An Anchorage hospital is rationing care, while rural hospitals are attempting to stretch supplies as long as possible until they can transfer patients to the city.
Since the beginning of the pandemic, hospitals across the country have been preparing for a scenario in which a large number of Covid-19 patients overwhelms their ability to care for them. During earlier pandemic waves, some facilities around the country approached a similar stage, though not all states required them to disclose when they needed to activate crisis teams.
Overwhelming Number Of COVID-19 Patients
Since the beginning of the pandemic, hospitals across the country have been preparing for a scenario in which a large number of Covid-19 patients overwhelms their ability to care for them. During earlier pandemic waves, some facilities around the country approached a similar stage, though not all states required them to disclose when they needed to activate crisis teams.
The triage team of doctors at Providence Alaska Medical Center in Anchorage has been using a formula to score patients’ probability of dying in recent weeks. They have also been consulting with an ethicist about their decisions. Patients suffering from Covid-19, as well as other ailments, are among those who have been admitted.
Recently, the team had to decide which of two critically ill COVID-19 patients should be treated with a single specialized dialysis machine. Because the team saw little hope for one patient, they chose the other to begin dialysis—the patient who had to wait passed away.
“We have the most highly sophisticated medicine and advanced training in the world, and we’re having to ration care,” said Javid Kamali, an intensive-care doctor at Providence. “We didn’t sign up for this.”
Data from the Centers for Disease Control and Prevention show that Alaska had the highest rate of Covid-19 cases per 100,000 people in the country over the seven days ending Saturday, nearly double that of West Virginia, the next closest state. Approximately 58 percent of Alaskans aged 12 and up are fully immunized, compared to 65 percent nationally.
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Providence Alaska Medical Center last month activated for the first time a team of doctors who use a formula and other information to ration medical care. (Photo: WSJ)
Triage Committee
The triage committee for the Anchorage hospital was established at the start of the pandemic in March 2020. Still, it was only activated for the first time on September 10 of this year, shortly after Michael Bernstein, chief medical officer for Providence hospitals in Alaska, became aware of the state’s deteriorating Covid-19 trends.
Alaska began to lag behind the rest of the country in April after initially having a higher vaccination rate than the national average. As a result, it is now just one of many states with a vaccination rate below the national average, and hospitals are being overrun with Covid-19 cases caused by the rapidly spreading Delta variant.
According to the Kaiser Family Foundation, Alaska has a population of 733,391 and has 1.8 intensive care units (ICUs) per 10,000 people, adding to the strain on the state’s hospitals. Only Hawaii and Vermont have fewer intensive care units (ICUs) than their respective populations.
Dr. Bernstein, who oversees the group, says that the team has been asked to step in for at least eight cases.
According to hospital officials, there is no way of knowing whether patients who died due to being forced to wait for care would have survived if they had not been forced to wait. However, such decisions have weighed so heavily on Providence staff, on top of the strain of caring for so many sick patients, that the hospital’s psychiatry department chairwoman has begun making rounds in the intensive-care unit to check on their mental health.
Doctors in Providence are also faced with difficult decisions about accepting more critically ill patients. Alaska, the country’s largest state by land area, is dotted with rural communities with limited healthcare facilities that frequently require patients to be flown to hospitals like Providence for specialized care.
“Our job normally is to get someone propped up until the other guys can take over,” Dr. Lemaire said. “Right now, we’re having to use whatever means necessary.”
According to the chief of staff John Cullen, the 11-bed Providence Valdez Medical Center in southeast Alaska, which frequently sends patients to its corporate hub hospital in Anchorage, has begun to conserve oxygen under the state’s crisis standards by limiting how much doctors pump into patients who are struggling to breathe.
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