Legislature(2021 - 2022)ANCH LIO DENALI Rm
09/02/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Overview: Covid-19 Update | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Anchorage, Alaska
September 2, 2021
3:05 p.m.
DRAFT
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Ken McCarty
Representative Mike Prax (via teleconference)
Representative Christopher Kurka (via teleconference)
MEMBERS ABSENT
Representative Zack Fields
OTHER LEGISLATORS PRESENT
Representative Andy Josephson
COMMITTEE CALENDAR
OVERVIEW: COVID-19 UPDATE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANNE ZINK, MD, Chief Medical Officer
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
HEIDI HEDBERG, Director
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
ADAM CRUM, Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Spoke during the PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
JOSEPH MCLAUGHLIN, MD, Epidemiologist, Chief
Section of Epidemiology
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
COLEMAN CUTCHINS, PharmD, BCPS, State Pharmacist
Office of Substance Misuse and Addiction Prevention
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
MATTHEW BOBO, Immunization Program Manager
Section of Epidemiology
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
GENE WISEMAN, Section Chief
Rural and Community Health Systems Bureau
Office of Emergency Medical Services
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Co-provided a PowerPoint presentation
titled, "COVID-19 Update", dated 9/2/21.
MICHAEL SAVITT, MD, Chief Medical Officer
Anchorage Health Department
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on the current
status of COVID-19 in Anchorage.
JARED KOSIN, President and CEO
Alaska State Hospital and Nursing Home Association (ASHNHA)
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on the current
status of COVID-19 in Alaska.
PRESTON SIMMONS, Chief Executive Officer
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on the current
status of COVID-19 at his hospital.
ELLEN HODGES, MD, Chief of Staff
Yukon-Kuskokwim Health Corporation (YKHC)
Bethel, Alaska
POSITION STATEMENT: Provided invited testimony on the current
status of COVID-19 in rural Alaska.
DAVID WALLACE, Chief Executive Officer
Mat-Su Regional Medical Center
Palmer, Alaska
POSITION STATEMENT: Provided invited testimony on the current
status of COVID-19 at his facility.
ROBERT ONDERS, MD, Administrator
Alaska Native Medical Center
Alaska Native Tribal Health Consortium
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on the current
status of COVID-19 at his facility.
ACTION NARRATIVE
3:05:25 PM
CO-CHAIR LIZ SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Prax (via teleconference), McCarty, Spohnholz,
Zulkosky, and Snyder were present at the call to order.
Representative Kurka (via teleconference) arrived as the meeting
was in progress.
^OVERVIEW: COVID-19 Update
OVERVIEW: COVID-19 Update
3:06:16 PM
CO-CHAIR SNYDER announced that the only order of business would
be a COVID-19 update.
CO-CHAIR SNYDER reported that the COVID-19 Delta variant is now
causing spikes in cases and deaths, and that this week Alaska
tied its record for the most patients hospitalized with COVID-
19. She further reported that Alaska's hospitals are at or near
capacity. She invited Dr. Anne Zink to begin the presentation.
3:10:41 PM
ANNE ZINK, MD, Chief Medical Officer, Division of Public Health,
Department of Health and Social Services (DHSS), co-provided a
PowerPoint presentation titled, "COVID-19 Update", dated 9/2/21.
She displayed the first slide and related that over 99 percent
of the COVID-19 cases in Alaska are the Delta variant, which is
spreading quickly across the state. She said an increasing
number of cases is being seen, along with an increasing strain
on hospital capacity. Early on with COVID-19, Alaskans
collectively worked together, which saved lives and reduced the
number of COVID-19 cases and hospitalizations, and DHSS hopes to
continue working together for this current surge.
3:11:52 PM
HEIDI HEDBERG, Director, Division of Public Health, Department
of Health and Social Services (DHSS), co-provided the PowerPoint
presentation titled, "COVID-19 Update", dated 9/2/21. She
proceeded to slide 2, "Continuing COVID-19 Response", and said
DHSS has been meeting weekly with tribal health organizations
organized by the Alaska Native Health board and the [Alaska
State Hospital and Nursing Home Association (ASHNHA) has another
meeting with all its hospital members. Additionally, DHSS is
conversing daily with hospitals and clinicians, and as issues
are identified DHSS is quickly finding solutions to respond to
those issues so that support can be provided to Alaskans,
patients, providers, and the state system. The public health
order, HB 76, is allowing DHSS to use additional flexibilities.
The department's focus is prevention and supporting the state's
hospitals during this surge.
MS. HEDBERG related that this morning the Alaska Chamber of
Commerce launched "Give AK a Shot", a strategy focused on
motivating the unvaccinated to become vaccinated. She explained
that it is a weekly drawing for eight weeks with an option for
those who are currently vaccinated to enter their name if they
so choose, and that over 3,000 people have already entered their
name into the sweepstakes.
3:13:50 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services (DHSS), announced that earlier today Governor Dunleavy
changed the call of the special session by reintroducing the
Nurse Licensure Compact, which had been previously introduced
under SB 67 and HB 83, as well as a new bill [SB 3006] which is
in direct response towards the COVID-19 response in working with
the Alaska State Hospital & Nursing Home Association (ASHNHA)
[now called the Alaska Hospital & Healthcare Association
(AHHA)]. This new bill includes items about telemedicine,
telehealth, prior authorizations, and background checks, and is
a tool that will enhance the state's response to open health
care capacity. Internally, the commissioner's public health
emergency powers or authorities under HB 76 have been used to
waive background checks for ASHNHA facilities personnel,
including non-healthcare providers like cooks and environmental
services personnel.
3:15:42 PM
JOSEPH MCLAUGHLIN, MD, Epidemiologist, Chief, Section of
Epidemiology, Division of Public Health, Department of Health
and Social Services (DHSS), co-provided the PowerPoint
presentation titled, "COVID-19 Update", dated 9/2/21. He
briefly displayed slide 3 and then moved to slide 4, "COVID-19
Statewide Dashboard, Sept. 1, 2021". He reported that every
region in Alaska is currently at the high alert level, with a
rate of 504.7 cases per 100,000 people. A high alert level is
reached when the rate is greater than 100 cases per 100,000
people on average over the past seven days. Over 85,000 cases
have been reported to the Section of Epidemiology since the
pandemic's start, and during the last week the number of cases
has increased by 13 percent. The number of hospitalizations
since the pandemic's start is just over 2,000 and 435 residents
have died.
DR. MCLAUGHLIN turned to slide 5, "COVID-19 Cases by Onset Date,
Statewide, March 2020 August 31, 2021". He said the graph
depicts the epidemic curve in Alaska, with the increase since
July [2021] mirroring what is happening on the national level.
