Thursday brought new pandemic records for Alaska, with the state's Department of Health and Social Services announcing 44 previously unrepresented COVID-19 deaths and 1,793 new cases — a case count that dwarfs those seen in recent record days.
But those numbers are a culmination of backlogged data from past weeks, which could not be reported due to a variety of systems being strained by increasing case counts.
State health officials held an hour-long press briefing on Friday afternoon that aimed to provide context for the record-breaking case count and deaths.
The deaths were recorded throughout several Alaska communities (including three Ketchikan deaths that were counted locally in mid-August), with some deaths dating back to early spring.
The case count, which was the third single-day high set this week, also include cases that occurred earlier this month.
"We always really want to push to make sure Alaskans can see this for themselves and help make their own determination," DHSS Commissioner Adam Crum said during the event.
He called the 1,793 cases reported on Thursday "a number that at first is very shocking."
"It is a mix of current and older cases, but that does not diminish the fact that community spread is very high," Crum said.
Some of the cases date back to the first week of the month, according to Louisa Castrodale, an infectious disease epidemiologist with DHSS.
"That 1,700 (-some) cases, that's a mix of cases that occurred recently, like within the past week, and prior weeks," Castrodale said.
There is an automatic system for receiving new case reports, Castrodale explained, but when cases began to escalate around the state this summer, a growing number of "backlogged" case reports became overwhelming.
"We had a certain level of cases that we were processing every day, and all of a sudden, a lot more people started getting sick," Castrodale said. "The backlog just didn't happen over one day. ... We've just got more reports piling up."
If officials clear the data backlog, they'd expect to be counting around 1,000 or 1,100 cases a day, Castrodale said.
Castrodale also noted that there's been a high rate of testing around the state, which leads to more reports being sent to DHSS.
"Some of our testing sites and smaller clinics and smaller providers may not be doing (real time) real-time reporting," she explained, noting that cases can sometimes come in batches from specific weeks.
Combined with the large number of cases, a cyberattack on DHSS computer servers this summer also slowed down the reporting of cases.
"It certainly contributed, but it's not the whole story," said Deputy Director of Alaska Public Health Clint Farr.
Farr said that the cyberattack would have affected cases being reported in May, June and July, but not in August.
The 44 deaths reported Friday included 41 Alaska residents and three nonresidents, bringing the state's virus death toll to 514, according to state health officials.
The process of finalizing a death certificate and reporting the death to the Alaska Section of Epidemiology can be time consuming, explained Farr.
COVID-19 deaths, unlike some other deaths, must be reported to the state Section of Epidemiology. That information is then sent to national departments and sent back to the Section of Epidemiology for confirmation and "reconciliation," Farr said.
Farr emphasized that all deaths go through a full certificate process, regardless of whether they are reported to the Section of Epidemiology.
"Every COVID death is going to have a death certificate that says 'COVID' and gets filed with the vital stats folks," Castrodale explained. "The bottom line is every single one of these has a death certificate that says COVID."
Adding to the process, a physician must determine what a person actually died of — even if they were infected with COVID-19 at the time of their death — and it can be time consuming, according to Dr. Anne Zink, Alaska's chief medical officer.
"We do our absolute best," Zink said, explaining that physicians sometimes have to look back at a patient's medical history or consult with their other doctors.
"There's a lot of research and verification that goes on throughout (the process)," said Crum.
It's that process that can cause death reports to be delayed and reported in bulk. Crum also noted that he expected another large batch of COVID-19 deaths to be reported at some point soon.
Of the resident deaths reported Friday, one occurred in April, six in May, one in June, four in July, 31 in August and one in September, state health officials shared in a presentation during the briefing.
"I think it was humbling to me to read through the ages and the locations and just thinking about each of these as individual people, and the burden of disease we're seeing across the state," Zink said.
The deceased included three Ketchikan residents all aged 80 or older (two women and one man) whose deaths were reported locally by Ketchikan Public Health early last month.
Two Ketchikan deaths reported by Ketchikan Public Health in August have not been reported by DHSS to date.
Ten of the 41 resident deaths reported Friday involved Anchorage residents, including a man in his 20s; a man in his 30s; a man in his 40s; a woman in her 40; a man in his 50s; a woman in her 50s; two men in their 70s; a woman in her 70s; and a man and a woman, both aged 80 or older, according to DHSS.
Another six of the deaths involved Wasilla residents; a woman in her 50s, a man in his 60s, a man in his 70s, a woman in her 70s, a man aged 80 or older, and a woman aged 80 or older.
Four Fairbanks residents died of the virus, including two women in their 60s, a man in his 50s and a man aged 80 or older.
The deaths of three Juneau residents also were counted, including that of a man in his 50s, a man in his 60s and a woman aged 80 or older.
The death of a Sitka man in his 50s and a Petersburg man in his 60s also were recorded by DHSS.
Other deaths included a Soldotna man in his 20s, a Palmer man in his 30s, a Willow man in his 60s, a Kenai man in his 60s, a Bethel man in his 60s, a Big Lake man in his 70s, a Soldotna woman in her 70s, a Bethel woman in her 70s a North Pole man in his 70s and a Northwest Arctic Borough man aged 80 or older.
All three nonresident deaths were recorded in Fairbanks, two involving men in their 50s and one in his 60s.
Zink added that "Alaska's current COVID incidence rate is, right now, the highest in the nation."
The state's average total of new cases per 100,000 people was 973.6 as of midnight Thursday, higher than any state in the country, and ranking directly above West Virginia, Wyoming, Montana, Kentucky, Idaho and South Carolina.
Zink also noted that, in general, for every 1,000 cases reported in Alaska, DHSS would expect 260 cases to involve children, 23 to lead to hospitalization, five patients to die, and, every other day, one child to be hospitalized.
As of midnight Thursday, 223 people were hospitalized due to COVID-19 around Alaska — 217 people with confirmed virus cases and six with suspected cases, according to DHSS. Of those patients, 41 were using ventilators.
According to a hospital data dashboard maintained by DHSS, intensive care units at a handful of hospitals around the state were closed, including units at Bartlett Regional Hospital, Alaska Regional Hospital, Providence Alaska Medical Center, Mat-Su Regional Hospital and Central Peninsula Hospital.
ICUs at Fairbanks Memorial Hospital and St. Elias Hospital were "near capacity," the dashboard displayed.
The ICUs at PeaceHealth Ketchikan Medical Center, Bassett Army Hospital, Alaska Native Medical Center and Southern Peninsula Hospital were in the "open" status, per DHSS' dashboard.
All but 58 of the COVID-19 cases reported on the DHSS data dashboard Thursday involved Alaska residents.
Areas with 10 or more newly reported resident cases included Anchorage (468),Wasilla (251), Fairbanks (217),Palmer (150), North Pole (81), Kenai (80), Soldotna (63), Eagle River (49), the Northwest Arctic Borough (42), Utqiagvik (35), Juneau (31), Kodiak (30), the Bethel Census Area (19), Chugiak (18), the North Slope Borough (15), Nikiski (14), Haines (13), the Kusilvak Census Area (11) and the Nome Census Area (10).
Southeast Alaska cases also were recorded in Yakutat plus Hoonah-Angoon (five), Ketchikan and Sitka (four each), the Prince of Wales-Hyder Census Area (three) and Douglas (two).
Nonresident cases were identified in Wasilla (18); Fairbanks (nine); Anchorage (eight); Prudhoe Bay (three); Juneau (two); and Delta Junction, Dillingham, Kenai, North Pole, Seward, Unalaska and Yakutat plus Hoonah-Angoon (one each).
Thirteen nonresident cases were still being investigated by DHSS.