Legislature(2019 - 2020)BETHEL

10/20/2020 03:00 PM HEALTH & SOCIAL SERVICES


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03:05:20 PM Start
03:06:00 PM Presentation(s): Covid-19 in Alaska: an Update on Local & State Pandemic Response
05:04:33 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Testimony <Invitation Only> --
+ Presentation: COVID-19 in Alaska - An update on TELECONFERENCED
local & state pandemic response
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         Bethel, Alaska                                                                                         
                        October 20, 2020                                                                                        
                           3:05 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Tiffany Zulkosky, Chair                                                                                          
Representative Ivy Spohnholz, Vice Chair (via teleconference)                                                                   
Representative Matt Claman (via teleconference)                                                                                 
Representative Harriet Drummond (via teleconference)                                                                            
Representative Geran Tarr (via teleconference)                                                                                  
Representative Sharon Jackson (via teleconference)                                                                              
Representative Lance Pruitt (via teleconference)                                                                                
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                              
Senator Elvi Gray-Jackson (via teleconference)                                                                                  
Representative Sara Hannan (via teleconference)                                                                                 
Representative Bryce Edgmon (via teleconference)                                                                                
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION(S):  COVID-19 IN ALASKA: AN UPDATE ON LOCAL & STATE                                                                
PANDEMIC RESPONSE                                                                                                               
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JANET JOHNSTON, MD, Epidemiologist                                                                                              
Anchorage Health Department                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation on COVID-                                                              
19 in Alaska.                                                                                                                   
                                                                                                                                
CHRISTY LAWTON, Public Health Division Manager                                                                                  
Anchorage Health Department                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation on COVID-                                                              
19 in Alaska.                                                                                                                   
                                                                                                                                
TOM HENNESSY, MD, Infectious Disease Epidemiologist                                                                             
University of Alaska                                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation on COVID-                                                              
19 in Alaska.                                                                                                                   
                                                                                                                                
TOM QUIMBY, MD, Emergency Physician                                                                                             
Matanuska-Susitna Regional Medical Center                                                                                       
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during  the presentation on COVID-                                                             
19 in Alaska.                                                                                                                   
                                                                                                                                
JAKE METCALFE, Executive Director                                                                                               
Alaska State Employees Association                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation on COVID-                                                              
19 in Alaska.                                                                                                                   
                                                                                                                                
JARED KOSIN, President and CEO                                                                                                  
Alaska State Hospital and Nursing Home Association                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation on COVID-                                                              
19 in Alaska.                                                                                                                   
                                                                                                                                
ELLEN HODGES, MD, Chief of Staff                                                                                                
Yukon-Kuskokwim Health Corporation                                                                                              
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during  the presentation on COVID-                                                             
19 in Alaska.                                                                                                                   
                                                                                                                                
ROBERT ONDERS, MD, Interim Hospital Administrator                                                                               
Alaska Native Medical Center                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation on COVID-                                                              
19 in Alaska.                                                                                                                   
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:05:20 PM                                                                                                                    
                                                                                                                                
CHAIR  TIFFANY  ZULKOSKY  called  the  House  Health  and  Social                                                             
Services Standing Committee meeting to order at 3:05 p.m.                                                                       
Representatives   Jackson   (via   teleconference),   Tarr   (via                                                               
teleconference),  Drummond (via  teleconference), Spohnholz  (via                                                               
teleconference),  Claman (via  teleconference) and  Zulkosky were                                                               
present  at  the  call  to order.    Representative  Pruitt  (via                                                               
teleconference) arrived as the meeting was in progress.                                                                         
                                                                                                                                
^PRESENTATION(S):   COVID-19  in  Alaska: An  Update  on Local  &                                                               
State Pandemic Response                                                                                                         
PRESENTATION(S):  COVID-19 in Alaska: An Update on Local & State                                                            
                       Pandemic Response                                                                                    
                                                                                                                              
3:06:00 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY  announced that the  only order of  business would                                                               
be a presentation  on COVID-19 in Alaska; an update  on the local                                                               
and state pandemic response.                                                                                                    
                                                                                                                                
3:08:46 PM                                                                                                                    
                                                                                                                                
JANET JOHNSTON, MD,  Epidemiologist, Anchorage Health Department,                                                               
reported  regarding  the  COVID-19 pandemic  Anchorage  had  just                                                               
topped 6,000 resident cases with  an approximate 95 new cases per                                                               
day.   These numbers compared to  an average of 40  new cases per                                                               
day  in  mid-September,  she  noted.    Hospitalizations  were  a                                                               
lagging indicator, tending to go  up after the cases, she pointed                                                               
out,  so Anchorage  was  just  starting to  show  an increase  in                                                               
hospitalizations  over  the  past  week.   She  also  noted  that                                                               
because  nursing homes  or skilled  nursing facilities  can still                                                               
care  for  some of  the  sicker  COVID patients,  hospitalization                                                               
counts are  not always  the most accurate  reflection.   Over the                                                               
summer  Anchorage saw  cases increase  steadily  during June  and                                                               
July,  and  the hospitalizations  increase  in  July and  August.                                                               
Daily  case  counts came  down  in  August and  early  September,                                                               
followed by a  decline in hospitalizations in  late September and                                                               
a plateauing in early October.                                                                                                  
                                                                                                                                