DR. MCLAUGHLIN addressed slide 6, "COVID-19 Variants of Concern
in Alaska, Weekly COVID Genomics Surveillance Report - Sept. 1,
2021". He related that this recent surge is being driven
primarily by the Delta variant, and that, nationally, according
to the federal government, 99 percent of all sequenced cases
have been positive for the Delta strain.
DR. MCLAUGHLIN spoke to slide 7, "Alaska Vaccine Breakthrough
Cases, Vaccinated vs. Unvaccinated Cases and Hospitalization".
He said this slide illustrates the changing epidemiology of
vaccine breakthrough cases in Alaska. The top figure shows that
from January-July 2021, 10 percent of the cases and 8 percent of
the hospitalizations were fully vaccinated people, and 90
percent of the cases and 92 percent of the hospitalizations were
unvaccinated. For the month of July 2021, 30 percent of the
cases and 20 percent of the hospitalizations were fully
vaccinated people, and 70 percent of the cases and 80 percent of
the hospitalizations were unvaccinated. First among multiple
reasons for the breakthrough vaccination rate is that the Delta
strain is much more transmissible than prior strains. Second is
that the Delta strain evades prior immunity better than other
strains of virus.
DR. MCLAUGHLIN displayed slide 8, "Hospitalization By
Vaccination Status". He pointed out that from January-June 2021
the risk of hospitalization increased 16-fold among people who
were not vaccinated as compared to those who were fully
vaccinated. In July 2021 the increased risk was 7.5-fold.
3:19:55 PM
COLEMAN CUTCHINS, PharmD, BCPS, State Pharmacist, Office of
Substance Misuse and Addiction Prevention, Division of Public
Health, Department of Health and Social Services (DHSS), co-
provided the PowerPoint presentation titled, "COVID-19 Update",
dated 9/2/21. He briefly showed slide 9 and then proceeded to
slide 10, "Alaska's Testing Update". He said Alaska is one of
the most tested states and is doing well in relation to other
states, although certain things are getting stressed. For
example, there are longer lines in Anchorage, Kenai, the
Matanuska-Susitna Valley, and Fairbanks. The turnaround time
for results is 24-72 hours, which is good compared to other
states that have turnaround times of 5-10 days. A year ago,
Alaska's two public health labs were handling the bulk of the
processing, but today two commercial labs and three hospitals in
Alaska are handling processing, so Alaska's capacity for lab
testing remains quite high. [The state warehouse] continues to
supply rapid molecular tests by Cue Health and ID NOW, and rapid
antigen tests by [BinaxNOW], and is actively trying to acquire
more. A new group of tests are also being looked at that can be
done in the home; they have some limitations but offer a lot of
benefit for certain things. The state is continuing to offer
airport testing for as long as it can.
DR. CUTCHINS proceeded to slide 11, "Rapid Antigen Testing by
YKHC". He stated that in outbreak response the Yukon-Kuskokwim
Health Corporation (YKHC) took the lead in using rapid antigen
testing and was able to get ahead of the outbreaks. This was
the first good data, and it was published in a Centers for
Disease Control and Prevention (CDC) Morbidity and Mortality
Weekly Report (MMWR), a high impact national publication. He
noted that the downward slope on the graph began once YKHC
started using these tests, then another decrease occurred once
the vaccine became available, and yet another decrease occurred
when the vaccine became widely available.
DR. CUTCHINS moved to slide 12, "Diverse Testing Partners +
Locations". He reported that DHSS has worked with schools,
university sports teams, fishing boats, fishing industry
processors, [television] reality show production sites, the
Iditarod Sled Dog Race, churches, remote lodges, and the tourism
industry by supporting their testing and offering them support
from clinical considerations to testing supplies.
3:23:25 PM
DR. CUTCHINS discussed slide 13, "Disease Progression +
Treatment". He specified that the graph, which looks at the
phases of how COVID-19 progresses, is based on the evidence that
is known and the treatment options available that evidence and
guidelines support. He said the prevention phase consists of
mitigation not medication, given there aren't good treatment
options for most viruses and the body is the best at eliminating
these type things. Vaccine is the best option because it is 90
percent effective at preventing severe disease. Monoclonal
antibodies are a synthetic antibody given by IV infusion or
subcutaneous injections and can be preventative in infection if
given at a specific time in a specific person and are the only
treatment option for patients not admitted to the hospital. The
earlier monoclonal antibodies are given in the infection the
better, which is why people are encouraged to test. If given
early before patients start to get very sick, they are 70
percent effective in reducing the patient's risk for severe
disease. Once hospitalized the treatment options are systemic
steroids, but vaccine and monoclonal antibodies are the best
tools for preventing people from getting severely sick.
DR. CUTCHINS proceeded to slide 14, "Monoclonal Antibodies". He
noted that [DHSS] changed its vaccine call line to a monoclonal
antibody call line to help people get access to these drugs. He
said DHSS is working with health care providers and the federal
government is still supplying most of these drugs for free.
3:26:38 PM
MATTHEW BOBO, Immunization Program Manager, Section of
Epidemiology, Division of Public Health, Department of Health
and Social Services (DHSS), co-provided the PowerPoint
presentation titled, "COVID-19 Update", dated 9/2/21. He
briefly displayed slide 15, then moved to slide 16, "COVID-19
Vaccine Summary Dashboard, September 1, 2021". He reported that
as of 9/1/21, 60.9 percent of residents 12 years and older have
received one dose of vaccine and 55.1 percent are fully
vaccinated. He further reported that 16,749 vaccine doses were
administered between 8/18/21 and 8/31/21, a 43.6 percent
increase compared to the week of 7/21/22 through 8/3/21.
MR. BOBO next reviewed the list on slide 17, "COVID Vaccine
Rates by Age Group, August 31, 2021". He noted that residents
with one dose are broken out on the list by [age group] within
each borough census area. Overall, for 12 years and older the
coverage rate is 60.7 percent, for 65 years and older the
coverage rate is 76 percent, and for all ages the coverage rate
is 50.6 percent.
3:28:18 PM
MR. BOBO spoke from slide 18, "Additional Dose for
Immunocompromised People", which read [original punctuation
provided]:
• CDC's Advisory Committee on Immunization Practices
(ACIP) recently recommended that people whose immune
systems are moderately to severely compromised receive
an additional dose of mRNA COVID-19 vaccine at least
four weeks after an initial two-dose mRNA series.
• CDC's recommendation includes people with a range of
conditions, such as recipients of organ or stem cell
transplants, people with advanced or untreated HIV
infection, active recipients of treatment for cancer,
people who are taking some medications that weaken the
immune system, and others.
