Legislature(2019 - 2020)ADAMS 519

03/17/2020 05:00 PM STATE AFFAIRS

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Audio Topic
05:07:23 PM Start
05:08:15 PM Presentation: Covid-19 Omnibus Hearing
07:45:00 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Uniform Rule 23(a) Waived
-- Please Note Time & Location Change --
+ Presentation: COVID-19 Omnibus Hearing by TELECONFERENCED
- Nirav Shah, Stanford Medical Center
- Tomas Pueyo, Modeler/Mathematician
- Nils Andreassen, Exec. Dir., Alaska Municipal
League
- Bryan Fisher, Incident Commander, Dept. of
Military & Veterans Affairs
                    ALASKA STATE LEGISLATURE                                                                                  
             HOUSE STATE AFFAIRS STANDING COMMITTEE                                                                           
                         March 17, 2020                                                                                         
                           5:07 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Zack Fields, Co-Chair                                                                                            
Representative Jonathan Kreiss-Tomkins, Co-Chair                                                                                
Representative Grier Hopkins                                                                                                    
Representative Andi Story                                                                                                       
Representative Laddie Shaw                                                                                                      
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Steve Thompson                                                                                                   
Representative Sarah Vance                                                                                                      
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
Representative Ben Carpenter                                                                                                    
Representative Adam Wool                                                                                                        
Representative Dan Ortiz                                                                                                        
Representative Matt Claman                                                                                                      
Representative Andy Josephson                                                                                                   
Representative Chris Tuck                                                                                                       
Representative Ivy Spohnholz                                                                                                    
Representative Dave Talerico                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION:  COVID-19 OMNIBUS HEARING                                                                                         
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
TOMAS PUEYO, Modeler/Mathematician                                                                                              
San Francisco, California                                                                                                       
POSITION STATEMENT:  Co-presented and answered questions during                                                               
the presentation, entitled "COVID-19 Omnibus Hearing," with the                                                                 
use of a PowerPoint presentation.                                                                                               
                                                                                                                                
NIRAV SHAH, MD                                                                                                                  
Stanford University Clinical Excellence Research Center                                                                         
Palo Alto, California                                                                                                           
POSITION STATEMENT:  Provided  information and answered questions                                                             
during the presentation, entitled "COVID-19 Omnibus Hearing."                                                                   
                                                                                                                                
BRYAN FISHER, Operations Manager                                                                                                
Division of Homeland Security and Emergency Management (DHS&EM)                                                                 
Department of Military & Veterans' Affairs (DMVA)                                                                               
Joint Base Elmendorf-Richardson (JBER), Alaska                                                                                  
POSITION STATEMENT:   Co-presented and answered  questions during                                                             
the presentation, entitled "COVID-19 Omnibus Hearing."                                                                          
                                                                                                                                
HEIDI HEDBERG, Director                                                                                                         
Division of Public Health (DPH)                                                                                                 
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Co-presented and answered  questions during                                                             
the presentation, entitled "COVID-19 Omnibus Hearing."                                                                          
                                                                                                                                
JARED KOSIN, Chief Executive Officer (CEO)                                                                                      
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided  information and answered questions                                                             
during the presentation, entitled "COVID-19 Omnibus Hearing."                                                                   
                                                                                                                                
NILS ANDREASSEN, Executive Director                                                                                             
Alaska Municipal League (AML)                                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Co-presented and answered  questions during                                                             
the presentation,  entitled "COVID-19 Omnibus Hearing,"  with the                                                               
use of a PowerPoint presentation.                                                                                               
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
5:07:23 PM                                                                                                                    
                                                                                                                                
CO-CHAIR JONATHAN  KREISS-TOMKINS called the House  State Affairs                                                             
Standing   Committee    meeting   to    order   at    5:07   p.m.                                                               
Representatives Shaw, Hopkins,  Story, Fields, and Kreiss-Tomkins                                                               
were  present at  the call  to order.   Also  in attendance  were                                                               
Representatives Carpenter, Wool,  Ortiz, Claman, Josephson, Tuck,                                                               
Spohnholz, and Talerico.                                                                                                        
                                                                                                                                
^PRESENTATION:  COVID-19 OMNIBUS HEARING                                                                                        
            PRESENTATION:  COVID-19 OMNIBUS HEARING                                                                         
                                                                                                                              
5:08:15 PM                                                                                                                    
                                                                                                                                
CHAIR KREISS-TOMKINS  announced that  the only order  of business                                                               
would be a presentation, entitled "COVID-19 Omnibus Hearing."                                                                   
                                                                                                                                
5:09:47 PM                                                                                                                    
                                                                                                                                
TOMAS  PUEYO, Modeler/Mathematician,  referred to  his PowerPoint                                                               
presentation, entitled "Coronavirus:   Why You Need  to Act Now,"                                                               
and reviewed the information on slide 2, which read:                                                                            
                                                                                                                                
     Who Am I?                                                                                                                  
                                                                                                                                
     ? A citizen                                                                                                                
     ? Author of viral post on Coronavirus (~37M views)                                                                         
     ? 2 MSc in Engineering                                                                                                     
     ? MBA from Stanford                                                                                                        
     ? Heavy stats and analytics background                                                                                     
     ? Created  viral applications with  10s of  millions of                                                                    
     users                                                                                                                      
     ?  Heavy  experience  modeling virals  and  exponential                                                                    
     growth                                                                                                                     
     ?  Currently  VP   Growth,  managing  a  billion-dollar                                                                    
     business at Course Hero                                                                                                    
                                                                                                                                
     Endorsements                                                                                                               
     ? >500 academics from > 10 countries                                                                                       
     ? Professors from MIT, NYU, Harvard, Cornell, WH                                                                           
     ? Famous thinkers: Ehud  Barak, Tim Berners-Lee, Steven                                                                    
     Pinker,  Andrew   Yang,  George  Takei,   Salman  Khan,                                                                    
     Margaret Atwood,  Patrick Collison (CEO  Stripe), Simon                                                                    
     Baron  Cohen,  Edward   Norton,  Dick  Costolo  (ex-CEO                                                                    
     Twitter), Kara Swisher,  Marc Benioff (Salesforce CEO),                                                                    
     Ev Williams (founder, Twitter, Medium)...                                                                                  
                                                                                                                                
MR.  PUEYO explained  that from  his  educational background  and                                                               
experience, he  has been able to  compile data and analyze  it to                                                               
understand the viral dynamics of spread.   At his current job, he                                                               
can   define  exponential   growth  and   make  decisions   under                                                               
uncertainty.                                                                                                                    
                                                                                                                                
MR. PUEYO turned  to the graph on slide 3,  entitled "Total Cases                                                               
outside of  China," to show  the steep  fast rise in  virus cases                                                               
from  the end  of  February to  the  middle of  March  2020.   He                                                               
relayed that the  slide 4 graph, entitled  "Coronavirus Cases per                                                               
Country,"  demonstrates the  steep  rise of  the  virus in  South                                                               
Korea, Italy,  and Iran from  2/20/20   3/7/20;  however, looking                                                               
at  the lower  right corner  of the  graph, it  is clear  that an                                                               
"explosion" of  cases will occur  beyond 3/7.   He turned  to the                                                               
graph on  slide 5, entitled  "Official Cases per  Country," which                                                               
zooms in on the lower right corner  of slide 4 and adds one week.                                                               
It shows the exponential growth in  the number of cases in Spain,                                                               
Germany, France, and the U.S.                                                                                                   
                                                                                                                                
5:12:53 PM                                                                                                                    
                                                                                                                                
MR. PUEYO tuned to slide 6, which read:                                                                                         
                                                                                                                                
                           USA, Today                                                                                           
                                                                                                                                
                          ~5,000 cases                                                                                          
                          ~100 deaths                                                                                           
                       +32% daily growth                                                                                        
                       2x every 2.5 days                                                                                        
             If growth continues ? 1000x in 4 weeks                                                                             
                     (5M cases in a month)                                                                                      
                                                                                                                                
MR. PUEYO  added that  these represent  only the  official cases.                                                               
He moved on to slide 7,  entitled "Chart 7: Timeline of Events in                                                               
Hubei," to  compare the  bar graphs  representing the  numbers of                                                               
true cases  with those of official  cases, and the time  lag that                                                               
exists between  the two trend  lines.   When a person  gets sick,                                                               
he/she does  not go to  the hospital immediately  and, therefore,                                                               
is  not diagnosed  immediately.   That  creates a  big lead  time                                                               
before a  true case becomes  an official  case.  The  chart shows                                                               
that between 1/21 and 1/23, the  number of cases in Hubei started                                                               
exploding; the  city was shut  down on 1/23; and  immediately the                                                               
number  of true  cases plummeted.    Up until  the shutdown,  the                                                               
number of true  cases had been growing exponentially.   After the                                                               
shutdown,  the diagnosed  cases  continued to  increase over  the                                                               
month, but  within two to  three weeks,  the number of  new cases                                                               
became very small.                                                                                                              
                                                                                                                                
5:15:16 PM                                                                                                                    
                                                                                                                                
MR. PUEYO posed the question of  how to assess the number of true                                                               
cases in the U.S.   Slide 8 shows the U.S.  with 94 deaths; slide                                                               
9 puts those 94 deaths at week 3  and shows that on week 0, there                                                               
were  at lease  94 cases.    Slide 10  demonstrates an  estimated                                                               
9,400  cases on  week 0  based on  information that  it takes  on                                                               
average three  weeks from onset  to death and the  mortality rate                                                               
is 1 percent.  Since the  spread of the virus doubles every week,                                                               
the estimated cases for week 1  are 18,400, as shown on slide 11;                                                               
slide  12 shows  an  estimated  number of  cases  for  week 2  at                                                               
36,800; and  slide 13 indicates  an estimated number of  cases at                                                               
present to  be about 70,000.   He  emphasized that 70,000  is not                                                               
the actual number  but is based on the number  of deaths; tens of                                                               
thousands of people are currently sick.                                                                                         
                                                                                                                                
5:17:23 PM                                                                                                                    
                                                                                                                                
MR. PUEYO moved on to slide 14  and stated that the U.S. has many                                                               
hidden  cases    in the  tens of  thousands    and the  cases are                                                               
growing exponentially.  He turned  to slide 15, entitled Chart 8:                                                               
Coronavirus  Cases,"  to  point  out  that  the  Chinese  regions                                                               
outside of  Hubei were  able to control  the epidemic,  but South                                                               
Korea, Italy, and  Iran, which did not take the  same measures as                                                               
China, were  not able to control  it.  Slide 16,  entitled "Chart                                                               
9: Total  Cases of Coronavirus  Outside of China,"  reveals other                                                               
countries able  to control the  epidemic   Singapore,  Hong Kong,                                                               
Japan, and Thailand.                                                                                                            
                                                                                                                                
