By SAM ALLEN
Daily News Staff Writer
Several national health guidelines and state mandates have come out in recent weeks in response to the COVID-19 pandemic.
Since Feb. 19, local officials have expanded the local emergency planning committee into an emergency operations center, making sense of federal and state mandates and applying them to the response in Ketchikan.
Ketchikan’s "hunker down" proclamation on Saturday went into immediate effect. It was one of the first in the state.
The proclamation was recommended by Ketchikan Emergency Operations Center and signed by the mayors of the three local governments in Ketchikan.
The proclamation strongly advised all residents to stay home and work from home as much as possible and asked all non-essential businesses to close for at least 14 days.
“We did have a recommendation from the state,” said Abner Hoage, Ketchikan Gateway Borough and City of Ketchikan emergency manager, about the proclamation.
“We were also already discussing that locally,” Hoage said of the proclamation. “And when all of that came together, we decided to go ahead and proceed with that.”
Hoage is also on the EOC unified command, along with Jen Bergen from Ketchikan Public Health and Corey Padron, the emergency manager for the City of Saxman. The unified command communicates with a policy group made up of the managers of the local governments.
The coronavirus causes only mild or moderate symptoms in most people. But it can cause more severe illness in people with existing conditions and the elderly. The vast majority of those who are infected recover.
“So, you know, as I'm making decisions,” said Hoage in a Monday afternoon interview, “I would much rather overreact than underreact because in three months or six months down the road when you look at me and say, ‘well, you overreacted.’ Uh, OK, I'll take that criticism. But if I have to stand there and you say, ‘you underreacted and we have people dead because of it,’ I don't want to be there.”
He said he’s concerned about medical staffing and supplies, especially if people don’t hunker down.
“I think that's the key message that we need people to understand right now is, we have enough right now, but if you just keep going about your normal life, we're not going to have enough,” Hoage said.
On March 3, the EOC moved from a level 1 preparedness level to a level 2. On March 12, the state announced Alaska's first confirmed case of COVID-19. The case was in Anchorage.
The first Ketchikan case was announced on Tuesday, March 17. The second case was announced on March 18, followed by a third on Friday. Three additional COVID-19 cases were announced on Saturday and three more on Tuesday, followed by two additional cases Wednesday.
As of Wednesday evening, the total COVID-19 cases in Ketchikan was 11.
As of Wednesday evening, the total statewide was 59 confirmed COVID-19 cases — and one Alaska resident died from the disease outside of Alaska.
During that time, EOC staffing has expanded from four or five people to around 20.
Nationally, there are shortages of medical supplies — test kits, masks, gloves, gowns — and staff is stretched thin because of the COVID-19 pandemic.
“We’re no different,” said Hoage in an interview Sunday afternoon.
“Not all of these (local) cases were people who traveled out of town now, and so it’s difficult to gauge what the spread is with the limited number of tests we have available,” said Hoage.
The number of test kits in the community hovered around 100 between Friday and Monday, according to data and conversations with the EOC.
“It changes, you know, on an hourly basis,” said Hoage.
Beyond testing kits, there are other needed supplies: masks, gowns, gloves — personal protection equipment.
While Hoage says the EOC currently maintains a supply of PPE where it can continue operating in accordance with Centers for Disease Control guidelines, several shipments are pending, and island-wide numbers for all the local providers are still being gathered.
“We do have a lot of hand sanitizer, a lot of surgical masks. We don't have a lot of N95 masks,” said Hoage of the EOC supply.
While Hoage couldn’t put a number to the supply, it has been inventoried by the EOC Logistic Section Chief Steve Rydeen, who said he’d have to go through Ketchikan EOC Public Information Officer Kacie Paxton to communicate.
The CDC is recommending that health care providers wear masks when dealing with patients who could potentially have the disease.
The N95 masks are more effective than surgical masks. They have a seal and block out 95% of air particles.
The Northway Family Healthcare Clinic had 18 testing kits on Sunday, and had gathered samples from two patients, but as of Sunday didn’t have an N95 mask.
“I hope I'm going to be able to test more people,” said Maureen Northway, doctor of nursing practice. “I just really hesitant to do more without a better mask.”
She said she hadn’t been able to get a mask through the EOC or local channels on Sunday, but was optimistic that something would come through so she could resume sample gathering earlier this week.