• Vaccine providers should administer vaccine in
accordance with the updated emergency use
authorization (EUA) per the COVID-19 vaccine provider
agreement.
MR. BOBO paraphrased from slide 19, "Pending Booster Doses",
which read [original punctuation provided]:
• COVID-19 vaccines continue to be highly effective in
reducing risk of severe disease, hospitalization, and
death, even against the widely circulating delta
variant.
• However, we are seeing a decrease in vaccine
effectiveness against infection.
• Nearly all the cases of severe disease,
hospitalization, and death continue to occur among
those not yet vaccinated at all.
• [Health and Human Services] HHS has developed a plan
to begin offering these booster shots this fall
subject to FDA [Food and Drug Administration]
authorization and CDC's Advisory Committee on
Immunization Practices (ACIP) issuing booster dose
recommendations based on a thorough review of the
evidence.
3:30:14 PM
GENE WISEMAN, Section Chief, Rural and Community Health Systems
Bureau, Division of Public Health, Office of Emergency Medical
Services, Department of Health and Social Services (DHSS), co-
provided the PowerPoint presentation titled, "COVID-19 Update",
dated 9/2/21. He briefly showed slide 20, and then continued to
slide 21, "COVID-19 Hospitalizations Dashboard, Sept. 1, 2021".
He drew attention to the graph at the bottom of the slide and
noted that the curve for the number of confirmed COVID hospital
beds occupied in 2021 is similar to November and December 2020.
Currently, 164 people are hospitalized and 16.9 percent of total
hospitalizations are COVID patients.
MR. WISEMAN moved to the graph on slide 22, "Alaska COVID 19
Hospital Admissions By Age". He specified that the graph
demonstrates admissions by age group and the mean age has
changed. In October, November, and December 2020 the age group
of 60-69 years was the mean age for the most admissions, but
currently 50-59 years is the mean age group. He pointed out
that the pediatrics age group is also increasing.
MR. WISEMAN discussed slide 23, "Covid-19 Update on Hospital
Capacity". He stated that there are other differences from last
year's surge, one being that Alaska is currently experiencing an
exhausted workforce from 18 months of this pandemic and staffing
shortages. He said it isn't uncommon for Alaska's hospitals to
have traveling nurses as a part of their augmentation for staff
year to year, but this year those professions are not there due
to a nationwide or global shortage for those professions. On
top of that, summers are the busy season and Alaska hospitals
are still treating heart attacks, strokes, and traumas,
resulting in a bottleneck that decreases access to specialty
care and urgent care, and making it difficult to find beds
throughout the state for placing patients where they need to be.
3:33:25 PM
MR. WISEMAN addressed slide 24, "Supporting Alaska's Health Care
System". He related that DHSS meets regularly with its ASHNHA
hospital partners to work through the problems and issues. He
said steps have been taken to expedite license and background
checks for providers. The department is working with emergency
medical services (EMS) partners on ways to decompress the
hospital through avoiding potentially unnecessary transports to
the emergency room (ER), or by supporting early discharge which
is done through [Centers for Medicare and Medicaid] 1135
waivers. The department has partnered with the [US General
Services Administration (GSA)] and Region 10, which has
established four contractors to specifically provide staff to
the region four states of Oregon, Idaho, Washington, and
Alaska, and for which there is currently a deficit of about 500
medical workers.
MR. WISEMAN spoke to slide 25, "Hospital Situational Awareness".
He said the dashboard shown on the slide was established in 2020
and is currently based on hospitals with intensive care units
(ICUs). He explained that the dashboard is used for load
leveling between hospitals and is in the process of being
expanded to include all hospitals. A morning situational brief
is going to be started where each hospital will talk about its
capacity so patients can be sent to those hospitals that can
give them the care they need.
3:36:56 PM
DR. ZINK briefly displayed slide 26, "The Next Few Months", then
proceeded to slide 27, "Supporting Alaskans". She highlighted
that DHSS is continuing to support Alaska's public schools and
health care workers. She emphasized that children learn best in
school, so DHSS has an ongoing school health and safety team
that works with schools to help each district with what makes
sense to keep their schools open and safe and the protocols that
may be used; DHSS also supports them with testing, supplies, and
resources. To support schools to stay in-person and help kids
be healthy and resilient, DHSS regularly holds [a
videoconference called Extension for the Community Healthcare
Outcomes (ECHO)]. The department continues to hold a parents
night to help parents with difficult decisions and to get their
kids in school. The department continues to support the public
via a weekly ECHO every Wednesday where the team is online to
take questions. The department further supports a variety of
healthcare providers with popup ECHOs to support them in better
understanding how COVID-19 is affecting kids and to collectively
work together in moving forward.
MS. HEDBERG closed the presentation with slide 28, "We can do
this, Alaska!" She underscored that this is about partnerships
and that DHSS works with communities, hospitals, and clinicians
every day seven days a week.
3:40:42 PM
CO-CHAIR ZULKOSKY, in relation to epidemiology, requested that
someone speak to the curve in Alaska about where the state is in
terms of case rates, hospitalization trajectories, and peaking.
DR. MCLAUGHLIN replied that Alaska is still in an increasing
trajectory with a 13 percent increase from last week.
Nationally, the week-to-week increase in cases is slowing down
with the last report being a 3 percent increase in cases, which
could be an indication that things are starting to level off
potentially in the US. Something learned early on with COVID-19
is that it is difficult to predict the future. In other
countries, such as the United Kingdom (UK), the trajectory
recently had a sharp rise that peaked, then it fell, and then it
started to rise again. In general, this pattern seems to go
over a period of two to three months in other countries, but at
this time it cannot be said whether that will occur in the US
and Alaska.
DR. ZINK added that when the world and the US surge, Alaska
tends to surge as well. She noted that the vaccination rate in
rural communities is better in general than in communities along
the road system, and that increased access to rapid testing is
even more important with the Delta variant than before. She
predicted that Alaska would see a series of outbreaks on top of
each other for some time before it comes down.
3:44:32 PM
CO-CHAIR ZULKOSKY shared her understanding that several
hospitals statewide are working with the state to centralize ICU
transfer requests. She inquired about the status of making this
effort happen and whether it is included on slide 25.
MR. WISEMAN responded that slide 25 represents a component of
that. He said DHSS has been working with the hospitals to bring
a mechanism together for that visual aspect of load leveling and
moving ICU patients appropriately. Transfers and transports are
different now than what was normally seen in the past; for
example, a critical patient was moved from Bethel to the ICU at
Fairbanks Memorial Hospital rather than to Alaska Native Medical
Center (ANMC) where that patient would normally have gone.