MR. PUEYO turned to slide 17,  which read, "This can be stopped."                                                               
He referred to slide 18 -  a chart developed by Dr. James Lawler,                                                               
a  University  of  Nebraska Medical  Center  professor,  for  the                                                               
American  Hospital   Association,  that  communicates   the  best                                                               
guesses on the  impact of the coronavirus on  the U.S. healthcare                                                               
system  in 2020.   The  chart shows  that at  the current  growth                                                               
rate, there  will be  an estimated 100  million cases;  of those,                                                               
about 5  percent will require  hospitalization; 1-2  percent will                                                               
require  an  intensive  care  unit   (ICU);  and  a  conservative                                                               
estimate  of fatalities  based  on a  .5  percent mortality  rate                                                               
would  be 500,000  people.    He explained  that  the .5  percent                                                               
mortality rate is  seen in the "best place" -  in China and South                                                               
Korea -  both very  much "on top  of it."   The fatality  rate in                                                               
places  that are  not on  top  of it  is  10 times  higher.   The                                                               
fatality rate  in Hubei,  Iran, and Italy  is about  4.8 percent.                                                               
The estimate  of a half a  million deaths is with  the assumption                                                               
of a very low fatality rate.                                                                                                    
                                                                                                                                
5:20:01 PM                                                                                                                    
                                                                                                                                
MR.  PUEYO turned  to  the  pictures on  slides  19,  20, and  21                                                               
showing the crowd  of people waiting to be treated  at a hospital                                                               
in  Hubei, the  ICU, and  an exhausted  health care  worker.   He                                                               
mentioned the consequences of an  overwhelmed ICU and overwhelmed                                                               
hospital  workers,  many  of  whom   will  contract  the  disease                                                               
themselves.                                                                                                                     
                                                                                                                                
MR.  PUEYO  turned   to  slide  22  and  relayed   that  with  an                                                               
overwhelmed health  care system, the  fatality rate would  be ten                                                               
times as  high as the  .5 percent   as  seen in Hubei  versus the                                                               
other Chinese regions  and in Italy and Iran  versus South Korea.                                                               
The picture in slide 23 shows  unmarked graves in Iran due to the                                                               
inability to manage all the deaths.                                                                                             
                                                                                                                                
5:21:20 PM                                                                                                                    
                                                                                                                                
MR. PUEYO referred to slide 24,  entitled "Why it is so important                                                               
to act early  on COVID-19," and stated that what  is needed is to                                                               
"flatten  the  curve."   Slide  24  graphically demonstrates  the                                                               
results  of  different approaches:    the  results of  taking  no                                                               
action is  a spike of patients    shown in purple  - overwhelming                                                               
the health  care system; the orange  line in the graph  shows the                                                               
capacity  of  the  health care  system;  consequently  the  large                                                               
number  of patients  represented by  the purple  spike above  the                                                               
orange line will  not receive proper treatment,  and the fatality                                                               
rate will be ten  times higher.  The goal is to  push the peak of                                                               
cases  back in  time  so  that the  fatality  rate  will be  much                                                               
smaller; it is called "flattening the curve."                                                                                   
                                                                                                                                
MR.  PUEYO moved  on  to  slide 25,  entitled  "Chart 21:  "Total                                                               
excess  pneumonia  and  influenza   mortality  by  public  health                                                               
response time."   The chart  illustrates the result  of different                                                               
U.S.  cities reacting  to the  1918  influenza ("flu")  pandemic:                                                               
St. Louis  had a  quick response  and there  were 350  deaths per                                                               
100,000 population;  Pittsburghs  response was seven  days later,                                                               
and deaths were about 800 per 100,000.                                                                                          
                                                                                                                                
MR. PUEYO turned to slide 26,  entitled "Chart 22: Model of Daily                                                               
New Cases  of Coronavirus with  Social Distancing  Measures Taken                                                               
One Day  Apart," to illustrate  the effects of  social distancing                                                               
on flattening  the curve.   "No social distancing" results  in an                                                               
exponential increase in cases;  "social distancing" flattens that                                                               
upward curve.  Slide 27,  entitled "Chart 23: Model of Cumulative                                                               
Cases of  Coronavirus with Social  Distancing Measures  Taken One                                                               
Day  Apart,"  demonstrates that  a  single  day delay  in  social                                                               
distancing results in 40 percent  more cases.  Taking the measure                                                               
of social distancing  is not only important  but extremely urgent                                                               
wherever there is an outbreak.                                                                                                  
                                                                                                                                
MR. PUEYO referred to slide 28, which read "What Strategy                                                                       
Should  We  Follow?" and  mentioned  that  politicians must  take                                                               
everyone into consideration, not just those who are sick.                                                                       
                                                                                                                                
5:25:18 PM                                                                                                                    
                                                                                                                                
MR. PUEYO turned  to slide 29, entitled "What  Strategy should We                                                               
Follow?" and said  that currently the number of  cases is growing                                                               
exponentially, and there are two  options.  He referred to slides                                                               
30-31  and said  that the  first option  is to  do nothing:   the                                                               
number of  cases would explode;  the health care system  would be                                                               
completely overrun; everyone could not  be treated; and the cases                                                               
and  deaths  would  multiply.     The  second  option  is  social                                                               
distancing:  it would slow down  the number of new cases per day;                                                               
and  in three  to six  weeks the  number of  cases would  be very                                                               
small.  Many view this solution  as "kicking the problem down the                                                               
road"  and in  the  meantime  hurting the  economy  greatly.   He                                                               
stated that  the way  to view  this is in  the context  of buying                                                               
time.   He  referred  to  slide 32  to  emphasize  what could  be                                                               
accomplished  in the  three to  six weeks  of social  distancing,                                                               
which read:                                                                                                                     
                                                                                                                                
        Cut  growth                                                                                                             
     • Understand true cases                                                                                                    
     • Get proper testing                                                                                                       
     • Release the pressure on the                                                                                              
        healthcare system                                                                                                       
     • Build healthcare capacity:                                                                                               
        masks, ventilators, ECMOs, ICU                                                                                          
        beds                                                                                                                    
     • Increase production                                                                                                      
     • Recruit personnel                                                                                                        
     • Understand cost-benefit of                                                                                               
        measures                                                                                                                
     • Improve treatments                                                                                                       
        Learn                                                                                                                   
                                                                                                                                
MR. PUEYO  offered that many  of the optional measures  are going                                                               
to  be  extremely  expensive;  people  might  lose  jobs,  commit                                                               
suicide,  or  die.   A  lockdown  for  months would  deplete  the                                                               
economy.   He recommended that  [social distancing]  would reduce                                                               
the  problem   immediately  allowing  time  to   determine  which                                                               
measures matter,  which measure dont  matter,  and which measures                                                               
give  the  most   "bang  for  the  buck."    He   said  that  the                                                               
transmission  rate is  2.5    meaning  that every  person who  is                                                               
infected will  infect 2.5  people.  That  number must  be brought                                                               
down  close to  zero immediately;  after that,  easing up  of the                                                               
social distancing measure  will bring the rate close to  one.  At                                                               
that point all measures can be  evaluated to decide which ones to                                                               
continue and  which to stop.   He gave an  example:  it  may make                                                               
sense not  to have meetings of  more than 100 people,  because of                                                               
the  spread of  the  virus  and the  small  contribution of  that                                                               
meeting to  the economy;  conversely, it may  make sense  to lift                                                               
the  prohibition  on  normal   business  operations  but  provide                                                               
hygiene  education  to  control  the   spread  of  disease.    He                                                               
maintained that this course of  action does not solve the problem                                                               
but offers time.                                                                                                                
                                                                                                                                
5:29:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS  maintained that the presentation  highlights the                                                               
importance of the  state government to take  aggressive action to                                                               
prevent  the spread  of  the virus.   He  emphasized  that it  is                                                               
imperative  that the  Department  of  Administration (DOA)  issue                                                               
guidance immediately  regarding teleworking  and staying  at home                                                               
without  penalty;  state  employees  are on  the  front  lines  -                                                               
interacting  with  each  other  and with  the  public  -  without                                                               
protective equipment.   Alaska does  not have an  adequate number                                                               
of  virus tests.   He  asked  Mr. Pueyo  for an  estimate of  the                                                               
actual number of cases in Alaska based on three confirmed cases.                                                                
                                                                                                                                
MR. PUEYO responded that Alaska  is fortunate in that the density                                                               
of population  is low and  it is far from  the other states.   He                                                               
said that  it is possible that  the true case rate  is not orders                                                               
of magnitude  higher; it  may be  a few thousand  cases or  a few                                                               
hundred cases, and  such that it is completely  controllable.  It                                                               
is also likely  that the transmission rate in  Alaska, because of                                                               
the lower  population density,  is lower;  therefore, it  is very                                                               
possible that some measures taken  today can be released quickly,                                                               
once there is a better understanding of the situation.                                                                          
                                                                                                                                
CO-CHAIR  FIELDS   commented  that   Mayor  Ethan   Berkowitz  of                                                               
Anchorage was  criticized for taking aggressive  action regarding                                                               
social distancing.   He maintained that it is time  for the state                                                               
government to take similarly aggressive steps.                                                                                  
                                                                                                                                
5:32:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STORY asked whether  Dr. Anne Zink, Alaskas  chief                                                               
medical  officer,  was  provided  with  the  information  in  the                                                               
presentation.                                                                                                                   
                                                                                                                                
CHAIR KREISS-TOMKINS  answered that he  has been in  contact with                                                               
the Department  of Health  and Social  Services (DHSS)  and email                                                               
contact with  Dr. Zink.   He added  that Director  Heidi Hedberg,                                                               
Division of Public Health (DPH),  [DHSS], will present during the                                                               
hearing.                                                                                                                        
                                                                                                                                
5:33:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOPKINS reiterated testimony  that if Alaska takes                                                               
strong measures now,  it might see a quicker  response because of                                                               
the lower density of population.   He asked whether with relaxing                                                               
the  measures,  including   mandatory  social  distancing,  there                                                               
exists an expectation of a second  peak of cases of viruses based                                                               
on research of coronaviruses.                                                                                                   
                                                                                                                                
MR.  PUEYO stated  that China  has the  most experience  with the                                                               
virus currently.   The province of  Hubei had a lockdown;  it was                                                               
released; and  there was  again growth of  the virus  prompting a                                                               
return  to  increasing  social   distancing  measures.    If  the                                                               
transmission rate is 2.5, then getting  it to below 1 will result                                                               
in the  virus dying  out because each  person with  the contagion                                                               
would not infect  more than 1 person.  Initially,  the goal is to                                                               
get the transmission rate as low  as possible as fast as possible                                                               
so that  by "buying time,"  Alaska can understand  the situation.                                                               
After that,  getting the  transmission rate  close to  1 controls                                                               
the spread of the virus  without heavy economic consequences.  He                                                               
added that the  2.5 transmission rate is what  occurred in China.                                                               
In Alaska, if  the rate is 1.5, the measures  needed to achieve a                                                               
rate of  1 would  be less than  in many other  locations.   It is                                                               
possible that  in Anchorage  the rate is  higher.   He maintained                                                               
that in the  next few weeks, once Alaska has  bought itself time,                                                               
there  will be  great  understanding of  the actual  transmission                                                               
rate and  the measures  with the  most impact.   Alaska  can then                                                               
implement  those  measures, choose  to  be  more conservative  or                                                               
aggressive, and, thereby, control the outbreak.                                                                                 
                                                                                                                                
5:36:59 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS referred to  the decision point indicated                                                               
on slide  31 and asked whether  there is any indication  that the                                                               
curve  is starting  to flatten  in  Italy in  response to  social                                                               
distancing.                                                                                                                     
                                                                                                                                
