HB 76-EXTENDING COVID 19 DISASTER EMERGENCY  4:13:02 PM CO-CHAIR SNYDER announced that the final order of business would be HOUSE BILL NO. 76, "An Act extending the January 15, 2021, governor's declaration of a public health disaster emergency in response to the novel coronavirus disease (COVID-19) pandemic; providing for a financing plan; making temporary changes to state law in response to the COVID-19 outbreak in the following areas: occupational and professional licensing, practice, and billing; telehealth; fingerprinting requirements for health care providers; charitable gaming and online ticket sales; access to federal stabilization funds; wills; unfair or deceptive trade practices; and meetings of shareholders; and providing for an effective date." [Before the committee was the proposed committee substitute (CS) for HB 76, Version 32-GH1011\B, Dunmire, 3/3/21 ("Version B"), adopted as a work draft on 3/4/21.] CO-CHAIR SNYDER opened invited testimony on HB 76, Version B. 4:13:23 PM KEVIN BERRY, PhD, Professor, Department of Economics" University of Alaska Anchorage (UAA), provided his invited testimony via a PowerPoint presentation titled "Economic Impacts of COVID." He began with slide 2, "Takeaways," and noted these takeaways fit with what is becoming the consensus of the research literature around pandemic events and economic growth. He said the first takeaway is that COVID-19 is an unprecedented shock to the economy. Simultaneously there is a health shock as well as a negative impact on people's ability to live prosperous good lives through the negative impacts of the pandemic on the economy. The second takeaway, he stated, is that the economic shock cannot end until COVID-19 is dealt with. For as long as the infectious disease persists the shock to the economy will continue as well. Masking, social distancing, and vaccination drive down case numbers, helping the economy. He continued with the third takeaway which is that policies that speed the end of the pandemic and allow safe economic activity are pro-business, pro-economic growth, pro-Alaska, and pro-U.S. These policies include masks, social distancing, and even travel screening. DR. BERRY spoke to slide 3, "Impact of Declaration Expiration." He said some of the main impacts of the expiration of the emergency declaration include the ability to require pretravel testing rather than suggesting it. A large body of literature indicates that requiring things leads to higher compliance than does suggesting that people do things. He specified that the expiration also potentially impacts the flexibility and the speed in response as the ability is lost to have things like emergency orders, other restrictions, and the ability to lift different regulations in response to needs of business. He credited Commissioner Crum and the administration for possibly solving the problem of the $8 million in Supplemental Nutrition Assistance Program (SNAP) funding that is at risk. Mr. Berry stated that another impact of the expiration of the declaration is the uncertainty for the healthcare sector. He stressed that the most important impact of the expiration is the clear communication of the risk of COVID-19 and that most Alaskans are still susceptible to the disease, and therefore the possibility of a third wave that could lead to the need for more blanket restrictions that can slow the economy. DR. BERRY noted that the graph on slide 4, "Total Employment in Total Nonfarm," depicts the total employment in nonfarm sectors in Alaska statewide [for the years 2018, 2019, and 2020]. He further noted that the four graphs on slide 5 depict the total employment in accommodation, food services and drinking, leisure and hospitality, and retail trade in Anchorage [for 2018, 2019, and 2020]. He said slides 4 and 5 highlight that there is a large impact to employment in Alaska, particularly focused in things that are thought of as the tourism sector, but these also provide services to Alaskans. So, he continued, the pain of the recession is not equal across everyone. He further noted that in Alaska the job losses are also focused on those who are between the ages 35 and 45, and between 25 and 35, particularly amongst lower income workers, mostly in these sectors where people are working face-to-face high-risk jobs in restaurants, bars, and other locations. 4:17:20 PM DR. BERRY displayed slide 6, "Total Employment in Health Care," and pointed out that the pain is felt everywhere. He related that the employment level in the health care sectors is down to that of 2018 following a steep drop early in the pandemic. DR. BERRY moved to slide 7, "COVID-19 is the problem," and discussed the driver of this trouble. He drew attention to the two studies cited on the slide, one by Cronin and Evans, and the other by Goolsbee and Syverson. He explained that both studies basically make the point that when talking about the difference between economic shutdowns and voluntary avoidance behavior, voluntary stay at home behavior seems to explain a large majority of the economic consequences of shutdown orders. This means that even when the orders are lifted these sorts of slowdowns remain, they are driven by the risk of the disease, not by the orders themselves. He allowed it is a bit difficult to look at shelter in place orders given Alaska hasn't been under one for quite some time now and Anchorage, which has had three different shutdowns, is not currently under one. People are responding to the risk of the disease, and so long as the disease persists economic malaise and less economic activity will be seen. He advised that to heal