DR.  JOHNSTON  said  given  the   previous  trends  she  expected                                                               
hospitalizations to continue increasing over  the next few weeks,                                                               
or  longer, depending  on the  case  counts.   With hospital  bed                                                               
space  already tight  and possible  difficulties recruiting  help                                                               
from outside  Alaska, she worried  about case  counts increasing,                                                               
she imparted.   Deaths were  also a lagging indicator,  she said:                                                               
In  August, the  death count  in  Anchorage was  41, the  highest                                                               
month, followed  by September  and July.   Given  previous trends                                                               
she  was worried  about increases  over the  next few  weeks, she                                                               
said.                                                                                                                           
                                                                                                                                
DR. JOHNSTON stated that in  terms of demographics, the race data                                                               
was incomplete and  there were probably some patterns  in the way                                                               
in which it  was missing, Dr. Johnston noted, but  even when that                                                               
was  taken into  consideration it  was clear  that Alaska  Native                                                               
people  made up  too  many cases,  hospitalizations, and  deaths.                                                               
When population was  considered, almost 20 percent  of cases have                                                               
been among Alaska Native or  American Indian people, whereas they                                                               
make up only about 10 percent  of the population of the Anchorage                                                               
population.  At the beginning of  the pandemic in March 2020 when                                                               
Anchorage  had   a  very   small  number   of  cases,   the  race                                                               
distribution  was similar  to  the  population distribution,  but                                                               
over  time this  has shifted,  she imparted,  with Alaska  Native                                                               
people and  Hawaiian Pacific  Islander people  being particularly                                                               
hard-hit.   Together  these two  groups represent  46 percent  of                                                               
hospitalizations and  42 percent  of the  deaths, but  again only                                                               
about 10 percent  of the population.  The bulk  of the infections                                                               
are among younger, working age  people ages 20-49, she added, and                                                               
the most obvious adverse outcomes are among older people.                                                                       
                                                                                                                                
DR. JOHNSTON continued  by saying people ages  20-49 are probably                                                               
most likely  to be out in  the community spreading the  virus and                                                               
are also experiencing the financial  impact to a high degree with                                                               
all  the quarantining  and isolating,  but  the older  population                                                               
have  higher numbers  of hospitalizations  and deaths.   In  some                                                               
cases, it has  been difficult to convince  the younger population                                                               
of  the importance  of  isolating and  quarantining  in order  to                                                               
protect the more vulnerable members of the population.                                                                          
                                                                                                                                
3:12:44 PM                                                                                                                    
                                                                                                                                
CHRISTY  LAWTON,  Manager,   Public  Health  Division,  Anchorage                                                               
Health Department,  Municipality of Anchorage, stated  there have                                                               
been  significant improvements  over  the last  couple of  months                                                               
since  the implementation  of the  database  CommCare, which  has                                                               
allowed  the   statewide  contact  tracing  workforce   to  share                                                               
information, collaborate, and respond  to an increasing number of                                                               
cases.   The  goal is  that each  new case  is investigated  by a                                                               
contact tracer  within 24 hours.   In  terms of what  the contact                                                               
tracers have  seen, Ms.  Lawton shared there  is some  fatigue in                                                               
terms  of  following  recommendations.   She  shared  an  example                                                               
anecdotally of a  close contact reached via  telephone of someone                                                               
who  had  recently  tested  positive.     When  the  contact  was                                                               
instructed  to  quarantine, he/she  let  the  tracer know  he/she                                                               
would do so only after finishing a lunch date with friends.                                                                     
                                                                                                                                
MS.  LAWTON suggested  it is  not only  this resistance  but also                                                               
folks  who   have  difficulty   quarantining  or   isolating  for                                                               
financial reasons,  that does  not help in  terms of  slowing the                                                               
spread of  the virus.  She  added that a concerning  recent trend                                                               
is people not  getting tested because they know they  will not be                                                               
able  to  go to  work  if  they  test  positive.   She  mentioned                                                               
outbreaks in  congregate care settings and  among the unsheltered                                                               
population,   the  virus   being   carried  to   the  former   by                                                               
unsuspecting, asymptomatic employees, and  cases among the latter                                                               
trending downward.   She went on to say case  numbers were rising                                                               
due  in  part  not  only   to  exposure  within  congregate  care                                                               
facilities,  but also  within family  gatherings, sports,  retail                                                               
businesses, churches, and the like.                                                                                             
                                                                                                                                
3:18:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND asked  after  the department's  thoughts                                                               
about sending kids  back to school in November  after taking into                                                               
consideration rising COVID numbers.                                                                                             
                                                                                                                                