"I just have the kind of paper surgical masks that you see so it doesn't have the proper filter inside, so it's not as safe for me to be doing it,” said Northway. “I don't want to be overexposing myself.”
She says she’s low on gowns, but probably has enough for her 18 tests, but doesn’t have any face shields or head covers.
“Those are those things which are really great if you can get them,” said Northway. “... If somebody coughs while we're going to test, it doesn't go into our hair, you know, and on our clothes.”
The Ketchikan EOC had a phone call with 11 different medical providers Monday to answer questions and gauge the supply needs and testing capacities of each for a more coordinated response.
While not every clinic is going to be providing testing, according to Hoage, the meeting was important to make sure the local clinics that are still seeing patients in person, can get all their appropriate PPE if their normal suppliers are low.
Several clinics in town have moved to telemedicine except in emergency situations. The Centers for Medicare and Medicaid Services was able to ease up on the requirements for telemedicine services because of recent federal legislation and a national emergency in response to COVID-19 pandemic.
Hoage said there still might be medical providers in town that the EOC hasn’t been able to reach, so he encouraged any of them to reach out to the EOC or the fire department.
Even with the coordination effort by the EOC, several clinics around town are low on supplies and backordered — and everyone is low on test kits because of national shortages.
On Tuesday, Legacy Health personnel, which had 19 testing kits and is only testing for current patients, said the clinic had four N95 masks, four gowns, and were low on gloves.
Northway said she’s backordered on everything — her regular supplier is out of stock.
She said she's low on medical wipes that kill viruses and bacteria such as tuberculosis and other bacteria.
She said prices have been raised on many items in the Amazon Marketplace.
“And then they say it's shipped and then it's, the tracking shows nothing is happening,” said Northway.
Ketchikan Indian Community Health Clinic has about 39 kits and can do testing free for its members, but they are backordered as well, according to Catherine Keene, during a Tuesday interview.
Keene said KIC has adequate PPE supplies on hand, and that it has weekly orders of medical supplies that include testing kits, gloves, N95 masks, gowns.
However, included with some of the weekly orders is a notice that some of the supplies requested are backordered.
“We're facing the same issues around supplies as everyone else,” said Keene.
Creekside Family Health Clinic had a large order of test kits from its supplier at Quest Analytical, but due to shortages, it is now expecting about 10 test kits a week, according to Vice President of Operations Trevor Shaw on Tuesday.
Creekside had 25 test kits and was down to 17 as of Tuesday. Shaw said they've tested eight people, with two tests coming back positive late Monday night.
“We're trying to get more tests. I mean that's — everyone's facing that issue,” said Shaw.
Typically the turnaround time for tests through Quest Analytics is 24 to 48 hours, but with the volume of tests, Shaw said it could easily be double that, and Northway said it might be around five days. She said her samples ended up going to California because the Washington state facilities were so busy.
Shaw said they’re pretty set as far as PPE right now.
“Of course the big concern is as this thing picks up, you know, and providers all over the community, not just us — PeaceHealth, everybody on down — will start eating through the supplies and resources that we currently have,” Shaw said.
“I know everyone's been working very closely with EOC, trying to make it a community—wide coordinated effort, doing the best we can, ensure everybody has what they need, sharing resources as needed,” said Shaw Monday evening. “And that process has been very helpful.”
On Tuesday, Creekside fielded around 100 phone calls and saw 20 patients. No tests were given, but the patient contacts were mainly alleviating concerns and answering questions about people’s colds, coughs and fevers.
Currently, about five providers in town are equipped to gather samples for testing, according to the Ketchikan EOC, with possibly more as supplies arrive.
The places that can currently test, according to the latest information from the EOC, are Creekside, Ketchikan Indian Community Health Clinic, PeaceHealth, Polaris Health and Power of Wellness.
Ketchikan Public Health is referring patients who meet the state criteria for testing to PeaceHealth, which has an outside area set up to test patients. A tent was set up outside the emergency room following the first confirmed case of COVID-19 in Ketchikan on March 17, as well as a designated area in the hospital with ventilators set up for hospitalized patients, of which there were none as of Monday afternoon.