the economy and be open for business, COVID-19 must be dealt with first and the administration needs the necessary tools to do so. DR. BERRY turned to slide 8, "Reopening has limited effects," and related that the graphs are from an event study done by Chetty et al. He said this study compared reopening in New Mexico and Colorado, two relatively similar states. Colorado opened first. He reported that there was roughly no difference between the two states in consumer spending or employment, although there was a relatively large difference in the number of businesses open. This suggests that reopening early did not help with economic activity, he continued, it simply meant that businesses were open but didn't have an increase in customers. So, he stated, some portion in the economic damage is due to people avoiding getting sick and trying to protect themselves. DR. BERRY explained that slide 9, "People respond to COVID risk," summarizes the idea behind these previous studies. He said this is an idea that is older than himself and older than the studies he has pointed to. He related that the literature itself got kicked off in about 2010 by a study done by Eli Fenichel at the Yale School of Forestry that suggests that basically the course of diseases and pandemics are often influenced by self-protective behavior. He said a lot of the economic cost of infectious disease comes from people trying to avoid getting sick, whether to do the right thing for their community, to protect their at-risk family members, protect themselves, or because they've been told it's an at-risk situation and they are doing their best to respond. So, to mitigate the economic cost of the disease, which includes the harmed human health and the economic harm, Mr. Berry advised that the spread of the virus and voluntary avoidance behavior must both be reduced by making it safer. Lockdowns and other mandates need to be avoided and, for this, things like testing matter as does the ability to identify variants and stop new outbreaks by detecting people when they are coming into the state. He said giving people good information about the risk in their community is important. These resources for groups like the Department of Health and Social Services (DHSS) and others are vital. Mr. Berry pointed out that there is cost to people staying home. For instance, if it is decided to depend solely on self-protective behavior, it will come at the cost of lower economic activity, decreased academic achievement from having schools closed, and increased calls to domestic violence and sexual assault organizations. So, allowing the pandemic to continue has monetary cost to the economy as well as social ill costs, he added. Targeted policies and resources for the state government to reduce the risk of the disease will reduce the social and economic ills and open the economy safely. DR. BERRY pointed to the graph on slide 10, "Passenger Volumes at Ted Stevens International Airport." He said he gathered this data from Kevin Sullivan who scraped TSA data through roughly June 2020, and he personally scraped the rest of the data from Freedom of Information Act (FOIA) documents in 2020 and 2021 to look at passenger volumes through this airport as sort of a measure of the number of visitors to Alaska. He said two things can be seen in the graph of the first four months of passenger traffic over the last four years. The years 2018 and 2019 see a consistent pattern in the number of visitors to the state. The year 2020 sees a discreet drop-off around the timing of the first case deemed confirmed in Alaska, the announcement of the emergency order, the announcement of various shutdown orders, and other things happening. So, Mr. Berry stated, it's hard to blame the declining passenger traffic solely on the emergency order. He further stated that in 2021 passenger volumes remain lower. The data is unavailable post expiration of the emergency order, he continued, but anecdotally it's unlikely Alaska will see a dramatic increase in passenger load. What is being seen is that people are making a choice to avoid traveling and avoid coming to Alaska because of the risk of COVID-19. He pointed to a study by Yan et al., published in "Nature Scientific Reports," that found people are making this risk tradeoff. He said the best thing that can be done to heal the economy is to reduce the prevalence of the disease. 4:24:18 PM REPRESENTATIVE MCCARTY inquired whether the graphs on slide 5 representing employment in accommodation, food services and drinking, leisure and hospitality, and retail trade are for Anchorage only or for the state. DR. BERRY replied that those graphs are focused on Anchorage. REPRESENTATIVE MCCARTY drew attention to slide 7, "COVID-19 is the problem." He asked if, while doing economic indicators, Dr. Berry is seeing a standard deviation of a delay in knowing the changes, and whether that delay is days or weeks. For example, he said, things have been opened in Anchorage and restaurants are filling up. He asked how long before that economic outcome will be seen. DR. BERRY confirmed there is potentially a delay. He explained that potentially people are going to make calculations about the risk that they face. Regarding the travel restrictions that he previously mentioned, he said the requirement to be tested is a signal to people coming to Alaska that the state is still taking COVID-19 seriously. So, removing that potentially could make people believe it's riskier to come here, although it's a burden to travelers and could also disincentivize people. If talking about a delay in people gaining new information as they change their travel plans, he stated it is entirely possible it will take a week or two to see the effect of policy. The problem is that it's unlikely something new will be seen, he continued, so people are still fairly educated on the risk of COVID-19 and that is not significantly changing. 