3:19:20 PM                                                                                                                    
                                                                                                                                
DR. JOHNSTON  replied numbers were  higher than they  would like,                                                               
but there  being so many negatives  as well to kids  not being in                                                               
school, unfortunately there were not a  lot of good choices.  She                                                               
said  that schools  around the  country have  been able  to bring                                                               
kids back "relatively safely" by  starting with the youngest kids                                                               
first.                                                                                                                          
                                                                                                                                
3:20:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  asked whether the department  was finding                                                               
contact tracing  effective and what,  if anything,  the committee                                                               
could do to help.                                                                                                               
                                                                                                                                
3:21:17 PM                                                                                                                    
                                                                                                                                
MS. LAWTON  replied it  was only effective  if contacts  could be                                                               
alerted  within  the  amount  of time  their  behavior  could  be                                                               
altered, but with widespread community  spread it is just harder.                                                               
She  added  that the  legislature  could  help by  spreading  the                                                               
message  to  the  public to  follow  health  recommendations,  no                                                               
matter how tedious  those recommendations might seem.   She added                                                               
financial incentives  and advocacy at other  levels of government                                                               
may also help.                                                                                                                  
                                                                                                                                
3:23:49 PM                                                                                                                    
                                                                                                                                
CHAIR   ZULKOSKY    restated   the   presentation    agenda   for                                                               
Representative   Hannan,  Representative   Pruitt,  and   Senator                                                               
Jackson, who joined late.                                                                                                       
                                                                                                                                
3:24:42 PM                                                                                                                    
                                                                                                                                
TOM HENNESSY,  MD, Infectious Disease  Epidemiologist, University                                                               
of  Alaska,  stated  that current  research  on  COVID-19  showed                                                               
community transmission was occurring  widely throughout Alaska as                                                               
daily case counts have been in  the triple digits for more than a                                                               
month, and more Alaskans have COVID-19  than ever before.  One of                                                               
the primary concerns,  he stated, is the ability of  the virus to                                                               
spread very  quickly and  for infected  persons to  overwhelm the                                                               
health care  system.  This has  been the case since  early in the                                                               
pandemic, even  in places with  extensive and modern  health care                                                               
capacities  such as  New  York  City and  Italy,  he added,  with                                                               
doctors even  in these  places having  to make  choices regarding                                                               
which patients would  receive intensive care unit  (ICU) care and                                                               
which would not.                                                                                                                
                                                                                                                                
DR. HENNESSY stated that preserving  the health care capacity has                                                               
been  a  primary goal  in  Alaska  and  something that  has  been                                                               
watched closely since the spring of  2020.  One tool used to keep                                                               
close watch is  called the COVID surge tool,  which was developed                                                               
by the CDC  and uses local data to make  projections about future                                                               
hospital beds needed to care for  COVID patients.  The inputs, he                                                               
explained,  included  the  population  of  Anchorage,  the  total                                                               
number of COVID  cases, and those that have occurred  in the last                                                               
two  weeks.    Available  adult  hospital  beds,  ICU  beds,  and                                                               
ventilators were also  included, he added.   Local information on                                                               
proportionate  cases  needing   hospitalization,  ICU  care,  and                                                               
ventilators was  used as input as  well, he stated.   Driving the                                                               
projections was  the current  reproductive number,  he explained,                                                               
which was  a measure of  how many additional people,  on average,                                                               
each person with  COVID-19 would infect.  This  changes over time                                                               
depending  how people  follow public  health recommendations,  he                                                               
said.                                                                                                                           
                                                                                                                                
DR.  HENNESSY imparted  early in  the  pandemic the  reproductive                                                               
number  in Alaska  was approximately  2.5, meaning  each infected                                                               
person infected two  or three others.  The  current estimate used                                                               
was 1.1, he  stated, his models ranging  from 1 to 1.3.   Some of                                                               
the current assumptions were that  hospital bed use for non-COVID                                                               
patients was  stable and that COVID-19  cases occurring elsewhere                                                               
in Alaska  were not being transferred  to beds in Anchorage.   In                                                               
this way  the forecast  is optimistic  and it's  conservative, he                                                               
said.   Based on  data through October  19, and  assuming current                                                               
rates  of  transmission  are  stable,   the  model  predicts  the                                                               
hospital bed, ICU  and ventilator capacity in  Anchorage will not                                                               
be exceeded.  Because the  reproductive number is above one, case                                                               
counts will  continue to rise  and hospitalizations  for COVID-19                                                               
will  increase,  but this  increase  is  projected to  be  within                                                               
current capacity.                                                                                                               
                                                                                                                                
DR.  HENNESSY  went on  to  say  that  while this  projection  is                                                               
encouraging,  the situation  regarding capacity  and COVID-19  is                                                               
precarious.   If  there  were  to be  an  increase  in levels  of                                                               
transmission, a  shortage of healthcare  workers due  to illness,                                                               
an increase  in non-COVID related hospitalizations,  or surges in                                                               
hospitals elsewhere  that would  require transfers  to Anchorage.                                                               
The model  does predict  ICU capacity would  be exceeded  by mid-                                                               
December,  he  stated,  if  transmission  increased  by  just  10                                                               
percent in Anchorage.   This would bring the  number in Anchorage                                                               
up to 1.2, which is what  was experienced throughout the month of                                                               
July.  If  transmission increased by 20 percent,  the levels that                                                               
were seen  around Memorial Day,  ICU capacity is predicted  to be                                                               
exceeded by late November.                                                                                                      
                                                                                                                                
