Legislature(2019 - 2020)ANCH BENSON BLDG
05/27/2020 01:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Impacts of Phase Iii & Safety for Working Alaskans | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
JOINT MEETING
HOUSE STATE AFFAIRS STANDING COMMITTEE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Anchorage, Alaska
May 27, 2020
1:01 p.m.
MEMBERS PRESENT
HOUSE STATE AFFAIRS STANDING COMMITTEE
Representative Zack Fields, Co-Chair
Representative Jonathan Kreiss-Tomkins, Co-Chair (via
teleconference)
Representative Grier Hopkins (via teleconference)
Representative Andi Story (via teleconference)
Representative Sarah Vance (via teleconference)
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Tiffany Zulkosky, Chair (via teleconference)
Representative Ivy Spohnholz, Vice Chair (via teleconference)
Representative Matt Claman (via teleconference)
Representative Harriet Drummond (via teleconference)
Representative Geran Tarr (via teleconference)
Representative Sharon Jackson
MEMBERS ABSENT
HOUSE STATE AFFAIRS STANDING COMMITTEE
Representative Steve Thompson
Representative Laddie Shaw
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Lance Pruitt
OTHER LEGISLATORS PRESENT
Representative Dan Ortiz (via teleconference)
Senator Elvi Gray-Jackson (via teleconference)
COMMITTEE CALENDAR
PRESENTATION(S): IMPACTS OF PHASE III & SAFETY FOR WORKING
ALASKANS
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANDREW ELSBERG, M.D.
Emergency Room Physician
Anchorage, Alaska
POSITION STATEMENT: As a physician, provided information about
the current COVID-19 pandemic.
JAKE METCALFE, Executive Director
Alaska State Employees Association (ASEA), Local 52
Anchorage, Alaska
POSITION STATEMENT: Testified regarding ASEA's efforts to
collaborate with the State of Alaska on safety measures for
Class 1 employees.
KATE SHEEHAN, Director
Division of Personnel and Labor Relations
Department of Administration (DOA)
State of Alaska
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding what the State
of Alaska is doing to ensure the safety of state employees and
the public.
CHARLES STEWART, Adult Probation Officer
Anchorage Correctional Complex
Department of Corrections
State of Alaska
Anchorage, Alaska
POSITION STATEMENT: Offered suggestions for providing safety to
staff and inmates.
KELLY FERGUSON, Nurse
Alaska Pioneer Home-Sitka
Department of Health and Social Services (DHSS)
State of Alaska
Sitka, Alaska
POSITION STATEMENT: Testified about the importance of screening
employees and providing them with personal protective equipment
(PPE).
RANDY MCLELLAN, President
Alaska Correctional Officers Association (ACOA)
Anchorage, Alaska
POSITION STATEMENT: Stressed the importance of COVID-19 testing
to protect correctional officers and inmates.
JOSHUA WILSON, Business Agent
Alaska Correction Officers Association (ACOA)
Anchorage, Alaska
POSITION STATEMENT: Urged cooperation between the State of
Alaska and employees in adopting measures to protect
correctional officers and inmates.
ROBERT LAWRENCE, M.D., Chief Medical Officer
Health and Rehabilitation Services (HARS)
Department of Corrections (DOC)
Anchorage, Alaska
POSITION STATEMENT: Reviewed the process that takes place when
someone tests positive within the DOC system.
KELLY HOWELL, Special Assistant to the Commissioner/ Legislative
Liaison
Office of the Commissioner
Department of Corrections (DOC)
Anchorage, Alaska
POSITION STATEMENT: Answered questions regarding COVID-19 and
DOC.
ERIN BROMAGE, Ph.D., Associate Professor of Biology
College of Arts and Sciences
University of Massachusetts Dartmouth
Dartmouth, Massachusetts
POSITION STATEMENT: Testified regarding the risks of COVID-19
and how to avoid them.
MARY SWAIN, Executive Director
Camai Community Health Care Center
Naknek, Alaska
POSITION STATEMENT: Testified about the testing and
collaboration going on within her community to reduce or prevent
the spread of COVID-19 during the commercial fishing season.
ACTION NARRATIVE
1:01:48 PM
CO-CHAIR ZACK FIELDS called the joint meeting of the House State
Affairs Standing Committee and the House Health and Social
Services Standing Committee to order at 1:01 p.m.
Representatives Story, Hopkins, Kreiss-Tomkins, and Fields of
the House State Affairs Standing Committee were present at the
call to order. Representative Vance arrived as the meeting was
in progress. Representatives Tarr, Jackson, and Zulkosky of the
House Health and Social Services Standing Committee were present
at the call to order. Representatives Claman, Drummond, and
Spohnholz arrived as the meeting was in progress. Also present
were Representative Ortiz and Senator Gray-Jackson.
^PRESENTATION(S): Impacts of Phase III & Safety for Working
Alaskans
PRESENTATION(S): Impacts of Phase III & Safety for Working
Alaskans
1:02:34 PM
CO-CHAIR FIELDS announced that the only order of business would
be a presentation on Impacts of Phase III & Safety for Working
Alaskans.
1:02:56 PM
ANDREW ELSBERG, M.D., Emergency Room Physician, stated he is an
emergency room physician at Providence Alaska Medical Center,
but is testifying as an individual, not a representative of the
hospital. He said he has been responsible for helping guide the
clinical care for the 2019 novel coronavirus ("COVID-19")
patients in the Providence emergency room. He is a volunteer
medical director and assistant medical director for the Alaska
Mountaineering School, Alaska Guide Collective, and a number of
other programs. He has kids in the Anchorage School District.
He is providing his background, he said, because this community
is his community. He is before the committee to share
information about COVID-19 and is fully aware that the decisions
made to manage this pandemic at both the state and local levels
have economic, educational, social, and health impacts.
DR. ELSBERG addressed why a person doesn't want to get COVID-19
and why public policy should aim to limit the spread of the
disease. He explained that the mortality rate goes up with age
and comorbidities, but that people of any age can get seriously
ill from COVID-19. While many people will be asymptomatic or
have mild illness, those who get severe illness get very, very
sick. Early system-wide data shows that, in general, people who
present with more severe illness and who meet sepsis criteria
have an 8-10 percent mortality rate. So, a serious COVID-19
patient has more than a one-third chance of not making it out
alive from the hospital. Getting worse than mild illness with
COVID-19 is very, very dangerous at any age. At his hospital,
patients at the level of the intensive care unit (ICU) aged 18
and up have had to be intubated. Although chronic problems
raise the risk of death, many previously healthy people on no
medications are getting sick and dying worldwide. In kids
specifically, there is an inflammation of the arteries of the
heart similar to the rare disorder called Kawasaki's Disease.
Sometimes it kills, but more often it leaves permanent/life-long
heart damage to otherwise healthy kids. It hasn't yet been seen
in Alaska, but will if COVID-19 explodes in the state.
DR. ELSBERG said much has been learned about treatment. For
example, addressing silent hypoxia early on by administering
oxygen with nasal cannulas to try avoiding intubation; carefully
managing intravenous fluids; and changing people's positions
early on before they get super sick to keep the lungs open and
continuing that in very sick patients. There are no proven
medications to treat this, which shouldn't be a surprise since
very few viruses have proven treatment directly against the
virus. There is only supportive treatment. A vaccine is the
only hope for herd immunity. Getting to 80 percent exposure to
this virus by letting the illness move through the population
will leave thousands of Alaskans dead, will overwhelm Alaska's
medical system, will put providers at risk due to shortages of
personal protective equipment (PPE), and patients will get
suboptimal care because sick patients need nurses, doctors, and
respiratory therapists at a safe ratio to provide good care.
For example, in New York there were stories of orthopedic
physicians running ICU care. That is scary because these
doctors are really good at dealing with bones and tendons, but
not at running ICUs. Nursing ratios in New York were 12:1 in an
ICU; normal in an ICU is 2:1 or 1:1. If Alaska has an
explosion, people will be lost just because of the inability to
give them the care that is needed to give them the best shot to
survive this illness. Alaska needs to maintain a reasonable
burden of illness.
