Legislature(2019 - 2020)Anch LIO Lg Conf Rm
06/24/2020 09:30 AM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Presentation(s): Covid-19 in Alaska: an Update on Pandemic Response & Mitigation Strategies. | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Anchorage, Alaska
June 24, 2020
9:34 a.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Ivy Spohnholz, Vice Chair (via teleconference)
Representative Matt Claman (via teleconference)
Representative Harriet Drummond (via teleconference)
Representative Geran Tarr
Representative Sharon Jackson
Representative Lance Pruitt (via teleconference)
MEMBERS ABSENT
All members present
OTHER MEMBERS PRESENT
Representative Kelly Merrick (via teleconference)
Representative Zach Fields (via teleconference)
Representative Bryce Edgmon (via teleconference)
Senator Wilson (via teleconference)
COMMITTEE CALENDAR
PRESENTATION(S): COVID-19 IN ALASKA: AN UPDATE ON PANDEMIC
RESPONSE & MITIGATION STRATEGIES.
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANNE ZINK, MD, FACEP, Chief Medical Officer
Central Office
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint Presentation,
entitled "House Health and Social Services Committee Update:
COVID-19 in Alaska."
JOE MCLAUGHLIN, MD, MPH, Chief and State Epidemiologist
Section of Epidemiology Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation,
entitled "House Health and Social Services Committee Update:
COVID-19 in Alaska."
TARI O'CONNOR, MSW, Deputy Director
Central Office
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation,
entitled "House Health and Social Services Committee Update:
COVID-19 in Alaska."
COLEMAN CUTCHINS, ParmD, BCPS
Epidemiology
Office of Substance Misuse & Addiction Prevention
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation,
entitled "House Health and Social Services Committee Update:
COVID-19 in Alaska."
ADAM CRUM, Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint titled "Reopening
Alaska Responsibly; Data-informed Mandates and Health Alerts."
HEIDI HEDBERG, MPP, Director
Central Office
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled "Reopening Alaska Responsibly; Data-informed Mandates and
Health Alerts."
SANA EFIRD, Assistant Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the presentation.
MARY SWAIN, Executive Director
Camai Community Health Center
Naknek, Alaska
POSITION STATEMENT: Provided information during the
presentation on COVID-19 in Alaska.
HELEN ADAMS, MD, Emergency Medicine
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Provided information during the
presentation on COVID-19 in Alaska.
MICHAEL BERNSTEIN, MD, Chief Medical Officer
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Provided information during the
presentation on COVID-19 in Alaska.
ACTION NARRATIVE
[9:34 a.m.]
[Due to technical difficulties, the audio was not picked during
the first few minutes of the recording; however, the key points
were noted by the secretary.]
CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 9:34 a.m.
Representatives Jackson, Tarr, Zulkosky, Spohnholz (via
teleconference), Claman (via teleconference), Pruitt (via
teleconference), and Drummond (via teleconference) were present
at the call to order. Other legislators present were
Representatives Merrick and Fields (via teleconference).
^PRESENTATION(S): COVID-19 in Alaska: An update on pandemic
response & mitigation strategies.
PRESENTATION(S): COVID-19 in Alaska: An update on pandemic
response & mitigation strategies.
CHAIR ZULKOSKY announced that the only order of business would
be a presentation, entitled "COVID-19 in Alaska: An update on
pandemic response & mitigation strategies."
9:37:00 AM
ANNE ZINK, MD, FACEP, Chief Medical Officer, Central Office,
Division of Public Health, Department of Health and Social
Services, co-provided a PowerPoint Presentation, entitled "House
Health and Social Services Committee Update: COVID-19 in
Alaska." She began the presentation with the first two slides.
Slide 1 introduced the presentation and Dr. Zink's team before
the committee. Slide 2, "COVID-19 Overview," next introduced
Dr. Zink's portion of the presentation. Dr. Zink continued
through to slide 3, giving a brief overview of COVID-19
internationally, nationally, and in the state of Alaska. Dr.
Zink stated that COVID-19 infection rates had continued to climb
both nationally and internationally. The Department of Health
and Social Services (DHSS) continued to watch this because how
the world pandemic is managed internationally makes a big impact
on Alaska. She then continued to slide 4. This slide showed
comparisons between Alaska's infection rates and the rest of the
United States as normalized by population. Dr. Zink noted that
Alaska had not been hit as badly as other states by COVID-19.
This continues to be an ongoing effort and something DHHS
continues to watch closely on a day-by-day basis.
DR. ZINK then showed slide 5, "Confirmed Cases by Onset Date."
She explained this as "our epidemiology curve" and then stated
that DHSS announced new cases every day, but that it is
important to figure out when the onset date was - when the
symptoms began or when they tested positive - whichever came
first. This is to help understand the epidemiology of the
disease. She explained that because of this, the case numbers
on slide 5's graph often changed as cases were further
investigated. Dr. Zink further explained the color coding of
the graph, noting that each color represents a city or region,
red being Anchorage, green as Fairbanks, and orange as the Kenai
Peninsula. As seen on this graph, she noted the first wave was
a combination of a lot of areas, but a lot of that was Fairbanks
and Anchorage. The second wave started off in the Kenai
Peninsula area, as well as Anchorage. Dr. Zink stated that DHSS
will continue to update the dashboard as it receives more
information and feedback so as to provide the public with real-
time information and transparency regarding what is happening
with COVID-19 in the state of Alaska.
9:39:36 AM
DR. ZINK then showed slide 6, "Cumulative Cases." This is a
summary slide showing active cases, recovered cases, and deaths
of residents. Dr. Zink explained that as shown on this slide, a
total of 778 Alaska residents had tested positive for COVID-19.
She related that 129 non-residents who are not shown on this
graph but are shown on "the dashboard," [a tool on the DHSS
website used to present the public with up to date COVID-19
statistics], had also tested positive at this point. The slide
also showed 63 people in total had required hospitalization, and
there was a total of 12 deaths and a total of 502 recovered
patients. Dr. Zink went on to offer statistics not on the slide
for the committee's awareness. She reported there were 21
additional cases on 6/24/20: 7 out of state, of which 2 are in
mining, 1 in seafood, 1 visitor, and 1 unknown; and 14 Alaska
Residents, of which 7 are in Anchorage, 1 from Ketchikan, 1 from
Palmer, 1 from North Pole, 1 from Chugiak, 1 from Matanuska-
Susitna (Mat-Su), and 1 from Fairbanks. At this time Alaska
also had 14 patients who were hospitalized or were in the
hospital under investigation for possible COVID-19.
DR. ZINK continued onto the next few slides starting with slide
7, entitled "Time-varying Reproductive Number (rT)." She
explained that this is going to be modified and varied based on
how much Alaskans interact as individuals and how much contact
tracing and isolation takes place. This really shows the
ability of this disease to move from one person to another.
[The rT value] is modifiable by the way individuals interact
with each other, the way they wear their masks, clean their
hands, and other preventative measures that have been discussed.
The rT value is just below one, but during the spikes it has
picked up above one and then was brought back down. Dr Zinc
noted for the committee that with a geographically diverse
population, as well as low numbers of people, these modeling and
statistic efforts are always limited.