DR. HENNESSY  added the  surge in Alaska  could be  reversed with                                                               
just  a 10  percent decrease  in  transmission.   He stated,  "By                                                               
bringing the  reproductive number  below 1,  we could  bring down                                                               
daily  case   counts,  ...  ensure  protection   of  health  care                                                               
capacity, and  save lives.  And  we've already shown that  we can                                                               
decrease  transmission  in  Alaska;  Alaskans  have  changed  out                                                               
behavior, and many  of us have adopted practices  such as wearing                                                               
a  mask,  watching  our  physical  distancing,  and  washing  our                                                               
hands."  He  mentioned that actions such as shelter  in place and                                                               
hunker  down  reduced  transmission  by  up  to  60  percent.  In                                                               
Anchorage,  the mask  mandate  in  late June  was  followed by  a                                                               
decrease in transmission  by 15 percent in two  weeks, he stated,                                                               
and  the month-long  reset beginning  in July  was followed  by a                                                               
decrease of 30 percent.                                                                                                         
                                                                                                                                
3:30:35 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY asked Dr. Hennessy  to speak to "pandemic fatigue"                                                               
around the country  and the world, and  specifically which health                                                               
measures, from  an epidemiological  point of  view, would  be the                                                               
most effective  measures to decrease  the recent influx  of cases                                                               
in Alaska.                                                                                                                      
                                                                                                                                
3:31:42 PM                                                                                                                    
                                                                                                                                
DR. HENNESSY reiterated that transmission  could be decreased, as                                                               
has  already  been  seen  done  in  Anchorage,  by  folks  social                                                               
distancing, hand washing,  and wearing face masks in  public.  He                                                               
suggested  closing businesses  or other  economically challenging                                                               
options  if larger  decreases  were needed  faster.   Also,  with                                                               
statewide  mask  orders  in  33  states,  that  policy  is  worth                                                               
pursuing,  he added,  and sets  a standard  for folks  to follow.                                                               
The  Department of  Health and  Social Services  (DHSS) has  been                                                               
clear  on mask  use,  and Alaska  could also  go  this route,  he                                                               
suggested.                                                                                                                      
                                                                                                                                
3:34:11 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY asked for questions from committee members.                                                                      
                                                                                                                                
3:34:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND  asked  Dr.  Hennessy  his  thoughts  on                                                               
returning  kids  to  school indoors,  which  would  mean  roughly                                                               
10,000 students and staff.                                                                                                      
                                                                                                                                
3:35:12 PM                                                                                                                    
                                                                                                                                
DR.  HENNESSY  replied  he  has  not been  in  contact  with  the                                                               
Anchorage School  District on the  issue but, having  followed it                                                               
closely  himself,  has learned  the  risk  to youngest  children,                                                               
especially  under age  10, is  lowest.   He  mentioned that  many                                                               
countries  worldwide  have sent  young  children  back to  school                                                               
successfully.                                                                                                                   
                                                                                                                                
3:36:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   DRUMMOND  asked   Dr.  Hennessy's   thoughts  on                                                               
teachers  in  the  higher-risk  category  and  those  they  could                                                               
potentially infect at home.                                                                                                     
                                                                                                                                
3:37:00 PM                                                                                                                    
                                                                                                                                
DR.  HENNESSY   replied  teachers  and  staff   members  becoming                                                               
affected  could be  mitigated  by  public health  recommendations                                                               
already brought forth.   He also acknowledged that  the return to                                                               
in-person classes  would not be  risk free and  individuals would                                                               
have to  assess on  a personal  level based  on their  own health                                                               
issues.                                                                                                                         
                                                                                                                                
3:38:42 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY asked, in terms  of bringing down the reproductive                                                               
number  and   the  widespread  community-based   transmission  in                                                               
Alaska,  whether it  was the  right  time to  be relaxing  travel                                                               
mandates  and other  protective measures  which were  implemented                                                               
early in the pandemic.                                                                                                          
                                                                                                                                
3:39:39 PM                                                                                                                    
                                                                                                                                
DR. HENNESSY replied that by  taking the courageous step only few                                                               
other  states  have done  by  putting  travel mandates  in  place                                                               
Alaska did  create a safer  environment, and relaxation  of those                                                               
mandates  is  indeed  a  small   step  backwards;  however,  most                                                               
transmission is community-based and  not imported, so the changes                                                               
to the  travel mandates  may not make  a big  difference overall.                                                               
Travel  restrictions in-state,  and  especially  travel to  rural                                                               
communities, can make a big difference, he put forth.                                                                           
                                                                                                                                
3:41:40 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY  asked whether  Dr. Hennessy  felt gains  could be                                                               
made through another shelter in  place or hunker down, especially                                                               
in   those   places   where   there   is   widespread   community                                                               
transmission.                                                                                                                   
                                                                                                                                
