Legislature(2019 - 2020)ANCH BENSON BLDG

05/27/2020 01:00 PM House HEALTH & SOCIAL SERVICES

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01:01:48 PM Start
01:02:34 PM Presentation(s): Impacts of Phase Iii & Safety for Working Alaskans
03:19:32 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Joint with House STA
+ Presentation: Impacts of Phase III & Safety for TELECONFERENCED
Working Alaskans
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
                         JOINT MEETING                                                                                        
             HOUSE STATE AFFAIRS STANDING COMMITTEE                                                                           
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       Anchorage, Alaska                                                                                        
                          May 27, 2020                                                                                          
                           1:01 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
HOUSE STATE AFFAIRS STANDING COMMITTEE                                                                                          
 Representative Zack Fields, Co-Chair                                                                                           
Representative    Jonathan    Kreiss-Tomkins,   Co-Chair    (via                                                                
 Representative Grier Hopkins (via teleconference)                                                                              
 Representative Andi Story (via teleconference)                                                                                 
 Representative Sarah Vance (via teleconference)                                                                                
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                             
 Representative Tiffany Zulkosky, Chair (via teleconference)                                                                    
 Representative Ivy Spohnholz, Vice Chair (via teleconference)                                                                  
 Representative Matt Claman (via teleconference)                                                                                
 Representative Harriet Drummond (via teleconference)                                                                           
 Representative Geran Tarr (via teleconference)                                                                                 
 Representative Sharon Jackson                                                                                                  
MEMBERS ABSENT                                                                                                                
HOUSE STATE AFFAIRS STANDING COMMITTEE                                                                                          
 Representative Steve Thompson                                                                                                  
 Representative Laddie Shaw                                                                                                     
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                             
 Representative Lance Pruitt                                                                                                    
OTHER LEGISLATORS PRESENT                                                                                                     
Representative Dan Ortiz (via teleconference)                                                                                   
Senator Elvi Gray-Jackson (via teleconference)                                                                                  
COMMITTEE CALENDAR                                                                                                            
PRESENTATION(S): IMPACTS OF PHASE III & SAFETY FOR WORKING                                                                      
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record                                                                                                    
WITNESS REGISTER                                                                                                              
ANDREW ELSBERG, M.D.                                                                                                            
Emergency Room Physician                                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   As a physician,  provided information about                                                             
the current COVID-19 pandemic.                                                                                                  
JAKE METCALFE, Executive Director                                                                                               
Alaska State Employees Association (ASEA), Local 52                                                                             
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Testified  regarding  ASEA's  efforts  to                                                             
collaborate  with the  State  of Alaska  on  safety measures  for                                                               
Class 1 employees.                                                                                                              
KATE SHEEHAN, Director                                                                                                          
Division of Personnel and Labor Relations                                                                                       
Department of Administration (DOA)                                                                                              
State of Alaska                                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions  regarding what the State                                                             
of Alaska  is doing to ensure  the safety of state  employees and                                                               
the public.                                                                                                                     
CHARLES STEWART, Adult Probation Officer                                                                                        
Anchorage Correctional Complex                                                                                                  
Department of Corrections                                                                                                       
State of Alaska                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Offered suggestions  for providing safety to                                                             
staff and inmates.                                                                                                              
KELLY FERGUSON, Nurse                                                                                                           
Alaska Pioneer Home-Sitka                                                                                                       
Department of Health and Social Services (DHSS)                                                                                 
State of Alaska                                                                                                                 
Sitka, Alaska                                                                                                                   
POSITION STATEMENT:  Testified about  the importance of screening                                                             
employees and  providing them with personal  protective equipment                                                               
RANDY MCLELLAN, President                                                                                                       
Alaska Correctional Officers Association (ACOA)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Stressed the  importance of COVID-19 testing                                                             
to protect correctional officers and inmates.                                                                                   
JOSHUA WILSON, Business Agent                                                                                                   
Alaska Correction Officers Association (ACOA)                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Urged  cooperation  between  the State  of                                                             
Alaska   and   employees   in  adopting   measures   to   protect                                                               
correctional officers and inmates.                                                                                              
ROBERT LAWRENCE, M.D., Chief Medical Officer                                                                                    
Health and Rehabilitation Services (HARS)                                                                                       
Department of Corrections (DOC)                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Reviewed the process that  takes place when                                                             
someone tests positive within the DOC system.                                                                                   
KELLY HOWELL, Special Assistant  to the Commissioner/ Legislative                                                               
Office of the Commissioner                                                                                                      
Department of Corrections (DOC)                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Answered  questions regarding  COVID-19 and                                                             
ERIN BROMAGE, Ph.D., Associate Professor of Biology                                                                             
College of Arts and Sciences                                                                                                    
University of Massachusetts Dartmouth                                                                                           
Dartmouth, Massachusetts                                                                                                        
POSITION STATEMENT:   Testified  regarding the risks  of COVID-19                                                             
and how to avoid them.                                                                                                          
MARY SWAIN, Executive Director                                                                                                  
Camai Community Health Care Center                                                                                              
Naknek, Alaska                                                                                                                  
POSITION   STATEMENT:      Testified  about   the   testing   and                                                             
collaboration going on within her  community to reduce or prevent                                                               
the spread of COVID-19 during the commercial fishing season.                                                                    
ACTION NARRATIVE                                                                                                              
1:01:48 PM                                                                                                                    
CO-CHAIR ZACK FIELDS called the  joint meeting of the House State                                                             
Affairs  Standing  Committee  and  the House  Health  and  Social                                                               
Services   Standing    Committee   to   order   at    1:01   p.m.                                                               
Representatives  Story, Hopkins,  Kreiss-Tomkins,  and Fields  of                                                               
the House  State Affairs Standing  Committee were present  at the                                                               
call to order.   Representative Vance arrived as  the meeting was                                                               
in progress.  Representatives Tarr,  Jackson, and Zulkosky of the                                                               
House Health and Social Services  Standing Committee were present                                                               
at  the  call to  order.  Representatives  Claman, Drummond,  and                                                               
Spohnholz arrived as  the meeting was in progress.   Also present                                                               
were Representative Ortiz and Senator Gray-Jackson.                                                                             
^PRESENTATION(S):  Impacts  of Phase  III  &  Safety for  Working                                                               
   PRESENTATION(S): Impacts of Phase III & Safety for Working                                                               
1:02:34 PM                                                                                                                    
CO-CHAIR FIELDS announced  that the only order  of business would                                                               
be a  presentation on Impacts of  Phase III & Safety  for Working                                                               
1:02:56 PM                                                                                                                    
ANDREW ELSBERG, M.D.,  Emergency Room Physician, stated  he is an                                                               
emergency  room physician  at Providence  Alaska Medical  Center,                                                               
but is testifying  as an individual, not a  representative of the                                                               
hospital.  He said he has  been responsible for helping guide the                                                               
clinical  care  for  the   2019  novel  coronavirus  ("COVID-19")                                                               
patients in  the Providence  emergency room.   He is  a volunteer                                                               
medical director  and assistant  medical director for  the Alaska                                                               
Mountaineering School,  Alaska Guide Collective, and  a number of                                                               
other programs.   He has  kids in the Anchorage  School District.                                                               
He is providing  his background, he said,  because this community                                                               
is  his  community.    He   is  before  the  committee  to  share                                                               
information about COVID-19 and is  fully aware that the decisions                                                               
made to manage  this pandemic at both the state  and local levels                                                               
have economic, educational, social, and health impacts.                                                                         
DR. ELSBERG addressed  why a person doesn't want  to get COVID-19                                                               
and  why public  policy should  aim to  limit the  spread of  the                                                               
disease.  He  explained that the mortality rate goes  up with age                                                               
and comorbidities, but  that people of any age  can get seriously                                                               
ill from  COVID-19.   While many people  will be  asymptomatic or                                                               
have mild  illness, those who  get severe illness get  very, very                                                               
sick.  Early system-wide data  shows that, in general, people who                                                               
present with  more severe  illness and  who meet  sepsis criteria                                                               
have  an 8-10  percent mortality  rate.   So, a  serious COVID-19                                                               
patient has  more than a  one-third chance  of not making  it out                                                               
alive from  the hospital.   Getting worse than mild  illness with                                                               
COVID-19 is  very, very dangerous at  any age.  At  his hospital,                                                               
patients at  the level of the  intensive care unit (ICU)  aged 18                                                               
and  up have  had to  be  intubated.   Although chronic  problems                                                               
raise the  risk of  death, many previously  healthy people  on no                                                               
medications  are  getting sick  and  dying  worldwide.   In  kids                                                               
specifically, there  is an  inflammation of  the arteries  of the                                                               
heart  similar to  the rare  disorder called  Kawasaki's Disease.                                                               
Sometimes it kills, but more  often it leaves permanent/life-long                                                               
heart damage to otherwise healthy kids.   It hasn't yet been seen                                                               
in Alaska, but will if COVID-19 explodes in the state.                                                                          
DR.  ELSBERG said  much has  been learned  about treatment.   For                                                               
example,  addressing silent  hypoxia  early  on by  administering                                                               
oxygen with nasal cannulas to  try avoiding intubation; carefully                                                               
managing  intravenous  fluids;  and changing  people's  positions                                                               
early on  before they get super  sick to keep the  lungs open and                                                               
continuing  that in  very sick  patients.   There  are no  proven                                                               
medications to  treat this, which  shouldn't be a  surprise since                                                               
very  few  viruses have  proven  treatment  directly against  the                                                               
virus.   There is only  supportive treatment.   A vaccine  is the                                                               
only hope for  herd immunity.  Getting to 80  percent exposure to                                                               
this virus  by letting  the illness  move through  the population                                                               
will leave  thousands of Alaskans  dead, will  overwhelm Alaska's                                                               
medical system,  will put providers  at risk due to  shortages of                                                               
personal  protective  equipment  (PPE),  and  patients  will  get                                                               
suboptimal care  because sick patients need  nurses, doctors, and                                                               
respiratory  therapists at  a safe  ratio to  provide good  care.                                                               
For  example,  in  New  York there  were  stories  of  orthopedic                                                               
physicians  running  ICU  care.   That  is  scary  because  these                                                               
doctors are  really good at  dealing with bones and  tendons, but                                                               
not at running ICUs.  Nursing ratios  in New York were 12:1 in an                                                               
ICU;  normal  in  an ICU  is  2:1  or  1:1.   If  Alaska  has  an                                                               
explosion, people will  be lost just because of  the inability to                                                               
give them the care  that is needed to give them  the best shot to                                                               
survive  this illness.   Alaska  needs to  maintain a  reasonable                                                               
burden of illness.                                                                                                              
DR. ELSBERG discussed the factors for  how Alaska got to where it                                                               
