Legislature(2019 - 2020)ADAMS 519
03/17/2020 05:00 PM House STATE AFFAIRS
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Covid-19 Omnibus Hearing | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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. [Although the meeting was announced as
joint with the House Special Committee on Military and Veterans'
Affairs, and several of that committee's members were present,
it was not scheduled as such.]
^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 |