4:27:23 PM REPRESENTATIVE MCCARTY addressed slide 10, "Passenger Volumes at Ted Stevens International Airport." He inquired whether the lower passenger numbers for 2021 could be attributed to Alaska Airlines not allowing the planes to be filled and the Al-Can Highway is closed. DR. BERRY allowed it's possible that other things are impacting this. He said this gets back to the main point that Alaska Airlines is imposing these restrictions in response to COVID-19 and COVID-19 risk and is doing this above and beyond what the state suggests as the company's response to try to make passengers feel safe. He stated that one of the best communication strategies he's seen so far is coming from the governor reminding people that Alaska is open but also safe to visit. By giving the governor additional resources to fight the pandemic and make it safer to visit Alaska by speeding vaccinations travel to Alaska can be encouraged by reducing those risks and making people feel safer on fuller flights. 4:28:31 PM REPRESENTATIVE KURKA shared that he and his wife own small businesses in the Matanuska-Susitna (Mat-Su) Valley that serve other small businesses "in terms of ... the accounting world," so they are in many networks. He stated that much of Dr. Berry's presentation "doesn't pass the smell test." He allowed there is some truth to the point that COVID-19 has brought on fear and therefore less people going out and doing consumer activities. But, he said, it wasn't COVID-19 that shut down businesses it was the government. He asked whether Dr. Berry has done a comparison of economic prosperity between businesses in Anchorage where there has been continued shutdowns and those in the Mat-Su, particularly restaurants. He related that he is hearing about and seeing successful generationally owned restaurants in Anchorage being shut down permanently but hasn't seen that happening in the Mat-Su. DR. BERRY responded that his presentation cites two nationwide studies that compare, sort of, county to county based on the timing of shutdown orders and other restrictions. He stated that the Cronin and Evans study and the Goolsbee and Syverson study, as well as others, demonstrate that the bulk of reduction in traffic seems to be explained by the local case counts and risk of COVID-19, not necessarily the timing of shutdowns. Anecdotes are individual data points, he added, and it's often better to look at the total dataset as widely as possible. There is also the potential that many of the businesses in the Mat-Su are relatively close and a lot of people commute between the Mat-Su and Anchorage, so it can be hard to disentangle what is happening between those two locations. He said it would be a worthwhile study that he'd be happy to look at. DR. BERRY continued his answer and explained that the nationwide studies cited in his presentation might, for instance, look at one county in Iowa and a county across the border in Illinois where one faces a shutdown order, and the other doesn't. He doesn't mean this to also sound like shutdown orders have no impact at all, he said, it's just that they are also simultaneously often occurring around the same time that COVID cases are increasing. For instance, he continued, the Anchorage shutdowns occurred in August when the summer wave was happening and again in December when the second wave was happening, so they are also timed to the highest risk periods to COVID-19. He allowed Representative Kurka raises a valuable point that there are some folks who are making risk calculations where they are willing to participate in the economy regardless of local case counts and what is going on but advised that what's overall happening in the economy depends on everybody's choices. There is some subset of the population that is very responsive to risk, so mandates that are not lockdowns - like mask mandates and testing - help encourage those people to feel safe and return to their typical economic behavior. Dr. Berry agreed that some businesses in the Mat-Su are potentially doing well and said that could also be because some of the people in Anchorage were making the risk calculation that they are unafraid of COVID, or have decided that their family is unlikely to be impacted, or they don't know anybody who is high risk, or they have miscalculated their own risk, and may be driving to the Mat-Su and increasing business there as well. So, it's unclear if that is a strategy that is possible for the entire state at once. 4:33:05 PM NILS ANDREASSEN, Executive Director, Alaska Municipal League (AML), noted AML's membership is comprised of Alaska's cities and boroughs. He pointed out that in considering the extension of the state's emergency declaration, it is three weeks past the declaration's expiration. That's important, he said, because it's reflective of the overall process that local governments have experienced. He continued: Over the course of the last year the experience that local governments have had can best be described as frustrating. For every state action or inaction 165 local councils, assemblies, have wrestled with what to do in response or in place of. That's required thousands of local elected officials and more than 100 administrators to become public health experts, incident commanders, and targets. Together they have dealt