3:46:11 PM
CO-CHAIR ZULKOSKY recalled that early in the pandemic DHSS was
reporting ICU capacity in terms of bed availability, but
providers pointed out that ICU capacity was based on the
[availability of] expert staff rather than number of beds. She
asked whether staffing capacity, not just bed capacity, is
layered into this new reporting.
DR. ZINK answered that it has to some degree. One set of
numbers, she explained, looks at the population as a whole and
considers the chance/risk of someone getting COVID-19 and being
hospitalized. However, she continued, several things must be
considered when the team is thinking about capacity, need for
care, and how much the state's hospitals take on. The available
beds reported by hospitals are their available staffed beds.
She pointed out that the number displayed on the dashboard is
the number of hospitalized people who are actively infectious
with COVID-19 that the hospital is reporting to the US
Department of Health and Human Services (HHS), and which DHSS
then sees. Not reflected in the overall dashboard numbers, but
still a continued burden on the hospital, is the number of
patients requiring hospital stays of 1-2 months and who are no
longer infectious beyond their first 10-15 days. Also not
necessarily reflected in the dashboard are patients infectious
with COVID-19 who start to recover but then must be treated for
a complication such as a pulmonary embolism or myocardial
infarction, which occur at higher rates in people with COVID-19.
Further, there is a pivot point in the first five to seven days
of either people do much better or they do much worse and are
hospitalized for a very long time. So, Dr. Zink advised, the
dashboard doesn't represent the overall burden on hospitals;
numerous points need to be considered when looking at hospital
capacity and the impact of COVID-19 on the hospitals.
3:48:57 PM
REPRESENTATIVE SPOHNHOLZ asked whether the governor or the
commissioner considered utilizing the public health emergency
disaster declaration to cut through the red tape and speed up
the implementation of some of the licensing suspending elements
to make it easier for telehealth and to eliminate the background
checks requirement without needing to pass legislation.
MR. CRUM replied that these are specific items that were laid
out by ASHNHA in conversation and in writing. He said the
disaster declaration is so overly broad that it would still
require legislative action to go beyond 30 days. Fine tuning
and tools are being looked at to deal with the large spikes that
seem to be occurring every six to seven months. These very
specific items need to be moved forward, and since legislative
action is going to be required anyway it was thought that this
narrow aspect was the best way to move that forward.
REPRESENTATIVE SPOHNHOLZ recalled that the Nurse Licensure
Compact wasn't well-received in the House when it was introduced
earlier. She said it focuses only on nurses and not any other
healthcare professionals, and she is concerned that it is too
narrow and does not respond to ASHNHA request for a much
broader public health emergency disaster.
3:51:50 PM
REPRESENTATIVE SPOHNHOLZ asked whether at-home testing is as
reliable and of the same standard as the rapid tests available
through a healthcare provider.
DR. CUTCHINS responded that there is a wide variety of these
tests, and some are appropriate for people who want to travel.
He said the most important thing is for people to follow the
test's directions and to reach out to their health care provider
with any questions on the results. Overall, over-the-counter
tests are very good at detecting positive, but the chance of a
negative result being real is only 50-75 percent.
3:54:05 PM
REPRESENTATIVE SPOHNHOLZ drew attention to the hospital
dashboard and remarked that it is alarming to see so many
hospitals at capacity. She noted, however, that Joint Base
Elmendorf-Richardson (JBER) Hospital appears to still have
capacity and asked whether people could be sent there rather
than to Washington state.
MS. HEDBERG answered that DHSS continues to encourage all the
hospitals to update the divert page, which is what is being
referenced. But, she explained, not all hospitals update that
page on a timely fashion and that is being worked on. Hospitals
are asking patients if they have [US Department of Veterans
Affairs (VA)] benefits and, if they do, whether they can be
transported to Fort Lehi or to the 673d Medical Group Hospital.
She advised that she therefore doesn't think it reflects bed
availability at the JBER hospital.
REPRESENTATIVE SPOHNHOLZ asked whether Ms. Hedberg is suggesting
that there is a higher utilization than what is reflected in the
dashboard.
MS. HEDBERG confirmed that JBER's hospital status is not
accurately reflected but that the hospital does have patients.
3:56:21 PM
REPRESENTATIVE MCCARTY inquired whether the dashboard variance
is a standard deviation variance of days or weeks or a lack of
reporting.
DR. ZINK replied that it is a combination of lack of reporting
results and the dashboard not being regularly updated. She
noted that the Anchorage Fire Department has a diversion website
so Anchorage hospitals can see who is full. She emphasized that
if [the dashboard] shows an emergency department is closed, it
doesn't mean that that department isn't delivering care as they
are still open to walk-ins and will treat people with a medical
emergency. She explained that this was initially made for the
Anchorage area EMS to be able to round-robin. The department
then stepped in to add additional hospitals to provide better
visibility of what was happening. Not all hospitals are used to
the system, but they are getting more comfortable with it over
time. The department is meeting with hospitals and transfer
centers on a regular basis to have a better understanding of
their capacity. Not every patient can go to every place, not
every bed is equal. For example, no dialysis is available at
JBER so a bed would not be available there for a patient who
needs dialysis. Complex decision making is happening at a
critical level for many of these patient transfers. The
dashboard is a rough tool used internally to give hospitals a
place to start calling other hospitals in the state.
MR. WISEMAN added that the dashboard is a capture in time and
hospitals under stress are entering when they can. Typically,
it is 24 hours, sometimes a couple days, but that is recognized
and is why DHSS is also putting emphasis on working through a
daily oral standup with each hospital, which will provide a
situational picture within the state. While that will only be a
piece of time when that briefing occurs, it should increase
awareness.
4:00:20 PM
REPRESENTATIVE MCCARTY stated he would like a copy of slide 4
along with data that shows what has happened between July 1,
2021, and now. Regarding slide 7, he asked whether there are
studies of what has happened with school starting and influenza
and how that compares over the years to what is going on
currently, i.e., whether this is an anomaly or a standard type
thing? Relative to slide 10, he asked whether there have been
studies on antigen longevity within people who are known to have
had COVID-19. Relative to slide 13, he said some places are
offering monoclonal antibodies and some are not. He asked
whether regulation difficulties or accessibility are the reasons
why outpatient clinics are not participating in this therapy.
DR. ZINK answered that DHSS does a monthly hospitalization and
vaccine breakthrough report, but since it takes a while for
those reports to come in the most recent report is for July
[2021] data. A comparison is made to 2020 and she is happy to
provide it. Addressing vaccine breakthrough, she explained that
it is a matter of understanding timing because when looking at
fully vaccinated individuals and those who get COVID-19, there
is not a perfect marker to understand whether someone exposed to
COVID-19 had full protection against the virus.