DR. ZINK next presented slide 8, showing geographic variances of
where there have been cases amongst the state [of Alaska]. She
then explained that DHHS plans on changing some additional
aspects of its dashboard to active cases as a rolling 14-day
average per 100,000 people so that there is better graphic
clarity showing were there are [current] cases.
9:42:05 AM
DR. ZINK then moved on to slide 9, entitled "Hospital Capacity,"
which showed data on available hospital beds, ICU beds,
ventilators, and people who are being hospitalized. She
expressed appreciation for the partnerships with healthcare
providers who are helping to build up healthcare capacity. The
information, she explained, was brought to DHSS by the Alaska
State Hospital and Nursing Home Association (ASHNHA) as it
collects this data daily. Dr. Zink noted that many factors go
into inpatient beds, ICU, and ventilator capacity outside of
COVID-19. Hospitals in Alaska can be overwhelmed with
influenzas or respiratory syncytial virus [RSV] on a bad year,
so DHSS intends to keep watching these numbers closely. Dr.
Zink further noted that the numbers shown did not represent the
other work and telehealth that healthcare providers and the
medical system were putting towards COVID-19.
9:43:02 AM
DR. ZINK next presented slide 10, "COVID-19 Signs and Symptoms."
She noted that one of the really challenging things about this
disease is that the signs can be very vague, they can be very
mild, and they can look like a lot of other things, including
allergies, colds, or just not feeling well. Typically, for
those who are older or have significant underlying medical
conditions, it can be hard to pick up on just from clinical
signs and symptoms alone. Dr. Zink further explained that the
medical community is still trying to understand the roll of
asymptomatic and pre-symptomatic spread, but, she noted, there
is clearly a roll that happens there. Another thing about this
disease, Dr. Zink added, is that it is highly contagious, and
people can pass the disease from one person to another before
they develop any symptoms.
DR. ZINK then moved onto slide 11, "Our Goal: Widespread,
Simple, Affordable Testing." She stated that because of the
challenge of diagnosing COVID-19 by signs and symptoms alone,
testing becomes a very important tool to identify these cases.
Testing continues to be a challenge worldwide and nationwide,
which will be addressed on later slides, she explained. She
related that DHSS's goal was widespread, easy, and accessible
testing for anyone who is symptomatic, particularly early on in
the symptoms, as that is the most useful point of that testing.
The department has added and will continue to add numerous
layers of asymptomatic testing, particularly for high-risk
individuals, as well as those who are at a higher risk to
transmit the disease. This includes pre-procedural screenings,
pre-dental screenings, screenings for admissions to health care
and congregate settings such as long-term care facilities,
testing for travel related cases, as well as use in outbreak
investigations.
9:44:41 AM
DR. ZINK then introduced slide 12, "Supporting Alaskans Through
COVID," and stated that a lot of work was being done to try to
support Alaskans through the pandemic. She acknowledged that
[COVID-19] has been very challenging and observed that the
general population was "over" COVID-19 that it was "no fun," but
COVID-19 sets the time table and [Alaskans must] continue to try
to find ways to be resilient and healthy. Between blog posts
and individual reach outs and community leadership meetings [it
is important to] try to find ways to support Alaskans through
COVID-19.
Dr. Zink closed her portion of the presentation with slide 13,
"Supporting Businesses Through COVID," acknowledging that
businesses have taken a huge toll. She admired the amazing
ability for businesses to stand up in this challenging
environment, be creative and inventive, and find ways to both
mitigate the disease and stay open. She concluded that it is
important to remember that the virus is the enemy here and not
each other and seeing businesses to come together to mitigate
this disease has been fantastic. Dr. Zink also mentioned that
DHSS has a new website as well as many tools for businesses to
help mitigate the spread of COVID-19.
9:45:45 AM
JOE MCLAUGHLIN, MD, MPH, Chief and State Epidemiologist, Section
of Epidemiology Division of Public Health, Department of Health
and Social Services, continued the PowerPoint presentation begun
by Dr. Zink, drawing attention to slide 14, beginning his
portion of the presentation: "Epidemiology." He moved to slide
15, "Contact Tracing and Case Investigation." Dr. McLaughlin
stated that, until there is an effective vaccine or treatment
for COVID-19, [the public] needs to continue to rely on non-
pharmaceutical public health interventions to slow the spread of
this virus. He then discussed one of the main interventions,
"containment," which has been informally referred to as "boxing
in the virus." The first step of containment, he continued,
involves the rapid identification of new cases of illness which
is generally aided through widespread availability of testing.
This is followed by isolation of these new contacts and then
interviewing them to identify their close contacts. This
process is called contact tracing. Next, Dr. McLaughlin
explained, close contacts are notified of their exposure and
[the contact tracers] let them know they need to quarantine for
14 days. This is then followed by testing. Initially, DHSS was
only testing if a patient had signs or symptoms of illness, but
more recent guidance from the Center for Disease Control (CDC)
suggests that anybody [who has come in contact with the virus
should] get tested, even if the individual doesn't have any
symptoms. This is because many individuals who are infected
never develop any symptoms at all.
9:47:43 AM
DR. MCLAUGHLIN prefaced slide 16, entitled "Types of Testing"
with some background information. He underlined the importance
of understanding the windows of time when [the different tests]
can detect [the virus]. First, he explained, it is important to
know that the incubation period for COVID-19 can range from 2 to
14 days, with an average of 5 days. This means it may take 2 to
14 days to develop symptoms after exposure for an infected
person to become symptomatic. The second piece of background
information he felt is relevant is that an infected person is
releasing the highest concentration of the virus in his/her
respiratory secretions about 2 days before symptom onset and
lasting about 3 days. This is when one is most likely to
transmit the virus to other people. The third piece of
background information he shared is that the body begins making
anti-bodies to the virus during the second week after symptom
onset.
DR. MCLAUGHLIN redirected the committee's attention to slide 16.
The first figure he noted was the blue line. This figure shows
the time frame when a nasopharyngeal swab, the swab that goes
into the back of the nose, is most likely to be positive by a
polymerase chain reaction (PCR) test when a person is infected
with the COVID-19 virus. He then pointed out that the curve [on
the slide] is highest during the period when an infected
person's body is secreting the most virus. The PCR test is used
to diagnose acute infections. Dr. Mclaughlin next addressed the
dashed green line. This line represents when Immunoglobulin
G(IgG) antibodies are detectable in an infected individual's
body. He reiterated that it starts during the second week after
symptom onset, peaks during the third week, but then remains
elevated for weeks. He clarified that the medical community did
not yet know how long it remained elevated, possibly months.
Dr. McLaughlin concluded this slide by explaining that this tool
is useful for detecting prior infections, but that it is not
recommended for diagnosing acute illness in patients.
9:50:49 AM
DR. MCLAUGHLIN introduced slide 17, "Notification of Patients
and Communities." Dr. McLaughlin began by explaining that once
an acute infection is diagnosed in a patient, this sets off a
"notification cascade." First, the laboratory that performed
the test is responsible for notifying the provider who ordered
the test whether the test is positive or negative, as well as
notifying the Division of Public Health. Then the provider is
responsible for notifying the division of the positive test
result, as well as notifying the patient. Once the division
gets notified, Dr. McLaughlin continued, the case is assigned to
a contact tracer who interviews the patient and then notifies
close contacts of their exposure. The Division of Public Health
also notifies the public of new cases, primarily through the
DHSS website, as well as via press releases and social media.
