Three additional COVID-19 cases were confirmed in Ketchikan late Saturday afternoon, bringing the community-wide total to six and prompting a ‘hunker down’ proclamation from local governments.

The joint proclamation, signed by the mayors of Ketchikan Gateway Borough, City of Ketchikan and City of Saxman, is effective immediately.

“We want to assure the public that vital services such as emergency, fire, police, and grocery stores will remain fully functioning and open,” stated a Ketchikan Emergency Operations Center press release.“The flow of goods to Ketchikan is continuing and grocery store shelves will remain stocked.”

The proclamation “strongly” urges local residents to stay home and work from home as much as  possible, sheltering in place to help stop the spread of COVID-19. Among other recommendations, it urges non-essential business to close for a period of 14 days, and all residents to follow health directives from state and federal authorities.

 “All it’s doing is telling people to use common sense,” City of Ketchikan Mayor Bob Sivertsen said in an interview with the Daily News on Saturday evening.

“If you don’t have to be out, don’t be out, because we know that this spreads through personal contact,” said Sivertsen.

The number of cases statewide jumped from 14 to 21 on Saturday, then jumped again on Sunday to 32.

In addition to the six cases reported in Ketchikan, Anchorage had a total of 13 cases as of early Sunday evening, Fairbanks had seven cases and the Matanuska-Susitna Borough had two, according to the Alaska Department of Health and Social Services. Seward, Soldotna and Sterling each had one — and Juneau had its first positive result announced on Sunday.

The rate of increase in Ketchikan — where the first positive test result was announced on Tuesday — has officials concerned.

“If growth continues at the current rate, by the end of the week Ketchikan could have over 20 positive cases of COVID-19 in the community,” according to a press release from the Ketchikan's EOC.

Ketchikan’s cases are not considered by the Centers for Disease Control to be community spread because all the confirmed cases can be traced back to a source, whereas community spread is "the spread of an illness for which the source of infection is unknown," according to the CDC.

Saturday’s three positive test results were linked to Ketchikan’s first two cases.

The first case involved Ketchikan Gateway Borough Attorney Glenn Brown and was travel-related, according to Brown’s discussions with Alaska Public Health.

Brown emailed the EOC that he and his spouse had returned to Ketchikan on March 10 after a short trip to Washington and Oregon, and had included an overnight stay in Juneau after their flight bypassed Ketchikan because of weather on March 9.

On Thursday, the second positive test result was announced, and was identified as Brown's spouse. She is a physician with PeaceHealth Ketchikan Medical Center, PeaceHealth has confirmed.

On Friday, the third case was announced  to be a borough employee at the White Cliff Building that had "close contact" with Brown.

"Upon experiencing symptoms of illness, the individual self-isolated and sought testing through the PeaceHealth Medical Center Emergency Room," a press release from the Ketchikan EOC read.

According to Saturday's press release, two of the three new cases had had direct contact with Brown, according to Saturday's press release.

The other case reported Saturday ”was a close contact” with the physician, according to the press release.

PeaceHealth has confirmed that the physician had seen patients in a clinic setting during one day of work since returning to Ketchikan on March 10.

“Public Health, they determined the exact date that those exposures may have happened. It happened to be one day of care, provided by that provider, in a clinic setting,” Mischa Chernick, marketing and communications manager for PeaceHealth, said on Friday.

She said staff and patient interaction was low — that the individual’s job doesn’t require them to visit multiple parts of the hospital.

“They were only seeing patients within their exam room area,” Chernick said.

She said staff at PeaceHealth worked with staff from Ketchikan Public Health as they conducted their investigation.

“We worked alongside them to make sure those people who needed testing, who had possible exposures through that caregiver, were tested,” she said, adding that, “those known exposures are all being tested.”

The number of people tested locally has not been released.

On Sunday, PeaceHealth confirmed that the individual identified Saturday as having had close contact with the physician and now having a positive test result is an administrator with the PeaceHealth Medical Group clinics.

Chernick said the person is not a direct caregiver. Both the physician and administrator are in quarantine at their homes, according to PeaceHealth.

“PeaceHealth’s Employee Health and Infection Prevention teams are working in partnership with Ketchikan Public Health to conduct a thorough investigation,” states a PeaceHealth press release issued on Sunday.

PeaceHealth staff is being required to follow Centers for Disease Control guidance for recognizing symptoms of COVID-19 and prevent illness, according to the announcement.