DR. ELSBERG discussed the factors for how Alaska got to where it
is with a low disease burden. He said Alaska was late to get
cases, the state and municipalities took relatively early action
to shut down or geographically isolate the virus, and Alaska has
space. The actions of Governor Dunleavy, Anchorage Mayor
Berkowitz, and others saved the state from a serious outbreak.
Staying open, he advised, requires avoiding a big outbreak.
Social distancing, wearing masks, good hand hygiene, and smart
business practices are all necessary to protect Alaska's
economy. Fully shutting down again, whether regionally or
statewide, isn't wanted. Many individuals and businesses are
acting responsibly, but many are not.
DR. ELSBERG opined that it's the domain of the state government
to have policies that create a safe place to work and live. It
isn't a political issue; it's common sense. Businesses should
be required to have patrons and employees wear masks. Mass
gatherings should be off the table. Long exposure at less than
six feet in indoor settings should not be considered okay. This
is simple and manageable and doesn't require shutdown to be
maintained, but it does need policy and required guidelines.
DR. ELSBERG said the importation of more cases is of serious
concern. The disease burden is higher nearly everywhere else in
the U.S. and the world than it is in Alaska. Despite tight
screening and quarantine protocols, Alaska has seen a consistent
but slow flow of new cases with the fishing industry ramping up.
Travel in and out of the state by Alaskans and others is going
to continue being of concern. The [current] self-isolation of
14 days is a joke. Each passenger arriving in Alaska should be
required to provide his or her quarantine plans before getting
off the plane. The state and municipality need to make this
happen instead of expecting the other party to do it. Thought
is needed in drawing up this requirement. Can rapid testing be
set up for every [flight] arrival and can it be done without
creating a bottleneck where people cannot distance? Can a
seven-day isolation, then a test, be required? Exemptions for
essential workers are being exploited inappropriately at times.
Can these exemptions be replaced with seven days and then a
test? A state tourism industry can't be had without a
coordinated plan that involves public health and industry
working together to prevent importing a lot more disease burden.
1:11:28 PM
DR. ELSBERG stressed that transparency of data is extremely
important. For example, what is the actual positive rate, not
the rumored rate, of the fishery workers who are being tested
out of state before coming to Alaska? Public-health-relative
data should be public information; it is needed to make sensible
decisions. State and federal dollars helped industry establish
the Experian programs; the data should be publicly available.
The addition of nonresident cases to the dashboard was an
important and welcome development. Pre-screening data for what
is happening outside Alaska in the oil and fishing industries is
important and needs to be shared.
DR. ELSBERG addressed testing. He said that continuing to ramp
up Alaska's testing capabilities is required for opening up
general healthcare elective procedures, dentistry, safely
operating industries where employees work in close proximity,
and keeping the state's hospitals, group living facilities,
prisons, and other places safe. Alaska is not there, he
maintained. State coordination is required, and state people
power is necessary to make it happen.
DR. ELSBERG concluded by saying that no one wants to be the
person who gets a severe case of COVID-19. The chance of death
is way beyond sepsis and influenza 100,000 Americans have died
in two and one-half months. Alaska is both lucky and reaping
the benefits of some very strong moves by state and local
leaders. To sustainably maintain this position, the state must
make social distancing, masking, and hygiene the norm; it's not
a political act, it's economic and health self-preservation.
Policies should reflect the known ways the virus is transmitted.
Screening of people traveling in and out of Alaska is needed and
having that capability is necessary before consideration is
given to dropping the 14-day self-isolation mandate. This
mandate must be made real. Essential exemptions must be truly
essential and essential workers must be responsible, which most
have been. Strong screening, testing, contact tracing, and
transparent data are needed. The Department of Health and
Social Services (DHSS) must be funded and staffed at a level
where the department can do the coordination that is needed.
1:14:14 PM
REPRESENTATIVE HOPKINS related that Foundation Health Partners
in Fairbanks is offering to provide consultations and
recommendations to local businesses to help set up guidelines
for safe working and spacing policies. He asked whether any
hospitals are offering these services to Anchorage businesses.
DR. ELSBERG replied that he is unaware of anything. He is a
volunteer with the local groups he mentioned earlier but doesn't
know what might be happening on a larger basis with businesses.
1:15:48 PM
REPRESENTATIVE TARR noted that due to lots of misinformation,
people are choosing to not believe things. For example, the
U.S. Surgeon General advised not to wear a mask just before the
change was made urging people to wear a mask. She asked Dr.
Elsberg for suggestions on how to overcome the misinformation
that has been put forth.
DR. ELSBERG postulated he hasn't contracted COVID-19 because he
wears PPE at work from the minute he walks into the hospital,
only takes off his PPE to eat or drink in an isolated spot,
wears gloves, washes his hands before and after every encounter,
and escalates to higher levels of PPE depending on the
situation. It's hard for legislators and state government, he
continued, when the federal government hasn't put forth a
coherent message. Pandering to certain demographics with that
[misinformation] has been done instead of sticking to the
scientific response, which has fanned the flames of what
Representative Tarr is talking about. At the state level it is
important that politicians representing all spectrums put forth
a clear message about what is known to work to slow or stop the
spread of this disease. It is incumbent upon people across the
political spectrum to fight back against the misinformation.
The debate is how to proceed forward while keeping people safe
and minimizing the impact on the other aspects of people's lives
including the economy. The debate is not on how does this
disease spread.
1:20:12 PM
CHAIR ZULKOSKY said she has witnessed a false sense of security
with the easing of various health mandates, but easing these
health mandates doesn't make the virus any less contagious or
the serious cases any less serious. She requested Dr. Elsberg
to discuss, from a clinical perspective, how much further Alaska
needs to go to achieve widespread immunity.
DR. ELSBERG responded that the only numbers he has seen so far
regarding the likely burden of disease in Alaska are from
[Alaska's state epidemiologist, Dr. Joseph] McLaughlin, who
believes Alaska is between 0.5 and 1 percent. To have herd
immunity to a virus such as this, Dr. Elsberg advised, the best
estimates are 70-80 percent. For perspective, antibody testing
was recently done in New York City to try to get an idea of what
percentage of people have been exposed to the virus and, if
there is immunity following exposure, how many people have that
immunity. It is thought that there is decent immunity, but that
thought isn't 100 percent for sure yet. The estimates for New
York City were in the 25 percent range. It needs to reach 70-80
percent to have herd immunity. That isn't going to happen until
this virus circulates for years or until there is a vaccine. A
vaccine can give herd immunity by induced immunity and this is
the most hopeful route to get out of this with an intact economy
and intact healthy population; there is no other way to get
there. What is being done right now is mitigating the spread as
best as possible and riding that fine balance between having an
economy and health until there is a vaccine.
1:23:36 PM
CO-CHAIR FIELDS requested Dr. Elsberg to discuss the current
uncertainty regarding herd immunity and how long immunity lasts
even if the population reaches that 70-80 percent exposure.
DR. ELSBERG explained that COVID-19 is so new there isn't yet
the ability to demonstrate that someone who has had the
infection has a long-lasting immunity. The modeling is being
done with what has been seen in the past with other
coronaviruses. Regular coughs and colds are caused by
coronaviruses and there are others like MERS [Middle East
Respiratory Syndrome] and SARS [Severe Acute Respiratory
Syndrome] that are more serious viruses. In general, most
coronaviruses induce a decent immunity response and antibody
testing is showing that people who are exposed are producing
antibodies. The belief, based on what has been seen with the
others, is that people will have 6-12 months of immunity, but
this isn't known because it hasn't been proved. There have been
some reports of people testing positive after having tested
negative. Other reports say it is unclear whether these are
just residual fragments of virus versus active virus. He hasn't
read any literature that says people who have already been
through the illness have contracted a significant illness again.