3:42:25 PM                                                                                                                    
                                                                                                                                
DR.  HENNESSY replied  the mandates  put in  place in  March 2020                                                               
slowed transmission but  came with a high degree of  cost, and it                                                               
was uncertain whether a repetition  of the mitigations would have                                                               
the  same effect:   in  places where  they have  been instated  a                                                               
second or  third time they  have typically not been  as effective                                                               
because people  have already adapted and  altered their behavior.                                                               
Much of  Alaska doesn't  need as  much transmission  reduction as                                                               
the 30  percent that  was needed  in Anchorage  to get  the curve                                                               
bent  the other  direction,  he added;  a decrease  of  10 or  15                                                               
percent  would have  an  effect  and reverse  the  course of  the                                                               
pandemic.                                                                                                                       
                                                                                                                                
3:44:39 PM                                                                                                                    
                                                                                                                                
CHAIR  ZULKOSKY  asked  whether   more  stringent  public  health                                                               
messaging about limiting social gatherings could be effective.                                                                  
                                                                                                                                
3:45:23 PM                                                                                                                    
                                                                                                                                
DR.  HENNESSY  encouraged  actively   engaging  the  public  with                                                               
additional  and consistent  messaging to  urge the  population to                                                               
take mitigation measures  into practice and stated  that the part                                                               
of the population  that continued to mix must be  made aware they                                                               
were causing  harm to  society overall:   to schools,  to elders,                                                               
and to the economy.                                                                                                             
                                                                                                                                
3:47:29 PM                                                                                                                    
                                                                                                                                
TOM QUIMBY,  MD, Emergency Physician,  Matanuska-Susitna Regional                                                               
Medical Center,  informed the  committee that  Alaskan physicians                                                               
are much better  situated for a surge at present  than they would                                                               
have  been  six  months  ago  and  expressed  gratitude  for  the                                                               
personal protective  equipment (PPE)  that has been  made readily                                                               
available.  Time  has also allowed for education on  how to treat                                                               
those who became seriously ill  with COVID-19.  This said, Alaska                                                               
is especially vulnerable  to a strain on its  health care system,                                                               
he  noted,   referencing  an  ICU   crisis  in   Anchorage  which                                                               
necessitated the  transfer of patients  out of Alaska.   There is                                                               
also  difficulty  finding  adequate  hospital  staff,  especially                                                               
nurses, he added.                                                                                                               
                                                                                                                                
DR.  QUIMBY  informed  the   committee  299,028  deaths  occurred                                                               
between late January  and October 3, 2020, with  198,091 of these                                                               
attributed to  COVID-19.  The  largest increase was  among adults                                                               
ages 25  through 44 years  and among Hispanic or  Latino persons.                                                               
Healthy  young  people  could  experience  debilitating  fatigue,                                                               
affecting their  job performance  and overall well-being.   Those                                                               
who overcame COVID-19 could still  experience long term damage to                                                               
the lungs, kidneys,  brain, and heart, changing  their quality of                                                               
life,  in  some  cases  forever.     Dr.  Quimby  reiterated  the                                                               
mitigations  distancing,  masking,  and  handwashing,  and  urged                                                               
widespread rapid testing.  When  a vaccine becomes available, its                                                               
distribution should be supported, he urged.                                                                                     
                                                                                                                                
3:54:11 PM                                                                                                                    
                                                                                                                                
CHAIR  ZULKOSKY referenced  research indicating  long-term health                                                               
impacts experienced by those with  mild to moderate infections of                                                               
COVID-19 and asked  at what rate Alaskans  are experiencing long-                                                               
term effects, even if they did  not have a "serious" infection of                                                               
COVID-19.                                                                                                                       
                                                                                                                                
3:55:06 PM                                                                                                                    
                                                                                                                                
DR. QUIMBY  replied that  he had no  specific numbers  for Alaska                                                               
but that he could try to find that information.                                                                                 
                                                                                                                                
3:56:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ,  referencing   the  capacity   crisis                                                               
resulting in Alaska  patients being sent out of  state, asked how                                                               
frequently surges occurred and what time of year to expect them.                                                                
                                                                                                                                
3:57:23 PM                                                                                                                    
                                                                                                                                
DR. QUIMBY replied that since his employment at Matanuska-                                                                      
Susitna (Mat-Su)  Regional commenced  in 2012, full  capacity had                                                               
been reached at least once  per year, and patients were routinely                                                               
sent to Anchorage when there was no longer room for them.                                                                       
                                                                                                                                