is with  a low disease  burden.  He said  Alaska was late  to get                                                               
cases, the state and municipalities  took relatively early action                                                               
to shut down or geographically  isolate the virus, and Alaska has                                                               
space.    The  actions  of  Governor  Dunleavy,  Anchorage  Mayor                                                               
Berkowitz, and  others saved the  state from a  serious outbreak.                                                               
Staying  open,  he advised,  requires  avoiding  a big  outbreak.                                                               
Social distancing,  wearing masks,  good hand hygiene,  and smart                                                               
business  practices   are  all  necessary  to   protect  Alaska's                                                               
economy.    Fully  shutting down  again,  whether  regionally  or                                                               
statewide,  isn't wanted.   Many  individuals and  businesses are                                                               
acting responsibly, but many are not.                                                                                           
DR. ELSBERG opined  that it's the domain of  the state government                                                               
to have policies that  create a safe place to work  and live.  It                                                               
isn't a  political issue; it's  common sense.   Businesses should                                                               
be  required to  have patrons  and  employees wear  masks.   Mass                                                               
gatherings should be  off the table.  Long exposure  at less than                                                               
six feet in indoor settings should  not be considered okay.  This                                                               
is  simple and  manageable  and doesn't  require  shutdown to  be                                                               
maintained, but it does need policy and required guidelines.                                                                    
DR.  ELSBERG said  the importation  of more  cases is  of serious                                                               
concern.  The disease burden  is higher nearly everywhere else in                                                               
the  U.S. and  the world  than it  is in  Alaska.   Despite tight                                                               
screening and quarantine protocols,  Alaska has seen a consistent                                                               
but slow flow of new cases  with the fishing industry ramping up.                                                               
Travel in  and out of the  state by Alaskans and  others is going                                                               
to continue  being of concern.   The [current]  self-isolation of                                                               
14 days is  a joke.  Each passenger arriving  in Alaska should be                                                               
required to  provide his or  her quarantine plans  before getting                                                               
off the  plane.   The state  and municipality  need to  make this                                                               
happen instead  of expecting the other  party to do it.   Thought                                                               
is needed in  drawing up this requirement.  Can  rapid testing be                                                               
set up  for every  [flight] arrival  and can  it be  done without                                                               
creating  a  bottleneck where  people  cannot  distance?   Can  a                                                               
seven-day isolation,  then a test,  be required?   Exemptions for                                                               
essential workers  are being exploited inappropriately  at times.                                                               
Can  these exemptions  be replaced  with  seven days  and then  a                                                               
test?    A  state  tourism   industry  can't  be  had  without  a                                                               
coordinated  plan  that  involves   public  health  and  industry                                                               
working together to prevent importing a lot more disease burden.                                                                
1:11:28 PM                                                                                                                    
DR.  ELSBERG  stressed that  transparency  of  data is  extremely                                                               
important.   For example, what  is the actual positive  rate, not                                                               
the rumored  rate, of  the fishery workers  who are  being tested                                                               
out  of state  before coming  to Alaska?   Public-health-relative                                                               
data should be public information;  it is needed to make sensible                                                               
decisions.   State and federal dollars  helped industry establish                                                               
the  Experian programs;  the data  should be  publicly available.                                                               
The  addition  of  nonresident  cases to  the  dashboard  was  an                                                               
important and  welcome development.  Pre-screening  data for what                                                               
is happening outside Alaska in  the oil and fishing industries is                                                               
important and needs to be shared.                                                                                               
DR. ELSBERG addressed  testing.  He said that  continuing to ramp                                                               
up  Alaska's  testing capabilities  is  required  for opening  up                                                               
general   healthcare  elective   procedures,  dentistry,   safely                                                               
operating  industries where  employees work  in close  proximity,                                                               
and  keeping  the  state's hospitals,  group  living  facilities,                                                               
prisons,  and  other  places  safe.   Alaska  is  not  there,  he                                                               
maintained.   State  coordination is  required, and  state people                                                               
power is necessary to make it happen.                                                                                           
DR.  ELSBERG concluded  by saying  that no  one wants  to be  the                                                               
person who gets  a severe case of COVID-19.   The chance of death                                                               
is way beyond sepsis and  influenza   100,000 Americans have died                                                               
in two  and one-half months.   Alaska  is both lucky  and reaping                                                               
the  benefits  of some  very  strong  moves  by state  and  local                                                               
leaders.  To  sustainably maintain this position,  the state must                                                               
make social distancing,  masking, and hygiene the  norm; it's not                                                               
a  political act,  it's  economic  and health  self-preservation.                                                               
Policies should reflect the known  ways the virus is transmitted.                                                               
Screening of people traveling in and  out of Alaska is needed and                                                               
having  that  capability  is necessary  before  consideration  is                                                               
given  to  dropping  the 14-day  self-isolation  mandate.    This                                                               
mandate must  be made real.   Essential exemptions must  be truly                                                               
essential and  essential workers must be  responsible, which most                                                               
have  been.   Strong  screening,  testing,  contact tracing,  and                                                               
transparent  data  are needed.    The  Department of  Health  and                                                               
Social  Services (DHSS)  must be  funded and  staffed at  a level                                                               
where the department can do the coordination that is needed.                                                                    
1:14:14 PM                                                                                                                    
REPRESENTATIVE  HOPKINS related  that Foundation  Health Partners                                                               
in   Fairbanks  is   offering   to   provide  consultations   and                                                               
recommendations  to local  businesses to  help set  up guidelines                                                               
for  safe working  and spacing  policies.   He asked  whether any                                                               
hospitals are offering these services to Anchorage businesses.                                                                  
DR. ELSBERG  replied that  he is  unaware of anything.   He  is a                                                               
volunteer with the local groups  he mentioned earlier but doesn't                                                               
know what might be happening on a larger basis with businesses.                                                                 
1:15:48 PM                                                                                                                    
REPRESENTATIVE  TARR noted  that due  to lots  of misinformation,                                                               
people  are choosing  to not  believe things.   For  example, the                                                               
U.S. Surgeon General  advised not to wear a mask  just before the                                                               
change was  made urging  people to  wear a mask.   She  asked Dr.                                                               
Elsberg  for suggestions  on how  to overcome  the misinformation                                                               
that has been put forth.                                                                                                        
DR. ELSBERG  postulated he hasn't contracted  COVID-19 because he                                                               
wears PPE  at work from  the minute  he walks into  the hospital,                                                               
only  takes off  his PPE  to eat  or drink  in an  isolated spot,                                                               
wears gloves, washes his hands  before and after every encounter,                                                               
and  escalates  to   higher  levels  of  PPE   depending  on  the                                                               
situation.   It's hard for  legislators and state  government, he                                                               
continued,  when  the  federal  government  hasn't  put  forth  a                                                               
coherent message.   Pandering to  certain demographics  with that                                                               
[misinformation]  has  been  done  instead  of  sticking  to  the                                                               
scientific  response,  which  has   fanned  the  flames  of  what                                                               
Representative Tarr is  talking about.  At the state  level it is                                                               
important that  politicians representing all spectrums  put forth                                                               
a clear message about  what is known to work to  slow or stop the                                                               
spread of this  disease.  It is incumbent upon  people across the                                                               
political  spectrum to  fight  back  against the  misinformation.                                                               
The debate  is how to  proceed forward while keeping  people safe                                                               
and minimizing the impact on  the other aspects of people's lives                                                               
including  the economy.    The debate  is not  on  how does  this                                                               
disease spread.                                                                                                                 
1:20:12 PM                                                                                                                    
CHAIR ZULKOSKY said  she has witnessed a false  sense of security                                                               
with  the easing  of various  health mandates,  but easing  these                                                               
health mandates  doesn't make  the virus  any less  contagious or                                                               
the serious  cases any less  serious.  She requested  Dr. Elsberg                                                               
to discuss, from a clinical  perspective, how much further Alaska                                                               
needs to go to achieve widespread immunity.                                                                                     
DR. ELSBERG  responded that the only  numbers he has seen  so far                                                               
regarding  the  likely  burden  of disease  in  Alaska  are  from                                                               
[Alaska's  state  epidemiologist,  Dr.  Joseph]  McLaughlin,  who                                                               
believes  Alaska is  between 0.5  and 1  percent.   To have  herd                                                               
immunity to a  virus such as this, Dr. Elsberg  advised, the best                                                               
estimates are  70-80 percent.  For  perspective, antibody testing                                                               
was recently done in New York City  to try to get an idea of what                                                               
percentage  of people  have been  exposed  to the  virus and,  if                                                               
there is immunity  following exposure, how many  people have that                                                               
immunity.  It is thought that  there is decent immunity, but that                                                               
thought isn't  100 percent for sure  yet.  The estimates  for New                                                               
York City were in the 25 percent  range.  It needs to reach 70-80                                                               
percent to have herd immunity.   That isn't going to happen until                                                               
this virus circulates  for years or until there is  a vaccine.  A                                                               
vaccine can  give herd immunity  by induced immunity and  this is                                                               
the most hopeful route to get  out of this with an intact economy                                                               
and  intact healthy  population; there  is  no other  way to  get                                                               
there.  What is being done  right now is mitigating the spread as                                                               
best as possible  and riding that fine balance  between having an                                                               
economy and health until there is a vaccine.                                                                                    
1:23:36 PM                                                                                                                    
CO-CHAIR  FIELDS requested  Dr.  Elsberg to  discuss the  current                                                               
uncertainty regarding  herd immunity and how  long immunity lasts                                                               
even if the population reaches that 70-80 percent exposure.                                                                     
DR. ELSBERG  explained that  COVID-19 is so  new there  isn't yet                                                               
the  ability  to  demonstrate  that   someone  who  has  had  the                                                               
infection has  a long-lasting  immunity.   The modeling  is being                                                               
done  with   what  has   been  seen  in   the  past   with  other                                                               
coronaviruses.     Regular  coughs   and  colds  are   caused  by                                                               
coronaviruses  and  there  are  others  like  MERS  [Middle  East                                                               
Respiratory   Syndrome]  and   SARS  [Severe   Acute  Respiratory                                                               
Syndrome]  that  are more  serious  viruses.   In  general,  most                                                               
coronaviruses  induce a  decent  immunity  response and  antibody                                                               
testing  is showing  that people  who are  exposed are  producing                                                               
antibodies.   The belief, based  on what  has been seen  with the                                                               
others, is  that people  will have 6-12  months of  immunity, but                                                               
this isn't known because it hasn't  been proved.  There have been                                                               
some  reports  of people  testing  positive  after having  tested                                                               
negative.   Other  reports say  it is  unclear whether  these are                                                               
just residual fragments of virus  versus active virus.  He hasn't                                                               
read  any  literature that  says  people  who have  already  been                                                               
through the illness have contracted  a significant illness again.                                                               
This is  where the  uncertainty is, he  added, because  the virus                                                               
hasn't been  around long enough  to know how strong  the immunity                                                               
is or  how long it  lasts.  The  hope with  a vaccine is  that it                                                               
induces an immunity that lasts a reasonable amount of time.                                                                     
CO-CHAIR FIELDS  related that  he has heard  the virus  should be                                                               
left to rampage  the population to reach herd immunity.   He said                                                               
there needs  to be public  understanding that that  would produce                                                               
mass deaths and even worse economic problems than are had now.                                                                  
1:26:25 PM                                                                                                                    