Other stakeholders [such as community officials] may be notified
by DHSS staff if necessary, such as when outbreaks are detected
within a facility or community.
DR. MCLAUGHLIN continued to slide 18, "Outbreaks -- Definition
and Response." He began by posing the question of how an
outbreak of COVID-19 is defined. Dr. McLaughlin defined an
outbreak as "two or more laboratory confirmed cases in a
population with onset dates within a 14-day period, and these
people have to be epidemiologically linked. We need to know
that they had some contact with each other, and they do not
share a household, and they were not identified as close
contacts with each other in another setting during standard case
investigation or contact tracing." He acknowledged that this is
a complex definition and went on to clarify with an example. He
stated that it is like if the virus spread within a facility
such as a workplace, a long-term care facility, or a fish
processing plant.
DR. MCLAUGHLIN moved to slide 19, "Immunity and Repeat
Infection." He posed the question, "Are we immune from the
infection if we have recovered from a prior infection, and if
so, how long are we immune?" He explained that [the scientific
community] still doesn't know the answer. Based on what is
known about other viral respiratory infections, including other
human coronavirus infections, Dr. McLaughlin continued, most
people do develop some level of immunity. The duration of
immunity varies. For some human coronaviruses aside from COVID-
19, the durability of that immunity is about one year, give or
take some months. [The scientific community] doesn't know how
long immunity will be conferred for COVID-19 amongst people who
have had an infection.
9:54:49 AM
DR. MCLAUGHLIN then offered an aside of further background
information, stating that it is unknown what proportion of the
population needs to be infected to confer herd immunity. He
defined herd immunity as the proportion of the community that
needs to be immune to this virus in order to prevent widespread
transmission in the community. He offered a possible projection
that herd immunity will result when 60-70 percent of the
population becomes immune to the virus. He then clarified that
Alaska has a long way to go before reaching herd immunity. He
cited the 778 reported cases to date and explained that even if
this figure is grossly underestimated by tenfold, that is still
about 1 percent of the state's population.
9:56:02 AM
CHAIR ZULKOSKY asked Dr. McLaughlin to repeat his previous
statement and asked where Alaska was in terms of its current
immunity.
9:56:15 AM
DR. MCLAUGHLIN repeated his explanation of herd immunity and
added that most likely less than 1 percent of the population of
Alaska was immune at this point. He clarified that it is
unknown the actual percentage of Alaskans infected with COVID-
19; all that is known is the reported case numbers, about .1
percent of the population. Because of Alaska's contact tracers
and slow infection rate, he felt [DHHS] has done a good job
tracking the case count, although he acknowledged that some
cases have most likely gone unreported.
DR. MCLAUGHLIN then resumed his portion of the presentation on
his last slide, titled "Vaccination." He explained how vaccines
work by tricking the immune system to develop antibodies. Dr.
McLaughlin informed the committee that there are over 135
vaccines in development, and in a best-case scenario many of
these would be found safe and effective. This would give
manufacturers and distributors many options to make and ship
vaccine across the globe. The United States Government has
focused on developing three vaccines for phase three trials
under Operation Warp Speed, one by the company Moderna, one by
Pfizer and BioNTech, and one by the University of Oxford and
AstraZeneca. Dr. McLaughlin then discussed the CDC's plans for
distribution of a vaccine once one was proven safe and
effective. The CDC outlined a two-phase distribution plan.
First, it planned to target "priority groups" through "mass
vaccination clinics" with the initial limited vaccine supply.
Second, once more widely available, the vaccine would be
distributed to the general population through traditional venues
such as clinics and pharmacies.
10:01:53 AM
TARI O'CONNOR, MSW, Deputy Director, Central Office, Division of
Public Health, Department of Health and Social Services, resumed
the presentation on slide 22, "Contact Tracing and Surge
Capacity." Ms. O'Connor discussed the increased staffing of
contact tracers since the onset of the pandemic, as shown on the
slide, and talked about where DHHS was in terms of contact
tracers prior to the pandemic, where they were at the time of
the presentation, and their future staffing and capacity goals.
Prior to COVID-19, she explained, [the state had] approximately
70 contact tracers statewide, primarily state staff members in
Public Health Nursing and the Section of Epidemiology, as well
as partners at the Anchorage Health Department (AHD). She then
stated DHSS has been working over the past month to bring in
partners and hire additional staff, reaching about 140 people in
the contact tracing workforce. Many of the individuals tasked
with this have taken it on in addition to their primary
workload, and when there is less of a need they focus on other
tasks. She further stated that 87 of the contact tracers are
state employees, and the rest are from the slide's listed
agencies that are partnering with the state. Partners included
the nurses from the Anchorage School District through the AHD,
The Yukon-Kuskokwim Health Corporation (YKHC), the Alaska Native
Tribal Health Consortium (ANTHC) Epidemiology Center, the
Maniilaq Association, the North Slope Borough (NSB), Fairbanks
Memorial Hospital, the CDC Arctic Investigations Program, and
more recently the Alaska National Guard/Air National Guard and
the Kenai Peninsula Borough School District.
MS. O'CONNOR stated that DHHS's goal was to have a total of 500
contact tracers with various partner organizations. Partners
for the additional capacity they hoped to gain are the
University of Alaska Anchorage (UAA), the Juneau School
District, the Fairbanks North Star Borough School District, and
the Matanuska-Susitna Borough School District. She further
stated that DHSS also hoped to work with other community health
centers, federally qualified health centers, and tribal health
organizations. Ms. O'Connor concluded this slide by explaining
that 500 was the midpoint goal of contact tracers needed for
Alaska's population according to recommendations from the
Association of State and Territorial Health Officials (ASTHO).
10:05:18 AM
MS. O'CONNOR continued to slide 23, "Infrastructure," and
discussed training sessions to onboard the new workforce. Ms.
O'Connor explained that the Department of Health and Social
Services (DHSS) had been working with the UAA College of Health
to adjust for onboarding a larger workforce. She next explained
the work going into developing a "case and contact management
tool." The goal of this program was to allow the different
agencies working together on contact tracing to share data and
coordinate staff assignments. Ms. O'Connor also stated that
this program will allow for better "quality assurance and
quality improvement." She stated, "It will allow us to more in
real time look at different metrics to see how well we are doing
and where there are opportunities for improvement." Ms.
O'Connor finished the slide by assuring that this program was
Health Insurance Portability and Accountability Act (HIPAA)
compliant and there are a number of agreements in place with the
program's partners to achieve this. Ms. O'Connor noted the
national attention regarding proximity tracking tools and
clarified that these are different from what she was working on
with the state.
10:08:46 AM
MS. O'CONNOR then began slide 24, "Priorities" and summarized
the goals of the contact tracing operation. The goals outlined
on the slide were "coordination, quality, confidentiality and
privacy, scalability, and building capacity Alaska can use in
future responses." Regarding coordination, she explained that
as the program began working with more partners, it was
important that they were coordinated in their efforts. This was
both so things wouldn't fall through the cracks and so things
were approached in a consistent way. Next, she explained that
it was important to maintain quality at a high level. This
included ensuring the individuals involved in contact tracing
have a strong background and interest in public health, the
quality of the training systems, and quality of the system
overall. Concerning confidentiality and privacy as well as
scalability, Ms. O'Connor stated that these are both big
priorities within the contact tracing project. She concluded
that this system was being implemented in such a way that it
could be used for future responses.