MR. PUEYO  referred to slide  7 to use  Hubei as an  example; the                                                               
lockdown  stopped the  true cases  but didn't  stop the  official                                                               
cases.  People  were becoming sick over the following  weeks.  In                                                               
Italy,  the  lockdown began  ten  days  ago; official  cases  are                                                               
increasing  exponentially as  demonstrated on  slide 5,  and that                                                               
would be expected.  By the end  of next week, it is expected that                                                               
the  number  of  official  cases will  slow  down  and  collapse,                                                               
because that is what was seen in Hubei.                                                                                         
                                                                                                                                
5:38:38 PM                                                                                                                    
                                                                                                                                
NIRAV SHAH, MD, Stanford  University Clinical Excellence Research                                                               
Center,  stated that  what was  learned  from China  was that  79                                                               
percent  of  all  the  infections was  spread  in  the  community                                                               
through people  who were  not diagnosed  early; therefore,  it is                                                               
not the  people with symptoms who  are doing most of  the damage,                                                               
but the people  walking around not knowing they are  sick or with                                                               
mild symptoms spreading the virus  in the community.  This points                                                               
to  early  lockdown and  social  distancing  as having  the  most                                                               
impact.  He maintained that it  is unknown at this point how many                                                               
have the virus in Alaska, especially with inadequate testing.                                                                   
                                                                                                                                
5:39:26 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS recollected  that South  Korea has  greater than                                                               
ten beds  per one thousand  people and  in Alaska there  are only                                                               
two per one  thousand.  He asked for comment  on the implications                                                               
that will have on mortality rates  if Alaska fails to contain the                                                               
virus and the number of hospital beds per capita is low.                                                                        
                                                                                                                                
5:39:56 PM                                                                                                                    
                                                                                                                                
DR. SHAH  answered that  Chinas  experience  provides information                                                               
on  who  is  infected  and who  requires  hospitalization.    The                                                               
Journal  of the  American Medical  Association (JAMA)  reported 0                                                               
deaths in children  age 9 and under; the  highest mortality rates                                                               
were among  older adults; among those  age 80 and over,  the case                                                               
fatality  rate was  about  15  percent.   It  is  a disease  that                                                               
severely  effects  older  adults,   and  the  chance  of  needing                                                               
hospitalization  increases exponentially  the older  one is.   He                                                               
stated that in Alaska the  number of hospital beds and ventilator                                                               
beds are  what will  make the  difference.   He relayed  that the                                                               
disease involves Severe Acute  Respiratory Syndrome (SARS); ones                                                                
lungs fail, and  they need support while they heal.   At the same                                                               
time, several investigative  drugs are being used to  try to help                                                               
the healing  process.  With  past SARS experience, it  is evident                                                               
that ICU beds with ventilators are needed.                                                                                      
                                                                                                                                
5:41:47 PM                                                                                                                    
                                                                                                                                
MR. PUEYO  added that Representative  Kreiss-Tomkinss  underlying                                                               
question is:   "Is our  system going to  collapse?"  He  said the                                                               
variable is the  number of cases; it is possible  that Alaska has                                                               
been extremely lucky  and there are not many more  cases than the                                                               
official  number;  however,  it  is unlikely.    He  stated  that                                                               
implementing social  distancing measures may prevent  collapse of                                                               
the  health care  system.    If Alaska  is  not  lucky, it  might                                                               
collapse in  the next few  weeks; the  key variable in  that case                                                               
would be the number of ventilators.                                                                                             
                                                                                                                                
5:42:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CARPENTER asked  for comment  on testing  for the                                                               
virus  at  the  onset  of  symptoms  versus  prior  to  onset  of                                                               
symptoms.                                                                                                                       
                                                                                                                                
DR. SHAH replied  that broad testing is limited by  the number of                                                               
tests on  hand.   When the  U.S. began  testing, it  was severely                                                               
undertesting because  testing was  limited to people  with direct                                                               
contact with those coming back from  China, Iran, and Italy.  The                                                               
testing strategy  should have been  much broader earlier.   Given                                                               
the  limited  number  of  tests, the  country  is  restricted  to                                                               
testing those  at highest  risk.   As soon  as tests  become more                                                               
available, testing  criteria should  be quickly broadened  to the                                                               
include those at mild risk or with any suspicion of the disease.                                                                
                                                                                                                                
5:43:51 PM                                                                                                                    
                                                                                                                                
MR.  PUEYO added  that a  comparison  can be  made between  South                                                               
Korea and  Italy; these  are the two  countries outside  of China                                                               
with the  highest rates of testing;  the test results of  the two                                                               
countries were completely different.   He explained that in Italy                                                               
the  testing was  performed  mostly  on people  who  came to  the                                                               
hospital; testing revealed  that the older a person  was the more                                                               
likely that  person was  infected.  In  South Korea  everyone who                                                               
wanted to be  tested was tested   tens of  thousands of tests per                                                               
day   and it  could be done at a drive-up station.   With so many                                                               
people,  with   or  without  symptoms,   being  tested,   it  was                                                               
discovered that most  people infected were not  older people, but                                                               
younger  people    in  their  30s and  40s.   Consequently,  most                                                               
people with  the virus  are not showing  symptoms, think  they do                                                               
not have the virus,  and may be spreading it.   The peak for true                                                               
cases comes just  before the peak in diagnosed  cases; it spreads                                                               
before  symptoms are  evidenced; and  everyone has  it, not  just                                                               
older people. He  emphasized the importance of more  tests due to                                                               
people unknowingly spreading the disease.                                                                                       
                                                                                                                                
5:45:50 PM                                                                                                                    
                                                                                                                                
DR. SHAH added  that New York City kept its  schools open because                                                               
of the hundreds of kids that  would be without school meals; then                                                               
it  shut   the  schools  down   to  contain  the   virus  through                                                               
"sheltering in place."  He  recommended acting early and quickly,                                                               
and  then changing  in  response  to the  changing  data and  new                                                               
information.                                                                                                                    
                                                                                                                                
5:46:52 PM                                                                                                                    
                                                                                                                                
DR. SHAH stated  that he is a general internist  by training, was                                                               
the New York State health  commissioner for four years, was chief                                                               
operating   officer   (COO)   for  Kaiser   Permanente   clinical                                                               
operations, and  currently is a professor  at Stanford University                                                               
advising the  state on public  health issues.  He  mentioned that                                                               
as of  yesterday, there  were 248 trials  for new  agents against                                                               
COVID-19, [a novel  coronavirus disease], in China  and 90 trials                                                               
in the U.S.  He said that he  is optimistic that an agent will be                                                               
found with some  activity against the virus.   Finding drugs that                                                               
are  effective  for  treatment   will  also  flatten  the  curve.                                                               
Vaccine  development   has  begun   in  the  U.S.,   but  vaccine                                                               
development  takes much  longer  due to  the need  for  it to  be                                                               
validated  and then  propagated; optimistically,  it would  be at                                                               
least 12 to 18 months before release for general use.                                                                           
                                                                                                                                
Dr.  SHAH  relayed  that  the  other  part  of  the  equation  is                                                               
diagnostic testing.   He  expressed his  optimism that  two weeks                                                               
from now  there will  be an adequate  supply of  COVID-19 testing                                                               
kits; currently  there are few  restrictions on who can  make the                                                               
high-quality testing kits; and over  200 organizations across the                                                               
country  are  making them.    He  mentioned severe  shortages  of                                                               
personal protective  equipment, which will be  real and sustained                                                               
over the next few  weeks and months.  Much work  is being done to                                                               
address that issue, but the U.S. was late in ordering.                                                                          
                                                                                                                                
5:49:49 PM                                                                                                                    
                                                                                                                                
DR. SHAH concluded  with three broad comments:   First, stay with                                                               
the science; information is published  daily; an excellent source                                                               
of real  data is the  World Health Organization (WHO);  listen to                                                               
Anthony  Fauci, [director  of the  National Institute  of Allergy                                                               
and  Infectious  Diseases  (NIAID)],  because he  is  an  expert.                                                               
Second, communicate  clearly and  speak with  one voice.   Third,                                                               
focus efforts on responding to the  needs and not the hype.  Some                                                               
of the  most vulnerable populations  in America are  the elderly,                                                               
who  are  not  only  the   most  susceptible  to  the  virus  but                                                               
susceptible to  social isolation and other  negative consequences                                                               
to trying to be compliant.   Another vulnerable population is the                                                               
homeless; they are very much at  risk, are not in the system, and                                                               
are  not tested  quickly.   The  third  vulnerable population  is                                                               
those  without  insurance  and  those  "undocumented"  [as  legal                                                               
residents].   He challenged  the legislators  to consider  how to                                                               
address the three vulnerable populations.                                                                                       
                                                                                                                                
5:51:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CARPENTER asked  whether there  is a  correlation                                                               
between the efficacy  of the influenza A vaccine and  what can be                                                               
expected  with  a  COVID-19  vaccine,   considering  there  is  a                                                               
significant number  of influenza  A deaths every  year regardless                                                               
of there being a vaccine.                                                                                                       
                                                                                                                                
DR.  SHAH answered  that flu  vaccines are  not always  effective                                                               
because  the predominant  strain  changes from  one  year to  the                                                               
next. The  U.S. observes the  results from Australia and  Asia to                                                               
make its best guess regarding  the most common strain and creates                                                               
the vaccine  from a mix of  elements.  Some years  the vaccine is                                                               
more effective than  others.  He offered that in  a bad year, the                                                               
flu will  kill 61,000  Americans; the ones  dying are  those with                                                               
weakened immune  systems, underlying medical conditions,  and the                                                               
elderly; but  it has become the  new normal.  He  maintained that                                                               
there  are too  many  differences between  the  two diseases  and                                                               
doesnt  want to speculate.   He offered his appreciation that the                                                               
effort to  make a vaccine has  begun; there is great  interest in                                                               
quickly making one that works.                                                                                                  
                                                                                                                                
5:53:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TUCK asked  whether  a person  who has  recovered                                                               
from  the virus  could be  tested to  determine if  he/she is  no                                                               
longer infectious  and whether  a person  can continue  to harbor                                                               
the virus after recovery.                                                                                                       
                                                                                                                                
DR.  SHAH   responded  that  in   China,  there  were   cases  of                                                               
individuals who tested positive,  recovered, tested negative, and                                                               
then were  infected again.   He stated  that not enough  is known                                                               
about the  virus   its  history, its transmission, or  whether it                                                               
can hide out in individuals and reemerge.                                                                                       
                                                                                                                                
5:55:16 PM                                                                                                                    
                                                                                                                                
MR. PUEYO  added that the answer  to the question depends  on the                                                               
test.  One test is a swab from  the nose and throat; the other is                                                               
a blood test for antivirals.   The swab detects the virus and the                                                               
blood sample detects antibodies against  the virus.  Depending on                                                               
the test,  one can determine  whether a healthy person  today was                                                               
or was not sick in the past.                                                                                                    
                                                                                                                                
5:56:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TUCK referred  to the experience of  South Korea -                                                               
which  was  able  to  flatten  the  curve  quickly  with  medical                                                               
attention -  and asked  how to  know when to  back off  on social                                                               
distancing and  other precautionary measures, especially  as they                                                               
so greatly affect the economy.                                                                                                  
                                                                                                                                