REPRESENTATIVE JACKSON inquired about  how there can be assurance                                                               
that  vaccines will  work, given  the uncertainty  about immunity                                                               
because  COVID-19 is  so new.    She further  inquired about  the                                                               
uncertainty for how long immunity from a vaccine would last.                                                                    
DR. ELSBERG confirmed  these are the exact things  being faced in                                                               
terms of  uncertainty.  Based  on models of  prior coronaviruses,                                                               
the hope is  that people's immune systems will  act similarly and                                                               
there will be  some immunity.  It is definitely  a question as to                                                               
whether  there will  be  a  viable vaccine.    Until  there is  a                                                               
vaccine,  if there  is one,  there needs  to be  a way  to manage                                                               
keeping the  burden of  disease at  a low  enough level  that the                                                               
state's healthcare  resources can manage that,  while still being                                                               
able to  perform regular preventative  health care,  cancer care,                                                               
and elective surgery  outside of the COVID-19 crisis,  as well as                                                               
keeping the  economy rolling  at some  level.   That will  be the                                                               
case  until there  is a  vaccine, or  something changes  with the                                                               
virus,  or the  virus  has gotten  through  the community,  which                                                               
would be incredibly destructive if it is allowed to happen fast.                                                                
1:29:36 PM                                                                                                                    
CO-CHAIR  FIELDS requested  Dr. Elsberg's  advice on  communities                                                               
holding Fourth of July parades.                                                                                                 
DR.  ELSBERG advised  that  any  mass gatherings  in  the age  of                                                               
COVID-19   are    not   realistic   and   should    not   happen.                                                               
"Superspreader" events  happen more easily indoors,  he said, but                                                               
getting people in close proximity  in large groups [outside] will                                                               
spread the disease  because some people with the  disease will be                                                               
1:30:46 PM                                                                                                                    
REPRESENTATIVE STORY  asked whether  Dr. Elsberg  is recommending                                                               
the seven-day  quarantine followed  by a  test that  he mentioned                                                               
earlier.     She  offered  her  understanding   that  the  14-day                                                               
quarantine in Alaska significantly prevents infection.                                                                          
DR. ELSBERG agreed Alaska's 14-day  quarantine has played a major                                                               
role.   Along  with what  is happening  in the  Lower 48,  it has                                                               
dissuaded Alaskans from  traveling, which is good  because it has                                                               
limited  the  amount of  disease  burden.    He noted  that,  for                                                               
himself, he couldn't  afford not to work for 14  days.  People in                                                               
the medical field are considered  essential workers, but they are                                                               
still subject to this quarantine.   He said he recently talked to                                                               
[Alaska's  chief medical  officer] Dr.  Anne Zink,  who said  the                                                               
state is looking at seven days plus  a test.  About 90 percent of                                                               
people who  contract COVID-19, he  explained, will  show symptoms                                                               
within  seven days.   So,  a seven-day  quarantine followed  by a                                                               
test  would likely  screen out  90-95 percent  of those  possibly                                                               
having  the virus.   This  would  not necessarily  be applied  to                                                               
everybody, but in  terms of taking away some  of those exceptions                                                               
for essential workers, it would  be a more workable timeframe for                                                               
people who do  need to travel in  and out of the  state for work.                                                               
While he doesn't know if this  will be adopted, it does seem like                                                               
a reasonable  perspective that will  screen 90-95 percent  of the                                                               
asymptomatic carriers.                                                                                                          
1:33:59 PM                                                                                                                    
REPRESENTATIVE STORY  asked whether  Dr. Elsberg  is recommending                                                               
that this should be just for essential workers.                                                                                 
DR. ELSBERG  replied that the  problem is  testing.  In  order to                                                               
test  people   after  seven   days  there   must  be   that  much                                                               
availability of testing and it  must be ensured that those people                                                               
actually get tested.  Therefore  it seems more realistic to apply                                                               
this  to a  limited population  of people  in certain  industries                                                               
that are  considered essential.   To apply it to  everyone coming                                                               
in and out  of Alaska gets into public health  logistics that are                                                               
beyond  his  world; while  it  would  be a  reasonable  alternate                                                               
strategy, he is unsure how to make it work on that level.                                                                       
1:35:10 PM                                                                                                                    
REPRESENTATIVE  DRUMMOND  related  that   she  just  returned  to                                                               
Anchorage from Juneau  on a plane that came from  Seattle and she                                                               
was impressed  with Alaska  Airlines' cleaning  process.   In the                                                               
Juneau  [airport] she  barely noticed  the forms  for the  14-day                                                               
quarantine  for incoming  travelers and  in Anchorage  she didn't                                                               
see  any.   She  asked  whether Dr.  Elsberg  and  Dr. Zink  have                                                               
discussed  enforcing the  signup for  quarantine and  tracking of                                                               
the information to know a person is following the quarantine.                                                                   
DR. ELSBERG offered  his understanding that the  state is looking                                                               
at local municipalities  to enforce that at the  airports and the                                                               
municipalities  are  looking at  the  state.   Enforcement  takes                                                               
people  power, and  given the  state's tight  budget, both  sides                                                               
have decided they  don't have the people power.   Some people are                                                               
aware of that and are taking  it to heart and self-isolating, but                                                               
there are  plenty of people who  don't know it exists  or who are                                                               
ignoring it.  The state and  the municipality must come up with a                                                               
solution because it is necessary, he advised.                                                                                   
1:38:21 PM                                                                                                                    
CO-CHAIR  FIELDS  outlined  three takeaways  from  Dr.  Elsberg's                                                               
testimony:  1)  mandate the use of masks in  public buildings; 2)                                                               
quarantine  procedures need  to be  meaningful, accountable,  and                                                               
enforceable;  and  3)  an  expanded  testing  regime  is  needed,                                                               
particularly in Pioneer Homes and other facilities.                                                                             
DR. ELSBERG  concurred and added  that no  one wants to  get this                                                               
disease because it is  a roll of the dice as  to whether a person                                                               
gets a more severe case.   While certain things can make a person                                                               
at higher  risk for getting a  more severe case, plenty  of young                                                               
or otherwise healthy people still get a severe case or die.                                                                     
1:39:19 PM                                                                                                                    
REPRESENTATIVE  CLAMAN  related  his understanding  from  talking                                                               
with a physician  in California that when there  is screening the                                                               
screening is  for specific hot  spots, such  as New York  and New                                                               
Jersey.   Folks  traveling from  those areas  are being  asked to                                                               
quarantine,  but folks  traveling from  non-hotspot areas  aren't                                                               
being  asked  to quarantine.    He  inquired whether  Alaska  has                                                               
looked at  being more  specific about  which travelers  should be                                                               
quarantined [like California has done].                                                                                         
DR.  ELSBERG  opined  that  Alaska  should  stick  with  anywhere                                                               
outside of the state because he  cannot think of a place that has                                                               
a lower burden than does Alaska.                                                                                                
1:40:41 PM                                                                                                                    
JAKE  METCALFE,   Executive  Director,  Alaska   State  Employees                                                               
Association  (ASEA), Local  52, said  ASEA represents  over 8,000                                                               
general government unit  employees at the State  of Alaska, which                                                               
includes the  largest group of Class  1 employees.  Class  1 is a                                                               
designation in  law that  says these  employees are  so essential                                                               
they  cannot   strike,  he  explained,  government   needs  their                                                               
services  in   order  to  function.     The  Class   1  employees                                                               
represented  by ASEA  include  police  officers, state  troopers,                                                               
airport  police,  court  service  officers,  probation  officers,                                                               
correctional officers,  many employees  within the  Department of                                                               
Health  and  Social  Services,  Pioneer  Home  employees,  Alaska                                                               
Psychiatric  Institute employees,  youth center  employees around                                                               
the  state,  Alaska  State  Trooper  dispatchers,  public  health                                                               
nurses,  Office of  Children's Service  employees, and  wild land                                                               
MR.  METCALFE  noted  he  is  a  lifelong  Alaskan  born  in  the                                                               
Territory  of  Alaska.   He  has  lived  in Juneau,  Bethel,  and                                                               
Anchorage for  significant amounts  of time.   His  children have                                                               
all gone  through the Anchorage  school system.  His  family went                                                               
through the 1918 Spanish Flu  pandemic in Alaska and survived it,                                                               
he  continued, and  it is  important that  the state's  essential                                                               
employees survive this [COVID-19] pandemic.                                                                                     
MR.  METCALFE   specified  that   ASEA  is  very   interested  in                                                               
maintaining  safety on  the job  site and  safety when  employees                                                               
return to work.  Essential workers  are going to work to continue                                                               
providing the  essential services that  the entire state  and its                                                               
communities need.   The ASEA  has been gathering  information and                                                               
working with other unions in the state  to stay on top of what is                                                               
going on so it can ensure that its members are safe on the job.                                                                 
MR.  METCALFE  offered  ASEA's wholehearted  agreement  with  Dr.                                                               
Elsberg that for services to  continue, and for ASEA's members to                                                               
be safe, there needs to  be a coherent message, transparency, and                                                               
sharing of data.  Since the  pandemic started ASEA has pushed for                                                               
communication and while  it hasn't always been a  great system it                                                               
has gotten better.  A number  of public employee unions meet once                                                               
a week  with the  Department of  Administration to  ask questions                                                               
and  get answers  for sharing  with their  members about  what is                                                               
going on  in the workplace regarding  safety.  A letter  is being                                                               
sent  to  a  number   of  commissioners,  including  Commissioner                                                               
Tshibaka  of   the  Department   of  Administration   (DOA),  and                                                               
Commissioner  Crum  of  the  Department   of  Health  and  Social                                                               
Services (DHSS).  He spoke from a paragraph in the letter:                                                                      
     We recently  sent a letter requesting  and recommending                                                                    
     that   public   employee   representatives   serve   as                                                                    
     cooperators in appropriate meetings.   Together we seek                                                                    
     not only  answers to  our questions  directly affecting                                                                    
     member rights, employment,  policy, and implementation,                                                                    
     but also development of  workplace mitigation plans and                                                                    
     transparent communication with  state employed workers.                                                                    
     To  help move  this step  forward we  are working  on a                                                                    
     draft workplace mitigation plan  for consideration.  It                                                                    
     is time to elevate  our conversations to an appropriate                                                                    
     level   of  decision-makers.     Our   members  deserve                                                                    
     answers.     They   deserve   timely  information   and                                                                    
     assurances  of  safety.   It  is  apparent through  our                                                                    
     teleconferences  that  cooperation  and  open  dialogue                                                                    
     must  occur  at  a  level within  the  state  at  which                                                                    
     decisions may be made and answers may be provided.                                                                         
1:48:16 PM                                                                                                                    
MR. METCALFE reviewed some of  ASEA's questions and concerns.  He                                                               
said responses have been inconsistent  to the question of whether                                                               
there  is  sufficient  personal protective  equipment  (PPE)  for                                                               
union  members.  It  has  been   heard  that  some  offices  have                                                               
sufficient PPE, and  some don't.  There is  concern about testing                                                               
in  the  24-hour  facilities  where  ASEA members  work.    If  a                                                               
resident, employee, or visitor tests  positive, there needs to be                                                               
some sort  of rapid  testing in place  so that  essential workers                                                               