10:11:08 AM
COLEMAN CUTCHINS, ParmD, BCPS, Epidemiology, Office of Substance
Misuse & Addiction Prevention, Division of Public Health,
Department of Health and Social Services, continued the
PowerPoint by directing attention to slide 26, "Testing in
Alaska," and he discussed testing for viral ribonucleic acid
(RNA). These are the molecular based rapid tests that detect
live virus in the upper respiratory tract. He addressed that
there has been a lot of discussion about both rapid tests and
high capacity tests. Dr. Cutchins explained that there are many
tests being used, but there are limiting factors to each type
and it's all about using "the right tool for the right job." He
explained that there are near-patient rapid testing devices like
the Abbott ID NOW and (indisc.) that can quickly return a
result, but their limiting factor is volume, as most can only
run one test at a time. Another type of test comes from the
state public health labs that are running high-throughput PCR
tests that can test large numbers. He said DHHS was also
working with out of state commercial labs.
DR. CUTCHINS used an analogy of a single cup coffee machine to
detail how rapid tests can only be processed one at a time, so
while these can offer a quick turn-around, he explained that
this method is inadequate for processing large volumes of tests.
Dr. Cutchins explained that this is why the state contracts with
private companies to develop tests in large batches out of
state.
DR. CUTCHINS then presented slide 27, which further detailed the
steps involved when administering, processing, interpreting, and
reporting a test. He stated that a patient has to be registered
into a system and have his/her sample collected; the sample is
then packaged and may likely require refrigeration; the sample
is passed on to a transport in a temperature controlled
insulation box with a temperature monitor; and then the lab
receives the sample to process. Dr. Cutchins noted that the
state public lab had significantly scaled up its capacity in the
past month, achieving a 48-hour turn-around. once the samples
are processed, he continued, the results aren't as simple to
read as a pregnancy test with a plus or a minus. The results
must be interpreted at a molecular level, and then they must be
sent back to the provider where the results are entered into a
data base.
10:15:26 AM
DR. CUTCHINS presented slide 28, which illustrated individual
testing site locations. He mentioned that this interactive map
with individual, up-to-date testing site information is
available through the DHSS website. He also pointed out the
green locations on the map where traveler vouchers are accepted
to get a second test 7-14 days after arrival in the state.
DR. CUTCHINS discussed slides 29 and 30, which showed cumulative
test results and the percentage of daily tests that reported
back as positive, respectively. He pointed out that in April
the positivity rate was over 4 percent. Since then, the daily
positive test rate had dropped down to about 1 percent.
DR. CUTCHINS next introduced slide 31: "National Data," which
shows tests by one million population, showing that Alaska ranks
seventh amongst the states. He said this is commendable, given
Alaska's geographic isolation. Dr. Cutchins concluded with
slide, 32, which shows a graph from the White House illustrating
the national percentage for positive tests by state. This
showed Alaska as having the lowest positives by state for the
last seven days, and the second lowest amount of positives by
state in the last 30 days.
10:19:41 AM
ADAM CRUM, Commissioner, Department of Health and Social
Services, began on slide 33 of the PowerPoint presentation,
entitled "Reopening Alaska Responsibly; Data-informed Mandates
and Health Alerts." He directed attention to slide 34, and
discussed the difference between the purpose of the mandates and
the health alerts. He explained that at the beginning of the
process, when "information was coming in fast and furious," the
Department of Health and Social Services (DHSS) decided to
release health alerts which would advise Alaskans what was
deemed by health organizations including the Center for Disease
Control (CDC) as the best guidance for Alaskans to protect
themselves against COVID-19. He expressed that many of these
alerts had remained the same, such as hand washing and social-
distancing. He added that DHSS also put out health mandates,
which were things that, at the time, were implemented as
requirements for Alaskans to keep the spread down as they built
up their healthcare capacity. He noted that DHSS pulled back
mandates as the healthcare capacity increased and hospitals went
back to performing elective and preventative procedures. The
changing nature of the mandates is the reason for the
differentiation. He briefly paraphrased slide 34, which read as
follows [original punctuation provided]:
Purpose of Mandates vs. Health Alerts
There are a few things we strongly advise all Alaskans
do to minimize the risk of COVID-19
? Wash your hands
? Wear a mask when around others
Stay at least 6 feet away from others when possible
? Keep your interactions and circles small when
possible.
? Even for mild symptoms get tested.
At this time, the State of Alaska does not mandate the
general use of masks, limit group size, or business
operations, but does encourage Alaskans to do their
part to limit the spread of COVID-19.
? Mask wearing is not mandated, but encouraged. Health
and science experts recommended that you wear a mask
in public where social distancing is challenging to
reduce the likelihood that you unknowingly spread
COVID-19.
? Private companies and entities can enact their own
requirements.
? Local communities can enact their own restrictions.
Check with local communities as it pertains to
nonessential travel off of the road system. Alaska has
many small and remote communities that lack a robust
healthcare system and they may restrict non-essential
travel.
COMMISSIONER CRUM directed attention to slide 35, "Monitoring
Metrics," and explained that the metrics listed on the slide are
the items that DHSS is continuously monitoring, such as the
disease activity and the current positivity rate in Alaska. He
paraphrased the chart depicted on the slide, which in one column
listed the various metrics and in the second column, titled
"What we need to achieve to move to a slightly less restrictive
phase," listed a goal for each metric. He explained that
although there are increased caseloads, there have been 3,100
tests, which makes the positive rate 0.44 percent. He assured
that DHSS is monitoring testing and public health so that it can
monitor any spikes that may occur. He continued that, due to
the "great behavior" by Alaskans, DHSS was able to put industry
protocols in place for some of the high-risk areas, such as the
commercial fishing and oilfield industries, which prevented the
spread from location to location.
10:24:06 AM
HEIDI HEDBERG, MPP, Director, Central Office, Division of Public
Health, Department of Health and Social Services, directed
attention to the portion of the PowerPoint addressing
"Resources," beginning on slide 36. She covered the information
on slide 37, "Supply Status," which read as follows [original
punctuation provided]:
? Initial attempts to procure PPE in March and April
were challenging - shortages in almost all PPE
categories
? Current PPE supply lines are more open but have not
returned to normal
State inventory is stable for PPE
? Allocations required to meet ongoing requests
? Resources from commercial, in-state manufacturing
and FEMA
MS. HEDBERG directed attention to slide 38, "6-22-20 Alaska
State Hospital Supplies 24 Hospitals Reporting," which depicted
a chart showing the supply levels of 24 hospitals in various
areas around Alaska, and explained that DHSS needed to
understand the needs of the public and look at some predictions
by partnering with the Alaska State Hospital and Nursing Home
Association (ASHNHA). She paraphrased the findings of the chart
and stated that this information is valuable to the department
to monitor in order to know when it is necessary to secure the
scarce resources from their federal partners that are needed to
keep people safe. She then directed attention to slide 39,
"Resource Request Process," which she explained aims to inform
on how the resource request process works during a disaster.