with hundreds of state and federal actions that provide guidance without clarity, direction without data, and an emergency declaration that hasn't been firmly in place since November. That means since October and every 30 days thereafter, our members in AML have reached out to the governor and to legislators to renew the declaration to ensure that Alaska's communities have the resources they need to respond to this pandemic. Alaska's local governments have managed through this process and continue to do so. This means that they have diverted a large amount of their attention to disaster response and management, to responding to the needs of their residents and businesses, and to fill the gap where the state was enacting at the local level. The governor has been clear throughout, placing emphasis on local control of COVID mitigation. This has come up most prominently with respect to business closures or limitations or requirements for face coverings. So, let's be clear, those had nothing to do with the state's emergency declaration and everything to do with the transfer of responsibility from the state to the local level to make decisions that helped contribute to flattening the curve and protecting our healthcare capacity. In a lot of ways local leaders have borne the brunt of the public backlash of these mitigation measures, but it's also true that the public may conflate the disaster declaration with these actions. The loss of the declaration means that local governments have been scrambling to fill holes created in its absence. Many declarations were tied to the state's and have either been renewed or now expired. Many have had to reconsider their own travel, quarantine, and testing restrictions when the state's [restrictions] went from mandatory to optional. Many are in the midst of operating testing or vaccination clinics with questions about available resources, training, and authorities. Some are now racing to address spikes in cases. Many are looking at an uncertain future, new strains, variants, supporting of vulnerable residents, preparing for an economic rebound, and preparing for the lack thereof. Ultimately, it's this uncertainty that ends up most challenging. A state government that is responsive and capable at the very least assists local governments in stabilizing their current operating environment. In fact, the emergency declaration just makes government work better when it's needed most. That means that while we, state and local officials charged with public welfare, continue to try and respond to the public health needs of our communities and to take necessary actions that support economic recovery, the declaration remains just a tool at our disposal. The Alaska Disaster Act, which within HB 76 I believe is just Sections 2 and 3, allows the state to allocate, distribute, and manage scarce resources, including vaccine and testing supplies, much of this in cooperation with and at the request of local governments; allows it to suspend regulations that may prevent or impede the provision of health services or COVID response, including many that businesses and organizations have depended on to ensure continued operations; allows DMVA [Department of Military and Veterans Affairs] and DHSS [Department of Health and Social Services] to work together within unified command structure, which has met weekly or bi-weekly with our members; and allows the state to coordinate with FEMA [Federal Emergency Management Agency] on non-congregate shelters, which is also intersected with municipal assets. There is a reason that the Alaska Disaster Act is in place to allow the state to act quickly and efficiently in response to a disaster. It's that easy. Any delay to this simply erodes the partnership that's in place between the state and local governments, between the state and its healthcare providers, and ultimately between the state and the business community. If we want to be open for business, local governments need a state whose emergency powers are fully employed on behalf of exactly that. Anything less places extreme pressure on local officials, slows Alaska's economic rebound, and places Alaskans' lives at risk. Chair and committee members, what's perhaps most disheartening is that I know my testimony today may not result in a desired or quick outcome. Not because of your action, but it's part of the situation where we're behind in responding to this continuing disaster and I've joined colleagues from all sectors in advocating for the Disaster Declaration's extension. At this point it isn't just COVID fatigue that I struggle with, but it's having this conversation about whether there is to be, or not, a disaster declaration placed when we continue to need exactly that. 4:39:01 PM KATI CAPOZZI, President & CEO, Alaska Chamber of Commerce, noted the chamber was founded in 1953 and its mission is to advocate for a healthy business environment in Alaska. She said the chamber has over 700 members and represents businesses of all sizes and histories from across the state. She expressed the chamber's support for passage of HB 76. MS. CAPOZZI said Alaska's businesses have suffered immensely over the course of the COVID-19 pandemic, and one year into this public health and economic crisis many are struggling to keep their doors open. The business community has endured and is beginning to see light at the end of the tunnel and is plotting a course for recovery, she continued. Economic recovery, however, hinges on (indisc.) COVID-19. The true economic impact of the COVID-19 pandemic to Alaska is yet to be determined, especially considering recent