are not  knocked out, because  those facilities must  continue to                                                               
function.  The union has  asked for notice about either residents                                                               
or employees who  test positive.  For example, an  ASEA member in                                                               
Juneau tested  positive and no  information went out  within that                                                               
facility  for  a  number  of  days.   Employees  in  that  office                                                               
building  experienced a  great deal  of  stress.   The union  has                                                               
asked  that  there  be  some  sort of  protocol  when  there  are                                                               
positive cases  in workplaces  and notice  to employees  in those                                                               
workplaces.  Violation of HIPPA  laws aren't being asked for, but                                                               
ASEA  is  asking  from  a public  health  perspective  that  that                                                               
information  be  shared  with  both  essential  and  nonessential                                                               
employees so  measures can be  taken to  protect them as  well as                                                               
the  public.    Mr.  Metcalfe  said  ASEA  is  also  looking  for                                                               
information  about  what  sanitation  will be  in  place  in  the                                                               
workplace  and   wants  to  ensure   there  is   adequate  social                                                               
distancing when workplaces are opened.                                                                                          
MR. METCALFE  further noted  that because  of Phase  III changes,                                                               
information has been insufficient regarding  return to work.  The                                                               
union understands  a master  plan is being  developed but  has no                                                               
idea what  that master  plan entails.   Everybody wants  to work,                                                               
and  everybody wants  to ensure  the state  functions safely  and                                                               
ASEA believes it  is essential that employees have a  spot at the                                                               
table and  a voice in  how that is done  for the safety  of every                                                               
employee and  resident within  the facilities.   It  is essential                                                               
for keeping the curve down on this virus.                                                                                       
MR. METCALFE added that ASEA believes  the curve can be kept down                                                               
through  meetings  and   discussing  the  aforementioned  issues.                                                               
Communication is  key, answers need  to be received  quickly, and                                                               
the ability  is needed to  share that information at  the highest                                                               
levels.   He said ASEA  wants to continue toward  cooperating and                                                               
ensuring that  the State of  Alaska has safe  workplaces, healthy                                                               
employees, and a healthy public.                                                                                                
1:53:06 PM                                                                                                                    
CO-CHAIR  FIELDS,   in  relation   to  coordinating   with  state                                                               
employees,  asked  whether  [DOA] has  notified  state  employees                                                               
about going back to work next week more or less as normal.                                                                      
KATE  SHEEHAN,   Director,  Division   of  Personnel   and  Labor                                                               
Relations, Department  of Administration (DOA), State  of Alaska,                                                               
replied that  there has  not been  a statewide  notification that                                                               
employees  are required  to come  back to  work.   She said  that                                                               
about  40  percent  of employees  are  teleworking  statewide  in                                                               
various departments.   Depending  on the missions  of departments                                                               
or divisions, some  may be coming back due to  the seasonality of                                                               
their work,  but as of  this point  there hasn't been  a mandate.                                                               
The department  is starting to  look at  what that plan  will be,                                                               
how to follow all the social  mandates, ensure there are PPEs for                                                               
employees, and social distancing.   Those employees that are able                                                               
to continue to  telework right now are teleworking.   In the plan                                                               
that  is  being  put  together   there  will  be  some  statewide                                                               
direction, but it is going to  depend on a division's mission and                                                               
what its jobs are.                                                                                                              
CO-CHAIR  FIELDS,  in  relation   to  Mr.  Metcalfe's  testimony,                                                               
inquired  whether  DOA can  commit  to  a protocol  of  notifying                                                               
workers when someone  in their workplace has  tested positive, as                                                               
well as notifying the workers' unions.                                                                                          
MS. SHEEHAN answered that [DOA]  has been following the decisions                                                               
and policy of  the Department of Health and Social  Services.  An                                                               
investigation is  done when state  residents or any  person tests                                                               
positive, and those  employees who may have been  in contact with                                                               
the  patient who  tested  positive  are alerted.    When a  state                                                               
employee tests positive, that same  course of action and protocol                                                               
is followed and  the people who need to know  are contacted.  The                                                               
offices are then cleaned and sanitized.                                                                                         
CO-CHAIR FIELDS  asked whether  the union  representing employees                                                               
at that worksite is notified.                                                                                                   
MS. SHEEHAN responded,  "At this point, no, we  are not notifying                                                               
the union."                                                                                                                     
1:55:39 PM                                                                                                                    
CO-CHAIR FIELDS inquired about the  department's vision in regard                                                               
to standards for providing adequate  PPEs, such as masks or other                                                               
equipment,  for state  employees working  on the  frontlines with                                                               
each other and the public, sometimes in close proximity.                                                                        
MS. SHEEHAN  replied it  would depend  on the  office.   She said                                                               
there are masks  for state employees.  Through  the Department of                                                               
Corrections, inmates have made thousands  of masks that have been                                                               
provided to  state office workers,  enough for two  per employee.                                                               
Shields are  in place for  healthcare workers.  Offices  that are                                                               
too close are  being reorganized to provide six  feet in between.                                                               
Staggered work  times are  being looked at  so there  aren't full                                                               
loads in the elevators.   Flexible workweeks are being looked at,                                                               
perhaps  with the  ability to  work on  a Saturday  instead of  a                                                               
weekday.   It is being looked  at on a statewide  basis, but each                                                               
division  or  office  will  be   able  to  tailor  things  a  bit                                                               
differently to fit its needs.                                                                                                   
1:57:13 PM                                                                                                                    
CO-CHAIR FIELDS  asked whether the  DOA could commit  to engaging                                                               
collaboratively with the employee unions  on safety planning.  He                                                               
offered his understanding from Mr.  Metcalfe's testimony that the                                                               
unions  had to  draft  a safety  plan on  their  own because  the                                                               
administration isn't substantively engaged on that.                                                                             
MS. SHEEHAN  answered yes.   The administration  absolutely wants                                                               
to  work with  and  have a  collaborative  relationship with  the                                                               
unions.   The goal  is to keep  government running  while keeping                                                               
employees safe.   She  said she has  enjoyed the  weekly meetings                                                               
with the  unions.  She doesn't  always have all the  answers, but                                                               
tries to get answers when questions are raised.                                                                                 
CO-CHAIR FIELDS pointed out that  one reason to notify the unions                                                               
in addition to the individual  employees about a positive test is                                                               
because  the features  and ventilation  systems of  each building                                                               
are  different   and  there  is  the   possibility  of  infecting                                                               
employees beyond  the immediate  area.   He brought  attention to                                                               
the  diagram of  a call  center provided  to the  committee where                                                               
people on  multiple floors  were infected  from a  single person.                                                               
He said  the diagram demonstrates that  six-foot distancing isn't                                                               
sufficient  to protect  people who  are around  each other  for a                                                               
long  time  and that  ventilation  systems  not designed  with  a                                                               
pandemic in  mind could quickly spread  infection across multiple                                                               
floors.   He urged the  administration to engage with  the unions                                                               
on notification  to ensure  people aren't  continuing to  come to                                                               
work after they have been exposed.                                                                                              
1:59:13 PM                                                                                                                    
REPRESENTATIVE STORY expressed her hope  that work from home will                                                               
be  stressed at  this time.   She  recalled a  statement that  40                                                               
percent of  the State of  Alaska workforce is working  from home.                                                               
She inquired  as to how  the department feels about  working from                                                               
home  and assessing  how many  employees  can work  from home  in                                                               
order to provide safe distancing  at work and providing safety to                                                               
employees during this time of coronavirus.                                                                                      
MS. SHEEHAN acknowledged  that the 40 percent figure  is her data                                                               
from mid-May,  and she doesn't have  the latest, but it  is about                                                               
6,000 employees.   The teleworking is going  well, she continued,                                                               
but obviously  not every position  is suitable for  telework, nor                                                               
is every  employee.   Also, some  people prefer  to be  at [their                                                               
office] because  of their home  environment or because  they need                                                               
multiple computer  screens beyond  a laptop.   There is  no state                                                               
directive  to return  to work,  but there  some things  that just                                                               
cannot be  done from home  and need to  be done at  [the office].                                                               
The state  is recognizing that there  won't be a back  to normal,                                                               
there is  going to  be a  new normal  and telework  is definitely                                                               
going to be a part of that.                                                                                                     
2:02:04 PM                                                                                                                    
REPRESENTATIVE  TARR asked  about the  narrative that  some state                                                               
employees, as  well as  non-state employees,  are trying  to take                                                               
advantage  of the  coronavirus situation  so they  don't have  to                                                               
work.  She  opined that that isn't a  fair representation because                                                               
it doesn't  capture that  some folks are  in the  predicament of,                                                               
yes, they  could go back to  work, but they have  personal health                                                               
concerns,  are concerned  about  someone at  home,  or they  have                                                               
childcare.  She has heard that  some state managers are not being                                                               
supportive of  employees who are  trying to balance  working from                                                               
home and  dealing with childcare.   She asked what could  be done                                                               
to ensure flexibility in the  workplace that is reflective of the                                                               
times and that supports people with the aforementioned concerns.                                                                
MR. METCALFE replied that childcare  is one of the biggest issues                                                               
faced by  ASEA members regarding a  return to work since  not all                                                               
childcare facilities are open.   Childcare and compromised immune                                                               
systems  are   important  reasons  for  why   telework  needs  to                                                               
continue.   He  related  that ASEA  sued  because people  weren't                                                               
being treated  the same  on telework; as  a result,  the telework                                                               
process  was sped  up.   The  union is  grateful that  it is  now                                                               
working  well for  both the  state and  employees, but  there are                                                               
still problems.   He said  ASEA's members  want to work  and they                                                               
know that  essential services have  to continue for the  state to                                                               
function.   Both  sides must  provide  clear communication,  must                                                               
listen  to one  another, and  must provide  ways that  people can                                                               
come back to  work safely.  Making people have  to choose between                                                               
taking  care of  their children  or  going to  their job  doesn't                                                               
benefit anybody in Alaska.                                                                                                      
2:07:59 PM                                                                                                                    
CHAIR  ZULKOSKY asked  how many  state offices  are operating  on                                                               
restricted  public  access   or  by-appointment-only  access  and                                                               
whether that will continue in the  future.  As stated in previous                                                               
testimony, Alaska  has far  to go to  achieve herd  immunity, and                                                               
protecting  employees should  be  a fundamental  function of  the                                                               
state's government.                                                                                                             
MS. SHEEHAN  answered she  will get back  to the  committee about                                                               
the specific number  of offices.  She pointed out  that the state                                                               
is open for  business and didn't shut down.   Certain precautions                                                               
have been  implemented; for example, the  Permanent Fund Division                                                               
in Juneau has a table in  the building's eighth floor lobby where                                                               
the public  can fill out  information forms rather than  going to                                                               