She paraphrased the slide, which read as follows [original
punctuation provided]:
Health care facility attempts to procure item through
commercial supply line/multiple vendorsitem is
unavailable
Health care facility submits a resource request to
Local Emergency Management
Local Emergency Management fills the resource request
or, if no sufficient resources, submits to the State
Emergency Operations Center State
Emergency Operations Center assigns the Resource
Request to DHSSDHSS fulfills dependent upon
availability of item and quantity available
Note: Federal facilities, state-run facilities, and
tribal health facilities may follow slightly modified
request pathways.
10:29:21 AM
MS. HEDBERG proceeded to slide 40, "Medical Supply Shipments to
Date," which represents the quantity of medical supplies shipped
out to date. She shared that DHSS has received an unprecedented
696 resource requests and explained that this had rendered the
normal supply chain unstable, but that the department is
starting to see it "come back online." She explained that the
slide represents the quantities of supplies that DHSS has
shipped out to hospitals, clinics, and communities to support
the pandemic response. Slide 40, which reads as follows
[original punctuation provided]:
? DHSS has shipped the following key resources as of
6/22/2020
? 965,100 Gloves
? 80,557 Surgical Masks
? 77,187 N95 Masks
? 46,381 Gowns
? 28,339 Face Shields
? 60,368 Swabs
35,479 Universal Transport Media/Viral Transport
Media
? 5,640 Abbott ID Tests
? 15,604 Collection Kits
? 285 gallons of Hand Sanitizer
? Additional resources deployed include Tyvek suits,
goggles, thermometers, cloth facial coverings, bleach
wipes, and other critical supplies
MS. HEDBERG turned attention to slide 41, which provided various
methods to contact DHSS with questions surrounding the COVID-19
response and data, and proceeded to ask for any questions from
the committee.
10:32:18 AM
CHAIR ZULKOSKY asked Commissioner Crum at what point the
department would step in to ensure the case spikes will
stabilize and decline. She also asked where out-of-state
travelers would go to get tested in small Alaska communities,
and if these communities would have the opportunity to restrict
travel and enforce testing mandates and their own public health
measures.
10:34:53 AM
COMMISSIONER CRUM stated that he did not understand the
question.
CHAIR ZULKOSKY repeated the question and offered her
understanding based off of Commissioner Crum's earlier portion
of the presentation that the state is not mandating various
protective measures and therefore "the burden of contact tracing
falls on the state," and restated her curiosity as to when the
state would step-in to enforce the mandates and when something
would be moved from a health alert to a mandate.
10:35:44 AM
COMMISSIONER CRUM answered with his belief that anyone who has
traveled into small Southeast communities has seen the process
that out-of-state travelers are "funneled through," including
the declaration form and the testing set-up. He offered his
understanding that the mandates are being complied with
currently.
REPRESENTATIVE ZULKOSKY clarified her question and asked at what
point the department will act and begin to enforce mandates such
as use of masks, limiting group sizes, and out-of-state travel,
and asked Commissioner Crum to speak more to the policy decision
rather than the existing mandates.
COMMISSIONER CRUM confirmed that the goal of DHSS is to allow
rural communities this autonomy. He used Kotzebue as an example
of a rural community that has its own travel restrictions in
place, and responded that if Bethel wanted to do this as well,
then it could have that conversation with DHSS. He stated that
the state has been having rising cases, but the aspect that DHSS
is focusing on is the percent positive rate.
10:38:51 AM
REPRESENTATIVE ZULKOSKY repeated her question again, this time
directing it to Dr. Zink. She restated that Alaska has been
seeing consistent and frequent record-setting increases in
positive COVID-19 cases and offered her understanding that this
has been mostly due to travel, and with that in mind she
questioned at what point Alaska is making a policy decision to
mandate protective measures. She directed an additional
question to Commissioner Crum, asking if communities off the
road system that do not have health powers are able to enact
further restrictions in addition to the ones enacted by the
state.
COMMISSIONER CRUM offered his understanding that DHSS has been
clear on the fact that those communities do have that power to
enact further restrictions.
10:40:16 AM
DR. ZINK responded to Chair Zulkosky's question by first
addressing the autonomy of the smaller and rural independent
boroughs and communities, sharing that they oftentimes work with
the law on that since there are numerous legal requirements at
play, and she offered to follow up individually with Chair
Zulkosky to discuss the legality of that matter. Dr. Zink then
responded to her second question regarding the decision to
mandate protective measures, and offered her understanding that
that the first restrictions during a pandemic or epidemic are
the most effective and that it becomes harder to do as the
pandemic or epidemic progresses. She explained that DHSS wants
to make quick decisions but doesn't want to impact people's
lives too drastically too quickly, and noted that balance is
particularly important. She added that DHSS is looking at four
metrics, which are as follows: testing, contact tracing,
epidemiology, and healthcare capacity. She explained that
within each one of those, there are steps that DHSS can take to
mitigate the disease and the overall burden. Regarding the
increasing cases, she offered her understanding that the
increase is slightly different from the first wave due to
increase in testing and contact tracing capability. Regarding
hospital capacity, she explained that holding back on elective
procedures has helped a lot in capacity, but that there are
consequences now that people are starting to get those
procedures again. She stated that masks continue to prove to be
a vital tool in preventing a rapid spread and transmission of
the disease, and that the goal is to get as many people to wear
masks as possible and mitigate the disease while having the
least impact on Alaskans as possible. She concluded that the
department is trying to implement as strategic and
geographically-responsive a plan as possible in order to try to
mitigate the disease.
10:43:09 AM
REPRESENTATIVE JACKSON asked how much the state is paying for
the testing. She stated her concern about the cost of vaccines
and expressed her understanding that the state knows little
about COVID-19 but is mass producing vaccines. She is also
concerned about the reasoning behind giving the vaccine to
schoolchildren first since her understanding is that they are
low risk. She then addressed the workforce increasement of 500
additional partners to maintain the [contact tracing] system,
and wondered if these employees are Alaskans or coming from out
of state, if these employees will work throughout the state
including villages, if this new workforce is permanent, and how
much this will cost the state.
10:46:00 AM
SANA EFIRD, Assistant Commissioner, Department of Health and
Social Services, responded to Representative Jackson that DHSS
is currently working on getting in place the contracts for the
testing centers around the state and that she doesn't have an
exact total at this time. She went on to answer that the state
is looking at maximizing the funding under possible Federal
Emergency Management Agency (FEMA) reimbursement, and also has
received other funds through the Center for Disease Control
(CDC)for epidemiology and expanding lab capacity, and that the
state is working on how these costs will be covered under the
various available federal programs.
CHAIR ZULKOSKY asked Ms. Efird to get that information to her
office and she will ensure that it is distributed. She prompted
additional discussion on Representative Jackson's questions
about the vaccine and schools.
10:47:36 AM
DR. ZINK answered Representative Jackson's question and
clarified that it is the intention of the department state
testing will be free-of-charge to make it as accessible and
affordable as possible. Regarding the question about school,
she continued that DHSS is working closely with Commissioner
Johnson on opening schools and what that looks like. She
explained that testing is not currently part of that plan but
that the CDC is working on it.