5:56:55 PM                                                                                                                    
                                                                                                                                
DR.  SHAH answered  that  currently  there is  not  good data  to                                                               
monitor  the  outbreak.    It  is believed  that  much  virus  is                                                               
spreading in communities and across  the U.S.  On Thursday, tools                                                               
will be released nationally at  the county level that can monitor                                                               
hidden COVID-19 in the community;  companies are working on units                                                               
with  smart  thermometers connected  to  smart  phones to  upload                                                               
temperatures.   There  are  very good  predictive  models on  the                                                               
movement  of  flu;  therefore,  after  subtracting  out  the  flu                                                               
temperature signals, the elevated  temperatures from the COVID-19                                                               
hotspots  around the  country  are presumed  to  be COVID-19  and                                                               
other  flu-like illnesses.   These  tools will  enable people  to                                                               
make   decisions  in   real-time  about   social  isolation   and                                                               
quarantine based  on new data  and the appropriate time  to relax                                                               
the counter measures.                                                                                                           
                                                                                                                                
5:58:39 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS  asked whether there  is such a  thing as                                                               
"too aggressive  a response in this  moment in time" in  terms of                                                               
social  distancing  measures  and other  measures  with  economic                                                               
impacts.   He  asked,  "Can you  go  too far  in  a reaction,  if                                                               
theres not documented spread?"                                                                                                  
                                                                                                                                
5:59:26 PM                                                                                                                    
                                                                                                                                
MR. PUEYO acknowledged that Alaska is  a special case in that the                                                               
current official  count is low;  therefore, it is  a cost-benefit                                                               
question.  He  said that if the state imposes  measures that lock                                                               
everyone at  home resulting  in people dying,  that would  not be                                                               
good.   Alaska is in  the position  of making decisions  based on                                                               
imperfect data;  the official count being  low is a benefit.   It                                                               
depends  on what  Alaskas  strategy  will  be.   For lower  risk,                                                               
aggressive action  is needed.   The  more social  measures Alaska                                                               
applies,  the safer  Alaskans will  be, and  the state  buys more                                                               
time;  however,  it  will  be   more  expensive.    Each  measure                                                               
represents a trade-off.   With low numbers, Alaska  may decide to                                                               
"take  a   gamble."     He  recommended   that  Alaska   be  more                                                               
conservative and choose the measures  for greater safety, if they                                                               
dont create undue hardship.                                                                                                     
                                                                                                                                
6:01:46 PM                                                                                                                    
                                                                                                                                
DR. SHAH  added that an ounce  of prevention is worth  a pound of                                                               
cure,  and public  health is  all  about prevention.   There  are                                                               
incredible down-stream  savings, as  demonstrated in the  model -                                                               
40  percent more  cases resulting  from one  day delay  in social                                                               
distancing.   He recommended  erring on the  side of  caution and                                                               
prudence  with clear  communications  about  the assumptions  and                                                               
data used to  make decisions.  Closing public  services have real                                                               
implications,  but   clearly  sharing  the  information   on  why                                                               
decisions  are being  made  and the  decision  points that  would                                                               
alter those decisions  garners public support.  He  said that the                                                               
lessons  of history  are clear:    the earlier  Alaska acts,  the                                                               
better  off it  will be;  there  are implications  of acting  too                                                               
slow; the  implications of acting  too quickly generally  pale in                                                               
comparison.                                                                                                                     
                                                                                                                                
6:03:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ referred  to the  example given  of New                                                               
York City not closing schools  due to children not getting meals.                                                               
She  offered  that  due  to   the  aggressive  social  distancing                                                               
policies,  especially in  Anchorage,  some people  are no  longer                                                               
employed  or not  earning  income,  including her  sister-in-law.                                                               
She asked  about the right  policy choices considering  the costs                                                               
of aggressive social distancing.                                                                                                
                                                                                                                                
6:05:00 PM                                                                                                                    
                                                                                                                                
MR. PUEYO responded that these  are hard decisions, and currently                                                               
Alaska is  not equipped to  make them  properly.  The  benefit of                                                               
the   social  distancing   measure  is   a  reduction   in  virus                                                               
transmission rates; the cost is of  lost wages for Alaskans.  One                                                               
strategy is  to compensate Alaskans  for lost wages so  that they                                                               
are  not  economically  impacted.   He  reiterated  the  problem:                                                               
currently Alaska  is not equipped  to make decisions but  will be                                                               
making them intuitively without data.   Not earning wages for two                                                               
weeks might  not be a  big expense, but if  it is, then  it might                                                               
not be  a big expense for  the government.  In  three weeks, with                                                               
more information  on the  cost-benefit, appropriate  measures can                                                               
be  selected  to control  the  illness.    Not acting  today  may                                                               
eliminate the options in three weeks  due to the virus becoming a                                                               
complete epidemic.                                                                                                              
                                                                                                                                
6:07:13 PM                                                                                                                    
                                                                                                                                
DR.  SHAH  said that  human  costs  are  hard  to quantify.    He                                                               
reiterated  that Alaska  should respond  to the  need not  to the                                                               
hype.   He asked how  Alaska can provide  a safety net  for those                                                               
affected by  the decisions that  have been made.   He recommended                                                               
that  the state  respond to  the needs  of today  and adjust  its                                                               
response daily based on the information.                                                                                        
                                                                                                                                
6:07:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ expressed the  importance of not viewing                                                               
the response  as binary and  abstract; there are  consequences to                                                               
decisions; in being aggressive in  minimizing the transmission of                                                               
COVID-19, the state must  also aggressively advance corresponding                                                               
investments to  protect people from the  negative consequences of                                                               
the decisions.                                                                                                                  
                                                                                                                                
6:08:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CARPENTER asked for comment  on the ability of the                                                               
virus to live outside the  host   specifically in relationship to                                                               
climate, humidity, and different surfaces.                                                                                      
                                                                                                                                
6:09:14 PM                                                                                                                    
                                                                                                                                
DR. SHAH  mentioned the  misinformation currently  in circulation                                                               
and recommended  the information on  the WHO website.   He stated                                                               
that the  understanding is  that COVID-19  is not  very different                                                               
from other  viruses.  On  any normal surface,  it is alive  for a                                                               
few hours.   Areas of concern are places that  many people touch,                                                               
such as door  handles; they should be avoided, a  napkin used, or                                                               
followed  by hand  washing or  hand sanitizer.   The  virus lives                                                               
longer in certain conditions according to moisture level.                                                                       
                                                                                                                                
6:10:15 PM                                                                                                                    
                                                                                                                                
MR.  PUEYO  added  that  there are  many  research  papers  being                                                               
published  on  the  topic,  and  soon there  will  be  much  more                                                               
understanding of the virus.  He  said that as of today, there are                                                               
1,500 cases  of the virus in  Norway, 1,200 cases in  Sweden, and                                                               
1,000  cases in  Denmark;  therefore, he  would  not view  Alaska                                                               
being safe by virtue of its weather.                                                                                            
                                                                                                                                
6:11:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CARPENTER asked  whether the  virus is  a "winter                                                               
bug" or whether  it will be year-round.  He  asked about cases in                                                               
Australia and South America.                                                                                                    
                                                                                                                                
6:12:00 PM                                                                                                                    
                                                                                                                                
DR. SHAH stated  that there are cases in  warmer countries; India                                                               
and Africa are seeing cases;  however, they have fewer cases than                                                               
Northern climate countries.   He maintained that it  is not known                                                               
whether the  virus will  be year-round; it  will depend  on human                                                               
behavior  and other  complex interactions  between the  virus and                                                               
the  host.   The hope  is  that spread  of the  virus during  the                                                               
summer months will decline, but that is not yet known.                                                                          
                                                                                                                                
6:12:48 PM                                                                                                                    
                                                                                                                                
MR.  PUEYO added  that  the most  relevant  paper addressing  the                                                               
topic looked  at the city  by city spread  in China; there  was a                                                               
correlation  between low  temperature  and  humidity and  spread;                                                               
there  were decreasing  transmission rates  with warmer  and more                                                               
humid  weather.   He  added  that the  paper  has  not been  peer                                                               
reviewed.                                                                                                                       
                                                                                                                                
6:13:44 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS  introduced the  next two  presenters and                                                               
mentioned that areas of interest  to the legislature and Alaskans                                                               
are current and future testing  capacity and the incident command                                                               
structure in  Alaska for supply  chains and  logistics, including                                                               
in rural Alaska.                                                                                                                
                                                                                                                                
6:14:41 PM                                                                                                                    
                                                                                                                                
BRYAN FISHER,  Operations Manager, Division of  Homeland Security                                                               
and  Emergency  Management  (DHS&EM), Department  of  Military  &                                                               
Veterans' Affairs  (DMVA), stated  that for  the response  to the                                                               
COVID-19  outbreak,  he is  Alaska's  incident  commander in  the                                                               
State  Emergency  Operations  Center  (EOC).    He  reviewed  the                                                               
bulleted  information   on  the  3/15/20  memorandum   from  DMVA                                                               
Commissioner  Torrence  Saxe to  the  House  Military &  Veterans                                                               
Affairs Committee, which read:                                                                                                  
                                                                                                                                
     The department's actions are as follows:                                                                                   
   • DMVA has been involved in the response to COVID-19                                                                         
     since the Wuhan Repatriation flight that occurred in                                                                       
     late January.                                                                                                              
   • Involvement has primarily been preparing to                                                                                
     participate in a Unified Command with the Department                                                                       
     of Health and Social Services (DHSS) and the                                                                               
     Department of Public Safety (DPS) in accordance with                                                                       
     the Alaska Pandemic Influenza Plan.                                                                                        
   • At direction of The Adjutant General, the Alaska                                                                           
     Organized Militia stood up a Joint Task Force to                                                                           
     prepare for any potential resource requests that may                                                                       
     come from the State                                                                                                        
     Emergency Operations Center (EOC) to the National                                                                          
     Guard in response to this event.                                                                                           
   • Governor Dunleavy's declaration of public health                                                                           
     disaster emergency, issued March 11, 2020, directed                                                                        
     the activation of the Unified Command described above.                                                                     
   • The State EOC is activated, and will be staffing the                                                                       
     Unified Command to coordinate the overall response to                                                                      
     COVID-19. This is similar to how the executive branch                                                                      
     responds to disasters, such as the 2018 Cook Inlet                                                                         
     Earthquake, flooding, etc.                                                                                                 
   • The mission of the State EOC and COVID-19 Unified                                                                          
     Command is to respond to requests for assistance or                                                                        
     resources from our local jurisdictions. We utilize the                                                                     
     Incident Command System to organize that response.                                                                         
   • The Alaska Organized Militia is prepared to respond to                                                                     
     resource requests or mission assignments that cannot                                                                       
     be fulfilled by local, private, or other civilian                                                                          
     methods.                                                                                                                   
   • The Alaska Military Youth Academy has been in direct                                                                       
     contact with the Department of Education and Early                                                                         
     Development, and DHSS, and has developed contingency                                                                       
     plans in case the Academy needs to close school.                                                                           
   • The entirety of DMVA has developed continuity of                                                                           
     operations plans and orders of succession, and are                                                                         
     planning to implement telework if directed by                                                                              
     Department of Administration on the state side, or at                                                                      
     the direction of the Adjutant General on the federal                                                                       
     side.                                                                                                                      
                                                                                                                                
COMMANDER FISHER  added two additional objectives  of the Unified                                                               
Command:  1)  to ensure the safety and security  of responders as                                                               
well as,  maximize the protection  of public health  and welfare;                                                               
and  2)  to   contain  the  spread  of  COVID-19   in  Alaska  by                                                               
implementing all  community mitigation actions  and interventions                                                               
that have  been described in the  past couple weeks.   He relayed                                                               
that DMVA  continues to support  DHSS; it  has a role  in keeping                                                               
the public and media informed and in rumor control.                                                                             
                                                                                                                                
