub cities have freely admitted that they are not prepared for an outbreak. Third, one air ambulance flight could easily cost Medicaid $30-40,000. If a person is not covered, they will likely be responsible for what could become a $60,000-$100,000 bill.
Further Preparation
The Samaritan’s Purse has donated beds and PPE and hygiene supplies to various communities across Alaska. The State has sent similar supplies to some communities.
Why this is dangerous:
While we are grateful for the donations of beds, these are not enough to address a possible hotspot outbreak. For example, as of April 3rd, Kodiak had only 16 hospital beds. Similarly, the donation of hygiene supplies is happily received. However, these measures are not enough for the state to wash its hands of its duty to support rural communities.
What must be done:
In addition to making tough choices about the fishing and tourist industry, the state must present a carefully prepared plan for our rural Alaskans. While the state’s current strategy is insufficient, it is indeed suitable beginning of a thorough plan. When each air ambulance will cost tens of thousands of dollars, the cost of sending a medical team to each affected village is not unreasonable.
Christina McDonogh, Sugpiaq
Native Village of Perryville
Her twitter handle is @SugpiaqatLaw
Governor Dunleavy is no friend to healthcare in Alaska
You don’t need to be a medical professional to understand that COVID-19 has a firm foothold in Alaska and our hospitals and clinics are now on the front lines. As physicians bracing for this emerging crisis, we write to remind you that Governor Dunleavy’s fiscal policies have been no friend to healthcare in our state. Earlier this month, he vetoed $210 million from the legislatively approved budget, including cuts to Medicaid and higher education—both of which play a vital role in delivering robust healthcare to Alaskans.
In the midst of rising COVID-19 infections in our state, it’s crucial to move quickly and ensure leaders at the highest level of government, especially our governor, set budget priorities which demonstrate that healthcare funding is not negotiable. With our recklessly under-funded healthcare system facing a global pandemic, it has never been more important to have a leader with the well-being of all Alaskans in mind.
The profound effects of underfunding Alaska’s healthcare system are just now coming to light. The Anchorage Daily News reports the state has already begun rationing Medicaid funds due to $170 million in cuts made last year to that program. Roughly 250,000 Alaskans—30% of our state—depend on Medicaid funds to obtain adequate medical care, which means a health coverage downgrade for nearly one in three people. In an average year, this is a short-sighted way to govern. During a major health crisis like COVID-19, it is unconscionable.
Seniors are another population negatively affected by Governor Dunleavy’s policies on health and social services. We don’t yet know exactly what COVID-19 will mean for elders who lost key food and housing benefits last year due to budget vetoes, but it is certain they will become increasingly vulnerable to disease if their basic needs aren’t being met. What about Pioneer Home residents who may no longer have a roof over their heads, much less ready access to medical care for end-of-life health concerns? We deserve a governor who makes future decisions with the health and well-being of all Alaskans in mind.
Almost anyone who has benefitted from medical care understands the value of educational programs that ensure our state has enough doctors, nurses, and other healthcare professionals. In light of this, we must ask ourselves why last year Governor Dunleavy fought to eliminate the WWAMI program, which trains Alaskan doctors, and slashed $70 million from our university system, which provides basic science education to future healthcare workers. We have yet to find rational answers.
The governor’s poor decision-making extends further still. Management of Alaska’s only state-run mental health facility, Alaska Psychiatric Institute, has been handed over in a no-bid contract to Wellpath Recovery Solutions, a for-profit company based in Tennessee.
On the best of days, doctors, nurses, and other medical professionals witness the devastating impacts of Governor Dunleavy’s fiscal policies on the health of Alaskans. COVID-19 is a wake-up call that worse days are coming.
Dr. Laurie Montano has practiced medicine in Anchorage for 18 years, Dr. Tina Tomsen has practiced medicine in Alaska for 34 years, and Dr. Robert Hunter has practiced medicine in Sitka for 40 years.