4:04:18 PM
DR. ZINK continued her response and addressed the difference
between antibodies and antigens. Antibodies are what the body
makes in response to either natural infection or to vaccination.
With vaccination, the body gets a signal that it needs to make
antibodies and ideally a longer-term response to that pathogen.
Because viruses replicate themselves by taking over the normal
cellular structure, they are not very responsive to treatment,
and as a result they are best prevented. The immune system is
the best way to take viruses down and the best way to take them
down is when the immune system knows how to do it efficiently.
Vaccines teach the immune system to take down a virus as quickly
as possible. Antibodies are the [immune system's] first
response. There are different ones IgG, IgM, IgA and they
last for different periods of time and are found in different
parts of the body in general. Additional parts of the immune
system are also important, including B cells and T cells which
play a key role in natural infection as well as vaccine induced
protection. Dr. Zinc further explained that there isn't a great
test to say that someone previously had COVID and are they
getting reinfected. According to national data, people who have
previously had COVID-19 are 2.5 times more likely to get COVID-
19 again with the Delta variant if they are not vaccinated. She
said antigens are small molecules that are tested for to see if
someone currently has a virus. Antigen testing looks for active
infections, it is not looking for past infections which
antibodies look at.
DR. ZINC continued further and addressed monoclonal antibodies.
She explained that it can be challenging to the workflow of an
infusion center or outpatient clinic - where there are
immunocompromised or sick people - to bring in a COVID-positive
patient. The health care system has been stretched for months
now, but more providers are stepping into that space. Alaskans
are encouraged to phone the DHSS call line for where they may be
able to access monoclonal antibodies in their community.
4:08:23 PM
MICHAEL SAVITT, MD, Chief Medical Officer, Anchorage Health
Department, provided invited testimony on the current status of
COVID-19 in Anchorage. He said city of Anchorage is in a high-
risk situation with a 7 percent positivity and 37,700 total
cases as of today. As of today, the total number of COVID-19
deaths is 215, and the number of new cases today is 251. The
city's 14-day rate average is 64.8 per 100,000. The highest
number of tests done across Anchorage is 1,900. Current
hospitalizations today include 93 confirmed cases and 5
suspected. Vaccination rate for the first dose is 67.1 percent
and the completed series is 59.3 percent, this includes the
municipality and JBER totaled together. Right now, Anchorage
has three staffed adult ICU beds available.
DR. SAVITT emphasized that this battle against COVID-19 is
really against the Delta variant and that it is not just for the
health care system to fight. He said the public must become
fully engaged and partner with the health care system to defeat
this virus. The health care system encourages vaccinations
because that is the single best weapon against the Delta variant
and COVID in general.
4:11:23 PM
DR. SAVITT encouraged the public to follow all the CDC
recommendations and to get early testing for COVID-19. He said
anyone exposed or experiencing symptoms should be tested because
the only way to make the diagnosis is with testing. Anyone
testing positive should call their health care provider as
quickly as possible to see what treatment is appropriate. If
eligible for monoclonal antibody treatment, try to get it done
as quickly as possible because the sooner the treatment the
better it works.
DR. SAVITT stressed that monoclonal antibody therapy is not in
place of vaccinations. If you are unvaccinated and have no
natural immunity your chance of severe disease and
hospitalization and death are much higher. Why put yourself,
family, friends, and neighbors at greater risk? Get vaccinated
and follow all the recommendations for proper use of masks,
handwashing, physical distancing, and adequate ventilation. In
addition to helping family, friends, and neighbors you are
helping hospitals by decreasing the need to go to the hospital
to begin with. Vaccines are safe and protective even if there
is decreased effectiveness against Delta, they still reduce the
severity of the disease and help to prevent death.
4:14:45 PM
CO-CHAIR SNYDER said she understands that the administration has
no intention to require masking or reduction of gathering sizes
or social distancing. She asked whether there is a threshold
where the administration would consider implementing orders to
minimize the impacts that are being seen from the Delta variant.
DR. SAVITT deferred to the administration to provide an answer.
CO-CHAIR SNYDER asked whether Dr. Savitt, as Chief Medical
Officer, has a sense of what that threshold should be.
DR. SAVITT answered, "We have made recommendations as to the
necessity for the vaccinations for the CDC recommendations;
going forward that would be up to the administration."
4:16:03 PM
REPRESENTATIVE MCCARTY pointed out that some people cannot get
vaccinated due to medical reasons. He requested Dr. Savitt's
suggestions for what these people can do to protect themselves.
DR. SAVITT replied that those who can't be vaccinated should be
surrounded by family members and close contacts who have been
vaccinated. Also, they should wash their hands, wear masks, do
physical distancing, limit their circle of friends, and be in
well-ventilated indoor spaces, and limit gatherings to people
who are not sick or have been vaccinated.
4:17:35 PM
REPRESENTATIVE SPOHNHOLZ noted that while Anchorage has 40
percent of the state's population it has 60 percent of the
hospitalizations. She asked whether this is because Anchorage
is receiving folks from outside the municipality who need a
level of care that cannot be gotten in other communities.
DR. SAVITT responded that the hospitals have a primary catchment
area of Anchorage, but second and tertiary catchment areas could
be from anywhere in the state. Many of the cases are from
Anchorage, he said, but there has been the influx from outside
of the municipality as well. Regarding ICU capacity, it is
important to note that not every bed in the ICU is filled with a
COVID patient, it is probably 30 percent COVID, which puts an
additional strain on already near capacity hospitals. So,
prevention is much more important than ever. Patients from all
over the state are taken, but a further strain is that
Washington state and Oregon, [Anchorage's] usual avenues for
transfer, are also at capacity and have been unable to help with
transfers to the extent that would be hoped.
4:19:54 PM
CO-CHAIR SNYDER opened invited testimony from the health care
sector.
4:21:01 PM
JARED KOSIN, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNHA), provided invited testimony on
the current status of COVID-19. He offered his recognition to
all the caregivers on the frontline and said this is and will be
the single biggest health care crisis of their lifetimes. What
these caregivers are witnessing, enduring, and returning to day-
after-day is unbelievable and they are owed support, especially
right now. He thanked Commissioner Crum and his health team,
and ASHNHA's health team, who are all exhausted from trying to
clear the way for facilities to respond.