6:17:35 PM                                                                                                                    
                                                                                                                                
COMMANDER  FISHER  continued  by   reporting  that  the  Incident                                                               
Command System (ICS) has two  branches:  1) an emergency services                                                               
branch that  is involved with sheltering  and housing quarantined                                                               
residents,  community  mitigation  strategies,  a  public-private                                                               
partnership with  industries through  the Alaska  Partnership for                                                               
Infrastructure  Protection, transportation  of people  around the                                                               
state,    and   the    logistics   for    transporting   medical,                                                               
pharmaceutical, and personal  protective equipment throughout the                                                               
state;  and 2)  a  medical branch    DHSS  -  which includes  the                                                               
Section  of   Epidemiology,  the   Alaska  State   Public  Health                                                               
Laboratories,  the  Section of  Public  Health  Nursing, and  the                                                               
medical countermeasures personnel.                                                                                              
                                                                                                                                
COMMANDER FISHER added that DMVA  is in constant contact with all                                                               
the [State  of Alaska] executive branch  agencies regarding their                                                               
activities.   He gave  as example    the Department  of Commerce,                                                               
Community, and Economic Development  (DCCED) just today forwarded                                                               
a  request  from  [Governor  Mike Dunleavy]  to  the  U.S.  Small                                                               
Business Administration  asking for  an Economic  Injury Disaster                                                               
[Loan] from the  U.S. Department of Agriculture (USDA).   All the                                                               
actions  by  the executive  branch  and  local jurisdictions  are                                                               
managed through the Unified Command.                                                                                            
                                                                                                                                
                                                                                                                                
6:20:59 PM                                                                                                                    
                                                                                                                                
HEIDI  HEDBERG,  Director,  Division   of  Public  Health  (DPH),                                                               
Department of Health and Social  Services (DHSS), stated that she                                                               
serves with the Unified Command.   She said that the focus of DPH                                                               
is  building health  care capacity  in Alaska,  and to  do so  it                                                               
engages in  multiple strategies.   Building health  care capacity                                                               
involves  leveraging  telehealth  and  ensuring  that  hospitals:                                                               
triage patients  outside the hospital or  in different locations;                                                               
recommend  and/or  cancel  elective  surgeries;  assess  staffing                                                               
capacity; have  at least two weeks  of supplies on hand;  and are                                                               
encouraged to exclude  visitors to acute care  patients and long-                                                               
term  care facilities.   She  maintained that  all hospitals  are                                                               
engaging  in  all  the  tactics  at various  levels  and  DPH  is                                                               
supporting that effort.                                                                                                         
                                                                                                                                
MS. HEDBERG continued  by saying that a key  health care strategy                                                               
is establishing  off-site sample collections.   It consists  of a                                                               
station  located   away  from  the  emergency   department  where                                                               
individuals who have signs and  symptoms consistent with COVID-19                                                               
and/or who  have travelled through countries  or communities with                                                               
widespread infection can be screened  and have samples collected;                                                               
samples are  sent to the  DHP laboratory ("lab") in  Anchorage or                                                               
Fairbanks or  one of the  two reference  labs   LabCorp  or Quest                                                               
[Diagnostics].                                                                                                                  
                                                                                                                                
6:23:47 PM                                                                                                                    
                                                                                                                                
MS. HEDBERG explained that "testing kit"  is a lab term; the kits                                                               
consist  of  the  reagents  and controls  that  the  Centers  for                                                               
Disease Control  and Prevention (CDC)  sends to the DPH  lab upon                                                               
request.   There  are  750  test kits  in  Fairbanks  and 900  in                                                               
Anchorage.  If  Alaska needs more, DPH will  proactively call CDC                                                               
for  more.    The  collection  kits  are  used  at  the  off-site                                                               
collection  sites to  collect  the  samples to  be  tested.   The                                                               
collection kit  includes personal protective equipment  (PPE) for                                                               
the health  care provider  who is collecting  the sample.   Viral                                                               
transport media  - or universal  transport media - refers  to the                                                               
media at the bottom of the  plastic test tube.  Most importantly,                                                               
the kit includes  a nasopharyngeal swab; the swab  is inserted up                                                               
into  the nose  almost  to the  tonsils to  collect  cells to  be                                                               
tested.  The sample is packaged  and sent to either the Anchorage                                                               
or Fairbanks labs.                                                                                                              
                                                                                                                                
6:26:05 PM                                                                                                                    
                                                                                                                                
MS.  HEDBERG relayed  that the  lab  in Fairbanks  is called  the                                                               
virology  lab;  it  is  located   on  the  University  of  Alaska                                                               
Fairbanks  (UAF) campus  and is  in  partnership with  UAF.   The                                                               
Fairbanks   lab   has   two   polymer   change   reaction   (PCR)                                                               
thermocyclers.      The   lab  in   Anchorage   has   three   PCR                                                               
thermocyclers.    Testing  is  done  seven  days  per  week  with                                                               
multiple shifts per day.  To  date, 295 samples have been sent to                                                               
the state DPH labs and 39  samples sent to the reference labs for                                                               
a total  of 334 samples.   Information  on the number  of samples                                                               
sent either to the state labs  or the reference labs is posted on                                                               
the COVID website.   The LabCorp testing facility is  on the East                                                               
Coast;   therefore,   transport   time   must   be   taken   into                                                               
consideration.   The  Quest testing  facility  is in  California.                                                               
The state is exploring the  expansion of lab capacity through the                                                               
University  of  Alaska  (UA).    The  DPH  is  ordering  a  high-                                                               
throughput  extractor   to  expedite   the  testing   process  in                                                               
Anchorage;  such  an  extractor   is  currently  located  in  the                                                               
Fairbanks lab.                                                                                                                  
                                                                                                                                
6:28:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TUCK asked for clarification  of the procedure for                                                               
collecting samples at the off-site station.                                                                                     
                                                                                                                                
MS. HEDBERG responded that one  can observe drive-through testing                                                               
for COVID-19  on a video  found on  the internet.   She explained                                                               
that  a  person  drives  up  to the  initial  station  to  answer                                                               
questions by way  of a screening form; at the  second station the                                                               
person receives  a visual assessment for  temperature, cough, and                                                               
shortness  of  breath; if  testing  is  warranted, at  the  third                                                               
station  a health  care provider  in PPE  collects cells  via the                                                               
nasopharyngeal swab, which  is placed into the  plastic test tube                                                               
with  a  screw top.    Several  communities  are setting  up  the                                                               
stations, and DHS&EM is facilitating  the logistics.  The goal is                                                               
to  prevent individuals  who need  testing from  overwhelming the                                                               
emergency departments.   It is important for DPH  to increase its                                                               
capacity  for  collecting  samples  and testing  to  monitor  the                                                               
spread of the virus in the state.                                                                                               
                                                                                                                                
6:31:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TUCK asked  how tests are distributed  in areas of                                                               
Alaska outside of Anchorage and Fairbanks.                                                                                      
                                                                                                                                
MS. HEDBERG answered  that DPH is working with  all hospitals and                                                               
clinics  to meet  their needs:   1)  it is  working with  federal                                                               
partners to access  the federal caches to supply  the clinics and                                                               
hospitals with  testing kits; and 2)  it has placed an  order for                                                               
swabs,  which  will  be  distributed upon  receipt.    There  are                                                               
shortages of all these items.   The U.S. Department of Health and                                                               
Human Services  (HSS) is sending  out collection kits to  all the                                                               
states  - giving  priority to  those  states hardest  hit by  the                                                               
outbreak.  She stated that  the collection kits include PPEs, but                                                               
it is  unknown when  the kits  will arrive.   The  state received                                                               
PPEs from  the Strategic  National Stockpile,  which was  used to                                                               
fill  four requests  from last  week.   She offered,  "Things are                                                               
moving incredibly fast."   She said that as soon  as DPH receives                                                               
supplies, it  sends them  out; DPH is  actively working  with its                                                               
federal  partners to  ensure they  understand Alaskas   shortages                                                               
and capacity and  to manage expectations.  She  mentioned that an                                                               
oral  and nasal  sample  was previously  required;  now CDC  only                                                               
requires a nasal sample.                                                                                                        
                                                                                                                                
6:34:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOPKINS referred to  a sample testing machine from                                                               
Roche [Diagnostics], recently approved by  the U.S. Food and Drug                                                               
Administration (FDA), and  asked whether Alaska has  any of those                                                               
machines and can utilize that new commercially approved test.                                                                   
                                                                                                                                
MS. HEDBERG offered to follow up to provide that information.                                                                   
                                                                                                                                
REPRESENTATIVE  HOPKINS  asked  about the  potential  for  Alaska                                                               
National Guard  (AKNG) medical  personnel to  screen and  test at                                                               
Alaskas airports.                                                                                                               
                                                                                                                                
6:35:40 PM                                                                                                                    
                                                                                                                                
COMMANDER FISHER  answered that DMVA must  exhaust commercial and                                                               
civilian  resources before  putting  AKNG on  active duty  orders                                                               
under  the governors   authority.    If there  is  a request  for                                                               
additional staff at  airports to do health  screening, DMVA would                                                               
source   the  request   through  civilian   contracts  or   local                                                               
resources.   If that is  not possible,  DMVA would rely  on AKNG;                                                               
AKNG is manned and ready  to respond; personnel and equipment are                                                               
well coordinated within the Unified Command.                                                                                    
                                                                                                                                
REPRESENTATIVE HOPKINS  asked whether DMVA  has begun to  look at                                                               
the option of local and private contractors.                                                                                    
                                                                                                                                
COMMANDER  FISHER replied  that  the Unified  Command and  DHS&EM                                                               
have standing  contracts for support  camps for security.   There                                                               
have  not  been  requests  as  yet for  that  type  of  manpower;                                                               
however, if there are, DMVA  would contact local jurisdictions to                                                               
determine local capacity, then turn  to other state agencies, and                                                               
if contracts are needed, work with procurement to expedite them.                                                                
                                                                                                                                
6:37:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CARPENTER asked for  clarification on samples sent                                                               
out  of state.   He  asked what  the throughput  was for  the PCR                                                               
thermocyclers  and how  many samples  can be  tested per  testing                                                               
kit.                                                                                                                            
                                                                                                                                
6:38:21 PM                                                                                                                    
                                                                                                                                
MS.  HEDBERG  responded that  a  sample  collected by  an  Alaska                                                               
health care provider may  be sent to a DPH lab or  one of the two                                                               
reference  labs  - LabCorp  or  Quest  Lab  -  for testing.    In                                                               
response to  the question about  throughput, she offered  that it                                                               
depends on  staffing capacity.   She said  that 125  samples were                                                               
tested over  the weekend, and  with increased  staffing capacity,                                                               
DPH would  be able to do  more.  Lab personnel  batch the samples                                                               
to  fill up  the slots  in  the PCR  thermocyclers and,  thereby,                                                               
stretch the reagents  and controls.  She maintained  that DPH has                                                               
not run  out of test  kits and has  been receiving more  from CDC                                                               
upon request.   She  added that DPH  proactively contacts  CDC to                                                               
ensure enough supply.                                                                                                           
                                                                                                                                