10:48:15 AM
DR. MCLAUGHLIN provided his understanding that the vaccine will
be funded by the federal government and that there will be no
cost to the state. In terms of supplies, he stated his
understanding that the Biomedical Advance Research and
Development Authority (BARDA) will be leading the effort in
getting supply kits out to states, which will be coming from the
federal government.
10:49:00 AM
DR. ZINK responded to Representative Jackson regarding who will
get the vaccine and offered her understanding that the state
first needs to find out more about the science, the data, and
understand the immunology of the vaccine before DHSS can
determine that. She explained that the required science to
understand that information is being conducted right now.
10:49:34 AM
MS. O'CONNOR addressed Representative Jackson's question
regarding contact tracers and referenced slide 22, "Status,
Targets, Partners," and explained that as is evident on the
slide, contact tracers are from Alaska agencies and are by and
large Alaskans. She added that depending on the agency, some
contact tracers are distributed throughout the state, such as
public health nurses and the University of Alaska Anchorage
(UAA) workforce, and some are not. She noted that DHSS is still
working on what this will look like in terms of community health
centers and federally-qualified health centers and how the state
will partner with these centers, but that those institutions are
distributed statewide as well.
10:51:13 AM
REPRESENTATIVE TARR asked several questions: first, on capacity,
she asked if the reason the dashboard [on slide 9, "Hospital
Capacity"] says 927 hospitals available is due to non-critical
procedures being set aside; in response to the testing, she
asked if there is any plan for the state lab to allow a self-pay
option for testing in order to encourage more testing; and
regarding contact tracing, she expressed her curiosity if there
is enough data to provide a percentage of people that have
tested positive as a result of the contact tracing and if there
is any information about trends. She offered her understanding
that as a result of mass misinformation, particularly around
masks and herd immunity, the public may not have heard about the
research published positing that herd immunity may only last for
a year, and she expressed her hope that that information be put
out to the public. In conclusion, she expressed her support of
more stringent guidelines and making the strongest statements
possible to protect the public and get the economy going.
10:54:36 AM
DR. ZINK addressed hospital capacities and responded that the
number of 927 does represent the total number of hospital beds
available in the state and does account for the increase in
elective and preventative procedures, but that the department
will continue to watch that number closely as the state can
sometimes reach capacity in the winter in particular during flu
season. She stated that the department will ensure that the
state will be able to accommodate for that increase. She shared
that there has been no restriction on elective procedures as of
yet. The department confirmed with ASHNHA and that [bed
capacity] is not backed up to the baseline, and the department
will continue to work in partnership with the association. She
agreed that the messaging is very challenging and that "you
can't communicate enough" during an episode such as this, and
for that reason the department is trying to find new and better
ways to communicate to the public. In support of this, she
shared that the department is starting to hold science forums
every other Wednesday where its science team will be present and
able to share information and answer questions, and this will be
streamed on Facebook live and other media sources. She added
that DHSS continues to do radio announcements in addition to
releasing information via Facebook and in city council hall
meetings around the state in order to answer local and specific
questions. She continued that they also hold a series of
various types of Echo meetings around the state for health care
providers to continue to engage the healthcare community.
CHAIR ZULKOSKY sought clarification on the efficacy of face
masks and asked if Dr. Zink would advise a temporary mandate in
cases where social distancing is not possible.
10:57:47 AM
DR. ZINK said they appear to be an effective tool for source
control, and there has been indication that a masks of tightly
woven material can afford protection to the wearer. She said
DHSS sees mask wearing as "an increasing tool" to prevent the
exponential spread of COVID-19. She explained that it's part of
the reason why the department have been trying to make mask
information and availability as widespread as possible, and
stated that her goal is to get people to wear them as much as
possible.
10:59:15 AM
DR. CUTCHINS answered Representative Tarr's question on
affordable testing. He said the Alaska State Public Health
Laboratory isn't charging anyone for testing. He explained that
it is the processing of the testing that the state isn't
charging for and explained that a lot more goes into testing as
previously referenced in a flow chart. He said that his agency
is working all over the state to make sure that all communities
have access to affordable testing, and he referenced a similar
statement earlier in the hearing from Dr. Zink. He explained
that the testing situation is fluid, sites are opening and
closing, and DHSS is working to stabilize the situation in terms
of access. He said there is a state standing order which is a
blanket order that providers can use to create drive through
testing locations. He explained that this means a member of the
public can utilize these testing facilities without having to
see his/her medical provider beforehand, if the person meets the
testing criteria which includes many asymptomatic cases.
11:00:33 AM
DR. MCLAUGHLIN said that there is a lot of variability in
contact tracing in terms of what is determined to be close
contact when there are confirmed cases. Sometimes there are
only one or two people who would be considered close contacts,
and sometimes a person who is a confirmed case is very
gregarious and can have close contacts numbering in the double
digits. Similarly, there can be wide variability in the number
of confirmed cases amongst the close contacts based on how
vigilant a given contact is in following recommendations like
social distancing and wearing a mask.
DR. MCLAUGHLIN addressed the question about herd immunity. He
said that the duration of immunity should last close to one
year, and there will likely need to be a booster dose or repeat
dose taken once a year like the yearly influenza shots.
11:02:03 AM
REPRESENTATIVE CLAMAN asked Dr. Zink what she recommends for
work at home versus returning to work, including how Dr. Zink is
managing that at her own office. He also asked what the main
conditions that predicated severe COVID-19 illness are and what
the risk factors for COVID-19 are, particularly in Native groups
and rural versus urban communities. He said that age and
obesity were major risk factors and said he was familiar with a
Johns Hopkins study that identified obesity and heart disease as
major risk factors.
11:03:03 AM
DR. ZINK answered that if work can be done via telework or other
remote means, then she highly recommends it. Her own office is
doing teleworking. She said that her work in the emergency
department cannot be done remotely and so she recommends wearing
a mask and minimizing the number of people in the space. She
replied to the question about risk factors and said that
preexisting conditions like heart and lung disease appear to be
significant risk factors. She said that she is often asked why
the small group of people with risk factors aren't protected,
but she explained that the group of people with risk factors is
actually a large group consisting of at least one-third of
Alaskans, as mentioned by the CDC. She referenced data from the
Lower 48 hospitalization rates that showed that younger people
do much better but that somewhere around 30-35 percent of people
are hospitalized despite not having any risk factors. In terms
of urban versus rural, she said that this was something she was
seeing playing out over the data nationwide. She explained that
the case numbers coming out of Alaska were still a small sample
size and so it is hard to make assessments based off of the
Alaska data; DHSS is continuing to monitor the data but the
department's goal is to have healthy and well Alaskans
regardless of location, ethnicity, gender, or age, and sometimes
that requires different resources being put with different
groups, for example, getting resources out to rural communities
earlier, getting personal protective equipment and testing in
long-term care facilities, and making sure testing is available
in communities that may be underserved and may not otherwise be
able to access testing. She said that these appear to be the
key strategies that she sees in the Lower 48, from which she is
trying to learn.
REPRESENTATIVE CLAMAN asked Dr. Zink for a clarification
regarding a statistic she had mentioned about Alaskans with one
or more risk factors.