4:00:18 PM                                                                                                                    
                                                                                                                                
JAKE  METCALFE,   Executive  Director,  Alaska   State  Employees                                                               
Association,  said  he  would  like to  share  the  requests  for                                                               
improvement  Alaska   State  Employees  Association   (ASEA)  had                                                               
received  from  the  government.    He began  with  the  lack  of                                                               
communication  which  he  said  has  left  ASEA  members  feeling                                                               
confused  and misinformed.   He  expressed his  disappointment in                                                               
DHSS not  taking the committee  up on the invitation  to testify,                                                               
as members  of ASEA had  questions and  wanted to know  they were                                                               
going  to be  safe on  the job.   Communications  with DHSS  have                                                               
improved, but  ASEA is still  being left out, he  explained, with                                                               
ASEA  members reporting  outbreaks before  they were  reported by                                                               
DHSS, Mr.  Metcalfe stated.   Outbreaks at the  Fairbanks Pioneer                                                               
Home and  Fairbanks Correctional  Center had increased  in number                                                               
from 30 to 50, and it  had been reported there was inadequate PPE                                                               
in that location, he imparted.                                                                                                  
                                                                                                                                
MR. METCALFE paraphrased  a plan [full text of  which is included                                                               
in   members'  packets]   which   should  be   put  into   effect                                                               
immediately:    facilities  should   be  cleaned  and  sanitized;                                                               
facilities  should   be  closed   to  outside   users,  including                                                               
deliveries, when there  is an outbreak; proper  signage should be                                                               
in place which  will alert members where there  are active COVID-                                                               
19  cases;  proper COVID-19  screening  should  be in  place  for                                                               
employees; and quarantining should  happen for employees who have                                                               
been   exposed  to   COVID.     He  went   on  to   recommend  an                                                               
implementation of  informational safety  councils so  that unions                                                               
and staff  were all able to  come together on a  regular basis to                                                               
share information  and safety mitigation protocols.   He imparted                                                               
to the  committee the lack  of information has  employees worried                                                               
for their  lives, families, and loved  ones.  By way  of example,                                                               
he  brought members'  attention to  an occurrence  at the  Atwood                                                               
building.   [Details included  in an  email included  in members'                                                               
packets.]  Employees  were told to evacuate  the building without                                                               
much information.   At the same time as the  evacuation, the news                                                               
was  released that  three  of the  governor's  staff members  had                                                               
tested positive for COVID-19.                                                                                                   
                                                                                                                                
MR. METCALFE said he thought  the evacuations were related to the                                                               
positive COVID  tests among staff  members, and at that  point he                                                               
found out  there was also  a bed  bug infestation, so  he thought                                                               
that's why  they had been  asked to  evacuate, and then  he found                                                               
out folks  were still  concerned about  the COVID-19  outbreak in                                                               
the  governor's  office.   There  was  no clarifying  information                                                               
until the next  day or the day after that  despite many concerns,                                                               
and  Mr. Metcalfe  said  he did  not  understand why  information                                                               
about positive cases  in a building was not being  shared.  There                                                               
were  good things  happening as  well, he  shared:   there was  a                                                               
labor  management  meeting  and  a follow-up  being  planned;  an                                                               
agreement was  signed to hire  an additional 200  long-term, non-                                                               
permanent contact  tracers; an  increase in  wages by  50 percent                                                               
would  be provided  for staff  at the  Fairbanks Pioneer  Home to                                                               
help  with  employees  getting  sick and  missing  work  in  that                                                               
facility.   Anyone going into  danger should at least  receive an                                                               
increase  in pay,  he said,  especially those  treating residents                                                               
who  needed them.   In  conclusion, Mr.  Metcalfe reiterated  the                                                               
request a crisis communication plan be put into place.                                                                          
                                                                                                                                
4:12:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked two  questions:   first at  what point                                                               
stronger  "remedies" would  be considered  due  to the  continued                                                               
lack of information  being put forth, and  second which employees                                                               
might  also be  eligible for  an increase  in pay  akin to  those                                                               
received by employees at the Pioneer Home.                                                                                      
                                                                                                                                
4:13:49 PM                                                                                                                    
                                                                                                                                
MR.  METCALFE replied,  regarding the  second question,  "premium                                                               
pay"  allowed workers  to stay  with their  current facility  and                                                               
rendered obsolete the need to  work second jobs, which would also                                                               
increase  exposure;  in terms  of  the  first question,  he  said                                                               
crisis  communication  is needed  and  ASEA  is willing  to  help                                                               
develop a plan  to further spread immediate  information and make                                                               
employees, families, and all Alaskans feel respected.                                                                           
                                                                                                                                
4:18:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  said she  especially appreciated  the answer                                                               
regarding premium  pay regarding  the ongoing challenge  of staff                                                               
retention  in some  of the  most important  facilities even  pre-                                                               
COVID.                                                                                                                          
                                                                                                                                
4:20:32 PM                                                                                                                    
                                                                                                                                
JARED  KOSIN,  President  and  CEO,  Alaska  State  Hospital  and                                                               
Nursing Home Association, said Alaska  State Hospital and Nursing                                                               
Home Association  (ASHNHA) saw 46  hospitalizations on  any given                                                               
day with multiple days of  50-plus patients.  As hospitalizations                                                               
are  a  lagging  indicator,  hospitalizations  were  expected  to                                                               
increase in the  foreseeable future.  Several  leaders in nursing                                                               
homes and  hospitals report that  staffing is stretched.   In PPE                                                               
news,  there  was  a  potential shortage  on  gloves,  Mr.  Kosin                                                               
reported.    He echoed  others  in  his encouragement  of  public                                                               
health   mitigation  strategies:     masks,   social  distancing,                                                               
handwashing, flu  shots.  He  also suggested an extension  of the                                                               
public health disaster emergency  declaration, as it would remove                                                               
significant  uncertainty  and  pressure  to  have  it  in  place.                                                               
Without it, he  cautioned, off-site screening centers  are put in                                                               
question and alternate  venues by which to  handle surge capacity                                                               
would become a factor, among other concerns.                                                                                    
                                                                                                                                