policy actions (indisc.) control that effectively shut down the largest portion of Alaska's tourism season for at least another season. MS. CAPOZZI related that there is concrete data on job losses. She specified that [according to the] Department of Labor there were 44,000 fewer jobs during peak employment months in 2020 than there were in 2019. Virtually every industry in Alaska was negatively impacted, she said, some far more significantly than others. The oil and gas and hospitality industries were hardest hit, each ending 2020 with nearly 30 percent fewer employees in their workforce than the year prior. MS. CAPOZZI stated it's never been clearer that healthy people are the foundation of a healthy economy. Addressing public health concerns contributes to Alaska's ability to recover, she pointed out. While Alaska has had lower case counts and hospitalizations and leads the nation in vaccinations per capita, she stressed it's important to keep the tools in place to allow for this positive trend. From the business community's perspective, she continued, providing the state with the appropriate authorities and tools to continue COVID-19 response and recovery does not represent more restrictions and burdensome mandates but quite the opposite. MS. CAPOZZI noted that before the Emergency Declaration expired in February the chamber had expressed concern that any lapse in the state's ability to receive and expend healthcare resources would immediately impede the progress made and add unacceptable uncertainty to the state's collective recovery, from both health and economic perspectives. She advised that without some of the regulatory flexibility provisions provided within HB 76, operations throughout the state and across many industries, particularly the healthcare industry, are forced to do their best to comply with confusing and unclear guidance. This unnecessarily adds increased uncertainty to the business community, she added. MS. CAPOZZI concluded by emphasizing the need for action and reiterating that the chamber supports passage of HB 76 or any legislation that provides the state authority to effectively address ongoing COVID-19 response and recovery efforts. She stressed that Alaska's economic health is depending on it. 4:42:13 PM REPRESENTATIVE MCCARTY stated he would like to see data showing the differentiation between areas and businesses. He said COVID is a real thing. He related that he has heard some businesses have adapted and done well, some have adapted and stayed in business, and some were not allowed to adapt and had to close their doors. But, he added, he is also hearing the "Stockholm Syndrome" where some businesses want to stay the way it's been with COVID and not go back to the way it was before COVID. He asked whether Ms. Capozzi has also been hearing that. MS. CAPOZZI requested clarification regarding businesses wanting to stay the way it is with COVID. REPRESENTATIVE MCCARTY asked whether Ms. Capozzi is familiar with the Stockholm Syndrome. MS. CAPOZZI responded yes. REPRESENTATIVE MCCARTY related that some restaurants were given the privilege of drive-through pickup of alcohol, but now will have to go back to the old way of doing things. He said restaurants have done great in adapting and want to be able to continue those adaptations. He inquired whether Ms. Capozzi has heard of other examples about businesses wanting to stay under the COVID structures that they've adapted. MS. CAPOZZI answered that there have been some regulatory rollbacks or pauses which allowed businesses to innovate and adapt, and thrive in some cases, and the alcohol pickup is certainly one of them. She pointed out that another small, but important, piece that the Senate is currently considering is the ability for nonprofits to hold their board meetings virtually, which is important for all nonprofits and something the chamber hopes to see permanently changed moving forward. She said she has heard anecdotally of opportunities that have become available throughout COVID and mostly have to do with businesses that innovated and pivoted virtually overnight to be able to thrive in this environment. REPRESENTATIVE MCCARTY requested Ms. Capozzi to provide the committee with information regarding the aforementioned. MS. CAPOZZI agreed to do so. 4:45:59 PM MICHELLE DEWITT, Executive Director, Bethel Community Services Foundation (BCSF), noted BCSF is the entity designated by statute that sponsors the Kuskokwim Ice Classic, a small and highly localized ice classic, as opposed to the Nenana Ice Classic with which people tend to be familiar. She stated the foundation operates a very similar fundraising contest, visible primarily in the Yukon-Kuskokwim (YK) Delta Region, where customers guess the month, day, and time of breakup. The foundation dedicates the net revenue to nonprofit organizations that provide services in the community, most of which are youth groups. MS. DEWITT recounted that in pre-COVID times youth groups would sell tickets in stores to earn money for their club or group. But last year at the time ticket sales were about to begin BCSF began to grasp the devastation of the pandemic. Realizing tickets could not be safely sold in person, she said the foundation pivoted to a phone sales strategy, which resulted in a logistics nightmare for this fundraiser. She explained that Ice Classic staff and the volunteer groups tried to staff the phones, but the phones were easily and quickly overwhelmed at peak times. The process relied on a very slow routine of taking down the customer's name, contact information, their guess, and details about which nonprofit