“Those employees potentially exposed to COVID-19 are following the guidelines for caregivers with known exposures by wearing a mask while in the facility, being checked for fever twice a day, and completing a daily Employee Health Screening Questionnaire for 14 days following exposure,” states the press release. “At the onset of any symptoms, employees are to immediately enter self-quarantine at home.”

PeaceHealth also announced that it will be closing the PeaceHealth Medical Group’s clinics for “thorough disinfection” on Monday and Tuesday.

The clinics are in the new addition to the medical center — the multi-story blue and grey structure that’s adjacent to the sidewalk with Tongas Avenue, with ground-level doors adjacent to the Borough Transit bus stop and offices above the new parking garage. Chernick said the clinics are connected to the rest of the medical center by a corridor that’s now closed.

The cleaning on Monday and Tuesday will be conducted by hospital staff, and will be similar to the cleaning done in the borough’s White Cliff Building, according to Chernick. She said the clinics are given an intense cleaning daily, but the cleaning scheduled for Monday and Tuesday will be “more extensive.”

The White Cliff Building was closed after Brown’s positive test results were announced on Tuesday, and is set to remain closed until April 1.

The PeaceHealth announcement said that all patients who are affected by the clinics’ closure will be contacted by phone to “hold their appointment via telemedicine or reschedule for a later date.”

Regarding access to other areas of the medical center, Chernick said that anyone coming into the hospital — staff, patients, or visitors — will be required to have their temperature taken before entry.

All doors are locked and all open entryways are manned either by a local private security company or hospital staff, according to Chernick.

If a staff member has a temperature of above 100 degrees, they will be sent home.

Approved visitors will have to wear wristbands given by security and stay in the room of the specific patient they are visiting.

If someone seeking treatment has a temperature above 100 degrees, a decision will be made on whether they need to be taken to a special area of the hospital, according to Chernick.

With the statewide mandate requiring providers to forgo elective surgeries, PeaceHealth has turned their surgery recovery space into a negative pressurized area Chernick called a “COVID isolation unit.”

The area is connected to the ER by a corridor.

“We’ll be able to care for an expanding number of people within that negative space area,” said Chernick, “which would contain that virus within that area, and not have it spreading to the rest of the population of the hospital or our clinics.”

Mayor Sivertsen, when asked Saturday whether Ketchikan has adequate medical staff to fight the outbreak, said, “We’re in a state right now, where we’re very manageable, and with anything, if you don’t take corrective action, you have the potential of overwhelming your health facilities.”

According to Kacie Paxton, the borough clerk, and public information officer for the Ketchikan EOC, local authorities learned of the newly confirmed cases from Public Health around 2 p.m. on Saturday and held a meeting to determine whether a shelter-in-place order was appropriate.

The shelter-in-place announcement was distributed early Saturday evening.

“The mayors are urging residents to work from home to the extent that they are able," said Paxton, "they’re urging that non-essential business to the extent that (they’re) able, close for a period of two weeks."

“I’m very concerned about our local businesses and the economy and the community,” said Sivertsen, “but at this time, I think public health trumps everything.”

“Err on the side of caution,” said Sivertsen.

He said if you do go shopping in grocery stores don’t linger and stay six feet away from other people and wash your hands.

For employees of city government, City Manager Karl Amylon said earlier this week that about 100 positions have been identified that can work from home. How many are currently working from home is unclear at this point, although an estimated 28 borough employees are working from home following the closure of the White Cliff building Tuesday evening, according to Paxton.

“If we have a snow forecast, we’re going make to sure we have crews out that will be able to handle that,” said Sivertsen. “If we have line issues, electric issues, telephone issues, we’ll handle that on a  case-by-case basis. We’re not going to stop providing services, we’re just going to try to be smarter about it.”

He said that there is no sunset date on the proclamation, “because we don’t know what the course of this is.”

“At this particular point,” said Sivertsen, “if we can get ahead of the curve early, flatten it out, I think that’s the best thing for the community.”

Also on Saturday, the Metlakatla Indian Community mayor’s office published a notice strongly discouraging travel on and off Annette Island.

“Anyone returning to Metlakatla must quarantine at home for 14 days — including from Ketchikan,” stated the notice signed by MIC Acting Mayor Albert Smith.

The notice said the medical care for urgent travel will be allowed, but patients returning to Metlakatla must be quarantined at home for 14 days.

Also, the mayor’s office “will be denying any visitors permits from this point forward until the COVID-19 pandemic status has been modified by the Centers for Disease Control,” stated the notice.