This is where the uncertainty is, he added, because the virus
hasn't been around long enough to know how strong the immunity
is or how long it lasts. The hope with a vaccine is that it
induces an immunity that lasts a reasonable amount of time.
CO-CHAIR FIELDS related that he has heard the virus should be
left to rampage the population to reach herd immunity. He said
there needs to be public understanding that that would produce
mass deaths and even worse economic problems than are had now.
1:26:25 PM
REPRESENTATIVE JACKSON inquired about how there can be assurance
that vaccines will work, given the uncertainty about immunity
because COVID-19 is so new. She further inquired about the
uncertainty for how long immunity from a vaccine would last.
DR. ELSBERG confirmed these are the exact things being faced in
terms of uncertainty. Based on models of prior coronaviruses,
the hope is that people's immune systems will act similarly and
there will be some immunity. It is definitely a question as to
whether there will be a viable vaccine. Until there is a
vaccine, if there is one, there needs to be a way to manage
keeping the burden of disease at a low enough level that the
state's healthcare resources can manage that, while still being
able to perform regular preventative health care, cancer care,
and elective surgery outside of the COVID-19 crisis, as well as
keeping the economy rolling at some level. That will be the
case until there is a vaccine, or something changes with the
virus, or the virus has gotten through the community, which
would be incredibly destructive if it is allowed to happen fast.
1:29:36 PM
CO-CHAIR FIELDS requested Dr. Elsberg's advice on communities
holding Fourth of July parades.
DR. ELSBERG advised that any mass gatherings in the age of
COVID-19 are not realistic and should not happen.
"Superspreader" events happen more easily indoors, he said, but
getting people in close proximity in large groups [outside] will
spread the disease because some people with the disease will be
there.
1:30:46 PM
REPRESENTATIVE STORY asked whether Dr. Elsberg is recommending
the seven-day quarantine followed by a test that he mentioned
earlier. She offered her understanding that the 14-day
quarantine in Alaska significantly prevents infection.
DR. ELSBERG agreed Alaska's 14-day quarantine has played a major
role. Along with what is happening in the Lower 48, it has
dissuaded Alaskans from traveling, which is good because it has
limited the amount of disease burden. He noted that, for
himself, he couldn't afford not to work for 14 days. People in
the medical field are considered essential workers, but they are
still subject to this quarantine. He said he recently talked to
[Alaska's chief medical officer] Dr. Anne Zink, who said the
state is looking at seven days plus a test. About 90 percent of
people who contract COVID-19, he explained, will show symptoms
within seven days. So, a seven-day quarantine followed by a
test would likely screen out 90-95 percent of those possibly
having the virus. This would not necessarily be applied to
everybody, but in terms of taking away some of those exceptions
for essential workers, it would be a more workable timeframe for
people who do need to travel in and out of the state for work.
While he doesn't know if this will be adopted, it does seem like
a reasonable perspective that will screen 90-95 percent of the
asymptomatic carriers.
1:33:59 PM
REPRESENTATIVE STORY asked whether Dr. Elsberg is recommending
that this should be just for essential workers.
DR. ELSBERG replied that the problem is testing. In order to
test people after seven days there must be that much
availability of testing and it must be ensured that those people
actually get tested. Therefore it seems more realistic to apply
this to a limited population of people in certain industries
that are considered essential. To apply it to everyone coming
in and out of Alaska gets into public health logistics that are
beyond his world; while it would be a reasonable alternate
strategy, he is unsure how to make it work on that level.
1:35:10 PM
REPRESENTATIVE DRUMMOND related that she just returned to
Anchorage from Juneau on a plane that came from Seattle and she
was impressed with Alaska Airlines' cleaning process. In the
Juneau [airport] she barely noticed the forms for the 14-day
quarantine for incoming travelers and in Anchorage she didn't
see any. She asked whether Dr. Elsberg and Dr. Zink have
discussed enforcing the signup for quarantine and tracking of
the information to know a person is following the quarantine.
DR. ELSBERG offered his understanding that the state is looking
at local municipalities to enforce that at the airports and the
municipalities are looking at the state. Enforcement takes
people power, and given the state's tight budget, both sides
have decided they don't have the people power. Some people are
aware of that and are taking it to heart and self-isolating, but
there are plenty of people who don't know it exists or who are
ignoring it. The state and the municipality must come up with a
solution because it is necessary, he advised.
1:38:21 PM
CO-CHAIR FIELDS outlined three takeaways from Dr. Elsberg's
testimony: 1) mandate the use of masks in public buildings; 2)
quarantine procedures need to be meaningful, accountable, and
enforceable; and 3) an expanded testing regime is needed,
particularly in Pioneer Homes and other facilities.
DR. ELSBERG concurred and added that no one wants to get this
disease because it is a roll of the dice as to whether a person
gets a more severe case. While certain things can make a person
at higher risk for getting a more severe case, plenty of young
or otherwise healthy people still get a severe case or die.
1:39:19 PM
REPRESENTATIVE CLAMAN related his understanding from talking
with a physician in California that when there is screening the
screening is for specific hot spots, such as New York and New
Jersey. Folks traveling from those areas are being asked to
quarantine, but folks traveling from non-hotspot areas aren't
being asked to quarantine. He inquired whether Alaska has
looked at being more specific about which travelers should be
quarantined [like California has done].
DR. ELSBERG opined that Alaska should stick with anywhere
outside of the state because he cannot think of a place that has
a lower burden than does Alaska.
1:40:41 PM
JAKE METCALFE, Executive Director, Alaska State Employees
Association (ASEA), Local 52, said ASEA represents over 8,000
general government unit employees at the State of Alaska, which
includes the largest group of Class 1 employees. Class 1 is a
designation in law that says these employees are so essential
they cannot strike, he explained, government needs their
services in order to function. The Class 1 employees
represented by ASEA include police officers, state troopers,
airport police, court service officers, probation officers,
correctional officers, many employees within the Department of
Health and Social Services, Pioneer Home employees, Alaska
Psychiatric Institute employees, youth center employees around
the state, Alaska State Trooper dispatchers, public health
nurses, Office of Children's Service employees, and wild land
firefighters.
MR. METCALFE noted he is a lifelong Alaskan born in the
Territory of Alaska. He has lived in Juneau, Bethel, and
Anchorage for significant amounts of time. His children have
all gone through the Anchorage school system. His family went
through the 1918 Spanish Flu pandemic in Alaska and survived it,
he continued, and it is important that the state's essential
employees survive this [COVID-19] pandemic.
MR. METCALFE specified that ASEA is very interested in
maintaining safety on the job site and safety when employees
return to work. Essential workers are going to work to continue
providing the essential services that the entire state and its
communities need. The ASEA has been gathering information and
working with other unions in the state to stay on top of what is
going on so it can ensure that its members are safe on the job.
MR. METCALFE offered ASEA's wholehearted agreement with Dr.
Elsberg that for services to continue, and for ASEA's members to
be safe, there needs to be a coherent message, transparency, and
sharing of data. Since the pandemic started ASEA has pushed for
communication and while it hasn't always been a great system it
has gotten better. A number of public employee unions meet once
a week with the Department of Administration to ask questions
and get answers for sharing with their members about what is
going on in the workplace regarding safety. A letter is being
sent to a number of commissioners, including Commissioner
Tshibaka of the Department of Administration (DOA), and
Commissioner Crum of the Department of Health and Social
Services (DHSS). He spoke from a paragraph in the letter:
We recently sent a letter requesting and recommending
that public employee representatives serve as
cooperators in appropriate meetings. Together we seek
not only answers to our questions directly affecting
member rights, employment, policy, and implementation,
but also development of workplace mitigation plans and
transparent communication with state employed workers.
To help move this step forward we are working on a
draft workplace mitigation plan for consideration. It
is time to elevate our conversations to an appropriate
level of decision-makers. Our members deserve
answers. They deserve timely information and
assurances of safety. It is apparent through our
teleconferences that cooperation and open dialogue
must occur at a level within the state at which
decisions may be made and answers may be provided.