group they wanted to support with their purchase. The guess, she specified, must be 100 percent accurate, and must be verified with the caller. With volunteers receiving the information, the accurate recording of the guess was out of the customer's hands and into a volunteer's hands. But, she noted, this transaction didn't stop there. MS. DEWITT explained that volunteers work remotely from their homes for COVID-19 safety, with phones forwarded to different people every few hours. Folks working the phones wrote guesses as quickly as they could on the forms, she related, and then the forms then had to be transferred to actual Ice Classic guesses. All the guesses in the forms now located at homes of volunteers throughout town had to be retrieved and physically sorted in chronological order. After all this, as a method of validating accuracy again, guesses are entered into a spreadsheet, she further explained. So again, a volunteer had to receive a call and complete a form, transfer the data to a ticket, sort the ticket into the entire pool of tickets in chronological order, and then enter guesses into a database. This was four layers of work 6,000 times over. A reduction in sales of more than 20 percent was seen, she reported. Normally, between 7,500 and 10,000 guesses are received, but with the phone-only approach about 6,000 were logged. MS. DEWITT stated that now, in 2021, the foundation is about to go into a similar position. A vaccine is here, many COVID-19 safety precautions and adaptations have been embraced, and the foundation is moving into an era of decreasing members, she said. But it's not yet safe or appropriate to return to in- person sales for this sort of fundraiser. So, BCSF is staring down this potentially cumbersome process and the language in the bill offers substantial relief. She asked the committee to support this language, which will allow this fundraiser and undoubtedly many others around the state to continue in a safe way online in the pandemic. MS. DEWITT emphasized that the true benefit of this [proposed] adaptation will be reaped by the groups the foundation serves, which most recently included a youth dance company, the group that offers swim passes and free swim lessons at the fitness center, the pet rescue nonprofit, the student council, and the local youth group Teens Acting Against Violence. She said that groups like these have had nearly all their venues for raising funds disappear in this year of COVID. An online adaptation will provide them with the ability to raise funds for their programs by using technology, she stated in conclusion. 4:50:07 PM CO-CHAIR ZULKOSKY requested Ms. Dewitt to talk about why having an online adaptation is worthwhile moving into 2021, and the importance of being able to do this online versus phones. MS. DEWITT replied that the online adaptation allows for increased efficiencies with the fundraiser. By phone, she said, it is a four-step process repeated over and over literally thousands of times. Online keeps everyone safe, reduces the significant stress, and keeps the accuracy in the hands of the customer who can submit his or her own guess and not have to rely on somebody at the receiving end to write down the guess accurately. It is a huge benefit for the customer as well as for the volunteers on the receiving end in terms of efficiency. 4:51:50 PM THOMAS QUIMBY, MD, Vice President, Alaska Chapter of the American College of Emergency Physicians, noted he is a full- time practicing emergency physician. He said that to date Alaska has weathered the COVID-19 pandemic relatively well and there are indicators that the pandemic is winding down. The number of vaccines administered thus far in Alaska is encouraging and is seen as a critical step towards achieving a degree of herd immunity. The chapter is optimistic about the future, he added, and is hoping for a return to a semblance of normality soon. DR. QUIMBY cautioned that, despite the many positive indicators, there remains considerable vulnerability to additional surges. He noted that currently there are worrisome case counts in Petersburg and the Mat-Su Valley. Repeatedly, a resurgence in cases has been seen throughout the country and globe when mitigation measures are relaxed. Even though vaccine rates increase daily and there is thought to be a degree of naturally acquired immunity, he said the data does not suggest that the population has yet reached a degree of immunity that would guarantee invulnerability to future surges. He related that his hospital continues to see COVID related complaints as an average of 30-40 percent of its daily emergency department volume. As well, he advised, the threat of new, more infectious variants remains to be fully understood. DR. QUIMBY stated that there are significant practical concerns with the lapse of the emergency disaster declaration. Broadly, he explained, the declaration provides important flexibility in resources for rapidly responding to the dynamics of the pandemic. The situation can change rapidly, he pointed out. For example, within a recent two-day period his hospital went from zero COVID patients to thirteen, a significant and concerning increase for a hospital with just sixteen intensive care unit (ICU) beds. Specifically, he further explained, there is concern about loss of access to a variety of federal (indisc.) waivers, with many potential implications. This may affect alternative care sites and there is much uncertainty now regarding the legality of existing sites and whether they can continue to operate. The Lake Otis Testing Center has shut down, he continued. It