MR. KOSIN explained that normally ASHNHA [now called the Alaska
Hospital & Healthcare Association (AHHA)] is a policy and
advocacy-based organization. But today ASHNHA is, and has been,
functioning as an operational support team solely dedicated to
getting resources to its facilities on the frontline. Yesterday
169 Alaskans were in the hospital with a COVID-19 diagnosis.
Anchorage is full, units are closed, people are waiting in
parking lots, and surgeries are being postponed. Outlier
hospitals are full. Mat-Su Regional [Medical Center in Palmer]
and Central Peninsula Hospital in Kenai are carrying 50 COVID
patients. Nursing homes are closed to admission and have been
for weeks due to severe staffing shortages. The situation is
intense and nearing desperation, [ASHNHA's members] are on fire
and need help.
MR. KOSIN related that yesterday ASHNHA sent a letter to the
governor asking him to declare a disaster for Alaska's health
care system. Since then, he said, his understanding that the
special session call has been amended to include a set of health
care relief bills. It is a crisis and ASHNHA's sole focus and
interest is getting resources and support to its facilities and
caregivers as fast as possible. It doesn't matter whether it's
a disaster declaration or legislation or neither, all ASHNHA
wants is support - now.
4:24:21 PM
PRESTON SIMMONS, Chief Executive Officer, Providence Alaska
Medical Center, provided invited testimony on the current status
of COVID-19 at his hospital. He said he echoes the comments of
his colleagues and today's co-presenters. Alaskans continue to
expect high quality care, but the state's health care safety net
is strained and being tested like never before. Patients are
coming to the hospital with more serious illnesses requiring
higher level acuity care; these cases require a skilled medical
team, including skilled nurses. Hospitals are consistently
operating near or at capacity and available staffed beds are at
a premium. Yesterday Providence had 30 patients holding in its
emergency department, a record number. The waiting room was
beyond its capacity to safely distance people, so people waited
in their cars to be triaged. This is not the care that Alaskans
deserve, and it has taken emotional and physical toll on the
caregivers.
DR. SIMMONS said he was going to focus his remarks on some of
the regulatory flexibilities and increased policy tools that are
needed to continue battling this pandemic. However, he
continued, he is instead going to a focus on caregivers and
recognize Alaska's health care workers for their unbelievable
strength and compassion. The mental and physical toll on health
care workers will have lasting impacts. There is concern about
the ongoing stress and demands placed on caregivers, they are
tired and burned out. A day doesn't go by without several
headlines and op-eds from caregivers begging for relief with
none in sight. Many are called to work in this field by a
desire to help people who are sick and care for the vulnerable.
Wave after wave of COVID-19 has been faced. Caregivers are
retiring and leaving health care at record rates. Retirement
rates at Providence Alaska Medical Center are more than 19
percent higher than they were a year ago. Vacancy rates for all
positions across Providence are more than double the target.
Providence has record job postings that are hiring at record
levels, yet Providence is struggling to keep up with attrition
even while implementing targeted bonuses and other incentives.
4:27:17 PM
DR. SIMMONS stated that there are things that can provide
relief. Good public health measures save lives, he pointed out.
Masking, social distancing, washing hands, and vaccines are
effective. Alaskans need to wear masks indoors and he supports
any statewide measures that result in increased use of masks,
which provide a layer of protection for Alaska's communities,
families, and workforce. Everyone hopes that relief is on the
horizon, especially as more Alaskans receive the vaccine.
However, he stressed, hope is not a strategy and there remains
opportunity. There are the ongoing partnerships with the state
and the suite of tools announced by Commissioner Crum today.
This ongoing dialogue and collaboration are critical to the
ability to care for Alaskans and working together must continue.
To continue adapting to the changing environment, lessons
learned along the way can be used as a road map towards a more
effective and efficient process. The disaster declaration, SB
241, and the additional flexibilities provided through executive
action can provide a roadmap towards more permanent
modernization for Alaska's health care environment. This
package of regulatory waivers and relief has allowed hospitals
to implement strategies to help flatten the curve and provide
more efficient care. Providence quickly ramped up full
telehealth programs, including home monitoring, and professional
licensing flexibilities brought caregivers to the bedside as
quickly as possible. These efforts have proven to be safe,
effective, efficient, and popular with patients and clinicians.
Providence pledges its partnership efforts to make some of these
measures a permanent part of the health care in Alaska.
DR. SIMMONS addressed the Nurse Licensure Compact [indisc.
audio interruption]. He said the current process discourages
caregivers from working in Alaska and is driving away Alaskans,
especially newer graduates. [The Nurse Licensure Compact] may
not provide immediate relief but can be a powerful long-term
tool. Every option available is needed to hire Alaskans and
attract the nation's health care workers to the state. He said
he looks forward to continuing these conversations.
4:30:32 PM
ELLEN HODGES, MD, Chief of Staff, Yukon-Kuskokwim Health
Corporation (YKHC), provided invited testimony on the current
status of COVID-19 in rural Alaska. She stated she is a
practicing family medicine physician and has served this region
for 17 years. She noted that YKHC is a tribal health facility
that provides health care to a region of about 28,000 primarily
Alaska Native residents from 56 tribes in 46 villages. Over the
past month, the region has seen a dramatic increase in the
number of COVID-19 cases with subsequent increases in
hospitalizations and deaths. These rates are being driven by
the Delta variant and are occurring in the region's unvaccinated
population. She said situation is dire - 50 percent of the
region's current active cases are in children under the age of
12 who are ineligible for vaccination and 60 percent of the
region's active cases are in children under the age of 18.
DR. HODGES related the recent story of a patient in the region
who was desperately ill, not with COVID, but with another
serious illness. Upon arrival by air medivac at YKHC's hospital
in Bethel it became immediately apparent that this person needed
intensive care treatment not available at the YKHC hospital.
Using the dashboard, the physician reached out to every hospital
in Alaska, all the while providing ongoing care at the bedside
of this desperately ill person who was deteriorating as precious
time went by. Hours later a bed was secured, and the patient
left the YKHC facility. Dr. Hodges urged committee members to
put themselves in the shoes of this patient, his family, and the
doctor as time ticked by.
DR. HODGES discussed how everyone is connected in Alaska. She
pointed out that choices made by each person affect the care
that others are able to access. The choice of an unvaccinated
person to go maskless in a crowded venue causes a person in a
village hundreds of miles away to go without the resources
needed to simply survive regardless of that person making the
choice to get vaccinated and wear a mask. A mask and
vaccination against COVID do not protect a person against
strokes, heart attacks, sepsis, traumatic injuries, or any of
the other reasons a person might need an intensive care unit
bed. No one is safe until everyone is safe.