1:48:16 PM
MR. METCALFE reviewed some of ASEA's questions and concerns. He
said responses have been inconsistent to the question of whether
there is sufficient personal protective equipment (PPE) for
union members. It has been heard that some offices have
sufficient PPE, and some don't. There is concern about testing
in the 24-hour facilities where ASEA members work. If a
resident, employee, or visitor tests positive, there needs to be
some sort of rapid testing in place so that essential workers
are not knocked out, because those facilities must continue to
function. The union has asked for notice about either residents
or employees who test positive. For example, an ASEA member in
Juneau tested positive and no information went out within that
facility for a number of days. Employees in that office
building experienced a great deal of stress. The union has
asked that there be some sort of protocol when there are
positive cases in workplaces and notice to employees in those
workplaces. Violation of HIPPA laws aren't being asked for, but
ASEA is asking from a public health perspective that that
information be shared with both essential and nonessential
employees so measures can be taken to protect them as well as
the public. Mr. Metcalfe said ASEA is also looking for
information about what sanitation will be in place in the
workplace and wants to ensure there is adequate social
distancing when workplaces are opened.
MR. METCALFE further noted that because of Phase III changes,
information has been insufficient regarding return to work. The
union understands a master plan is being developed but has no
idea what that master plan entails. Everybody wants to work,
and everybody wants to ensure the state functions safely and
ASEA believes it is essential that employees have a spot at the
table and a voice in how that is done for the safety of every
employee and resident within the facilities. It is essential
for keeping the curve down on this virus.
MR. METCALFE added that ASEA believes the curve can be kept down
through meetings and discussing the aforementioned issues.
Communication is key, answers need to be received quickly, and
the ability is needed to share that information at the highest
levels. He said ASEA wants to continue toward cooperating and
ensuring that the State of Alaska has safe workplaces, healthy
employees, and a healthy public.
1:53:06 PM
CO-CHAIR FIELDS, in relation to coordinating with state
employees, asked whether [DOA] has notified state employees
about going back to work next week more or less as normal.
KATE SHEEHAN, Director, Division of Personnel and Labor
Relations, Department of Administration (DOA), State of Alaska,
replied that there has not been a statewide notification that
employees are required to come back to work. She said that
about 40 percent of employees are teleworking statewide in
various departments. Depending on the missions of departments
or divisions, some may be coming back due to the seasonality of
their work, but as of this point there hasn't been a mandate.
The department is starting to look at what that plan will be,
how to follow all the social mandates, ensure there are PPEs for
employees, and social distancing. Those employees that are able
to continue to telework right now are teleworking. In the plan
that is being put together there will be some statewide
direction, but it is going to depend on a division's mission and
what its jobs are.
CO-CHAIR FIELDS, in relation to Mr. Metcalfe's testimony,
inquired whether DOA can commit to a protocol of notifying
workers when someone in their workplace has tested positive, as
well as notifying the workers' unions.
MS. SHEEHAN answered that [DOA] has been following the decisions
and policy of the Department of Health and Social Services. An
investigation is done when state residents or any person tests
positive, and those employees who may have been in contact with
the patient who tested positive are alerted. When a state
employee tests positive, that same course of action and protocol
is followed and the people who need to know are contacted. The
offices are then cleaned and sanitized.
CO-CHAIR FIELDS asked whether the union representing employees
at that worksite is notified.
MS. SHEEHAN responded, "At this point, no, we are not notifying
the union."
1:55:39 PM
CO-CHAIR FIELDS inquired about the department's vision in regard
to standards for providing adequate PPEs, such as masks or other
equipment, for state employees working on the frontlines with
each other and the public, sometimes in close proximity.
MS. SHEEHAN replied it would depend on the office. She said
there are masks for state employees. Through the Department of
Corrections, inmates have made thousands of masks that have been
provided to state office workers, enough for two per employee.
Shields are in place for healthcare workers. Offices that are
too close are being reorganized to provide six feet in between.
Staggered work times are being looked at so there aren't full
loads in the elevators. Flexible workweeks are being looked at,
perhaps with the ability to work on a Saturday instead of a
weekday. It is being looked at on a statewide basis, but each
division or office will be able to tailor things a bit
differently to fit its needs.
1:57:13 PM
CO-CHAIR FIELDS asked whether the DOA could commit to engaging
collaboratively with the employee unions on safety planning. He
offered his understanding from Mr. Metcalfe's testimony that the
unions had to draft a safety plan on their own because the
administration isn't substantively engaged on that.
MS. SHEEHAN answered yes. The administration absolutely wants
to work with and have a collaborative relationship with the
unions. The goal is to keep government running while keeping
employees safe. She said she has enjoyed the weekly meetings
with the unions. She doesn't always have all the answers, but
tries to get answers when questions are raised.
CO-CHAIR FIELDS pointed out that one reason to notify the unions
in addition to the individual employees about a positive test is
because the features and ventilation systems of each building
are different and there is the possibility of infecting
employees beyond the immediate area. He brought attention to
the diagram of a call center provided to the committee where
people on multiple floors were infected from a single person.
He said the diagram demonstrates that six-foot distancing isn't
sufficient to protect people who are around each other for a
long time and that ventilation systems not designed with a
pandemic in mind could quickly spread infection across multiple
floors. He urged the administration to engage with the unions
on notification to ensure people aren't continuing to come to
work after they have been exposed.
1:59:13 PM
REPRESENTATIVE STORY expressed her hope that work from home will
be stressed at this time. She recalled a statement that 40
percent of the State of Alaska workforce is working from home.
She inquired as to how the department feels about working from
home and assessing how many employees can work from home in
order to provide safe distancing at work and providing safety to
employees during this time of coronavirus.
MS. SHEEHAN acknowledged that the 40 percent figure is her data
from mid-May, and she doesn't have the latest, but it is about
6,000 employees. The teleworking is going well, she continued,
but obviously not every position is suitable for telework, nor
is every employee. Also, some people prefer to be at [their
office] because of their home environment or because they need
multiple computer screens beyond a laptop. There is no state
directive to return to work, but there some things that just
cannot be done from home and need to be done at [the office].
The state is recognizing that there won't be a back to normal,
there is going to be a new normal and telework is definitely
going to be a part of that.
2:02:04 PM
REPRESENTATIVE TARR asked about the narrative that some state
employees, as well as non-state employees, are trying to take
advantage of the coronavirus situation so they don't have to
work. She opined that that isn't a fair representation because
it doesn't capture that some folks are in the predicament of,
yes, they could go back to work, but they have personal health
concerns, are concerned about someone at home, or they have
childcare. She has heard that some state managers are not being
supportive of employees who are trying to balance working from
home and dealing with childcare. She asked what could be done
to ensure flexibility in the workplace that is reflective of the
times and that supports people with the aforementioned concerns.
MR. METCALFE replied that childcare is one of the biggest issues
faced by ASEA members regarding a return to work since not all
childcare facilities are open. Childcare and compromised immune
systems are important reasons for why telework needs to
continue. He related that ASEA sued because people weren't
being treated the same on telework; as a result, the telework
process was sped up. The union is grateful that it is now
working well for both the state and employees, but there are
still problems. He said ASEA's members want to work and they
know that essential services have to continue for the state to
function. Both sides must provide clear communication, must
listen to one another, and must provide ways that people can
come back to work safely. Making people have to choose between
taking care of their children or going to their job doesn't
benefit anybody in Alaska.
2:07:59 PM
CHAIR ZULKOSKY asked how many state offices are operating on
restricted public access or by-appointment-only access and
whether that will continue in the future. As stated in previous
testimony, Alaska has far to go to achieve herd immunity, and
protecting employees should be a fundamental function of the
state's government.
MS. SHEEHAN answered she will get back to the committee about
the specific number of offices. She pointed out that the state
is open for business and didn't shut down. Certain precautions
have been implemented; for example, the Permanent Fund Division
in Juneau has a table in the building's eighth floor lobby where
the public can fill out information forms rather than going to
the division's eleventh floor office. Floors have been blocked
off and some offices have telephones for the public to use for
calls and some have put up shields to prevent direct contact.