REPRESENTATIVE CARPENTER  referred to  testimony that  testing is                                                               
of the utmost importance and asked  the question:  If manpower is                                                               
a problem for  maximizing the use of the  PCR thermocyclers, then                                                               
what staffing leveling would fully  utilize the equipment for the                                                               
best throughput on testing.                                                                                                     
                                                                                                                                
MS.  HEDBERG answered  that the  test  itself takes  four to  six                                                               
hours, regardless  of staffing.   Staff  must extract  the sample                                                               
and  load it  into the  PCR thermocycler;  two staff  is optimal;                                                               
there is a  requirement to enter the information  into a database                                                               
that  is   transmitted  to  CDC.     The  totality   of  staffing                                                               
requirement is two  to three people.  The Division  is looking at                                                               
various  procedures   to  increase  efficiency  in   testing  and                                                               
notification.    It   has  reached  out  to   UA  for  additional                                                               
personnel; long-term  non-permanent positions have  been approved                                                               
and are being filled to help with testing.                                                                                      
                                                                                                                                
6:43:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS asked  what the  limiting factor  is for                                                               
testing?                                                                                                                        
                                                                                                                                
MS. HEDBERG answered,  "It takes a system."   She maintained that                                                               
DPH requires the kits, the  staffed off-site collection stations,                                                               
and lab testing.  She  expressed her concern with staff burn-out;                                                               
they are  working 12- to  14-hour days;  the work to  prepare and                                                               
respond to  the virus has  been non-stop since  the re-patriation                                                               
flight  on January  25  [bringing the  first  documented case  of                                                               
COVID-19  to  Alaska].    More  staff is  being  hired  and  more                                                               
equipment  expedited.   She stated  that the  limiting factor  is                                                               
that  "the whole  system has  to  be stood  up."   She said  that                                                               
bending the  curve through  social distancing  will help  to slow                                                               
down  number  of  tests  that need  processing.    She  expressed                                                               
appreciation for  the work of  the reference labs in  testing the                                                               
samples.   Beyond that, DPH  conducts further  investigation with                                                               
the positive cases.                                                                                                             
                                                                                                                                
6:45:18 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS  mentioned that  Fairbanks Memorial  Hospital has                                                               
indicated that  it has an  inadequate number of test  kits; also,                                                               
the Anchorage Neighborhood Health  Center personnel have reported                                                               
a shortage of test kits.                                                                                                        
                                                                                                                                
MS.  HEDBERG  answered  that  DPH is  tracking  the  clinics  and                                                               
hospitals to determine  what elements are lacking    PPEs, media,                                                               
and  swabs.   Communities must  pool their  resources to  compile                                                               
complete  collections  kits.   She  said  HSS communicated  their                                                               
recognition that states need more  collection kits; it is sending                                                               
the kits to  the states; Alaska is not first  on the list because                                                               
of its low case count.                                                                                                          
                                                                                                                                
6:47:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ asked how the  state will find the long-                                                               
term  non-permanent personnel  to  hire under  the Alaska  Mental                                                               
Health  Trust  Authority  (AMHTA) funding  that  was  authorized,                                                               
since they represent high-demand  professions.  She asked whether                                                               
such  staff  can be  borrowed  from  tribal, military,  or  other                                                               
entities to  get them on  the payroll  as quickly as  possible in                                                               
order to respond to the need.                                                                                                   
                                                                                                                                
MS. HEDBERG mentioned partnerships  with the Alaska Native Tribal                                                               
Health Consortium  (ANTHC) and the  Alaska Native  Medical Center                                                               
(ANMC),  which  provided the  Section  of  Epidemiology with  two                                                               
nurses;  DPH  is  looking  to  UA  for  microbiologists  and  lab                                                               
technologists (techs); DPH is looking  to other state agencies as                                                               
well.   She  said  that with  the limited  number  of lab  techs,                                                               
microbiologists,  and  chemists  in  the  state,  DPH  has  asked                                                               
retired people with current licenses to fill the positions.                                                                     
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  referred  to the  four  travel-related                                                               
cases confirmed  in Alaska, countries who  are screening incoming                                                               
travelers,  and  Alaskas  reliance  on  air  travel.   She  asked                                                               
whether there  has been discussion  of screening at  the airports                                                               
to identify  people - who are  unknowingly sick with the  virus                                                                 
before they are integrated into their communities.                                                                              
                                                                                                                                
6:49:52 PM                                                                                                                    
                                                                                                                                
COMMANDER  FISHER  answered  that since  the  first  repatriation                                                               
flight,  DMVA  has  been  in discussions  with  partners  at  the                                                               
airports, CDC,  HHS, U.S. Customs  and Border  Protection (USBP),                                                               
and  the U.S.  Coast  Guard  (USCG).   He  offered  that the  Ted                                                               
Stevens Anchorage International Airport  screens workers on their                                                               
way to work on the oil fields  on the North Slope.  He maintained                                                               
that  CDC is  dynamically updating  its recommended  guidance for                                                               
travelers, workers, airports, and industry.                                                                                     
                                                                                                                                
6:51:49 PM                                                                                                                    
                                                                                                                                
MS.  HEDBERG  added  that  it is  paramount  that  every  Alaskan                                                               
returning  to Alaska  from  any  country with  a  level 3  Travel                                                               
Health Notice  - as  published on the  CDC website  - immediately                                                               
return to his/her home, do not engage with anyone, and self-                                                                    
quarantine  for 14  days.   She relayed  that Alaskans  returning                                                               
from a level 2 country - such as  the U.S. - should stay home and                                                               
monitor themselves  if they  are not feeling  well.   They should                                                               
contact  their providers,  if  they  develop symptoms  consistent                                                               
with COVID-19.   She mentioned  the governors  focus  on telework                                                               
and actions  of other companies.   She emphasized that  the state                                                               
needs the help  of Alaskans; they must be aware  of the signs and                                                               
symptoms;  they must  stay home  if  sick.   She maintained  that                                                               
neither the state  nor AKNG have the capacity  to screen everyone                                                               
coming into Alaska.                                                                                                             
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  asked for the threshold  point at which                                                               
DPH might decide to screen  [all] incoming travelers, considering                                                               
the  oil  industry  has identified  the  issue  as  strategically                                                               
important.   She  expressed the  importance of  a functional  air                                                               
system  in  Alaska,  especially  now that  the  ferries  are  not                                                               
functioning, and the importance of  managing the spread of COVID-                                                               
19.                                                                                                                             
                                                                                                                                
MS.  HEDBERG suggested  that the  question of  when to  institute                                                               
such a  measure is one  of the factors  that Alaska needs  to put                                                               
into its "triggers."                                                                                                            
                                                                                                                                
6:55:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS  mentioned that  during the  hearing, two                                                               
more cases  of COVID-19  in Alaska  have been  reported    one in                                                               
Fairbanks and one in Anchorage.                                                                                                 
                                                                                                                                
6:55:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STORY asked  whether  Alaska has  reached out  to                                                               
other states  in anticipation  of needing  more testing  kits and                                                               
equipment.                                                                                                                      
                                                                                                                                
MS. HEDBERG replied  that every state is in  the same predicament                                                               
as Alaska; the difference between  Alaska and the other states is                                                               
Alaskas   aggressiveness  on   social  distancing  and  community                                                               
mitigation,  which  is enabled  by  Alaskas   health care  system                                                               
being small.   The  State of  Washington asked  Alaska to  do its                                                               
tuberculosis  testing when  it became  overwhelmed, which  Alaska                                                               
can  do currently.   She  maintained  that since  every state  is                                                               
grappling with the  same issues, Alaska needs to  look to private                                                               
industry, reference labs with a  higher capacity for testing, and                                                               
ways to maximize its own testing capabilities.                                                                                  
                                                                                                                                
6:57:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS stated  that it is clear  from all public                                                               
health guidance that  a high throughput of  testing is absolutely                                                               
vital  to get  a handle  on the  scope of  the epidemic,  so that                                                               
Alaska is  able to make  a more data-informed decision,  know how                                                               
much to restrict the economy  through social distancing, and know                                                               
the  right  balance.   There  is  not  a  great deal  of  testing                                                               
capacity in  Alaska or  the U.S.  compared with  other countries,                                                               
which has  been a  source of  immense frustration  for Americans.                                                               
He  asked Ms.  Hedberg what  the ideal  throughput of  testing in                                                               
Alaska  would be    in  her professional  perspective -  if there                                                               
were no resource constraints or limiting factors.                                                                               
                                                                                                                                
MS. HEDBERG responded  that without any barriers,  DPH would want                                                               
to test anyone with  any signs or symptoms of the  virus.  A test                                                               
only confirms  that a  person has  COVID-19:   80 percent  of the                                                               
population with COVID-19 will have  mild to moderate symptoms and                                                               
will recover; it is the 20  percent with a severe response to the                                                               
virus  and who  could die  that  will overwhelm  the health  care                                                               
system.  She offered that with  no limitations, she would want to                                                               
test everyone;  however, currently  Alaska is testing  those with                                                               
signs and  symptoms who have  had recent travel.   She maintained                                                               
that  DPH has  not refused  testing for  anyone.   She reiterated                                                               
that "it  takes a system"  to increase throughput;  hospitals and                                                               
clinics must  have the supplies  they need - the  collection kits                                                               
and the PPEs.                                                                                                                   
                                                                                                                                
7:00:16 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS   asked  whether  the  state   is  automatically                                                               
relicensing   recently  retired   nurses,   doctors,  and   other                                                               
frontline professionals  who have  continued to reside  in Alaska                                                               
and who  will probably be  needed in anticipation  of exponential                                                               
progression [of the virus] in Alaskas communities.                                                                              
                                                                                                                                
MS. HEDBERG answered that she  has been working with the director                                                               
of  the  Division  of  Corporations,  Business  and  Professional                                                               
Licensing  (CBPL) [DCCED],  Sara Chambers,  and offered  that the                                                               
division  has been  able to  fulfill the  request for  anyone who                                                               
needs an emergency license.                                                                                                     
                                                                                                                                
CO-CHAIR FIELDS  asked whether automatic relicensing  of recently                                                               
retired people is possible, so that there would be no lag time.                                                                 
                                                                                                                                
MS. HEDBERG replied  that an individual would have  to apply [for                                                               
the license].   She maintained  that to her knowledge  there have                                                               
been  no barriers  to emergency  licensing when  identified as  a                                                               
COVID-19 response.                                                                                                              
                                                                                                                                
CO-CHAIR FIELDS  suggested that the  state proactively  reach out                                                               
to  these individuals  or even  relicense them  before they  even                                                               
ask.  He  offered that waiting for  them one at a  time may leave                                                               
the state with  an inadequate capacity at the time  of a surge in                                                               
cases.  He  mentioned that frontline State of  Alaska employees                                                                 
such as airport  workers - do not have PPEs;  he asked the status                                                               
of  providing them  with PPEs  to  protect them  and prevent  the                                                               
spread of the virus.                                                                                                            
                                                                                                                                
MS.  HEDBERG  responded  that  the  state  is  employing  several                                                               
tactics:   1)  protective barriers,  such as  plexiglass, between                                                               
the employee and the public;  and 2) encouraging Alaskans to make                                                               
online transactions to  decrease the number of  people in lobbies                                                               
and waiting areas.                                                                                                              
                                                                                                                                