DR. HODGES stressed that immediate action must be taken to
protect the lives of Alaskans. She said Alaskans should be able
to rely on their leaders in government to fully support and
tirelessly promote each of the following evidence-based
measures: 1) All eligible persons need to be vaccinated against
COVID-19; there should be no equivocation on this matter; the
vaccines are safe and effective; the way to end this seemingly
endless pandemic is through vaccination. 2) All persons over
the age of two need to be masked in all public settings; there
should be no equivocation on this; it is a safe and cost-
effective method of preventing the transmission of the virus, as
shown by multiple studies; all politics must be taken out of
that discussion immediately; if this commonsense measure was
universally applied it would dramatically decrease the
transmission of disease. 3) Telehealth needs to be widely
available, and all measures need to be taken to ensure this
highly valuable tool is available to all Alaskans without any
barriers; this is especially true for behavioral health clients
who have fared poorly in pandemic society. Dr. Hodges concluded
by urging legislators to do everything in their power to reduce
the transmission of COVID-19 in Alaska because the lives of
everyone depend on everything legislators do.
4:35:50 PM
DAVID WALLACE, Chief Executive Officer, Mat-Su Regional Medical
Center, provided invited testimony on the current status of
COVID-19 at his facility. He expressed his appreciation for the
teamwork between the government entities and his heath care
colleagues represented at this presentation. He stated that the
burnout being felt is not just a little burnout. The paradox is
the high levels of COVID-19 hitting the system and staying in
the system for a long time, plus the highest need for other
services simultaneously, which is a very difficult landscape to
navigate. Concern started to get high at Mat-Su Regional when
it was one of the last hospitals with ICU capacity to fill up
that capacity because it meant that a patient in an outlying
community with no ICU or ventilator was being bagged
indefinitely while a transfer was being sorted out. Mat-Su
Regional, at 125 beds, has an ICU and the same level of
intensivists available at Providence, although Providence has
quite a bit more subspecialties. Mat-Su Regional has the same
intensivist group, so the same high-quality physicians and an
outstanding staff, and wants to help anybody it can.
MR. WALLACE reported that two weeks ago Mat-Su Regional had
unprecedented transfers in and reached full capacity, with
patients received from Homer, Ketchikan, Barrow, and Cordova.
However, with the nature of this pandemic, beds then opened as
some of those patients got better and some expired. He
explained that receiving transfers puts Mat-Su Regional at a
position of making decisions on how long that can be done. With
all respect to the capacity dashboards that use the numbers of
ICU beds available, Mat-Su Regional is in disaster mode.
Because the hospital is in the situation of not wanting to close
or not accepting the next patient, a step-down unit has been
made available on the second floor for those patients that are
just under ICU status. They are moved to the second floor if we
are at full capacity in our ICU.
4:40:34 PM
MR. WALLACE related that he rounds on the hospital's departments
to see how they are doing. He recounted that several months ago
a ward clerk in ICU told him that every nurse in the ward was
going to counseling of one kind or another. When an ICU nurse
with critical care training and 20 years of experience says,
Last week was the worst week in my entire career, I didn't know
what was going to happen but I just wanted to make it through
the week" because she is watching the desperation on the faces
of patients that are far too young to be dying from a disease
that could be prevented by immunization, and when looking at the
faces of nurses who are ready to throw up their hands and walk
away, [administrators] find themselves begging this staff to
please come back for the next shift because [the hospital] is
stretched so thin. Staffing is in a grim situation. When the
ER director says, "I cry on the way to work and I cry on the way
home and I try and hold it together the rest of the day one
knows that things are at an unprecedented level of stress.
MR. WALLACE pointed out that this disaster is now a year and a
half old and now at its very worst state but ironically no one
seems to want to talk about it anymore let alone recognize that
the hospital safety net is starting to fray and very close to
breaking. He implored the governor's office, the committee, and
DHSS to work together to help provide resources that should not
be a part of politics at this time. Working together is how
things get done and a difference is made, and the list of things
provided in the presentation are a good start.
4:44:22 PM
ROBERT ONDERS, MD, Administrator, Alaska Native Medical Center,
Alaska Native Tribal Health Consortium, provided invited
testimony on the current status of COVID-19 at his facility. He
related that there is a general feeling of the staff at his
hospital that the public and governmental entities are not
recognizing how strained the system is, combined with the
emotional and physical toll that this has taken. In the fall,
direct actions were taken related to mitigation measures that
helped decrease the case counts; right now, immediate
governmental interventions are needed to decrease the case
counts. The current COVID surge is impacting his organization
and everywhere. The long road out is vaccination, but short-
term relief is needed and needed now. Things are much worse off
than [last] fall, both from a combination of all the hospitals
feeling this stress and the long standing emotional and physical
toll. [Alaska Native Medical Center] is not doing well, and the
general perception is that no action is being taken.
4:47:05 PM
CO-CHAIR ZULKOSKY expressed her recognition of the very sobering
testimony heard by the committee. She asked Mr. Kosin whether
the temporary 30-day disaster declarations issued by the
governor in November-January would give Alaska's hospital system
all the tools that would be needed now.
MR. KOSIN answered yes, it got resources fast. It allowed for
reciprocal licensing, people could come in quicker and easier,
and it had telehealth.
4:48:22 PM
REPRESENTATIVE SPOHNHOLZ stated that the tenor of today's
testimony was heartbreaking, and the committee wants to do what
it can to provide support quickly. She said it sounds like the
emergency disaster declaration allowed all the flexibilities
that were very useful for hospitals and health care
organizations to be able to recruit people and get access to
out-of-state resources, including technical expertise and
consultation. She asked whether there is anything else that
would urgently make a significant difference right now.
MR. KOSIN responded that right now the time is now. Another
second should not be wasted in getting resources to [facilities]
as fast as possible. A disaster declaration is fast because
it's immediate and he understands there is legislation in play.
Whatever way this gets done, ASHNHA just wants it done as fast
as possible. Regarding whether there is anything else, he said
he commends the commissioner and his team for the expedited
background check workaround that was created for facilities, and
which is a huge help. Immediate impacts that would go a long
way are anything around background checks, standing up an
emergency and aid program, and telehealth. Everything else
starts to get into the mid- and long-term stuff.
4:51:21 PM
REPRESENTATIVE MCCARTY, regarding the Nurse Licensure Compact,
said he hears from health care professionals that boots are
needed on the ground now so that people can be touched, but that
they are not so plentiful. He said he also hears of not getting
background checks done fast enough, so he is glad to hear the
resolve for that. He asked what things are inhibiting the
process and whether people in the health industry not wanting to
get vaccinated is an element.