CHAIR ZULKOSKY requested Ms. Sheehan to also provide information
on how the state is providing proactive outreach about the
change in operations and which offices have restricted access.
MS. SHEEHAN agreed to do so.
2:10:37 PM
CO-CHAIR FIELDS inquired whether the state has mandated
facemasks for members of the public entering buildings to
interact with state employees.
MS. SHEEHAN responded that she doesn't know the answer and will
include that in her response to the committee.
2:11:06 PM
CHARLES STEWART, Adult Probation Officer, Anchorage Correctional
Complex, Department of Corrections, State of Alaska, related
that the Anchorage Correctional Complex is one of the facilities
that has had a positive case of COVID-19. He said the
department has done an excellent job of screening people, but
one problem is communication with staff. It would be helpful
and appreciated if management would notify staff of a possible
case as well as a positive case because waiting all day and
listening to rumors causes more stress for the staff. Resources
within the facility are scarce and the department may want to do
better preparing in the future. Staff recommends that everyone
wear masks at all times for as long as new cases are popping up.
MR. STEWART said tension among the inmates is very high, with a
noticeable increase in fights and unrest since the cancelling of
programming and visiting privileges. With appropriate
precautions in place, some of these things could be reinstated
and would be helpful in decreasing tension levels, thereby
increasing staff and inmate safety. Letting people back into
the facility should be done slowly with proper mitigation
planning in place. He related that the positive case was in a
place isolated from the other residents, but had it been in a
module of 60-70 inmates it could have passed around the whole
facility in less than a week and caused more cases than there
are total cases in the state.
2:14:15 PM
KELLY FERGUSON, Nurse, Alaska Pioneer Home-Sitka, Department of
Health and Social Services (DHSS), State of Alaska, emphasized
the importance of maintaining a strict health mandate, strong
screening, inclusion of antibody screening, and [contact]
tracing. She pointed out that many nurses are over the age of
45 and have an increased chance of complications and death when
exposed to COVID. She stressed the importance of making full,
structured, organized PPE kits available to staff, not piecemeal
PPE. Organizing full PPE is very important when working in a
24/7 facility that houses the state's precious elders who
deserve respect. Employees also deserve respect by providing
them with the necessary equipment for taking care of these
elders.
MS. FERGUSON stressed the importance of consistent testing. She
said some employees working at the SouthEast Alaska Regional
Health Consortium (SEARHC) in Sitka get screened every two weeks
for COVID-19, but the Pioneer Home doesn't screen residents or
staff at this point. The Pioneer Home has employees who also
work at SEARHC or other facilities, so the importance of
consistent organized structuring of combatting and controlling
the disease process is very important. She further stressed the
importance that all employees who work on the frontline be
screened appropriately and be provided with PPE.
MS. FERGUSON stated that quarantine is very important as well.
She related that a friend of hers who traveled to Africa was
immediately detained at the airport and quarantined for 14 days
in a hotel at his own expense. She said she has lived in Sitka
for 26 years and doesn't want to see it devastated by a virus.
It is important for all communities and all departments to work
together in finding an organized consistent plan of action that
works everywhere in the state.
2:18:53 PM
RANDY MCLELLAN, President, Alaska Correctional Officers
Association (ACOA), stated that the Anchorage Correctional
Complex recently had a confirmed COVID-19 case, bringing the
number of facilities in Alaska with positive cases to three.
More than ever, he continued, it is imperative to protect
correctional officers and other first responders who risk their
lives and the lives of their families protecting Alaskans during
this state and national health emergency.
MR. MCLELLAN urged that DOC follow the lead of other states by
drastically increasing COVID-19 testing within correctional
facilities. The DOC, he related, declined COVID-19 testing even
when it was offered for free to everyone at the Anvil Mountain
Correctional Center by the Norton Sound Health Corporation.
Many states are aggressively testing for COVID-19 within
institutions. For example, Ohio has tested over 5,000 people in
its state prisons so far. It is still unknown how a Goose Creek
Correctional Center inmate and an Anchorage Correctional Complex
inmate, both having been incarcerated for a considerable amount
of time and so didn't come to prison with COVID-19, tested
positive for the virus. He said he thinks it is due to lack of
testing. Every DOC staff member and inmate should be given the
opportunity to be tested if it isn't mandatory. Every new
inmate entering an Alaska correctional facility should be tested
and quarantined until the inmate's test comes back negative.
MR. MCLELLAN quoted from a statement on the website of the
Centers for Disease Control and Prevention (CDC): "Another
population in which the prioritized testing of minimally
symptomatic and even asymptomatic persons are long-term care
facility residents, especially in facilities where one or more
residents have been diagnosed with symptomatic or asymptomatic
COVID-19." Dealing effectively with the virus can only be done,
he continued, if the extent of the virus's spread within a
facility is known. It is understood that the state doesn't wish
to see an increase in diagnosed cases, but now is not the time
to put politics before lives.
MR. MCLELLAN noted that the State of Alaska was awarded $3.6
million from the federal Coronavirus Emergency Supplemental
Funding Program to support law enforcement during this COVID-19
pandemic. He said these funds should be used to support
correctional officers, make appropriate protective equipment
available, and conduct widespread testing of inmates within
Alaska's correctional system. As of this date, none of this
money has been specifically allocated to DOC. The DOC needs PPE
to give to all security staff, not just medical staff. Making
N95 masks available to all DOC employees would provide another
tool that officers could use to protect themselves and others
from COVID-19. This pandemic has resulted in additional
significant dangers to correctional officers. Aware of the
risk, correctional officers continue to perform their duties
with dedication and courage, even in those facilities with
confirmed cases of COVID-19.
2:22:53 PM
JOSHUA WILSON, Business Agent, Alaska Correction Officers
Association (ACOA), noted he has been representing correctional
officers in the state of Alaska for over seven years.
Everything needs to be done, he said, to ensure the safety of
the staff and incarcerated Alaskans within the state's
correctional facilities. Any reasonable safety plan and
mitigation strategy should include cooperation between the state
and the employees. Last week the state refused to meet with
ACOA to bargain about the changes unilaterally made to
correctional officers' working conditions. A reasonable and
appropriate solution that protects correctional officers and
Alaska's institutions can only come about by working together.
MR. WILSON pointed out that the dangers are throughout the
correctional institutions. He said DOC couldn't successfully
adhere to the governor's COVID-19 mandate because social
distancing is simply not possible within a correctional
facility. On May 5, 2020, it was reported that over 5,000
correctional officers in the U.S. had contracted COVID-19 and 46
had died due to the virus. While none of those deaths were in
Alaska, the staff and those incarcerated at correctional
facilities are at significant risk of infection and outbreak.
As such, the measures put in place reduce the spread of COVID-19
within Alaska correctional facilities, and it is extremely
important that they be adhered to and maintained: no visitors,
no nonessential staff or personnel in and out of correctional
facilities, and continue to limit or cease altogether the
transfer of inmates between facilities or any other outside
location other than for serious medical emergencies.
2:25:08 PM
REPRESENTATIVE HOPKINS inquired about the communication that Mr.
Wilson is seeing with administrators and whether there seems to
be concern about people being infected.
MR. WILSON replied that a great improvement in communication is
needed, as there is very little. He said there is very little
information for officers and things are not uniformly set at
each institution, which leads to much confusion. Many questions
have been sent to the state, but there haven't been many
answers. Even receiving a response that an answer is being
worked on would be beneficial and could be passed on to
officers. The association has requested that names not be
provided, but that it be alerted when officers have tested
positive so support can be provided for something that could be
life threatening. The state has refused to give the association
that information, yet the state has had no problem providing
that publicly to other entities.
REPRESENTATIVE HOPKINS requested DOA to comment as to whether
there are any plans to communicate quickly or going forward with
the ACOA and/or ASEA.