is known that testing is a critical component of managing the pandemic to take intermediate steps before healthcare systems become completely overwhelmed necessitating shutdowns. He said the Alaska Chapter is concerned about other existing sites and whether they can continue to operate. With the lapse of the declaration, patients have lost access to tele-health providers due to concerns about liability. DR. QUIMBY stated that his organization believes a bill to permanently allow non-Alaska state license tele-health providers is the wrong answer. He specified that an emergency order extending access temporarily allows Alaska to craft a more nuanced permanent bill that can serve Alaskans in the future. He further noted that travel related testing has been severely curtailed. He pointed out that this has been an important tool for many rural communities with limited healthcare services to prevent outbreaks. He advised that mandatory airport testing will help protect Alaskans, should be in place until vaccination is more widespread, and allows for detection control of COVID-19 variant strains. DR. QUIMBY further related that some [case management] facility regulations have also been waived in the meantime that allow placement for personal protective equipment (PPE) supplies, temporary walls and barriers, and other modifications to facilities necessitated by COVID related protocols. He stressed that the Alaska Chapter has concerns for potential misuse of accessing supplies from the state and national stockpiles, which include PPE such as masks, gloves, gowns, and powered air purifying respirators (PAPRs); and essential medical equipment such as ventilators, high-flow nasal canula devices, and testing supplies. He shared that at one point during the November [2020] surge his hospital was down to only one or two high-flow nasal canula devices available, none were available on the commercial market. His hospital was able to quickly get 15 from the state but it's uncertain whether his hospital would be able to do that in the future. He pointed out that during much of the pandemic these items have been unreliably available on the private market and the ability to get them quickly from the state has made all the difference during surges. DR. QUIMBY advised that there is also increased complexity and difficulty with a variety of procurement issues, such as lengthy standardized contract processes that prohibit rapid hiring for vaccine distribution, testing, and delivery of health care as needed. He stated there is concern for communications between agencies and facilities given the loss of the Incident Command System (ICS). Also, he said, potential messaging to the public of the need for personal caution and responsibility in protecting the community has been reduced. This would be a great mistake, Dr. Quimby counseled, especially with the rapidly improving situation. To date, countless examples of large surges have been seen when communities, states, and countries have relaxed mitigation measures, such as physical distancing, indoor gathering, and masking, prior to widespread vaccination. These surges invariably tax the healthcare system's capacity which necessitates shutdowns that have many negative consequences such as harming the economy, restricting liberties, and affecting mental health. DR. QUIMBY allowed there are many promising indicators that the end of the pandemic draws near but cautioned that "we are not there yet." While dropping case counts is very encouraging and the desire to send the public positive messaging is appreciated, he continued, failure to extend the emergency declaration has many negative consequences for those working in healthcare and still very much involved in managing the pandemic. He related that, most of all, repeal of the declaration has created considerable confusion and created uncertainty in addition to loss of access to important tools for combatting the pandemic. He pointed out that, overall, there is no apparent financial or other significant negative consequences to continuing the declaration for the immediate future. He further noted that alternative solutions through patchwork legislation thus far did not thoroughly address the issues created by repeal of the declaration and had many potential unintended consequences. He said the Alaska Chapter of the American College of Emergency Physicians therefore respectfully requests that the committee renew the disaster declaration. 4:58:47 PM REPRESENTATIVE MCCARTY, regarding the recent COVID surge in the Mat-Su Valley mentioned by Dr. Quimby, inquired about the severity of these COVID cases compared to the past. DR. QUIMBY replied that current cases are not looking like the November surge. He said cases rapidly climbed several weeks ago and have started to drop off some. Part of his concern is that a significant outbreak among younger and healthier people is being seen. There was a school outbreak and many of those people are showing up in the emergency department, but they aren't requiring hospitalization consistent with what has been seen other places. The concern, he stated, is that if this spills over into the more vulnerable population another large surge could be seen. He said it is manageable at this time but could change very quickly as mentioned in his testimony. 5:00:03 PM CO-CHAIR SNYDER opened public testimony on Version B, the proposed CS for HB 76, then closed it after ascertaining no one from the public wished to testify. She said public testimony would be reopened at the bill's next hearing on 3/9/21. CO-CHAIR SNYDER announced that HB 76 was held over.