MR. KOSIN answered that what the commissioner did for background
checks has been very impactful, and it is correct that what is
needed is physical people and that is the challenge. He said
the Nurse Licensure Compact is ASHNHA's top priority in normal
times, has been for several years, and will be next year as
workforce is focused on. However, it takes time to stand that
up, so in ranking these it is the smaller levels around
background checks, trying to get CNAs here, and telehealth.
[The association] wants everybody vaccinated. Masking indoors
needs to be done, so ASHNHA is completely behind that. The
world is breaking before our eyes and were asking for anything
you can do," he added.
4:54:20 PM
CO-CHAIR SNYDER stated that one benefit of the disaster
declaration is the streamlining of professional and occupational
licensing, which has been offered up in a separate piece of
legislation that may or may not be necessary. For much of this
time, she continued, the focus has been on the need to increase
capacity to respond and what [health care providers] need from
the state to make that happen. The other side of that coin is
efforts to reduce the number of infections, which then reduces
the pressure on health care providers. She asked what can be
done from the state's side to reduce the number of infections
and whether directives for mask wearing, social distancing, and
gathering size be helpful at this point.
DR. ONDERS replied that as a tribal facility, the Alaska Native
Medical Center can accept licenses from other states related to
nursing staffing. He cautioned against thinking that this alone
will provide an immediate solution because there is a limited
number of traveling nurses. Since that solution is unlikely to
be as robust as needed, the prevention of infection is even more
critical than the hope of staffing coming in via a streamlined
process. A key component of mitigating spread is public indoor
masking, and this is needed. When this measure was previously
in place in the Anchorage area, case counts rapidly went down.
4:57:24 PM
CO-CHAIR ZULKOSKY recalled it being said that Alaska is seeing a
growth phase of cases and there is no guarantee it is peaking.
She asked what this means for how health care delivery is
provided to all patients, COVID or otherwise, in the coming
weeks and how long before Alaska starts to see those impacts.
MR. SIMMONS responded that he would say [Alaska] is already
starting into alternative provisions of care. He said the
nursing to staffing ratio at Providence as well as many of the
hospitals that are at capacity around the state are different
than they normally would be. The system of care within Alaska
is designed such that Anchorage is the referrable hub throughout
the state for the quaternary and tertiary services. Capacity is
backing up into the communities so right now communities are
having to care for patients that they normally would not. As
that continues to back up it will eventually start causing harm
to patients. The normal channels in the system of care aren't
there and it's going to get backed up, which is being seen in
other states. Many hospitals in Washington state don't have the
referral sources into typical tertiary and quaternary hubs and
some of the smaller hospitals are seeing as much as 30-50
percent COVID populations. It will get worse before it gets
better. The health care industry will do its best, but a change
to ratios of nursing to patients will be seen, along with levels
of having to care for patients beyond [staff's] typical scope of
practice as [the pandemic] continues.
MR. SIMMONS continued his response. He recalled Dr. McLaughlin
stating that Alaska will follow the pattern that was seen in the
United Kingdom, India, and other areas. He said Alaska is
likely to see this continue to escalate through probably the
latter part of this month and then towards the end of October it
will go back down. Alaska is far from seeing the peak of this
yet. What helps in the immediate is just to quit the spread of
the virus and the way to do that is through masking. He pointed
out that children have a lower acuity when they get the disease
but are good vectors for spreading. Last year when all the
school districts were masking, Alaska had very little
transmission within the school districts. But this year when
school started up and some of the school districts didn't mask,
there were massive numbers of infections right away, with 300
cases in the Mat-Su in the last week. There isn't outside help
coming in, Alaska needs to immediately tamp down the spread to
get through this.
5:03:00 PM
REPRESENTATIVE KURKA stated that this hearing feels politically
manipulated. He stated that right now Israel is the world's
most vaccinated country at 85 percent vaccinated. Conversely,
some of the COVID-19 variants are running rampant in Israel and
the hospitals are full of vaccinated patients who have
breakthrough COVID. He asked how that is reconciled with what
has been heard today about those who are in hospitals.
DR. MCLAUGHLIN answered that the Delta variant is more than
twice as transmissible as the original Wuhan strain of the
severe acute respiratory syndrome corona virus 2 (SARS-CoV-2),
so transmission of cases is occurring at a much faster rate
across the globe. Regarding the proportion of cases that are
vaccine breakthrough cases, he explained that the Delta variant
has mutations that allow it to evade prior immunity better than
other variants. That is part of why the vaccine efficacy is
dropping from an original range of 90 percent prevention of
cases to the currently much lower vaccine efficacy with Delta.
It is still quite good in terms of vaccines in general. In
terms of preventing SARS-CoV-2 infection it is probably a
vaccine efficacy of 66 percent or higher against infection,
which means quite a few vaccine breakthrough cases are being
seen. The other factor is that as the proportion of the
population becoming fully vaccinated increases, the number of
vaccine breakthrough cases also increases. For example, if only
100 people in the whole population of Israel are vaccinated,
probably 1-2 cases of vaccine breakthrough over a 2-month period
would be seen. If 1000 people are vaccinated, more breakthrough
cases would be seen. If 80 percent of the population is
vaccinated, the proportion of cases that are vaccine
breakthrough compared to non-vaccine breakthrough is really
going to increase because the proportion of the population that
is vaccinated increases. If 100 percent of the population is
vaccinated, then 100 percent of the cases are going to be
vaccine breakthrough cases. So, when looking at these numbers
one must think through the proportions.
CO-CHAIR SNYDER stated that the primary focus of the hearing
today is hospital capacity.
5:09:21 PM
REPRESENTATIVE PRAX related that people are still sending him
questions about efficacy and side effects of the vaccine. He
requested the DHSS phone number for people to call with their
questions and for receiving answers.
MS. HEDBERG responded that the phone number is 907-646-3322. In
further response, she said the website address is
covid.alaska.gov.
5:11:36 PM
CO-CHAIR SNYDER summarized that what was heard today from the
health care sector is that an increase in resources and
flexibility [is needed] to increase the sector's response
capability and to address the burnout being seen in the
overburdened health care providers. Also needed are renewed
efforts at reducing the number of infections to then in turn
reduce the pressure on the health care sector. A variety of
individuals from the health care sector testified today that
they need relief immediately and they need the flexibility that
was previously provided in the disaster declaration and that
flexibility is needed now. She implored committee members and
members of the administration to heed that call and take a close
look at the quickest way to provide that relief.
5:12:32 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at [5:12] p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| House HSS Sept2_2021 FINAL.pdf |
HHSS 9/2/2021 3:00:00 PM |
DHSS Presentation 9-2-21 |