MS. SHEEHAN responded that she hears what Mr. Wilson is saying.
She said the institutions are a unique environment and she feels
she is often the middleman in getting the questions and probably
the hang-up in getting out some of the answers, for which she
takes responsibility. She added that ACOA will absolutely be
communicated with and the state is working on answers.
2:28:13 PM
CO-CHAIR FIELDS invited Dr. Lawrence and Ms. Howell of the State
of Alaska to provide testimony regarding communication, the
availability of N95 masks, and testing frequency at facilities.
2:29:19 PM
ROBERT LAWRENCE, M.D., Chief Medical Officer, Health and
Rehabilitation Services (HARS), Department of Corrections (DOC),
State of Alaska, addressed communication. He said it is an
important point to hear from the officers themselves because
there are actually four different epidemics ongoing at the same
time. The first is COVID-19. The others are misinformation,
fear, and stigma, and staying ahead of those waves is very
difficult. In the attempt to stay ahead of those waves, care
must be taken not to throw out the principles of patient privacy
and making sure that communication, when it does occur, occurs
to the right people at the right time.
DR. LAWRENCE explained that when there is an outbreak, DOC does
its best to ensure that the patient is the first person who is
given the test result information. The second people to be
contacted are those who have been in close contact with that
patient. By that point, the rumor mill has already spun out and
there are many others who want information right then. But
DOC's next move is to meet with its partners in the Section of
Epidemiology and Division of Public Health because that is where
a plan specific to the given outbreak is formulated, and this
takes time. As soon as that plan is available, DOC goes back
into the facility and speaks specifically to officers and
inmates. In most cases it has been the superintendent of each
facility who then personally goes and gives that communication.
In other cases some of the officers are given the information to
pass on to other officers. It is not a simple posting of an
announcement on a wall or sending out an email because that
would be a dangerous way to get out that information. Instead
DOC does its best to keep that balance of patient privacy while
ensuring that everyone who is affected by an outbreak receives
that information in the appropriate amount of time.
CO-CHAIR FIELDS stated that it is important for the union to be
integral in that process because employees have chosen to be
represented by the union, including for purposes of workplace
safety. He asked whether N95 masks are available to
[correctional] officers as they are to Anchorage police officers
and other frontline public safety officials.
DR. LAWRENCE replied yes, N95 masks are available to officers
just like they are to medical personnel within the department.
He said it is important to understand that that is only one form
of PPE. For example, everyone in the room [where he is
testifying] is wearing a mask and practicing social distancing.
The masks are a form of PPE, but would not be appropriate if he
were doing a medical procedure that required an N95 mask. There
is an escalation of the appropriate PPE for a given situation.
He confirmed that the department has the appropriate PPEs for
any medical-type situation that arises within DOC.
Additionally, one thing he values about the officers is that,
even though he as a physician is taking care of some of the most
dangerous patients in Alaska, he has an officer right there at
his back and he is going to make sure that that officer has the
appropriate PPE to wear during that procedure because in that
sense he also has the officer's back. He noted that DOC
publishes materials to ensure that everyone knows exactly what
type of PPE is appropriate for any given situation and that PPE
is available.
2:33:37 PM
CO-CHAIR FIELDS requested clarification on whether N95 masks are
available to any correctional officer who chooses to wear one at
work on a daily basis.
DR. LAWRENCE responded that N95 masks are available, but are not
always the appropriate mask to wear just because of being in a
correctional facility or state office building. He added that
N95 masks are not available at the entry door, but are available
when that is the appropriate PPE for the given situation.
CO-CHAIR FIELDS asked whether N95 masks provided by DOC are
available for correctional officers to wear on the job if an
officer feels that that mask is appropriate. He offered his
concurrence with ACOA's contention that making N95 masks
available to employees is a reasonable thing to do.
DR. LAWRENCE answered, "Yes, N95 masks are available."
CO-CHAIR FIELDS asked what DOC's current testing frequency is of
employees and inmates. He also asked what DOC's ideal testing
frequency would be to catch an outbreak at the earliest stage
given the anticipation that there will be a rise in cases with
re-opening of the economy.
DR. LAWRENCE replied that DOC's testing follows CDC guidelines
and that DOC also works in collaboration with the Section of
Epidemiology and Division of Public Health. He said DOC's
testing occurs in three different settings and formats: 1)
anyone who has COVID symptoms, screening of inmates, screening
of employees every day; 2) anyone being prepared for transport
to the hospital; and 3) broad-base testing of asymptomatic
people as part of contact tracing.
2:36:21 PM
CO-CHAIR FIELDS inquired whether, in the interest of safety, DOC
will be able to move to a more proactive form of testing of
asymptomatic people as has been done in some countries.
DR. LAWRENCE responded that there is not yet data to say broad-
base testing in the absence of a known outbreak is actually
beneficial. When testing an entire facility, he continued, it
has been found that the virus hasn't spread beyond the index
case. This is instructive when looking at models for what will
work throughout the state to identify and then prevent spread.
CO-CHAIR FIELDS asked what assistance is offered by DOC to test,
particularly in facilities that are off the road system where it
wouldn't be wanted for the facility to be the primary vector for
infecting an entire community.
DR. LAWRENCE answered that an offer has been made by certain
hospitals throughout the state to provide testing. In this
pandemic, hospitals and communities have told DOC to let them
know if they can be of help with testing and Nome was one of
those communities. When the offer was made there was no one in
the facility with symptoms, and per CDC guidelines there was not
a reason for broad-base testing at that time. However, if that
point is reached, DOC will reach out to the hospitals in Nome,
Fairbanks, and elsewhere.
2:40:10 PM
REPRESENTATIVE JACKSON inquired whether it is accurate that
Alaska's correctional system has had only three cases.
DR. LAWRENCE replied it is important to separate the number of
cases among staff members and the number of cases among inmates.
Within DOC there have only been two cases among inmates, one at
the Goose Creek Correctional Center and the other at the
Anchorage Correctional Center. For cases among staff members it
is important to note that the Division of Public Health is the
agency that keeps those numbers, and the 11 published positive
cases were at the Lemon Creek facility.
REPRESENTATIVE JACKSON asked why Alaska's correctional officers
believe they are not receiving the $3.6 million that was to go
to law enforcement.
2:41:55 PM
KELLY HOWELL, Special Assistant to the Commissioner/ Legislative
Liaison, Office of the Commissioner, Department of Corrections
(DOC), explained that this funding is coming from the Department
of Justice and the $3.6 million is part of the carve-out to the
State of Alaska's administering agency, which is the Department
of Public Safety (DPS). The DPS, then, will allocate those
funds as it determines appropriate to law enforcement agencies
across the state. That application process is occurring right
now, and DOC is submitting an application to DPS for a portion
of that $3.6 million and DOC is looking forward to receiving
funds to help support its efforts in combatting the COVID virus.
REPRESENTATIVE JACKSON offered her understanding that it is a
matter of timing and process and the process hasn't gotten there
yet, but a portion of those funds will be there to ensure that
all departments are kept safe.
MS. HOWELL answered correct; DOC expects to receive a portion of
that funding. How much is yet to be determined. The Department
of Public Safety is the administering agency for those federal
funds, DOC expects to receive some of the funds, and DOC will
have its application submitted to DPS by the end of the week
[May 29, 2020].
CO-CHAIR FIELDS requested Dr. Erin Bromage discuss why six feet
of distancing indoors doesn't necessarily provide protection
from the COVID-19 virus and to discuss the risks of being inside
for long periods of time with multiple people.
