For more than an hour on Friday night, representatives of the Ketchikan Emergency Operations Center responded to COVID-19 related questions from local community members.

The questions focused largely on topics such as the source of the most recent outbreak, Ketchikan's capacity to care for COVID-19 patients, local testing efforts and local risk levels.

Participating in the session were EOC Incident Commander Abner Hoage, Public Health Nurse IV Theresa Rusek, EOC Public Information Officer Kacie Paxton and PeaceHealth Ketchikan Medical Center Chief Administrative Officer Dori Stevens.

Hoage opened the session with a statement regarding the COVID-19 outbreak that began in late October.

"In early October, you probably recall we had a week where we were at (Risk) Level 2, and that was due to a high positivity rate," Hoage said.

Hoage noted that the community then "tamped down" the positivity rate and returned to the lowest level of risk before the beginning of a "pretty significant outbreak" on Oct. 26, 27 and 28.

In response to the outbreak of COVID-19 seen late in October, the EOC's Unified Command announced a move to Risk Level 3 (High) on Nov. 4.

"We asked the community to take some significant mitigation actions and we gave it some time to work, and people really stepped up," Hoage said.

"By (Nov.) eighth, we had kind of crested the peak of that outbreak and we started trending back down, which is good."

That outbreak included four community spread cases that resulted in 103 total cases. Of those 103 cases, 16 were determined to be community spread and 79 were connected to close contacts of a known positive.

Sixty-one of the cases were all connected to a single "cluster," Hoage explained.

"Part of the reason that we didn't go to Risk Level 4 was because such a large portion of that outbreak was identified to a single cluster," Hoage explained.

Also during that same timeframe, eight travel-related cases were detected in Ketchikan.

Hoage noted that one-third of Ketchikan's total travel-related cases have been counted within the past 30 days.

He attributed Ketchikan's ability to move past the outbreak to testing, contact tracing and isolation.

"We have a pretty major capacity to test here in Ketchikan," Hoage noted, adding that the testing available helped to "get our arms around that pretty major outbreak."

EOC data (indiciated) indicated that more than 3,900 tests were conducted in Ketchikan during the outbreak.

Hoage said that "we are pretty spoiled here in Ketchikan with our turnaround results and test times."

COVID-19 tests have been processed on-island by local providers since earlier this month, with the exception of tests conducted Tuesday through early Thursday, which had to be sent to Quest laboratories in Seattle due to a delayed shipment of reagents.

Responding to a question, Hoage said that the reason that further details as to the source of the outbreak had not been publicly announced was a matter of privacy.

"We have a requirement to make sure we protect the privacy of the individuals involved, and so we're very careful about what we release and when we release it," he said. "We've continued to release more information, for example, the information about the one very large cluster (the outbreak) had. And we had a local business in town that announced that a person tested positive."

When it comes to deciding when to move between risk levels, Hoage said that "we have to apply some critical thinking and situational awareness."

Although the EOC uses several metrics — such as the number of recent community spread cases or the local positivity rate — to determine the risk level, decisions can be made based on the needs of Ketchikan's situation.

Ultimately, the decision to move between risk levels will be made by EOC Unified Command, which includes Theresa Ruzek and Hoage. The EOC's policy group — which includes Ketchikan Gateway Borough Mayor Rodney Dial, City of Ketchikan Mayor Bob Sivertsen, Saxman Mayor Frank Seludo, and many city managers and officials — also contributes to a variety of decisions.

Hoage said that the reason the local risk level system doesn't align with those of the Ketchikan School District (which uses three risk tiers) or the state (which also uses three levels) is because they all were developed independently of each other.

In the beginning of the pandemic, Ketchikan was "very far out in the lead" when it came to creating its risk matrix, said Hoage.

"We settled on a four-tier risk level matrix, and it's worked really well for our community," Hoage explained. "We've adjusted that to be based on community need and to respond to the unique situations we need here in Ketchikan."

Hoage said that although the local, state and district risk levels differ, "they can feed off each other and support each other very well."

During the question and answer portion of the event, KMC Chief Administrative Officer Dori Stevens also took questions about the COVID-19 unit at the hospital.

Stevens said that the facility's stock of personal protective equipment was adequate.

Due to the unique issues that an island location can create when it comes to receiving shipments, Stevens said that KMC had "stockpiled up a little bit" when it came to PPE.

The COVID-19 unit at KMC currently has six beds available in an isolated area of the facility, but could be expanded to other beds in the hospital.

Additionally, Stevens said, "If we are experiencing a surge where all those areas are full, before they got full, we would be able to transfer patients to our sister PeaceHealth hospitals."

Stevens also noted that "we do have enough ventilators on hand," adding that more research has been done regarding placing COVID-19 patients on ventilation.

Theresa Ruzek, Public Health nurse IV, said that as of Friday, she wasn't "concerned about the capacity" at the hospital.

Ruzek also spoke to contact tracing investigation efforts in Ketchikan.

Ruzek noted that Public Health officials receive a call from the local providers when a positive test result comes in.

"This really gives us a jump on our ability to contact trace quickly," Ruzek commented. "They provide us the information they gather when they provide the test."

For individuals who are in a "high risk" category — such as health care workers or individuals who attend school or daycare — Public Health will launch a "very thorough" investigation into their contacts, while educating the individual about how to reach out to their contacts.

Contact tracers do a lot of "education and teaching" about the quarantine and isolation processes.

If an individual is in a "low risk" category, they can be tasked with making the calls to their own contacts.

"I know this is not a perfect system, but we have had wonderful results from this," Ruzek said.

As to evidence of this, Ruzek said that there have been multiple situations where an individual who had been placed in quarantine as a close contact tested positive after their quarantine period ends.

At the end of the session, Hoage thanked Ketchikan for its response to the COVID-19 pandemic.

"Thank you to the community for really stepping up and responding to the actions that we ask you to," he said.

Hoage noted that "we don't think we can stop it (the virus)."

"As a nation, as a country, as a world, right now, we just don't have the ability to stop it," he said. We have to make the curve flat."