4:26:21 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY  asked in terms  of the nationwide  glove shortage                                                               
where Alaska was in terms of access to critical PPE.                                                                            
                                                                                                                                
4:26:51 PM                                                                                                                    
                                                                                                                                
MR.  KOSIN replied  there was  a possible  N95 mask  shortage and                                                               
gloves were a critical issue as  they were brought up at multiple                                                               
facilities.                                                                                                                     
                                                                                                                                
CHAIR  ZULKOSKY asked  if ASHNHA  had identified  a date  for the                                                               
emergency declaration extension.                                                                                                
                                                                                                                                
MR.  KOSIN  replied  the   emergency  was  relevant,  flexibility                                                               
critical,  and the  declaration  set to  expire  on November  15,                                                               
2020.                                                                                                                           
                                                                                                                                
4:31:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR sought  clarification on  communication with                                                               
the governor's office.                                                                                                          
                                                                                                                                
4:31:49 PM                                                                                                                    
                                                                                                                                
MR. KOSIN  replied he spoke  with Commissioner Dr. Anne  Zink who                                                               
speaks  frequently  with  the governor's  office,  so  there  was                                                               
communication  and  hope  it  would be  figured  out  before  the                                                               
November 15 deadline.                                                                                                           
                                                                                                                                
4:32:50 PM                                                                                                                    
                                                                                                                                
ELLEN  HODGES,   MD,  Chief  of  Staff,   Yukon-Kuskokwim  Health                                                               
Corporation,  reported  a  "dramatic,  exponential"  increase  in                                                               
severity and  acuity of COVID-19 cases  associated with community                                                               
spread.    She  reported  Yukon-Kuskokwim  Health  Center  (YKHC)                                                               
tracked  all its  own contacts  and currently  had well  over 500                                                               
contacts  under investigation.   In  terms of  demographics, like                                                               
much of  Alaska case  counts skewed younger,  with 52  percent of                                                               
COVID-19 cases  under the  age of  40.   She echoed  Dr. Johnston                                                               
that hospitalizations and  deaths disproportionately affected the                                                               
elderly.   She voiced concern about  exceeding hospital capacity,                                                               
relating stories  of patients having to  wait up to 19  hours for                                                               
available  beds elsewhere.    She  urged immediate  intervention.                                                               
She  mentioned Bethel  does have  a mask  ordinance, and  all air                                                               
travelers  are   tested  upon  arrival.     She   reiterated  the                                                               
importance  of   adhering  to  mitigations  mentioned   by  other                                                               
testifiers.                                                                                                                     
                                                                                                                                
4:38:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked about the  issue in Bethel with lack of                                                               
sanitation and running water and asked  if there was some way the                                                               
legislature could help.                                                                                                         
                                                                                                                                
4:39:35 PM                                                                                                                    
                                                                                                                                
DR. HODGES replied 60 percent  of households did not have running                                                               
water  or  sewer   which  didn't  help  with   the  adherence  to                                                               
mitigation  strategies, especially  handwashing. She  agreed that                                                               
providing  adequate  water  and  sewer was  an  essential  public                                                               
health measure that should be undertaken.                                                                                       
                                                                                                                                
4:40:59 PM                                                                                                                    
                                                                                                                                
CHAIR  ZULKOSKY, referencing  the  interconnectedness Dr.  Hodges                                                               
brought  up regarding  health systems,  asked how  easing certain                                                               
restrictions could impact  the current status of  the pandemic in                                                               
the Y-K Delta.                                                                                                                  
                                                                                                                                
4:41:41 PM                                                                                                                    
                                                                                                                                
DR. HODGES replied kids returning  to school was a high priority,                                                               
but positivity  rates and case  rates must  decrease considerably                                                               
before  returning to  school in  person.   She emphasized  school                                                               
exposure  would  put  the elderly  population  living  in  multi-                                                               
generational  households  at  risk.   Finally,  village  teachers                                                               
needed  to be  protected and  preserved as  limited and  valuable                                                               
resources.                                                                                                                      
                                                                                                                                