2:44:02 PM
ERIN BROMAGE, Ph.D., Associate Professor of Biology, College of
Arts and Sciences, University of Massachusetts Dartmouth, stated
that for the past month he has been looking at where the primary
risk factors for infection take place. He hasn't necessarily
been looking at one-to-one interactions, he explained, but at
single events where superspreading has taken place. All of
these superspreading events tend to have a similar underlying
cause - many people in an enclosed environment for an extended
period of time. Poor air filtration and poor air exchange
increase the magnitude of attack rates and the number of people
who actually get infected. This is different from other
respiratory viruses in the past. For example, with influenza
most of the time face-to-face interactions for 10 minutes at
less than six feet without masks will lead to infection. With
COVID-19 there is a window of about five days where infected
people are infectious but not showing any symptoms. With
influenza, as well as with the original SARS virus, this period
is only 24 hours. This cryptic pathogen can stay hidden in
people that appear otherwise healthy but who are literally
shedding enormous amounts of the virus into the environment.
When these people are put with lots of people into an enclosed
space, rather than spreading to just one or two others, the
virus can spread to tens, hundreds, and even thousands of
others.
DR. BROMAGE specified that new data show that just breathing
releases small amounts of respiratory droplets into the air.
These droplets persist in the air for up to eight minutes in a
still-infectious state. After eight minutes in the air the
viral envelope begins to lose its moisture and breaks down, or
the virus falls out of the air. However, he continued, an
infected person who is just breathing in an enclosed space can
build that up so that others in the room can inhale small
amounts of the virus over a period of 30 minutes to hours,
thereby building up to a level of viral load that can establish
an infection. In the case of COVID-19, a person with a high
viral load, which can only be told by testing the person, can
result in half of the people in a building or half of the people
attending a conference becoming infected. If there is also
yelling, talking loudly, or singing, the amount of respiratory
emissions increases between 10 and 100-fold over just breathing
and these emissions will also be projected over a greater
distance and reach more people inside that enclosed space.
DR. BROMAGE explained that to minimize the risk of jumping from
1-10 cases per day in the state to 100-200 cases from a single
incident, a look must be taken at how interior spaces are
engineered, how many people are in the spaces, and at airflow
patterns. For example, Victoria, Australia, was down to fewer
than two cases per day and then a single asymptomatic person
went to work in a meat packing facility and caused 34 cases. In
another event, 30 gym instructors came together at an event
where 12 of them became infected and those 12 infected 108 of
their customers. Failure to look at situations of a number of
people close to each other in an enclosed environment for an
extended period of time as being a high risk for a rapid
escalation of cases will result in a rapid escalation of cases.
2:51:32 PM
CHAIR ZULKOSKY requested DOC to verify that the department
refused the offer of COVID-19 testing of its employees.
MS. HOWELL confirmed the testing was offered. She deferred to
Dr. Lawrence for further response.
DR. LAWRENCE clarified that the offer from multiple hospitals is
that, in the case of an outbreak, the hospitals would be happy
to test all the inmates. That offer, he continued, is separate
from the offer to test DOC officers or employees. At this time
that testing is available to anyone working within DOC within
the respective communities. There has been no attempt to
restrict employees from taking advantage of that testing offer
within their communities.
CHAIR ZULKOSKY inquired whether she is correct in concluding
that there has been no inclination to prohibit employees from
receiving COVID-19 testing, but there has not been an accepted
offer to test the inmates at these facilities.
DR. LAWRENCE replied that there have been at least two outbreaks
involving inmates and three when counting staff members who
tested positive through screening. Each of those outbreaks led
to a broad-based testing and there is never a time that DOC
declined to do the broad-based testing that was recommended.
CHAIR ZULKOSKY offered her understanding from today's testimony
that it was previous thought there was no need for asymptomatic
testing, but that there is now a growing body of evidence
suggesting that COVID-19 is infectious even when a person is
asymptomatic. She related from her experience within healthcare
that many healthcare facilities have broadened their testing
criteria to testing asymptomatic people because there are
individuals who can test positive while remaining asymptomatic.
She requested Dr. Bromage to speak to the growing body of
evidence around the testing of individuals regardless of whether
they are symptomatic.
DR. BROMAGE pointed out that those countries doing well in
controlling the outbreak have provided testing for anyone
wanting the testing while prioritizing the testing to people who
are sick, at highest risk, or who have come in contact with
someone who is sick. Alaska has done a remarkable job at
keeping the general infection rate quite low and its testing is
quite high. The desired test ratio is between 2 and 5 percent
positive and Alaska is at 0.4 percent. This is good in that
Alaska is capturing a lot of the community transmission just
with its standard testing alone. Of concern, he continued, is
that when this particular virus is brought into an enclosed
environment it cannot be easily contained, as has been seen in
jails throughout the world. However that needs to be tempered
with the fact that [DOC] could be testing all of its employees
and prison guards today and they may actually be infected but
not infectious at the time of the test and the next day there is
enough virus to be detected and testing needs to be done again.
When dealing with that type of situation, the utility of testing
the guards and getting a single snapshot in time when there is
already a good handle of it in the state may not have value
unless there is regular testing every day in order to ensure the
virus doesn't get in. He said he is unsure that that is
practical given the limited testing capability and access to
resources for testing. He would be giving different advice, he
continued, if he were being asked about this in Boston or New
York City. But from what he can see of the quality of testing
and the amount done locally in Alaska, he isn't sure that would
be money and resources well spent with the state's low level of
community spread.
CO-CHAIR FIELDS pointed out that Alaska is just reopening its
economy, including restaurants and places identified by Dr.
Bromage as vectors in other regions. He asked how outbreaks
could be prevented, and particularly prevented from spreading
into rural communities that heretofore have been protected, as
Alaska looks forward to a more open economy.
DR. BROMAGE responded that, in general, Alaska needs to keep its
testing where it is in order to keep a handle on it. Alaska, he
continued, is much better situated than the other states around
the U.S. because it has an excess testing capacity because it
has so fewer cases. If Alaska sees an uptick in its daily cases
and the trend starts to go up, Alaska is able to implement a
knowledge-based campaign to get people thinking about increasing
their social distancing and using masks to tamp it back down
again. Alaska has the capacity with its testing to capture it
early before it goes crazy. When looking at stopping it from
getting into high-risk environments, and maybe from employees
and prison guards bringing it in, Alaska may want to consider
categorizing its prison guards in regard to the contacts they
have to the outside of their workplace. If they live in a house
with someone who is in a frontline place or a place where it is
high risk, then Alaska might want to allocate resources to be
testing them more often. The risk is much lower for people who
are more isolated and have fewer contacts in the day outside of
work, and they can be put on a different testing or risk
spectrum in regard to what is being looked for, such as how to
evaluate, test, and mitigate risk in the best way possible.
3:00:34 PM
CO-CHAIR FIELDS requested Dr. Bromage to provide examples of
where a restaurant or other workplace served as a superspreader
event so that people can take risk into account as the Alaska
economy reopens.
DR. BROMAGE cited a recent example of a bus trip where 64 people
spent a little over an hour together and 27 of them became
infected. A second bus traveling with the first had none, so
the transmission happened on board the bus in that time during
traveling. For restaurants, an example is where one infected
person sat a table with nine other people. Five of the others
at that table were infected, as were three of the four people at
the table slightly downwind of the air conditioning blast from
the first table. Two of five people at the table underneath the
air conditioner and upstream of the first table also became
infected. This was because the air conditioner blew the air
downward and then the air circulated around the room. A
workshop conference is another example. Sixty attendees spent
two days together in a room and 34 of them became infected.
Another example is the Biogen Conference held in Boston,
Massachusetts, which resulted in many, many people becoming
sick. At a call center in South Korea there was a single
asymptomatic worker on the eleventh floor of the building; 94 of
the 214 people on that floor became sick and 91 of those 94 were
in the same vesseled area as the one infected person. Only
three of the people sitting on the other side of the floor-to-
ceiling partition became sick. Yet another example is a choir
in Washington State where 60 people were in attendance. They
had the requirements of the social distancing regulations in
place. The choir was in a hall a bit larger than a volleyball
court, the 60 people were as far apart as they could be and
didn't touch one another or share food, they just sang for a few
hours. Thirty-two of the people became sick and three died. It
is being seen that when a lot of people are together in an
enclosed space and the longer the time they spend together, the
higher the chance that someone is going to get sick and the more
people from that group will get sick.