the division's eleventh  floor office.  Floors  have been blocked                                                               
off and  some offices have telephones  for the public to  use for                                                               
calls and some have put up shields to prevent direct contact.                                                                   
CHAIR ZULKOSKY requested Ms. Sheehan  to also provide information                                                               
on  how  the state  is  providing  proactive outreach  about  the                                                               
change in operations and which offices have restricted access.                                                                  
MS. SHEEHAN agreed to do so.                                                                                                    
2:10:37 PM                                                                                                                    
CO-CHAIR  FIELDS   inquired  whether   the  state   has  mandated                                                               
facemasks  for  members  of  the  public  entering  buildings  to                                                               
interact with state employees.                                                                                                  
MS. SHEEHAN responded  that she doesn't know the  answer and will                                                               
include that in her response to the committee.                                                                                  
2:11:06 PM                                                                                                                    
CHARLES STEWART, Adult  Probation Officer, Anchorage Correctional                                                               
Complex,  Department of  Corrections,  State  of Alaska,  related                                                               
that the Anchorage Correctional Complex  is one of the facilities                                                               
that  has  had  a  positive  case  of  COVID-19.    He  said  the                                                               
department has  done an  excellent job  of screening  people, but                                                               
one problem  is communication  with staff.   It would  be helpful                                                               
and appreciated  if management would  notify staff of  a possible                                                               
case  as well  as a  positive case  because waiting  all day  and                                                               
listening to rumors causes more  stress for the staff.  Resources                                                               
within the facility are scarce and  the department may want to do                                                               
better preparing in  the future.  Staff  recommends that everyone                                                               
wear masks at all times for as long as new cases are popping up.                                                                
MR. STEWART said  tension among the inmates is very  high, with a                                                               
noticeable increase in fights and  unrest since the cancelling of                                                               
programming   and   visiting   privileges.     With   appropriate                                                               
precautions in  place, some of  these things could  be reinstated                                                               
and  would  be  helpful  in decreasing  tension  levels,  thereby                                                               
increasing staff  and inmate  safety.   Letting people  back into                                                               
the  facility  should  be  done  slowly  with  proper  mitigation                                                               
planning in  place.  He related  that the positive case  was in a                                                               
place isolated  from the other  residents, but  had it been  in a                                                               
module of  60-70 inmates  it could have  passed around  the whole                                                               
facility in  less than a  week and  caused more cases  than there                                                               
are total cases in the state.                                                                                                   
2:14:15 PM                                                                                                                    
KELLY FERGUSON,  Nurse, Alaska Pioneer Home-Sitka,  Department of                                                               
Health and  Social Services (DHSS),  State of  Alaska, emphasized                                                               
the  importance of  maintaining a  strict health  mandate, strong                                                               
screening,  inclusion   of  antibody  screening,   and  [contact]                                                               
tracing.   She pointed out that  many nurses are over  the age of                                                               
45 and have  an increased chance of complications  and death when                                                               
exposed to  COVID.  She  stressed the importance of  making full,                                                               
structured, organized PPE kits available  to staff, not piecemeal                                                               
PPE.   Organizing full PPE  is very  important when working  in a                                                               
24/7  facility  that  houses  the  state's  precious  elders  who                                                               
deserve  respect.   Employees also  deserve respect  by providing                                                               
them  with  the necessary  equipment  for  taking care  of  these                                                               
MS. FERGUSON stressed the importance  of consistent testing.  She                                                               
said  some employees  working at  the  SouthEast Alaska  Regional                                                               
Health Consortium (SEARHC) in Sitka  get screened every two weeks                                                               
for COVID-19,  but the Pioneer  Home doesn't screen  residents or                                                               
staff at  this point.   The Pioneer  Home has employees  who also                                                               
work  at  SEARHC  or  other  facilities,  so  the  importance  of                                                               
consistent  organized structuring  of combatting  and controlling                                                               
the disease process is very  important.  She further stressed the                                                               
importance  that  all employees  who  work  on the  frontline  be                                                               
screened appropriately and be provided with PPE.                                                                                
MS. FERGUSON  stated that quarantine  is very important  as well.                                                               
She related  that a  friend of  hers who  traveled to  Africa was                                                               
immediately detained at  the airport and quarantined  for 14 days                                                               
in a hotel at  his own expense.  She said she  has lived in Sitka                                                               
for 26  years and doesn't want  to see it devastated  by a virus.                                                               
It is important  for all communities and all  departments to work                                                               
together in finding  an organized consistent plan  of action that                                                               
works everywhere in the state.                                                                                                  
2:18:53 PM                                                                                                                    
RANDY   MCLELLAN,   President,   Alaska   Correctional   Officers                                                               
Association  (ACOA),  stated   that  the  Anchorage  Correctional                                                               
Complex  recently had  a confirmed  COVID-19  case, bringing  the                                                               
number  of facilities  in Alaska  with positive  cases to  three.                                                               
More  than  ever,  he  continued, it  is  imperative  to  protect                                                               
correctional officers  and other first responders  who risk their                                                               
lives and the lives of  their families protecting Alaskans during                                                               
this state and national health emergency.                                                                                       
MR. MCLELLAN  urged that DOC follow  the lead of other  states by                                                               
drastically  increasing  COVID-19   testing  within  correctional                                                               
facilities.  The DOC, he  related, declined COVID-19 testing even                                                               
when it  was offered for free  to everyone at the  Anvil Mountain                                                               
Correctional  Center  by  the Norton  Sound  Health  Corporation.                                                               
Many  states   are  aggressively  testing  for   COVID-19  within                                                               
institutions.  For example, Ohio  has tested over 5,000 people in                                                               
its state prisons so far.  It  is still unknown how a Goose Creek                                                               
Correctional Center inmate and  an Anchorage Correctional Complex                                                               
inmate, both  having been incarcerated for  a considerable amount                                                               
of  time and  so  didn't  come to  prison  with COVID-19,  tested                                                               
positive for the virus.   He said he thinks it is  due to lack of                                                               
testing.  Every  DOC staff member and inmate should  be given the                                                               
opportunity  to be  tested  if  it isn't  mandatory.   Every  new                                                               
inmate entering an Alaska correctional  facility should be tested                                                               
and quarantined until the inmate's test comes back negative.                                                                    
MR.  MCLELLAN quoted  from  a  statement on  the  website of  the                                                               
Centers  for  Disease Control  and  Prevention  (CDC):   "Another                                                               
population  in   which  the  prioritized  testing   of  minimally                                                               
symptomatic  and even  asymptomatic  persons  are long-term  care                                                               
facility residents,  especially in  facilities where one  or more                                                               
residents have  been diagnosed  with symptomatic  or asymptomatic                                                               
COVID-19."  Dealing effectively with  the virus can only be done,                                                               
he  continued, if  the  extent  of the  virus's  spread within  a                                                               
facility is known.  It is  understood that the state doesn't wish                                                               
to see  an increase in diagnosed  cases, but now is  not the time                                                               
to put politics before lives.                                                                                                   
MR.  MCLELLAN noted  that the  State of  Alaska was  awarded $3.6                                                               
million  from  the  federal  Coronavirus  Emergency  Supplemental                                                               
Funding Program  to support law enforcement  during this COVID-19                                                               
pandemic.    He  said  these  funds should  be  used  to  support                                                               
correctional  officers,  make  appropriate  protective  equipment                                                               
available,  and  conduct  widespread testing  of  inmates  within                                                               
Alaska's  correctional system.   As  of this  date, none  of this                                                               
money has been specifically allocated to  DOC.  The DOC needs PPE                                                               
to give  to all security staff,  not just medical staff.   Making                                                               
N95 masks  available to all  DOC employees would  provide another                                                               
tool that  officers could  use to  protect themselves  and others                                                               
from  COVID-19.    This  pandemic   has  resulted  in  additional                                                               
significant  dangers  to correctional  officers.    Aware of  the                                                               
risk,  correctional officers  continue  to  perform their  duties                                                               
with  dedication  and  courage,  even in  those  facilities  with                                                               
confirmed cases of COVID-19.                                                                                                    
2:22:53 PM                                                                                                                    
JOSHUA  WILSON,   Business  Agent,  Alaska   Correction  Officers                                                               
Association (ACOA),  noted he has been  representing correctional                                                               
officers  in   the  state  of   Alaska  for  over   seven  years.                                                               
Everything needs  to be done,  he said,  to ensure the  safety of                                                               
the   staff  and   incarcerated  Alaskans   within  the   state's                                                               
correctional  facilities.     Any  reasonable  safety   plan  and                                                               
mitigation strategy should include  cooperation between the state                                                               
and the  employees.   Last week  the state  refused to  meet with                                                               
ACOA  to   bargain  about  the   changes  unilaterally   made  to                                                               
correctional  officers' working  conditions.    A reasonable  and                                                               
appropriate  solution  that  protects correctional  officers  and                                                               
Alaska's institutions can only come about by working together.                                                                  
MR.  WILSON  pointed out  that  the  dangers are  throughout  the                                                               
correctional  institutions.   He said  DOC couldn't  successfully                                                               
adhere  to   the  governor's  COVID-19  mandate   because  social                                                               
distancing  is   simply  not   possible  within   a  correctional                                                               
facility.   On  May  5, 2020,  it was  reported  that over  5,000                                                               
correctional officers in the U.S.  had contracted COVID-19 and 46                                                               
had died due  to the virus.   While none of those  deaths were in                                                               
Alaska,  the   staff  and  those  incarcerated   at  correctional                                                               
facilities  are at  significant risk  of infection  and outbreak.                                                               
As such, the measures put in  place reduce the spread of COVID-19                                                               
within  Alaska  correctional  facilities,  and  it  is  extremely                                                               
important that they  be adhered to and maintained:   no visitors,                                                               
no nonessential  staff or  personnel in  and out  of correctional                                                               
facilities,  and  continue  to  limit  or  cease  altogether  the                                                               
transfer  of  inmates between  facilities  or  any other  outside                                                               
location other than for serious medical emergencies.                                                                            
2:25:08 PM                                                                                                                    
REPRESENTATIVE HOPKINS inquired about  the communication that Mr.                                                               
Wilson is seeing  with administrators and whether  there seems to                                                               
be concern about people being infected.                                                                                         
MR. WILSON replied  that a great improvement  in communication is                                                               
needed, as  there is very little.   He said there  is very little                                                               
information  for officers  and things  are not  uniformly set  at                                                               
each institution, which leads to  much confusion.  Many questions                                                               
have  been  sent  to  the  state, but  there  haven't  been  many                                                               
answers.   Even  receiving a  response  that an  answer is  being                                                               
worked  on  would  be  beneficial  and  could  be  passed  on  to                                                               
officers.    The association  has  requested  that names  not  be                                                               
provided,  but  that it  be  alerted  when officers  have  tested                                                               
positive so support  can be provided for something  that could be                                                               
life threatening.  The state  has refused to give the association                                                               
that  information, yet  the state  has had  no problem  providing                                                               
that publicly to other entities.                                                                                                
REPRESENTATIVE  HOPKINS requested  DOA to  comment as  to whether                                                               
there are any plans to  communicate quickly or going forward with                                                               
the ACOA and/or ASEA.                                                                                                           
