Alaska’s isolation and recruiting challenges during a pandemic are hampering the state’s largest hospitals to staff ICUs as the state’s COVID-19 cases begin to swell.
Hospital administrators here say that while they are concerned about the strong community spread, they do not see any unusual crowding in the Anchorage ICUs, at least so far. The sickest patients in the state tend to end up at Providence Alaska Medical Center, Alaska Native Medical Center, and Alaska Regional Hospital.
Despite record numbers of daily resident cases and high alert levels in Anchorage, Fairbanks, and Northwest Alaska, hospitalization and death rates across the state remain relatively low. Many new cases involve young people between the ages of 20 and 30 who generally resist COVID-19 infections better than the elderly.
But the virus is already cutting staffing and skill levels in other ways that could leave the system vulnerable if the virus moves into older or more medically compromised people who end up in hospital, in need of critical care.
ICU recruitment is always challenging due to the specialized training required to care for critically ill patients, said Mikal Canfield, a Providence spokesperson. It became especially difficult during the pandemic due to supply and geography.
“The need for ICU nurses nationwide in response to the pandemic has increased, which has made recruiting much more competitive,” Canfield wrote in an email. “This challenge is compounded here due to our distance from families outside Alaska, which is a disincentive for both travelers and permanent locations.”
Alaska’s unique healthcare setting creates unique problems for hospital staff.
According to state recommendations to slow the spread of the virus from other places, nurses and other health care workers must quarantine if they travel out of the state. They also face potential exposure to the virus that forces them out of work and in isolation.
And the pandemic is making ICU bed staffing more difficult for another reason: Hospitals here say it is a challenge to recruit traveling ICU and ICU nurses to fill short-term staffing gaps across the country.
Instead of coming to Alaska, nurses staying in Lower 48, where significant COVID-19 spikes mean a lot of work. They are also put off by Alaska travel test mandates that complicate any plans to visit with the Outside family while they work here, the administrators say.
Hospitals can make internal changes, including delaying non-essential surgeries, to move staff, officials say. But that may not be up to par if the state’s rising coronavirus numbers translate into more diseases.
“The difference is that the pandemic has the potential to really aggravate the problem if we get a significant increase in hospitalizations,” said Kjerstin Lastufka, a spokesman for the Alaska region. “We are carefully managing our resources and strongly urge the community to help by continuing to do the things we know will slow the pandemic: wear a mask in public, wash your hands and keep the circles very small.”
COVID-19 patients tend to stay in intensive care beds longer as they struggle to recover, health officials say. They can also require time-consuming levels of care.
Donna Phillips, an Anchorage ICU nurse with decades of experience, described the current challenge in critical care as a combination of pre-existing staffing problems and new pressures from COVID-19 in terms of patients, travel restrictions and stress. personal.
Nurses must wear multiple layers of protection – headgear, scrubs, masks, two pairs of gloves – each time they enter a patient’s room, said Phillips, an RN who chairs the labor council at the Alaska Nurses Association. Often, patients need to be rolled onto their stomachs to help the lungs recover, a maneuver that may require a team of healthcare professionals to make sure IV lines or breathing tubs aren’t ripped off.
The complications of Alaska’s geographic isolation also play into current staffing levels.
Phillips has elderly parents and sometimes travels to help them. To return to work after a visit, he needs a COVID-19 test at the airport, seven days off, then another test and negative results. Rapid hospital tests are not available to nurses, he said. The delay in returning to work after the trip is “absolutely” leading to staff shortages.
When asked about his take on ICU capacity in the coming weeks, Phillips paused.
“Almost every day I am asked to work extra. It went on for weeks, ”he said. “These nurses are trying to juggle the kids at home… coming to work with all this pressure at work, maybe having to go to that COVID unit and work. At some point, people say, you could pay me millions of dollars and it’s not worth it. “
The fall season tends to bring more hospital traffic, and the critical care units in Anchorage are busy now, according to data from the Alaska State Hospital and the Nursing Home Association. But critical care units are not yet seeing a sudden spike in COVID-19 cases – the number of coronavirus-infected patients sick enough to need that level of care has remained relatively constant at least so far in recent weeks.
According to the association’s president and CEO Jared Kosin, the number of current overall hospitalizations for COVID positive patients decreased slightly towards October. While hospitals and intensive care units are busy right now, that’s only partly due to the tighter treatment of people with coronavirus, Kosin said. “COVID is further pressure but, based on numbers alone, it is not driving what we see today.”
As of the second week of October, Anchorage hospitals had an average of 57 ICU patients per day, according to Kosin. There were 54 patients per day on average in September, 53 in August and 56 in July. COVID-19 patients in intensive care have also remained stable, he said: 9.6 so far this month and 9.1 in September.
Hospitals also tend to operate as close to capacity as possible, so it’s not unusual for most of the unit to be in use, he said.
Providence has 37 ICU beds, according to Canfield. Hospital staff arrange beds according to planned procedures and anticipated emergency needs, he said. Providence has a hike plan if COVID-19 patients reach the point where they begin to threaten capacity.
Regional has 14 regular ICU beds, but COVID-positive patients are treated in a separate area with 19 additional beds, Lustafka said. That number isn’t concrete, he said, because if there is an increase in the community and more beds are needed, the hospital has plans for it.
ANMC has 22 ICU beds, according to public records. Hospital representatives declined to specifically confirm that number. Capacity throughout the hospital, including the intensive care unit, changes every shift, spokeswoman Shirley Young said. ANMC also has overvoltage capability.
The challenge right now, hospital representatives say, is to make sure the public follows protocols to slow the spread of the virus as hospitals grapple with staffing challenges that can limit capacity.
“More hospital beds and more hospital staff is not a solution that will stop the spread of COVID-19,” Young said.
It is simply not clear what will happen, hospital and health officials say. Hospitalization rates don’t immediately show that people are starting to get sick.
Municipal health officials have warned that models show cases of COVID-19 could threaten critical care capacity by early next month if record case counts begin to translate into sicker patients.
“We remain concerned about hospitalizations and the resulting need for ICU beds,” Anchorage Department of Health epidemiologist Janet Johnston said Friday. “Keep in mind that this is a lagging indicator and something we need to look at.”