CO-CHAIR  FIELDS  expressed  the   importance  of  PPEs  for  the                                                               
frontline employees.                                                                                                            
                                                                                                                                
7:03:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ mentioned the  testimony stating that no                                                               
one has  been turned away for  testing.  She stated  that she has                                                               
heard from  numerous people who  have been  turned away due  to a                                                               
concern for not enough tests;  the threshold for allowing someone                                                               
to be  tested is  very high.   She  offered that  there may  be a                                                               
rationing of  tests which is not  best for what Alaska  should be                                                               
doing.   She mentioned  a woman  in Juneau  with symptoms  and an                                                               
underlying medical  condition who was turned  away several times.                                                               
She said that there is a  perception that there is some rationing                                                               
of COVID-19 tests.                                                                                                              
                                                                                                                                
MS. HEDBERG  stated that she  is aware of providers  being afraid                                                               
of not  having enough collection kits  and prioritizing patients.                                                               
She said that providers used  to call the Section of Epidemiology                                                               
to ask  whether to  test, and  the section  has never  said "no."                                                               
She added  that DPH has  communicated that a healthy  person with                                                               
no  signs  and  symptoms  does  not need  to  be  tested.    Many                                                               
individuals fear  that they have  COVID-19 but have  not traveled                                                               
recently  from an  area with  community transmission  and do  not                                                               
have  signs and  symptoms; therefore,  a provider  may tell  them                                                               
they dont need to be tested.                                                                                                    
                                                                                                                                
7:06:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS  indicated that the committee  would move                                                               
on to the next two presenters.                                                                                                  
                                                                                                                                
7:07:30 PM                                                                                                                    
                                                                                                                                
JARED  KOSIN,   Chief  Executive  Officer  (CEO),   Alaska  State                                                               
Hospital  and Nursing  Home  Association  (ASHNHA), relayed  that                                                               
emergency operation  plans are  in place,  and the  hospitals and                                                               
nursing homes conduct regular drills.   The ICS at all facilities                                                               
has been  activated.  Conceptually,  the plans  contemplate surge                                                               
events; the facilities are at a  level 1; as the surge hits, they                                                               
will adapt.   Alaska has  about 1,500 acute care  beds, excluding                                                               
military beds.   The  state, not ASHNHA,  maintains count  of ICU                                                               
beds  and ventilators.   He  pointed out  that as  the facilities                                                               
fill  up with  patients, the  distribution of  patients within  a                                                               
facility  will change.    He  maintained, "A  lot  of people  are                                                               
trying to do  the math problem to figure out  what the surge will                                                               
look like  and do we have  enough capacity."  He  offered that if                                                               
the  surge hit  all at  once and  the state  took no  action, the                                                               
state would not have enough capacity.   He said that ASHNHA is in                                                               
wholehearted agreement with the  idea that lengthening the spread                                                               
of the  outbreak over  time offers the  best chance  for Alaskas                                                                
health care  system to cope.   He acknowledged that  the economic                                                               
cost as well as the human  cost is challenging.  He asserted that                                                               
if  the outbreak  "gets out  of control,"  the challenge  will be                                                               
unprecedented.    He reiterated  that  the  hospitals can  manage                                                               
surges;  hospital  resources  would  be  redistributed.    As  an                                                               
example,  an  entire  hospital  hallway can  be  converted  to  a                                                               
negative  pressure unit  through mechanical  means if  necessary.                                                               
He concluded  that the facilities  would adapt to the  surge, but                                                               
they  could be  overwhelmed if  the state  takes no  action.   He                                                               
maintained  that  the  measures  that the  state  has  taken  [to                                                               
mitigate the spread] are appropriate.                                                                                           
                                                                                                                                
MR. KOSIN expressed  his concern with the  disruption in revenue,                                                               
especially  for the  small  and mid-sized  facilities.   For  the                                                               
smaller  facilities, the  "cash on  hand" is  very small;  making                                                               
payroll and  having staff come to  work is a concern.   He stated                                                               
that ASHNHA is polling its members  as to costs and needs, and it                                                               
will be requesting funds in the future.                                                                                         
                                                                                                                                
7:13:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR   KREISS-TOMKINS  commented   that  without   performing                                                               
elective procedures and receiving  that cashflow, small hospitals                                                               
with little cash on hand may be faced with bankruptcy.                                                                          
                                                                                                                                
MR.  KOSIN responded  that one  facility asked  about the  [U.S.]                                                               
Stark Law,  which prohibits hospitals  and other  facilities that                                                               
refer  patients   from  paying  money  to   physicians  to  avoid                                                               
inducements for  referrals.   He said that  ASHNHA has  asked the                                                               
federal government whether  it would be relaxing  Stark Law rules                                                               
so that hospitals may supplement their surgical groups.                                                                         
                                                                                                                                
7:14:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  referred to Mr. Kosins   testimony regarding                                                               
the number  of hospital beds  in the  state; he offered  that the                                                               
number  does  not  address  the   distribution  of  the  beds  in                                                               
communities.    He maintained that the distribution  of beds will                                                               
not align with the cases.                                                                                                       
                                                                                                                                
MR. KOSIN  agreed and  offered that  at least  20 percent  of the                                                               
beds are  not accessible from  road system.  He  stated, "Theres                                                                
no doubt  that you cant   just look at this  from a bed  count, a                                                               
ventilator  count,  an ICU  bed  count"  due to  resources  being                                                               
spread  out  in  the  state.   He  maintained  for  much  of  the                                                               
equipment, deployment requires staffing;  if the [pandemic] event                                                               
disproportionately  affects health  care workers  and maintaining                                                               
staff is a problem, then the  ability to deploy resources will be                                                               
strained, and  the bed and ventilator  numbers become irrelevant.                                                               
He emphasized that the precautions  of social distancing and hand                                                               
washing  provide the  best opportunity  for as  little impact  as                                                               
possible.                                                                                                                       
                                                                                                                                
REPRESENTATIVE WOOL offered that  childcare for health care staff                                                               
is an issue as well.                                                                                                            
                                                                                                                                
MR. KOSIN agreed that  it is a concern.  He stated  that he is in                                                               
constant  communication with  his counterparts  in other  states;                                                               
Minnesota has converted  some of the schools into  safe places to                                                               
watch  the children  of health  care  workers.   He offered  that                                                               
compared to  the rest  of the  country, arrival  of the  virus in                                                               
Alaska is slow.  He mentioned  that the health care system in the                                                               
state of Washington is close to being overwhelmed.                                                                              
                                                                                                                                
7:19:13 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS  mentioned  rural Alaska     communities                                                               
without road access  and villages in different  regions of Alaska                                                               
-  and  asked about  the  outlook  for transporting  a  high-risk                                                               
COVID-19 patient  with a deteriorating  condition from  a village                                                               
to the closest hospital by air.                                                                                                 
                                                                                                                                
MR. KOSIN replied that the issue  is under discussion.  He stated                                                               
that  the Seattle  hospitals  have declared  that  they will  not                                                               
accept  any transports  except for  high-scale  emergencies.   He                                                               
mentioned   discussions  with   personnel   from  the   Anchorage                                                               
hospitals and  the incident commander of  the EOC.  Dr.  Zink has                                                               
indicated  that the  state  has  been working  on  the issue  for                                                               
months and  has a  solution for  air transport  which will  be in                                                               
place when needed.   He maintained that  the Anchorage facilities                                                               
are ready to receive patients  through the mechanism put in place                                                               
by the  state and that  the logistical hurdle will  be addressed.                                                               
He reiterated that multiple transports  could very well overwhelm                                                               
the  system.   He  confirmed  that  he  is referring  to  private                                                               
transport  a standard medivac  not military.                                                                                    
                                                                                                                                
7:22:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  asked  whether  the  emergency  departments                                                               
would be able  to handle non-COVID-19 emergencies as  well as the                                                               
COVID-19 emergencies.                                                                                                           
                                                                                                                                
MR.  KOSIN  answered  that  currently   hospitals  are  open  and                                                               
operating  with their  traditional utilization  patterns; as  the                                                               
COVID-19  event escalates,  different  emergency operation  plans                                                               
and  different levels  will be  executed  by the  ICS to  triage,                                                               
prioritize,  and move  patients.   He maintained  that if  Alaska                                                               
experiences a  [COVID-19] surge  event in  addition to  its usual                                                               
patients,  it  will  have  a major  problem;  such  is  currently                                                               
occurring in Seattle.                                                                                                           
                                                                                                                                
7:25:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS introduced the final testifier.                                                                         
                                                                                                                                
7:26:05 PM                                                                                                                    
                                                                                                                                
NILS  ANDREASSEN,  Executive  Director, Alaska  Municipal  League                                                               
(AML), referred  to his PowerPoint presentation,  entitled "Local                                                               
Governments  Act,"  and  reviewed  the information  on  slide  2,                                                               
entitled "Recognizing," which read:                                                                                             
                                                                                                                                
   • The  federal government  is ramping  up its  efforts to                                                                    
        respond both to the public health crisis and the                                                                        
     corresponding economic challenge facing the nation.                                                                        
   • The  State of  Alaska  has taken  necessary actions  to                                                                    
      flatten the curve, which will preserve the integrity                                                                      
     of our healthcare infrastructure.                                                                                          
   • Transportation and  supply linkages remain  intact, and                                                                    
       there is no indication that food or fuel shortages                                                                       
     will occur.                                                                                                                
   • Working  together, across  levels of  government, we're                                                                    
      developing solutions to what comes next in order to                                                                       
     support residents, families and businesses.                                                                                
                                                                                                                                
MR.  ANDREASSEN  stated that  the  leadership  teams in  each  of                                                               
Alaskas  165 cities  and boroughs are "trying to  figure out what                                                               
to do" to support state action.   He reviewed the five priorities                                                               
that  AML has  sent  to  local governments,  listed  on slide  3,                                                               
entitled "Local Government Processes," which read:                                                                              
                                                                                                                                
   1. Coordination of policy-making and community impact                                                                        
     considerations                                                                                                             
   2. Continuity of Government (COG)                                                                                            
   3. Continuity of Operations Planning (COOP)                                                                                  
   4. Support for public health emergency measures                                                                              
   5. Messaging to the community                                                                                                
                                                                                                                                
Essential deployment of first responders                                                                                        
- Law enforcement, EMTs and fire departments, emergency response                                                                
teams                                                                                                                           
                                                                                                                                
7:32:47 PM                                                                                                                    
                                                                                                                                
MR. ANDREASSEN referred to slide 4, entitled "Local Governments                                                                 
- roles and responsibilities," which read:                                                                                      
                                                                                                                                
   • Some  have health  powers, especially  Anchorage, which                                                                    
       allows them to determine their own response to the                                                                       
     pandemic, in cooperation with DHSS                                                                                         
   • The majority  do not,  and depend  on direction  by the                                                                    
      CDC and DHSS  this requires regular communication on                                                                      
     the part of DHSS                                                                                                           
   • Continuity of Operations  Planning   ensuring essential                                                                    
     operations                                                                                                                 
   • Implement social distancing within workforce of 20,000                                                                     
   • Implement   social   distancing   by   closing   public                                                                    
     facilities                                                                                                                 
   • Compliance with Open Meetings Act and ensuring public                                                                      
     participation                                                                                                              
   • In the middle of budget cycles that now must                                                                               
     anticipate additional expenses and decreased revenues                                                                      
                                                                                                                                