4:43:52 PM                                                                                                                    
                                                                                                                                
ROBERT ONDERS, MD, Interim  Hospital Administrator, Alaska Native                                                               
Medical Center, mentioned we are  still early in the pandemic and                                                               
will be  judged on how we  did at the  end.  He brought  up rural                                                               
Alaska and  Alaska Natives  have not  fared well  during previous                                                               
pandemics  such  as  H1N1, where  there  was  a  disproportionate                                                               
amount of disease, morbidity, and  mortality.  There seemed to be                                                               
a lot of  focus on hospitals, he stated,  referencing Dr. Quimby,                                                               
which  deal  with the  consequences  of  public health  measures.                                                               
There should be less focus on  ICU beds and bed capacity and more                                                               
on  preventative  measures,  he   suggested.    He  informed  the                                                               
committee additional  hospital beds  had been  added, but  it was                                                               
unclear  whether  they would  continue  to  be provided  as  case                                                               
counts rose.                                                                                                                    
                                                                                                                                
DR.  ONDERS   brought  an  article  from   the  American  Medical                                                               
Association entitled "Sensible  Medicine - Balancing Intervention                                                               
and  Inaction during  the COVID-19  Pandemic" to  the committee's                                                               
attention,  the  message  being the  possibility  of  the  former                                                               
negating the latter, which is a detriment to the economy.                                                                       
                                                                                                                                
4:50:11 PM                                                                                                                    
                                                                                                                                
CHAIR  ZULKOSKY, referencing  a sobering  update received  by the                                                               
committee  by many  of the  same testifiers  in July  2020, asked                                                               
what  were  some  of  the   basic  interventions  from  a  policy                                                               
perspective that could be put forward  to stem the tide of COVID-                                                               
19 in Alaska, especially heading into the winter months.                                                                        
                                                                                                                                
4:51:45 PM                                                                                                                    
                                                                                                                                
DR. ONDERS replied  when measures were in place  case counts went                                                               
down and  when they were  not in place they  went up.   In Alaska                                                               
case  counts  went   down  with  the  early   lockdown  and  when                                                               
municipalities  implemented  their  month-long measures.    Rural                                                               
communities implement their own  protective measures.  Dr. Onders                                                               
reiterated  mask  wearing,  avoiding gatherings,  and  the  like,                                                               
which all drove case counts down.                                                                                               
                                                                                                                                
4:53:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked, as travel became  more restrictive in                                                               
the winter  months, whether  capacity should  be considered  in a                                                               
different way.                                                                                                                  
                                                                                                                                
4:54:55 PM                                                                                                                    
                                                                                                                                
MR. KOSIN replied  that if things did not  improve, then staffing                                                               
would  be limited  and  a  system-wide surge  could  occur.   All                                                               
efforts needed  to be  put toward  public health  measures before                                                               
finite points were reached.                                                                                                     
                                                                                                                                
4:56:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked Dr.  Onders  how  capacity should  be                                                               
looked at differently than it would be in a non-pandemic year.                                                                  
                                                                                                                                
4:57:13 PM                                                                                                                    
                                                                                                                                
DR.   ONDERS  replied   Alaska  Native   Medical  Center   (ANMC)                                                               
prioritized  travel in  from rural  communities,  and at  normal-                                                               
capacity  standards  ANMC  would usually  accept  transfers  from                                                               
those  facilities,  but the  current  focus  should be  on  those                                                               
hospitals which do  not have the extra  level of care.   If all 3                                                               
Anchorage  hospitals were  challenged,  it  would create  ripples                                                               
across the entire state, he said.                                                                                               
                                                                                                                                
CHAIR ZULKOSKY  asked for  a sense of  where Alaska  is regarding                                                               
the pandemic,  what should  be anticipated  soon, and  what steps                                                               
could be taken to avoid the inevitable scenario.                                                                                
                                                                                                                                
MR.  KOSIN  replied  the  hardest part  was  managing  cracks  in                                                               
staffing,  because the  only other  place  to send  those in  the                                                               
vulnerable population is to the hospitals.                                                                                      
                                                                                                                                
5:02:06 PM                                                                                                                    
                                                                                                                                
DR.  HENNESSY replied  reproductive numbers  were higher  in July                                                               
2020, but  overall numbers  were lower,  so now  there are  a lot                                                               
more  COVID-19 infected  persons.   The state  is in  a dangerous                                                               
position, he said,  but Alaskans have shown the  ability to bring                                                               
case numbers down through policy and through individual actions.                                                                
                                                                                                                                
5:04:03 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY thanked testifiers.                                                                                              
                                                                                                                                
5:04:33 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:04 p.m.                                                                                                          

Document Name Date/Time Subjects
Atwood building issues.pdf HHSS 10/20/2020 3:00:00 PM
Supporting Document - ASEA
FW Atwood Update .pdf HHSS 10/20/2020 3:00:00 PM
Supporting Document - ASEA
ASEAAFSCME COVID-19 Outbreak Best Practices to keep Employees Safe.pdf HHSS 10/20/2020 3:00:00 PM
Supporting Document - ASEA
Fwd Final Issues List for Labor Management Meetings.pdf HHSS 10/20/2020 3:00:00 PM
Supporting Document - ASEA
RE LMC.pdf HHSS 10/20/2020 3:00:00 PM
Supporting Document - ASEA
FW LMC on COVID related issues.pdf HHSS 10/20/2020 3:00:00 PM
Supporting Document - ASEA