DR. ZINK answered that the statistic was approximately one-third
of Alaskans had one or more risk factors; she said the most
recent data she looked at was that 32 percent of Alaskans had
one or more risk factors.
11:05:51 AM
REPRESENTATIVE SPOHNHOLZ asked about the recent outbreak that
occurred at the Providence Alaska Medical Center ("Providence")
in East Anchorage that was likely caused by a staff member who
inadvertently contacted other caregivers. She asked what the
protocol is for containing outbreaks at high-risk facilities.
She also said that she has heard that testing capacity is an
issue that prevents all healthcare providers at Providence and
other healthcare providers from being able to identify
asymptomatic carriers. She asked whether Dr. Zink could address
the issue of testing capacity and whether testing all caregivers
of vulnerable populations should be required.
11:07:10 AM
DR. ZINK, regarding the individual case at Providence, answered
that it was a humbling experience, and DHSS is still learning
about testing at long-term care facilities. She said DHSS is
testing healthcare employees at these facilities, including
baseline testing of all employees at the Kenai, Mat-Su, and
Anchorage facilities to try to identify any further incidents.
She said the disease does not care whether employees are having
contact during work or while socializing at a restaurant or at
home; the disease lives among any group of humans that are
having contact. She said DHSS is continuing to look at ways
that it can prevent outbreaks at long-term care facilities where
the department knows the mortality is going to be higher. She
said the department has been testing the workers associated with
the outbreak at Providence on a weekly basis, and it is also
evaluating how it tests long-term care workers throughout the
state on a regular basis, which is a priority. She related that
her team has been working with Dr. McLaughlin and his team on
this issue.
11:08:42 AM
DR. MCLAUGHLIN said 57 laboratory confirmed cases are associated
with this outbreak: 18 patients, 28 caregivers, and some
secondary cases, as well. He added that CDC offers guidance
that includes weekly testing of staff. Every facility needs to
determine the proportion of staff it is able to test on a weekly
basis, which varies widely from state to state. Some facilities
are able to test 25 percent per week and thus are able to test
100 percent of staff every month; some are able to test 50
percent per week and thus are able to test 100 percent of staff
every two weeks; and smaller facilities are able to test all of
their staff every week. He said that there is also guidance
from the CDC that when an outbreak occurs, the facility should
do weekly testing of its residents until two weeks have passed
since cases have occurred.
CHAIR SPOHNHOLZ clarified that she wanted to know whether Alaska
had the testing capacity to test all the healthcare workers in
hospitals to prevent an outbreak.
DR. ZINK answered that it would be difficult to define how often
DHSS would need to test healthcare workers. She said that DHSS
does have the capacity to test the most vulnerable populations
at long-term care facilities per the CDC guidance, but that DHSS
has been moving more conservatively than the guidance because
the long-term facilities in the state are small. She said DHSS
is working to determine what testing modalities are best for
those groups.
CHAIR ZULKOSKY expressed her appreciation for the witnesses
being available to answer questions and said she would like to
schedule an additional hearing sooner rather than later so that
the committee is not waiting an additional four months to ask
questions.
11:12:41 AM
MARY SWAIN, Executive Director, Camai Community Health Center,
said that Camai Community Health Center is located in Naknek in
the Bristol Bay Borough. She said that most of the sockeye
salmon that is harvested in the upper Bristol Bay region is
processed in Naknek. Last year, of the total 96.5 million
sockeye run, total catch was 4.5 million fish, and approximately
38 million of that catch was processed in Naknek. She explained
that with a fishery this large, with a community of only 800
people, the expansion that takes place is quite large; over a
course of four weeks Naknek grows to over 10,000. Camai
Community Health Center is a small facility with three exam
rooms and an emergency care room. She said that beginning in
March, the health center knew that it had to plan for a worst-
case scenario for a fishing season with an outbreak of COVID-19,
and it began evaluating what it had and what it would need based
on the recommendations of the state, federal, and other partners
who were already dealing with COVID-19. She said that the first
decision the health center made was to increase staffing levels
for the season; in a typical fishing season the center would
have five providers and this year it has seven. She said that
the center also identified the need to coordinate with as many
fishing processors and industry businesses as early as possible
so that the center could build a plan together. She said that
once a week the health center meets to discuss changes in the
mandates and policies as well as to discuss concerns anyone in
the community might have. She said the center also began
providing updates on its website and Facebook page three days a
week about CDC guidelines and mandates as well as plans and
processes that are being put into place. She said there are
times where the center reaches over 3,000 people with its
updates. She said she knew early in the process that the only
way forward was to provide clear and concise communications with
the community.
MS. SWAIN said during a pandemic, the medical community takes
the lead and, as a clinic with only 14 employees, the health
center had to come together and be as prepared as possible while
making decisions and working with processors for plans for
isolation and treatment when a worker becomes ill. She said
that most plans have medical staff to assist with care of ill
persons. She said that community members are able to isolate in
their homes and be monitored by the health center staff or by
public health officials. This left the fishing communities as
outliers who needed a place to isolate if community members
became ill while on the water, and a place close to the clinic
was needed as to not burden the staff with long distances to
travel to monitor patients. She said that during this time she
was contacted by a freight company with an offer of several
modular home units if needed, and the health center decided that
it had the staff to monitor 15 mildly ill patients if it had
available beds. She said that with the help of the Bristol Bay
borough, the health center purchased an 11-bed unit and leased
an 8-bed unit for the season, which are in place and awaiting
sewer and electricity and should be ready to go this week. She
relayed that the state contacted her this week regarding the
need for additional medical care if there were to be a bigger
outbreak than the health center could manage; the state had an
offer from Samaritan's Purse for a field hospital with the staff
to manage it, and she said the Bristol Bay Borough seems to be
the right place to have one if there is an outbreak during the
fishing season. She said that plans have now been made and a
field hospital can now be set up in a matter of a couple of
days. She said that this has given the staff peace of mind in
knowing that if the health center is overwhelmed, plans are in
place, and the state has been wonderful in this endeavor.
11:16:39 AM
MS. SWAIN said the last part of the health center's response is
testing and that its responsibility is to ramp up its ability to
test in a short amount of time. She said that the center has
processed 3,500 tests within the last few weeks, including
through a walk-up clinic that is open Monday through Friday at
the swimming pool across the parking lot from their building,
and groups of ten or more can sign up to go to the pool outside
of that timeframe. She said that the health center also
coordinates with the project staff employees to send the tests
to the state lab, and sometimes the center processes the tests
in Naknek. Results are typically available within two to three
days. She said that the health center also coordinates testing
for four processors that are not in Naknek: Ekuk and Togiak
Fish, which are on the Nushagak/Dillingham side of the bay, as
well as Big Creek and Coffee Point Fisheries in the Egegik
District. She said the health center also can do in-clinic
testing with point-of-care "ID Now," which allows patients with
symptoms to more quickly know whether the patients are positive.
MS. SWAIN said the health center has been sending its negative
tests to the state because the viral load needed for the Avid
[test] to detect a positive is much higher than the state can
detect. She also relayed that all negatives sent to the state
have been verified as negative. She said the health center also
has a sixteen-point testing machine in its facility which can
run sixteen tests at a time and have results in about one hour,
and it has the supplies needed to send out tests to the state.