MS. SHEEHAN responded  that she hears what Mr.  Wilson is saying.                                                               
She said the institutions are  a unique environment and she feels                                                               
she is often the middleman  in getting the questions and probably                                                               
the hang-up  in getting out  some of  the answers, for  which she                                                               
takes responsibility.   She  added that  ACOA will  absolutely be                                                               
communicated with and the state is working on answers.                                                                          
2:28:13 PM                                                                                                                    
CO-CHAIR FIELDS invited Dr. Lawrence  and Ms. Howell of the State                                                               
of  Alaska  to  provide testimony  regarding  communication,  the                                                               
availability of N95 masks, and testing frequency at facilities.                                                                 
2:29:19 PM                                                                                                                    
ROBERT  LAWRENCE,   M.D.,  Chief  Medical  Officer,   Health  and                                                               
Rehabilitation Services (HARS),  Department of Corrections (DOC),                                                               
State  of Alaska,  addressed communication.    He said  it is  an                                                               
important  point to  hear from  the  officers themselves  because                                                               
there are actually  four different epidemics ongoing  at the same                                                               
time.   The first  is COVID-19.   The others  are misinformation,                                                               
fear,  and stigma,  and  staying  ahead of  those  waves is  very                                                               
difficult.   In the attempt  to stay  ahead of those  waves, care                                                               
must be taken not to throw  out the principles of patient privacy                                                               
and making  sure that communication,  when it does  occur, occurs                                                               
to the right people at the right time.                                                                                          
DR. LAWRENCE explained  that when there is an  outbreak, DOC does                                                               
its best  to ensure that the  patient is the first  person who is                                                               
given  the test  result information.    The second  people to  be                                                               
contacted  are those  who have  been in  close contact  with that                                                               
patient.  By that point, the  rumor mill has already spun out and                                                               
there  are many  others who  want  information right  then.   But                                                               
DOC's next  move is to meet  with its partners in  the Section of                                                               
Epidemiology and Division of Public  Health because that is where                                                               
a plan  specific to  the given outbreak  is formulated,  and this                                                               
takes time.   As soon  as that plan  is available, DOC  goes back                                                               
into  the  facility  and  speaks  specifically  to  officers  and                                                               
inmates.   In most cases it  has been the superintendent  of each                                                               
facility who  then personally goes and  gives that communication.                                                               
In other cases some of the  officers are given the information to                                                               
pass on  to other  officers.  It  is not a  simple posting  of an                                                               
announcement  on a  wall or  sending  out an  email because  that                                                               
would be  a dangerous way to  get out that information.   Instead                                                               
DOC does its  best to keep that balance of  patient privacy while                                                               
ensuring that  everyone who is  affected by an  outbreak receives                                                               
that information in the appropriate amount of time.                                                                             
CO-CHAIR FIELDS stated  that it is important for the  union to be                                                               
integral  in that  process because  employees have  chosen to  be                                                               
represented  by the  union, including  for purposes  of workplace                                                               
safety.     He  asked   whether  N95   masks  are   available  to                                                               
[correctional] officers as they  are to Anchorage police officers                                                               
and other frontline public safety officials.                                                                                    
DR. LAWRENCE  replied yes,  N95 masks  are available  to officers                                                               
just like  they are to  medical personnel within  the department.                                                               
He said it is important to  understand that that is only one form                                                               
of  PPE.    For  example,  everyone in  the  room  [where  he  is                                                               
testifying] is  wearing a mask and  practicing social distancing.                                                               
The masks are a  form of PPE, but would not  be appropriate if he                                                               
were doing a medical procedure that  required an N95 mask.  There                                                               
is an  escalation of the  appropriate PPE for a  given situation.                                                               
He confirmed  that the  department has  the appropriate  PPEs for                                                               
any    medical-type   situation    that   arises    within   DOC.                                                               
Additionally, one  thing he  values about  the officers  is that,                                                               
even though he as a physician is  taking care of some of the most                                                               
dangerous patients  in Alaska, he  has an officer right  there at                                                               
his back and he  is going to make sure that  that officer has the                                                               
appropriate PPE  to wear  during that  procedure because  in that                                                               
sense  he  also has  the  officer's  back.    He noted  that  DOC                                                               
publishes materials  to ensure that  everyone knows  exactly what                                                               
type of PPE  is appropriate for any given situation  and that PPE                                                               
is available.                                                                                                                   
2:33:37 PM                                                                                                                    
CO-CHAIR FIELDS requested clarification  on whether N95 masks are                                                               
available to any correctional officer  who chooses to wear one at                                                               
work on a daily basis.                                                                                                          
DR. LAWRENCE responded that N95  masks are available, but are not                                                               
always the  appropriate mask to wear  just because of being  in a                                                               
correctional facility  or state office  building.  He  added that                                                               
N95 masks are not available at  the entry door, but are available                                                               
when that is the appropriate PPE for the given situation.                                                                       
CO-CHAIR  FIELDS asked  whether  N95 masks  provided  by DOC  are                                                               
available  for correctional  officers to  wear on  the job  if an                                                               
officer  feels that  that mask  is appropriate.   He  offered his                                                               
concurrence  with   ACOA's  contention  that  making   N95  masks                                                               
available to employees is a reasonable thing to do.                                                                             
DR. LAWRENCE answered, "Yes, N95 masks are available."                                                                          
CO-CHAIR FIELDS asked what DOC's  current testing frequency is of                                                               
employees and  inmates.  He  also asked what DOC's  ideal testing                                                               
frequency would  be to  catch an outbreak  at the  earliest stage                                                               
given the  anticipation that there will  be a rise in  cases with                                                               
re-opening of the economy.                                                                                                      
DR. LAWRENCE  replied that DOC's  testing follows  CDC guidelines                                                               
and  that DOC  also works  in collaboration  with the  Section of                                                               
Epidemiology  and  Division of  Public  Health.   He  said  DOC's                                                               
testing  occurs in  three  different settings  and  formats:   1)                                                               
anyone who  has COVID symptoms,  screening of  inmates, screening                                                               
of employees  every day; 2)  anyone being prepared  for transport                                                               
to  the  hospital;  and 3)  broad-base  testing  of  asymptomatic                                                               
people as part of contact tracing.                                                                                              
2:36:21 PM                                                                                                                    
CO-CHAIR FIELDS inquired whether, in  the interest of safety, DOC                                                               
will  be able  to move  to a  more proactive  form of  testing of                                                               
asymptomatic people as has been done in some countries.                                                                         
DR. LAWRENCE responded  that there is not yet data  to say broad-                                                               
base  testing in  the absence  of  a known  outbreak is  actually                                                               
beneficial.   When testing an  entire facility, he  continued, it                                                               
has  been found  that the  virus hasn't  spread beyond  the index                                                               
case.  This  is instructive when looking at models  for what will                                                               
work throughout the state to identify and then prevent spread.                                                                  
CO-CHAIR FIELDS asked what assistance  is offered by DOC to test,                                                               
particularly in facilities that are  off the road system where it                                                               
wouldn't be wanted for the facility  to be the primary vector for                                                               
infecting an entire community.                                                                                                  
DR.  LAWRENCE answered  that an  offer has  been made  by certain                                                               
hospitals  throughout the  state  to provide  testing.   In  this                                                               
pandemic, hospitals  and communities  have told  DOC to  let them                                                               
know if  they can  be of help  with testing and  Nome was  one of                                                               
those communities.   When the offer was made there  was no one in                                                               
the facility with symptoms, and  per CDC guidelines there was not                                                               
a reason for  broad-base testing at that time.   However, if that                                                               
point is  reached, DOC will reach  out to the hospitals  in Nome,                                                               
Fairbanks, and elsewhere.                                                                                                       
2:40:10 PM                                                                                                                    
REPRESENTATIVE  JACKSON  inquired  whether it  is  accurate  that                                                               
Alaska's correctional system has had only three cases.                                                                          
DR. LAWRENCE  replied it is  important to separate the  number of                                                               
cases among staff members and  the number of cases among inmates.                                                               
Within DOC there  have only been two cases among  inmates, one at                                                               
the  Goose  Creek  Correctional  Center  and  the  other  at  the                                                               
Anchorage Correctional Center.  For  cases among staff members it                                                               
is important  to note that the  Division of Public Health  is the                                                               
agency that  keeps those numbers,  and the 11  published positive                                                               
cases were at the Lemon Creek facility.                                                                                         
REPRESENTATIVE JACKSON  asked why Alaska's  correctional officers                                                               
believe they  are not receiving the  $3.6 million that was  to go                                                               
to law enforcement.                                                                                                             
2:41:55 PM                                                                                                                    
KELLY HOWELL, Special Assistant  to the Commissioner/ Legislative                                                               
Liaison, Office  of the  Commissioner, Department  of Corrections                                                               
(DOC), explained that this funding  is coming from the Department                                                               
of Justice and  the $3.6 million is part of  the carve-out to the                                                               
State of  Alaska's administering agency, which  is the Department                                                               
of  Public Safety  (DPS).   The  DPS, then,  will allocate  those                                                               
funds as  it determines appropriate  to law  enforcement agencies                                                               
across the  state.  That  application process is  occurring right                                                               
now, and  DOC is submitting an  application to DPS for  a portion                                                               
of  that $3.6  million and  DOC is  looking forward  to receiving                                                               
funds to help support its efforts in combatting the COVID virus.                                                                
REPRESENTATIVE  JACKSON offered  her understanding  that it  is a                                                               
matter of timing and process  and the process hasn't gotten there                                                               
yet, but  a portion of those  funds will be there  to ensure that                                                               
all departments are kept safe.                                                                                                  
MS. HOWELL answered correct; DOC  expects to receive a portion of                                                               
that funding.  How much is  yet to be determined.  The Department                                                               
of Public  Safety is the  administering agency for  those federal                                                               
funds, DOC  expects to receive  some of  the funds, and  DOC will                                                               
have its  application submitted  to DPS  by the  end of  the week                                                               
[May 29, 2020].                                                                                                                 
CO-CHAIR FIELDS requested  Dr. Erin Bromage discuss  why six feet                                                               
of  distancing  indoors  doesn't necessarily  provide  protection                                                               
from the COVID-19 virus and to  discuss the risks of being inside                                                               
for long periods of time with multiple people.                                                                                  
2:44:02 PM                                                                                                                    
ERIN BROMAGE,  Ph.D., Associate Professor of  Biology, College of                                                               
Arts and Sciences, University  of Massachusetts Dartmouth, stated                                                               
that for the past month he  has been looking at where the primary                                                               
risk factors  for infection  take place.   He  hasn't necessarily                                                               
been  looking at  one-to-one interactions,  he explained,  but at                                                               
single  events where  superspreading  has taken  place.   All  of                                                               
these  superspreading events  tend to  have a  similar underlying                                                               
cause -  many people in  an enclosed environment for  an extended                                                               
period  of time.    Poor  air filtration  and  poor air  exchange                                                               
increase the magnitude  of attack rates and the  number of people                                                               
who  actually  get  infected.    This  is  different  from  other                                                               