MR.  ANDREASSEN  moved  on  to  slide  5,  entitled  "State-Local                                                               
Collaboration," which read:                                                                                                     
                                                                                                                                
   • Emergency Operations Centers       communication with                                                                      
      local emergency management officials should include                                                                       
     municipal managers, as possible                                                                                            
   • Tabletop planning  this should occur with cities and                                                                       
     boroughs, prioritized as necessary                                                                                         
   • Public   health    and   emergency   powers        some                                                                    
        municipalities have these, and are interested in                                                                        
     applying them as needed                                                                                                    
   •      How is the State tracking and leveraging these?                                                                       
   • Communicating with the federal government  what is                                                                         
        that mechanism for leveraging CDC, FEMA, and SBA                                                                        
     resources?                                                                                                                 
                                                                                                                                
7:35:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOPKINS asked whether  tabletop planning, shown in                                                               
the second bullet on slide 5,  was currently happening or will be                                                               
happening.                                                                                                                      
                                                                                                                                
MR. ANDREASSEN replied that it  is happening but doesnt  know how                                                               
extensively.   He maintained that  there needs  to be a  plan for                                                               
what it  consists of, how it  is implemented, and what  should be                                                               
communicated to local governments in terms of expectations.                                                                     
                                                                                                                                
REPRESENTATIVE  HOPKINS stated  that some  communities, like  the                                                               
Fairbanks  North Star  Borough  (FNSB), do  not  have health  and                                                               
social service  powers, cannot declare a  local health emergency,                                                               
and,  therefore,  cannot   access  Federal  Emergency  Management                                                               
Agency  (FEMA) [U.S.  Department  of  Homeland Security  (USDHS)]                                                               
funds.   He  asked whether  the governors   state declaration  of                                                               
emergency  covers those  municipalities that  do not  have health                                                               
and social  service powers,  or whether it  could be  expanded to                                                               
cover them if needed.                                                                                                           
                                                                                                                                
MR.  ANDREASSEN answered  that he  does not  know the  answer but                                                               
will consult municipal attorneys.                                                                                               
                                                                                                                                
7:37:15 PM                                                                                                                    
                                                                                                                                
MR.  ANDREASSEN turned  to slide  6, entitled  "Lessons Learned,"                                                               
and  reviewed  a  list  compiled  through  discussions  with  his                                                               
colleagues  from  other  states   and  members  of  the  National                                                               
Association  of Counties  (NACo)  and National  League of  Cities                                                               
(NLC).  It read:                                                                                                                
                                                                                                                                
   • Sufficient testing                                                                                                         
   • Protective gear for all first responders                                                                                   
   • Containment. Containment. Containment.                                                                                     
   • Cross-jurisdictional information sharing (horizontal)                                                                      
   • Inter-governmental information sharing (vertical)                                                                          
   • State-led management, local implementation                                                                                 
   • Responding to social and economic considerations                                                                           
   • Messaging  clear, honest and concise, consistent                                                                           
   • Don't reinvent the wheel.                                                                                                  
   • Document expenses.                                                                                                         
                                                                                                                                
MR. ANDREASSEN moved on to slide 7, entitled "Continuity of                                                                     
Operations Planning," to point out the questions that local                                                                     
governments are having to ask, which read:                                                                                      
                                                                                                                                
   • How will  day-to-day business processes be  impacted in                                                                    
     the event of reduced staffing levels?                                                                                      
   • Are  systems  accessible  remotely, and  are  personnel                                                                    
     properly equipped to work from home if necessary?                                                                          
   • Do  personnel  policies  allow  teleworking,  and  have                                                                    
     employees been trained on procedures to?                                                                                   
   • What are the cyber  security considerations that should                                                                    
     be evaluated and addressed before placing an emphasis                                                                      
     on remote work?                                                                                                            
   • Are  backup   systems  in  place  to   ensure  critical                                                                    
      business tasks continue to be performed in the event                                                                      
     key staff are unavailable?                                                                                                 
   • Is  there a  list of  functions that  are essential  to                                                                    
       public safety and government business that must be                                                                       
     performed in all cases?                                                                                                    
   • Has  the   city  or  borough  identified   backups  for                                                                    
     specialized vendors in order to limit?                                                                                     
   • Does the  city or borough have  "devolution" procedures                                                                    
     in place to limit, pause or discontinue performance of                                                                     
        functions that are not essential or that may be                                                                         
     performed at a reduced level?                                                                                              
   • Are  systems   in  place  to  allow   city  or  borough                                                                    
     personnel to coordinate remotely?                                                                                          
   • Is   clear   guidance   available  to   employees   for                                                                    
     expectations with regard to the time, attendance, and                                                                      
     leave policies?                                                                                                            
   • Is  there a  consolidated document  that outlines  COOP                                                                    
     policies and procedures, and has it been communicated?                                                                     
                                                                                                                                
MR.  ANDREASSEN  referred  to  the   map  on  slide  8,  entitled                                                               
"Emergency or  Disaster Declarations,"  to illustrate  the cities                                                               
and boroughs  in Alaska with  such declarations, by type  of city                                                               
government   home  rule, first class, second  class, registered                                                                 
and borough classification   non-unified  home rule, unified home                                                               
rule, first class, second class, unorganized.                                                                                   
                                                                                                                                
7:39:38 PM                                                                                                                    
                                                                                                                                
MR.  ANDREASSEN said  that even  though now  is not  the time  to                                                               
worry  about an  economic downturn,  "I  dont  know  we can  lose                                                               
sight  of it."   He  continued with  slide 9,  entitled "Economic                                                               
Downturn," which read:                                                                                                          
                                                                                                                                
   • Tourism,  retail,  service,  fishing    all  industries                                                                    
     that expect severe economic contraction                                                                                    
   • 10% contraction  = $25 million  reduction in  sales tax                                                                    
     collection                                                                                                                 
   • Cruise-related communities  depend on sales tax  as 50%                                                                    
     of their revenue                                                                                                           
   • 50%  reduction  =  $20 million  reduction  in  bed  tax                                                                    
     collection and $3 million in rental car tax collection                                                                     
   • Long term may mean property devaluation                                                                                    
   • Need to support small and local businesses                                                                                 
   • Any  industry  impacted   by  travel  restrictions  and                                                                    
      social distancing will impact community revenues and                                                                      
     expenses directly                                                                                                          
      Expecting federal aid package       but advocate for                                                                      
     Alaska interests.                                                                                                          
                                                                                                                                
He  maintained that  communities  will suffer,  not  just in  the                                                               
short term,  but the  medium and  long term.   He  mentioned that                                                               
local governments  are spending money  to prepare and  respond to                                                               
the  situation,  and  there  will  not  be  incoming  revenue  to                                                               
reimburse those  expenditures.  He  asserted that  the governors                                                                
Alaska  Economic  Stabilization  Team   needs  to  include  local                                                               
economic development  officials who understand what  is occurring                                                               
at the local level.                                                                                                             
                                                                                                                                
MR.  ANDREASSEN   referred  to  a   list  of  tools   that  local                                                               
governments are bringing to bear  in the medium term for managing                                                               
communities   social  and  economic  risk,  shown  on  slide  10,                                                               
entitled "Local Government Tools," which read:                                                                                  
                                                                                                                                
   • Ensuring  that   utilities  remain  online,   and  that                                                                    
     residents remain connected                                                                                                 
   • Economic  development  strategies   support  small  and                                                                    
     local businesses                                                                                                           
   • Implementing   staff    support   measures,   including                                                                    
     teleworking options and adequate paid time off                                                                             
   • How  best  to  utilize  savings  both  for  short  term                                                                    
      emergency management and long-term needs caused by a                                                                      
     reduction in economic activity  liquidity                                                                                  
   • Accessing State  and Federal funds, resources  meant to                                                                    
     support community members and businesses                                                                                   
   • Mechanisms   to  help   with   childcare,  short   term                                                                    
     unemployment, food and fuel purchases                                                                                      
   • Tax relief, where possible                                                                                                 
                                                                                                                                
MR.  ANDREASSEN  added  that  all  of  the  tools  point  to  the                                                               
underlying question:   "To what  extent does the State  of Alaska                                                               
have the  resources necessary,  not only to  respond to  a public                                                               
health  crisis, but  to support  communities, local  governments,                                                               
residents to manage throughout this process?"                                                                                   
                                                                                                                                
7:41:39 PM                                                                                                                    
                                                                                                                                
MR. ANDREASSEN  concluded with slide 11,  entitled "AML Actions,"                                                               
which read:                                                                                                                     
                                                                                                                                
   • Dedicated newsletter sharing information and resources                                                                     
   • Host weekly calls with managers, attorneys and mayors                                                                      
   • Regular calls with White House,  NACo and NLS to follow                                                                    
     national action                                                                                                            
   • Draft documents for preparations                                                                                           
   • Dedicated  webpage for  resource  sharing and  tracking                                                                    
     local decisions                                                                                                            
   • Develop templates for policy and municipal actions                                                                         
   • Outreach to Governor's office and DHSS EOC                                                                                 
                                                                                                                                
MR.  ANDREASSEN emphasized  the importance  of communication  and                                                               
information sharing with the legislature  as well as the State of                                                               
Alaska.                                                                                                                         
                                                                                                                                
7:42:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS  mentioned that in coastal  Alaska, where                                                               
the tourism industry is an economic  mainstay, there may not be a                                                               
cruise  ship season  in 2020    resulting  in loss  of sales  tax                                                               
revenues for  municipalities, other revenues, jobs,  and economic                                                               
activity.   He  asked, "What  is the  outlook for  some of  those                                                               
municipalities youre  talking  with in terms of  their ability to                                                               
stay  solvent,  to balance  a  budget?   Whats   that  worst-case                                                               
scenario look like for those communities?"                                                                                      
                                                                                                                                
7:43:04 PM                                                                                                                    
                                                                                                                                
MR. ANDREASSEN answered  that for some, such as  Skagway, the tax                                                               
collected during the summer cruise ship  season can be as much as                                                               
95 percent its budget.  He  said that for the Denali Borough, bed                                                               
tax can  be as  much as 80  percent of its  budget.   For coastal                                                               
communities, tourism  can account for  50 percent of  the budget.                                                               
He stated, "It  will be devastating in every regard."   The local                                                               
governments will be  asked to do more and provide  the same level                                                               
of services to residents at the  same time access to resources is                                                               
restricted.  There  are important decisions to be  made this week                                                               
regarding  how to  support  local governments  so  that they  can                                                               
"weather the storm" as they support the states actions.                                                                         
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS commented  that  such a  call to  action                                                               
resonates with him and many colleagues.                                                                                         
                                                                                                                                
7:45:00 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
State Affairs  Standing Committee  meeting was adjourned  at 7:45                                                               
p.m.                                                                                                                            

Document Name Date/Time Subjects
DMVA ANG COVID-19 Planning and Response.pdf HSTA 3/17/2020 5:00:00 PM
COVID-19 Coronavirus DMVA
COVID-19 Considerations for Local Government (AML) 3.17.20.pdf HSTA 3/17/2020 5:00:00 PM
COVID-19 Coronavirus
COVID AML presentation.pptx HSTA 3/17/2020 5:00:00 PM
COVID-19
Pueyo Presentation - Coronavirus_ Why You Need to Act Now – Alaska.pdf HSTA 3/17/2020 5:00:00 PM
COVID-19