She said the health center runs all walk-up patients and
processor groups on this machine. She said she thinks the
health center has a good plan in place to respond to positive
cases quickly and the center has identified a few issues with
processors the center is working through. The center had to get
creative when sending over 700 tests to the lab, for example by
using fish boxes instead of sending many smaller boxes. She
said the center had also dealt with issues with a big impact
like on Monday, June 22, when the center received a call
regarding a positive that was detected at the state lab
regarding a sample that was taken on the fifteenth.
11:19:12 AM
CHAIR ZULKOSKY asked Ms. Swain to submit her testimony in
writing because of time constraints and because of additional
testifiers. She further inquired whether the Camai Community
Health Center was also testing people in the communities of
Bristol Bay.
MS. SWAIN answered absolutely, the health center does so in
addition to the other communities mentioned in her testimony.
CHAIR ZULKOSKY asked for confirmation that there were 14
employees at the facility who were able to facilitate the tests.
MS. SWAIN explained that the health center has 27 total
employees because the center increased provider staff, support
staff, and staff for the testing center.
CHAIR ZULKOSKY asked whether all employees are eligible to test
for COVID-19 in Bristol Bay and the increased fisheries
population.
MS. SWAIN responded yes.
11:20:41 AM
CHAIR ZULKOSKY asked Commissioner Crum how the state is ensuring
that the processors who are doing their own testing are
reporting their cases appropriately, timely, and thoroughly.
She also asked if the state has a strong will to enforce the
mandates and how the state plans to do so.
11:21:20 AM
COMMISSIONER CRUM answered that DHSS put processes in place so
people can comply with the mandates. He said that for Health
Mandate 17 for the Bristol Bay region, DHSS requested some
outside help, and the state has procured a contract for health
safety monitors to work in the region. He said there is public
health law that requires these cases to be reported, and Dr.
McLaughlin may be able to address the timing of the reporting.
11:21:59 AM
CHAIR ZULKOSKY asked Dr. McLaughlin about the state of Alaska
allowing some fish processors to do their own testing and how
the state is ensuring that any cases are reported timely,
accurately, and thoroughly.
11:22:19 AM
DR. MCLAUGHLIN answered that any COVID-19 testing is reportable
by both the ordering provider as well as the laboratory
provider. He said that depending on who is doing the testing,
the laboratory is required to report to the state as soon as the
laboratory gets positive test results, and the same is true for
the ordering provider.
CHAIR ZULKOSKY asked what happens when entities do not comply
with mandates, and she asked how concerned community members can
report that an entity or organization is not complying with the
mandates issued by the Office of the Commissioner or the Office
of the Governor.
11:23:15 AM
COMMISSIONER CRUM replied that people can report via e-mail and
can reach out with concerns.
CHAIR ZULKOSKY, given the gravity of this virus, requested the
department commit to a follow-up hearing possibly in July to
provide the committee with an update on new numbers.
11:24:31 AM
COMMISSIONER CRUM responded that as issues arise, some team
members may not be available, nonetheless, his team can arrange
for something towards the end of July.
11:25:05 AM
HELEN ADAMS, MD, Emergency Medicine, Providence Alaska Medical
Center, said DHSS was incredibly effective, which has allowed
[Providence] to be in the position it is in today. She said she
thinks that "since we've re-opened," the increase in cases
represents "a paradigm shift in our COVID-19 story." She
cautioned that failure to address this shift could result in
downstream mistakes in the transmission of cases and the overall
burden of disease in Alaska. She explained that there are three
things that must be pushed: handwashing, mask-wearing, and
social distancing. She explained that she, too, was incredibly
frustrated with the confusing mask regulations that were issued
at the federal level, including recommendations to healthcare
providers to maintain their own safety. She said that the data
on mask wearing is changing where it was previously "as clear as
mud." It is becoming clear that masks are effective in both
clinical and non-clinical settings. She referred the committee
to a large meta-analysis published on June 1 in The Lancet,
which looked at 146 studies. It is becoming clear that there is
power in studies showing masks are effective; the study looked
at 29 studies that compared masks versus no masks and involved
cumulatively over 13,000 participants, and these interventions
were shown to reduce transmission. She said that Alaska doesn't
want to be another Sweden where there were twice as many
infections and five times as many deaths as in its Scandinavian
neighbors. She said that she doesn't want this issue to be
political and she wants to tap into the Alaska spirit. She said
that as a physician she doesn't want to tell legislators how to
do their jobs, and whether encouraging the population to wear
facemasks is done through education, outreach, or a mandate, she
thinks that all of these options need to be on the table and an
ongoing conversation. She proffered that the wearing of masks
in public spaces is the lesser of two evils in that it allows
people to go about their business and participate in the
economy. The alternative is more sick people and higher costs,
including Medicaid costs, or isolating again. She encouraged
support of hand washing, social distancing, and dissemination of
the new data that mask wearing is effective.
11:28:53 AM
MICHAEL BERNSTEIN, MD, Chief Medical Officer, Providence Alaska
Medical Center, said that Providence provides acute and chronic
care facilities in Anchorage, Seward, Valdez, and Kodiak. He
said that he thinks that Providence does have adequate care
capacity to handle surges that have been anticipated.
Providence has learned from the recent outbreak in its
transitional care center about the importance of doing careful
monitoring. Testing has been handled by DHSS officials. He
said Providence is in support of education and service
announcements about masking, social distancing, and hygiene
behaviors, and it is important to convey to the public that
these activities help protect the more vulnerable members of the
population; Providence is continuing its efforts in that regard.
DR. BERNSTEIN related that Providence is also encouraging the
public to get important preventative and long-term care and is
engaged in a campaign to let the public know that care should
not be delayed, including stressing that it is very important to
get flu vaccination this coming fall. He said while Providence
is hopeful that a COVID-19 vaccination will be available, the
flu vaccination will be very important to prevent influenza from
confounding COVID-19 evaluations. He said that Providence
doesn't know what the effects of co-infection will be. Dr.
Bernstein said he continues to believe that the most vulnerable
are people in long-term care and those with chronic diseases,
homeless populations, and individuals of color who may have
reduced access to care. He said Providence is continuing to
support those populations.
11:32:04 AM
CHAIR ZULKOSKY stated that recent reporting indicates that
Alaska is reaching its maximum ability to conduct contact
tracing, and she said contact tracing and isolation are critical
to box in and push back the spread of the virus. She asked if
there are enough local tracing resources in the state and
whether it was local contact tracers who were being used for
non-resident cases.
11:32:58 AM
MS. O'CONNOR answered that DHSS is shooting for a capacity of
500; the capacity is at 140 right now, and she expects the
current level to change significantly over the next couple of
weeks. She said that DHSS is finalizing the steps to get
infrastructure into place, including finalizing legal agreements
and case and contact management systems.
11:34:07 AM
CHAIR ZULKOSKY suggested the way that the department has
displayed hospital capacity as a dashboard that is visual and
easy to understand has proven helpful.
CHAIR ZULKOSKY thanked testifiers and indicated that there would
be a follow-up July hearing.
11:35:12 AM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 11:35 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HHSS Update.pdf |
HHSS 6/24/2020 9:30:00 AM |
DHSS COVID-19 Update |