respiratory viruses  in the  past.   For example,  with influenza                                                               
most  of the  time face-to-face  interactions for  10 minutes  at                                                               
less than  six feet without masks  will lead to infection.   With                                                               
COVID-19  there is  a window  of about  five days  where infected                                                               
people  are  infectious  but  not showing  any  symptoms.    With                                                               
influenza, as well  as with the original SARS  virus, this period                                                               
is  only 24  hours.   This cryptic  pathogen can  stay hidden  in                                                               
people  that  appear  otherwise healthy  but  who  are  literally                                                               
shedding  enormous amounts  of the  virus  into the  environment.                                                               
When these  people are put with  lots of people into  an enclosed                                                               
space,  rather than  spreading to  just  one or  two others,  the                                                               
virus  can  spread  to  tens, hundreds,  and  even  thousands  of                                                               
DR.  BROMAGE specified  that new  data show  that just  breathing                                                               
releases  small amounts  of respiratory  droplets  into the  air.                                                               
These droplets  persist in the air  for up to eight  minutes in a                                                               
still-infectious  state.   After  eight minutes  in  the air  the                                                               
viral envelope  begins to lose  its moisture and breaks  down, or                                                               
the  virus falls  out  of the  air.   However,  he continued,  an                                                               
infected person  who is just  breathing in an enclosed  space can                                                               
build  that up  so  that  others in  the  room  can inhale  small                                                               
amounts  of the  virus  over a  period of  30  minutes to  hours,                                                               
thereby building up  to a level of viral load  that can establish                                                               
an infection.   In  the case  of COVID-19, a  person with  a high                                                               
viral load,  which can only  be told  by testing the  person, can                                                               
result in half of the people in  a building or half of the people                                                               
attending  a conference  becoming  infected.   If  there is  also                                                               
yelling, talking  loudly, or singing,  the amount  of respiratory                                                               
emissions increases  between 10 and 100-fold  over just breathing                                                               
and  these  emissions  will  also be  projected  over  a  greater                                                               
distance and reach more people inside that enclosed space.                                                                      
DR. BROMAGE explained  that to minimize the risk  of jumping from                                                               
1-10 cases  per day in the  state to 100-200 cases  from a single                                                               
incident,  a  look must  be  taken  at  how interior  spaces  are                                                               
engineered, how  many people  are in the  spaces, and  at airflow                                                               
patterns.   For example, Victoria,  Australia, was down  to fewer                                                               
than  two cases  per day  and then  a single  asymptomatic person                                                               
went to work in a meat packing  facility and caused 34 cases.  In                                                               
another  event, 30  gym  instructors came  together  at an  event                                                               
where 12  of them became  infected and  those 12 infected  108 of                                                               
their customers.   Failure to look  at situations of a  number of                                                               
people  close to  each other  in an  enclosed environment  for an                                                               
extended  period  of time  as  being  a  high  risk for  a  rapid                                                               
escalation of cases will result in a rapid escalation of cases.                                                                 
2:51:32 PM                                                                                                                    
CHAIR  ZULKOSKY  requested  DOC to  verify  that  the  department                                                               
refused the offer of COVID-19 testing of its employees.                                                                         
MS. HOWELL  confirmed the testing  was offered.  She  deferred to                                                               
Dr. Lawrence for further response.                                                                                              
DR. LAWRENCE clarified that the  offer from multiple hospitals is                                                               
that, in  the case of an  outbreak, the hospitals would  be happy                                                               
to test all  the inmates.  That offer, he  continued, is separate                                                               
from the offer  to test DOC officers or employees.   At this time                                                               
that testing  is available  to anyone  working within  DOC within                                                               
the  respective  communities.    There has  been  no  attempt  to                                                               
restrict employees  from taking  advantage of that  testing offer                                                               
within their communities.                                                                                                       
CHAIR  ZULKOSKY inquired  whether  she is  correct in  concluding                                                               
that there  has been  no inclination  to prohibit  employees from                                                               
receiving COVID-19  testing, but there  has not been  an accepted                                                               
offer to test the inmates at these facilities.                                                                                  
DR. LAWRENCE replied that there  have been at least two outbreaks                                                               
involving  inmates  and three  when  counting  staff members  who                                                               
tested positive through  screening.  Each of  those outbreaks led                                                               
to  a broad-based  testing and  there is  never a  time that  DOC                                                               
declined to do the broad-based testing that was recommended.                                                                    
CHAIR ZULKOSKY  offered her understanding from  today's testimony                                                               
that it was  previous thought there was no  need for asymptomatic                                                               
testing,  but  that there  is  now  a  growing body  of  evidence                                                               
suggesting  that COVID-19  is infectious  even when  a person  is                                                               
asymptomatic.  She related from  her experience within healthcare                                                               
that  many healthcare  facilities  have  broadened their  testing                                                               
criteria  to  testing  asymptomatic   people  because  there  are                                                               
individuals who  can test positive while  remaining asymptomatic.                                                               
She  requested  Dr. Bromage  to  speak  to  the growing  body  of                                                               
evidence around the testing of  individuals regardless of whether                                                               
they are symptomatic.                                                                                                           
DR.  BROMAGE  pointed out  that  those  countries doing  well  in                                                               
controlling  the  outbreak  have   provided  testing  for  anyone                                                               
wanting the testing while prioritizing  the testing to people who                                                               
are  sick, at  highest risk,  or who  have come  in contact  with                                                               
someone  who is  sick.    Alaska has  done  a  remarkable job  at                                                               
keeping the general  infection rate quite low and  its testing is                                                               
quite high.   The desired test  ratio is between 2  and 5 percent                                                               
positive and  Alaska is  at 0.4  percent.  This  is good  in that                                                               
Alaska  is capturing  a lot  of the  community transmission  just                                                               
with its  standard testing alone.   Of concern, he  continued, is                                                               
that  when this  particular  virus is  brought  into an  enclosed                                                               
environment it  cannot be easily  contained, as has been  seen in                                                               
jails throughout  the world.   However that needs to  be tempered                                                               
with the  fact that [DOC] could  be testing all of  its employees                                                               
and prison  guards today  and they may  actually be  infected but                                                               
not infectious at the time of the  test and the next day there is                                                               
enough virus to  be detected and testing needs to  be done again.                                                               
When dealing with that type  of situation, the utility of testing                                                               
the guards  and getting a single  snapshot in time when  there is                                                               
already  a good  handle of  it in  the state  may not  have value                                                               
unless there is regular testing every  day in order to ensure the                                                               
virus  doesn't  get in.    He  said he  is  unsure  that that  is                                                               
practical  given the  limited testing  capability  and access  to                                                               
resources for testing.   He would be giving  different advice, he                                                               
continued, if  he were being  asked about  this in Boston  or New                                                               
York City.   But from what he  can see of the  quality of testing                                                               
and the amount  done locally in Alaska, he isn't  sure that would                                                               
be money and  resources well spent with the state's  low level of                                                               
community spread.                                                                                                               
CO-CHAIR FIELDS  pointed out  that Alaska  is just  reopening its                                                               
economy,  including  restaurants  and places  identified  by  Dr.                                                               
Bromage  as vectors  in other  regions.   He asked  how outbreaks                                                               
could  be prevented,  and particularly  prevented from  spreading                                                               
into rural  communities that heretofore  have been  protected, as                                                               
Alaska looks forward to a more open economy.                                                                                    
DR. BROMAGE responded that, in  general, Alaska needs to keep its                                                               
testing where it is in order to  keep a handle on it.  Alaska, he                                                               
continued, is much  better situated than the  other states around                                                               
the U.S.  because it  has an excess  testing capacity  because it                                                               
has so fewer cases.  If Alaska  sees an uptick in its daily cases                                                               
and the  trend starts  to go  up, Alaska is  able to  implement a                                                               
knowledge-based campaign to get  people thinking about increasing                                                               
their  social distancing  and using  masks to  tamp it  back down                                                               
again.   Alaska has the capacity  with its testing to  capture it                                                               
early before  it goes crazy.   When  looking at stopping  it from                                                               
getting  into high-risk  environments, and  maybe from  employees                                                               
and prison  guards bringing  it in, Alaska  may want  to consider                                                               
categorizing its  prison guards  in regard  to the  contacts they                                                               
have to the outside of their workplace.   If they live in a house                                                               
with someone who is  in a frontline place or a  place where it is                                                               
high risk,  then Alaska  might want to  allocate resources  to be                                                               
testing them more  often.  The risk is much  lower for people who                                                               
are more isolated  and have fewer contacts in the  day outside of                                                               
work,  and  they can  be  put  on  a  different testing  or  risk                                                               
spectrum in  regard to what is  being looked for, such  as how to                                                               
evaluate, test, and mitigate risk in the best way possible.                                                                     
3:00:34 PM                                                                                                                    
CO-CHAIR  FIELDS requested  Dr.  Bromage to  provide examples  of                                                               
where a restaurant  or other workplace served  as a superspreader                                                               
event so  that people can  take risk  into account as  the Alaska                                                               
economy reopens.                                                                                                                
DR. BROMAGE cited a recent example  of a bus trip where 64 people                                                               
spent  a little  over  an hour  together and  27  of them  became                                                               
infected.   A second bus  traveling with  the first had  none, so                                                               
the transmission  happened on board  the bus in that  time during                                                               
traveling.   For restaurants,  an example  is where  one infected                                                               
person sat  a table with nine  other people.  Five  of the others                                                               
at that table were infected, as  were three of the four people at                                                               
the table  slightly downwind of  the air conditioning  blast from                                                               
the first table.  Two of  five people at the table underneath the                                                               
air  conditioner and  upstream  of the  first  table also  became                                                               
infected.   This  was because  the air  conditioner blew  the air                                                               
downward  and  then  the  air  circulated around  the  room.    A                                                               
workshop conference  is another  example.  Sixty  attendees spent                                                               
two  days together  in a  room and  34 of  them became  infected.                                                               
Another  example  is  the  Biogen   Conference  held  in  Boston,                                                               
Massachusetts,  which  resulted  in many,  many  people  becoming                                                               
sick.   At  a  call center  in  South Korea  there  was a  single                                                               
asymptomatic worker on the eleventh  floor of the building; 94 of                                                               
the 214 people on that floor became  sick and 91 of those 94 were                                                               
in  the same  vesseled area  as the  one infected  person.   Only                                                               
three of the people sitting on the other side of the floor-to-                                                                  
ceiling partition  became sick.   Yet another example is  a choir                                                               
in Washington  State where  60 people were  in attendance.   They                                                               
had  the requirements  of the  social  distancing regulations  in                                                               
place.  The  choir was in a  hall a bit larger  than a volleyball                                                               
court,  the 60  people were  as far  apart as  they could  be and                                                               
didn't touch one another or share  food, they just sang for a few                                                               
hours.  Thirty-two of the people  became sick and three died.  It                                                               
is  being seen  that when  a  lot of  people are  together in  an                                                               
enclosed space and  the longer the time they  spend together, the                                                               
higher the chance that someone is  going to get sick and the more                                                               
people from that group will get sick.                                                                                           
CO-CHAIR FIELDS said the takeaway  is that indoors with prolonged                                                               