Hoage said about 100 N95 masks and 100 additional test kits are expected from the national stockpile Tuesday.
The EOC also has requested 5,000 additional test kits from the state EOC. However, local officials are still in discussions about that order.
“Our goal is to get enough testing capability here that we can begin testing people,” said Hoage. “You know, pretty much anybody who wants to, who's symptomatic at least.”
The EOC is considering Berth 3 as a potential drive-thru testing location. If requested by EOC, Creekside and KIC are onboard to implement drive-through testing.
However, the testing criteria is limited.
“Testing is going to be very stringent on whom they test currently,” said Hoage on Sunday. “They're only testing high risk until we can get more kits available.”
According to an EOC press release on Friday, in order to get a test, a patient must not only show symptoms, but also be categorized into the following: having direct contact with a confirmed case, be elderly or have underlying health conditions, traveled out of state within 14 days, or be a medical or EMS provider.
People meeting one of the above criteria are being told to self-quarantine at home.
According to the CDC, people can develop symptoms anywhere from two to 14 days after contracting the virus.
In addition to the statewide testing criteria, individual providers are allowed to use their own discretion, and can gather samples as the situation warrants.
The Alaska Department of Health and Social Services website as of Wednesday evening showed that 1,860 people have been tested statewide, 1051 in state labs and 809 through private labs.
Alaska Chief Medical Officer Anne Zink said in a state briefing this past week that the state had been processing tests for other states.
Local numbers for testing have not been compiled by the EOC yet and public health is not sharing data on the number of people tested in the community. Local public health officials have not responded to several Daily News inquiries about testing, current COVID-19 cases, or supplies.
The increase in COVID-19 patients in Ketchikan, and the statewide, nationwide and local response, has added much strain on staffing.
Many people within the EOC are taking on duties in addition to their everyday jobs.
For example, Hoage is the Ketchikan Fire Department chief, Jen Bergen is lead nurse at Ketchikan Public Health, and Padron is the village public safety officer for Saxman.
Sherry Dunlay, nurse manager for the emergency department at PeaceHealth, was recently pulled away from her role as EOC operations section chief because of increased demands at PeaceHealth, which has its own incident command structure set up within the hospital in response to the virus. Mark Hilson, who also works as the public works director for the City of Ketchikan, took over for Dunlay, according to Hoage.
While Hoage said there is a national pool of qualified EOC workers, from which the community could possibly pull, the demand is greater elsewhere.
The National Guard has been in communication with the EOC, offering a dozen local national guardsmen to assist in operations if needed.
KIC has done some emergency hires for more housekeeping and cleaning to keep the risk of infection down, according to Keene. She estimates about four staff members are working 14 to 16 hours a day to keep up with state and federal guidelines to implement the proper processes in the clinic.
Public Health is contacting those individuals who have tested positive, and is interviewing them to figure out what direct contacts they have had and when as part of their investigations.
“The local Public Health nurses are primarily doing those contact investigations here in Ketchikan; their staffing is fairly low,” said Hoage.
Ketchikan Public Health has a staff of three nurses and one nurse practitioner, according to Kacie Paxton, EOC public information officer.
“And they've been pretty busy with the number of cases and contacts to follow up with, based on the activities of our first few cases,” said Hoage.
He said over the weekend Public Health workers from Juneau took over some of the contact investigations calls “so that our local nurses can get a little bit of a break.”
A Public Health nurse from Juneau arrived in Ketchikan on Monday to assist in Public Health’s ongoing investigations.
Additionally, University of Alaska Southeast Ketchikan nursing students have been assisting Public Health workers with the growing investigation into the cases in Ketchikan.
“I'm not sure that people completely understand, just how much of a difference they can make by simply adjusting how they live their life, for now,” said Hoage, talking about observing the hunkering down order. “It's a short-term request that we have and we really need people to do that. So that we don't overwhelm what we have.”
He said that if people don’t take it seriously, “We're not going to have enough providers. We're not going to have enough PPE. And, and it's just not, it's not that we haven't done what we can, it’s that it’s not available nationwide right now.
“We're preparing for people that choose not to listen to us is really what we're doing,” he said.
“It's kinda like when you're in kindergarten and keep losing recess because two kids won't listen,” Hoage said. ”We need those two kids to listen, so that we can all have recess again.”