CO-CHAIR FIELDS said the takeaway is that indoors with prolonged
exposure, even with social distancing, the rate of spread can be
very high, which has implications for Alaska's state facilities.
3:04:33 PM
REPRESENTATIVE JACKSON asked whether the [first group of
customers] in the restaurant example were screened before they
went into the restaurant because without screening how would it
have been known [someone at that table had the virus].
DR. BROMAGE answered that this is one of the best studies
because it was known that the people at the different tables
weren't related, didn't know each other, and had had no contacts
with each other prior to coming into the restaurant. The
authors did genetic sequencing to address the chance that other
people in there might have been infected and it wasn't from that
point source. This virus has a fairly predictable mutation
rate, so if the customers had acquired the infection at
different places before coming into the restaurant, and it just
so happened they infected their own tables, it would be expected
that the genetic sequencing between the viruses would be
different. In this particular case the sequencing from the
people that were infected there showed an identical viral
sequence, so the transmission in this event was definitely from
the first person with the virus to the others. What can't be
discounted is that the person at the table infected two people
at the table and then those two people in 24 hours infected the
other people at the table in their home environments. But it is
known that in this particular case the index case for all of
those people in that environment was from that single point
source.
3:07:47 PM
REPRESENTATIVE STORY said a plan of safeguards is being
developed for when state employees working from home are brought
back to [the workplace]. From Dr. Bromage's testimony regarding
space and airflow, she surmised it would be best to have people
who aren't essential employees be able to work from home if they
can until there is a vaccination or getting through the pandemic
in some other way.
DR. BROMAGE recommended that anyone who can work from home and
who can work efficiently from home should be encouraged to do
that. The Australian and New Zealand governments are doing this
right now. Fewer people in any enclosed space results in a
decrease in infecting others and a decrease in the size of an
outbreak. He noted he is working with the U.S. District Court
in Rhode Island on managing indoor environments and coming up
with ways to engineer spaces most effectively with air flow and
better filtration to make the work environment less conducive to
the spread of this infection in the workplace. Collaborating
with other facilities and agencies is an important part of
making government and private workplaces as safe as possible.
Combining fewer people, air exchange, and air filtration will
further reduce the risk of infection.
3:10:44 PM
MARY SWAIN, Executive Director, Camai Community Health Care
Center, stated that a majority of the sockeye salmon harvested
in the upper Bristol Bay region is processed in Naknek. With a
fishery this large (38 million salmon processed in Naknek) and
with a community of only 800, the expansion that takes place for
the season is quite large. Over about four weeks Naknek grows
to more than 10,000 and when the season is over the workers and
fishermen leave faster than when they came in.
MS. SWAIN related that Camai Community Health Care Center is
small, with only three exam rooms and two beds that are urgent
and emergency care. In early March, she said, Camai began
taking steps to protect the community. Camai had to plan for a
worst case scenario and that meant fishing season with an
outbreak of COVID-19. Camai began analyzing what it had and
what it would need based on recommendations from state, federal,
and other partners already dealing with the impacts of COVID-19
in their communities. The first decision was to increase
staffing levels for the season. In a typical fishing season
Camai has five providers for the peak; this year Camai will have
seven.
MS. SWAIN said Camai identified the need to coordinate with as
many fishing processors and industry businesses as possible as
early as possible, so a plan could be built together. These
once-a-week conversations include discussions about the changes
and mandates, policies, and what is being put in place for
businesses, as well as discussing the concerns of the industry
and the community. Normally when there is an emergency or
disaster, medical plays a part in the response. In the case of
a pandemic, medical takes the lead in many cases in many areas.
Camai's clinic of 14 employees came together to learn as much as
possible to be as prepared as possible when making decisions.
By working with the processors Camai learned about their plans
for isolation and quarantine in response to workers becoming ill
with COVID-19. Most plants will have medical staff in their
facility to assist in the care of ill people. Community members
will be able to isolate and quarantine in their homes and, if
ill, they can be monitored by Camai staff, Bristol Bay Area
Health Corporation, or public health.
MS. SWAIN continued and explained that this left the fishermen
as outliers potentially needing a place to isolate if they
became ill while they were on the water. A place close to the
clinic was needed so as to not burden the staff because long
travel distances to monitor the fishermen would be difficult.
She said she was contacted by a freight company that offered
several modular-housing units if needed. Camai decided that,
with beds, staff could manage about 15 mildly ill patients.
With help from the Bristol Bay Borough, Camai purchased an 11-
bed unit and leased an 8-bed unit for the season. The units are
on the barge and should be ready by the second week of June just
before fishing begins.
MS. SWAIN further noted that the state contacted her regarding
Camai's need for additional medical care in the event of an
outbreak bigger than Camai can manage. The state has an offer
from Samaritans First for a field hospital with the staff to
manage it if needed and the Bristol Bay Borough seemed to be the
right place to put it. Plans have now been made and if alerted
the hospital can be set up within a couple of days. This has
given Camai staff peace of mind knowing that if it becomes
overwhelmed there is a plan for help.
MS. SWAIN said testing is the last part of Camai's response.
Due to the mandates of the fishing industry, she stated, Camai
had to ramp up its ability to test a lot of people in a short
amount of time. Camai has tested over 600 people within the
last couple weeks and today 250 people were added. Testing is
being done in several ways. One is drive-up testing behind the
clinic, and another is testing groups at their processing plants
so they don't need to leave the plant. Samples are sent to the
state lab for testing and results are usually received in two to
three days. Tests can be run in the clinic setting with Camai's
"Abbott ID Now" point-of-care machines, or samples can be sent
to the state lab, whichever a provider prefers. This allows a
patient who has been exhibiting symptoms to know exactly whether
they are COVID-19 positive. Camai sends all negative Abbott
results to the state lab for verification and as of today all
negatives have been verified as negative by the state. Camai
hasn't yet had one positive in the community. Ms. Swain
continued her discussion of testing, announcing that today Camai
opened its walk-in/drive-up testing site in the building across
the parking lot from its clinic. This facility has a 16-port
point-of-care machine, so 16 tests can be run at a time and the
results reported within an hour. As well, Camai has the
supplies necessary to send out tests from that facility.
MS. SWAIN concluded by stating that Camai believes it has a good
plan in place to quickly identify positive persons and will be
able to respond as needed. As the state decides to reopen, the
community has, at this point, decided to continue to use
precaution until the fishing season is over. Stores have
continued to require face coverings, local eateries and bars
have limited seating, local tribal organizations have put hand
sanitizer and glove stations in high traffic areas in the
community, and expediters are expanding to deliver to boatyards
and to pick up groceries for those in quarantine. Community
members are aware that the risk is still there, and they are
personally limiting interactions in public buildings and public
gatherings. Even if the state reopens, the community still
plans to button down the hatch even further.
3:17:17 PM
CO-CHAIR FIELDS requested Ms. Swain's view of information
sharing between processors, the state, and Camai as a local
healthcare provider regarding the testing that is being done,
including the testing that is being done in Seattle as workers
are traveling up. He asked what an ideal system looks like and
what can be done to get there.
MS. SWAIN replied that currently the local processors are
working closely with her. She knows which ones are having tests
done before arriving and which ones Camai needs to test upon
arrival. Communication between Camai and the state, she said,
is probably the best it has ever been. She hasn't gone more
than 24 hours without getting a response to her question from
the state, probably because the state feels that if an outbreak
happens it is going to happen in the fishing industry. Testing
is the flip side of communication. Several processors want to
do both antibody and "PCU," which she doesn't think is a good
mix because she doesn't believe it is at a point for antibodies.
She offered her opinion that antibodies are a way to study the
virus but not to diagnose it.
3:19:32 PM
ADJOURNMENT
There being no further business before the committees, the joint
meeting of the House State Affairs Standing committee and the
House Health and Social Services Standing Committee meeting was
adjourned at 3:20 p.m.
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