exposure, even with social distancing,  the rate of spread can be                                                               
very high, which has implications for Alaska's state facilities.                                                                
3:04:33 PM                                                                                                                    
REPRESENTATIVE  JACKSON   asked  whether  the  [first   group  of                                                               
customers] in  the restaurant example  were screened  before they                                                               
went into the  restaurant because without screening  how would it                                                               
have been known [someone at that table had the virus].                                                                          
DR.  BROMAGE  answered that  this  is  one  of the  best  studies                                                               
because  it was  known that  the people  at the  different tables                                                               
weren't related, didn't know each  other, and had had no contacts                                                               
with  each  other prior  to  coming  into  the restaurant.    The                                                               
authors did genetic  sequencing to address the  chance that other                                                               
people in there might have been  infected and it wasn't from that                                                               
point  source.   This  virus has  a  fairly predictable  mutation                                                               
rate,  so  if  the  customers   had  acquired  the  infection  at                                                               
different places before  coming into the restaurant,  and it just                                                               
so happened they infected their  own tables, it would be expected                                                               
that  the  genetic  sequencing   between  the  viruses  would  be                                                               
different.   In  this  particular case  the  sequencing from  the                                                               
people  that  were  infected  there  showed  an  identical  viral                                                               
sequence, so the  transmission in this event  was definitely from                                                               
the first  person with the  virus to the  others.  What  can't be                                                               
discounted is  that the person  at the table infected  two people                                                               
at the table  and then those two people in  24 hours infected the                                                               
other people at the table in  their home environments.  But it is                                                               
known that  in this  particular case  the index  case for  all of                                                               
those  people in  that  environment was  from  that single  point                                                               
3:07:47 PM                                                                                                                    
REPRESENTATIVE  STORY   said  a  plan  of   safeguards  is  being                                                               
developed for when state employees  working from home are brought                                                               
back to [the workplace].   From Dr. Bromage's testimony regarding                                                               
space and airflow,  she surmised it would be best  to have people                                                               
who aren't essential employees be able  to work from home if they                                                               
can until there is a  vaccination or getting through the pandemic                                                               
in some other way.                                                                                                              
DR. BROMAGE  recommended that anyone  who can work from  home and                                                               
who can  work efficiently  from home should  be encouraged  to do                                                               
that.  The Australian and  New Zealand governments are doing this                                                               
right  now.   Fewer people  in any  enclosed space  results in  a                                                               
decrease in  infecting others and  a decrease  in the size  of an                                                               
outbreak.   He noted he is  working with the U.S.  District Court                                                               
in Rhode  Island on  managing indoor  environments and  coming up                                                               
with ways to  engineer spaces most effectively with  air flow and                                                               
better filtration to make the  work environment less conducive to                                                               
the spread  of this  infection in  the workplace.   Collaborating                                                               
with  other  facilities and  agencies  is  an important  part  of                                                               
making  government and  private workplaces  as safe  as possible.                                                               
Combining  fewer people,  air exchange,  and air  filtration will                                                               
further reduce the risk of infection.                                                                                           
3:10:44 PM                                                                                                                    
MARY  SWAIN,  Executive  Director, Camai  Community  Health  Care                                                               
Center, stated  that a majority  of the sockeye  salmon harvested                                                               
in the upper  Bristol Bay region is processed in  Naknek.  With a                                                               
fishery this  large (38 million  salmon processed in  Naknek) and                                                               
with a community of only 800,  the expansion that takes place for                                                               
the season  is quite large.   Over about four weeks  Naknek grows                                                               
to more than  10,000 and when the season is  over the workers and                                                               
fishermen leave faster than when they came in.                                                                                  
MS.  SWAIN related  that Camai  Community Health  Care Center  is                                                               
small, with  only three exam rooms  and two beds that  are urgent                                                               
and  emergency care.    In  early March,  she  said, Camai  began                                                               
taking steps to  protect the community.  Camai had  to plan for a                                                               
worst  case  scenario  and  that meant  fishing  season  with  an                                                               
outbreak  of COVID-19.   Camai  began analyzing  what it  had and                                                               
what it would need based  on recommendations from state, federal,                                                               
and other partners  already dealing with the  impacts of COVID-19                                                               
in  their  communities.    The first  decision  was  to  increase                                                               
staffing  levels for  the season.   In  a typical  fishing season                                                               
Camai has five providers for the  peak; this year Camai will have                                                               
MS. SWAIN  said Camai identified  the need to coordinate  with as                                                               
many fishing  processors and industry  businesses as  possible as                                                               
early as  possible, so  a plan  could be  built together.   These                                                               
once-a-week conversations  include discussions about  the changes                                                               
and  mandates, policies,  and  what  is being  put  in place  for                                                               
businesses, as  well as discussing  the concerns of  the industry                                                               
and  the community.    Normally  when there  is  an emergency  or                                                               
disaster, medical plays  a part in the response.   In the case of                                                               
a pandemic, medical  takes the lead in many cases  in many areas.                                                               
Camai's clinic of 14 employees came  together to learn as much as                                                               
possible to  be as  prepared as  possible when  making decisions.                                                               
By working  with the processors  Camai learned about  their plans                                                               
for isolation and quarantine in  response to workers becoming ill                                                               
with  COVID-19.   Most plants  will have  medical staff  in their                                                               
facility to assist in the care  of ill people.  Community members                                                               
will be  able to isolate  and quarantine  in their homes  and, if                                                               
ill,  they can  be monitored  by  Camai staff,  Bristol Bay  Area                                                               
Health Corporation, or public health.                                                                                           
MS. SWAIN  continued and explained  that this left  the fishermen                                                               
as  outliers  potentially needing  a  place  to isolate  if  they                                                               
became ill while  they were on the  water.  A place  close to the                                                               
clinic was  needed so  as to  not burden  the staff  because long                                                               
travel  distances to  monitor the  fishermen would  be difficult.                                                               
She  said she  was contacted  by a  freight company  that offered                                                               
several  modular-housing units  if needed.   Camai  decided that,                                                               
with  beds, staff  could  manage about  15  mildly ill  patients.                                                               
With help  from the Bristol  Bay Borough, Camai purchased  an 11-                                                               
bed unit and leased an 8-bed unit  for the season.  The units are                                                               
on the barge and should be ready  by the second week of June just                                                               
before fishing begins.                                                                                                          
MS. SWAIN  further noted that  the state contacted  her regarding                                                               
Camai's  need for  additional medical  care  in the  event of  an                                                               
outbreak bigger  than Camai can manage.   The state has  an offer                                                               
from  Samaritans First  for a  field hospital  with the  staff to                                                               
manage it if needed and the  Bristol Bay Borough seemed to be the                                                               
right place to put  it.  Plans have now been  made and if alerted                                                               
the hospital  can be set  up within a couple  of days.   This has                                                               
given  Camai staff  peace  of  mind knowing  that  if it  becomes                                                               
overwhelmed there is a plan for help.                                                                                           
MS.  SWAIN said  testing is  the last  part of  Camai's response.                                                               
Due to  the mandates of  the fishing industry, she  stated, Camai                                                               
had to  ramp up its ability  to test a  lot of people in  a short                                                               
amount of  time.   Camai has  tested over  600 people  within the                                                               
last couple  weeks and today 250  people were added.   Testing is                                                               
being done in  several ways.  One is drive-up  testing behind the                                                               
clinic, and another is testing  groups at their processing plants                                                               
so they don't need  to leave the plant.  Samples  are sent to the                                                               
state lab for testing and results  are usually received in two to                                                               
three days.  Tests can be  run in the clinic setting with Camai's                                                               
"Abbott ID  Now" point-of-care machines,  or samples can  be sent                                                               
to the  state lab, whichever a  provider prefers.  This  allows a                                                               
patient who has been exhibiting  symptoms to know exactly whether                                                               
they  are COVID-19  positive.   Camai sends  all negative  Abbott                                                               
results to  the state lab  for verification  and as of  today all                                                               
negatives have  been verified  as negative by  the state.   Camai                                                               
hasn't  yet  had  one  positive  in the  community.    Ms.  Swain                                                               
continued her discussion of testing,  announcing that today Camai                                                               
opened its  walk-in/drive-up testing site in  the building across                                                               
the parking  lot from its  clinic.   This facility has  a 16-port                                                               
point-of-care machine, so  16 tests can be run at  a time and the                                                               
results  reported  within  an  hour.   As  well,  Camai  has  the                                                               
supplies necessary to send out tests from that facility.                                                                        
MS. SWAIN concluded by stating that  Camai believes it has a good                                                               
plan in  place to quickly  identify positive persons and  will be                                                               
able to respond  as needed.  As the state  decides to reopen, the                                                               
community  has,  at  this  point,  decided  to  continue  to  use                                                               
precaution  until  the  fishing  season is  over.    Stores  have                                                               
continued  to require  face coverings,  local  eateries and  bars                                                               
have limited  seating, local tribal  organizations have  put hand                                                               
sanitizer  and  glove  stations  in high  traffic  areas  in  the                                                               
community, and  expediters are expanding to  deliver to boatyards                                                               
and  to pick  up groceries  for those  in quarantine.   Community                                                               
members are  aware that  the risk  is still  there, and  they are                                                               
personally limiting  interactions in public buildings  and public                                                               
gatherings.   Even  if  the state  reopens,  the community  still                                                               
plans to button down the hatch even further.                                                                                    
3:17:17 PM                                                                                                                    
CO-CHAIR  FIELDS  requested  Ms.   Swain's  view  of  information                                                               
sharing  between processors,  the  state, and  Camai  as a  local                                                               
healthcare  provider regarding  the testing  that is  being done,                                                               
including the  testing that is  being done in Seattle  as workers                                                               
are traveling up.   He asked what an ideal  system looks like and                                                               
what can be done to get there.                                                                                                  
MS.  SWAIN  replied  that  currently  the  local  processors  are                                                               
working closely with her.  She  knows which ones are having tests                                                               
done  before arriving  and which  ones Camai  needs to  test upon                                                               
arrival.   Communication between Camai  and the state,  she said,                                                               
is probably  the best  it has  ever been.   She hasn't  gone more                                                               
than 24  hours without  getting a response  to her  question from                                                               
the state, probably  because the state feels that  if an outbreak                                                               
happens it is  going to happen in the fishing  industry.  Testing                                                               
is the  flip side of  communication.  Several processors  want to                                                               
do both  antibody and "PCU,"  which she  doesn't think is  a good                                                               
mix because she doesn't believe it  is at a point for antibodies.                                                               
She offered  her opinion that antibodies  are a way to  study the                                                               
virus but not to diagnose it.                                                                                                   
3:19:32 PM                                                                                                                    
There being no further business  before the committees, the joint                                                               
meeting of  the House  State Affairs  Standing committee  and the                                                               
House Health  and Social Services Standing  Committee meeting was                                                               
adjourned at 3:20 p.m.                                                                                                          

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