Ketchikan has finally been struck with a significant increase in COVID-19 cases. COVID took a while to get here because of our geographic isolation, but its arrival was completely predictable. We did not mandate masks; we did not adequately support social distancing, and the governor did not institute a travel quarantine within the state of Alaska.
All these measures could have prevented or blunted the increase in local COVID-19 cases. Moreover, the EOC algorithm our local governments use to determine COVID response is reactive rather than proactive. It does not prevent cases, it simply recommends action after cases have increased. I encourage citizens to view Dr. Anne Zink’s Oct. 30 statement on the Alaska Department of Health and Social Services website for accurate COVID-19 information. Dr. Zink is Alaska’s chief medical officer, appointed by Gov. Dunleavy.
Dr. Zink states that Alaska is in danger of running out of hospital staff and beds to care for COVID. The Nov. 6 Ketchikan Daily News ran an article with statement from the COO of KMC regarding the medical capacity for dealing with COVID. The information provided by Ms. Stevens was accurate, but not complete. KMC has 25 beds, but four of these are labor and delivery. Moreover, for years we have not been able to utilize beds on the med/surg ward to capacity because most rooms are semiprivate. When people have an infection or are colonized with certain bacteria, they cannot have a roommate. Therefore, the functional maximum bed capacity on that unit is usually about 14. Winter is usually the busiest time of year for hospitals, including ours, which can also limit bed availability.
Ketchikan regularly medivacs its most critically ill patients to large medical centers, where patients can receive a higher level of care. It is likely we will have increased medivac needs if there are more COVID hospitalizations. During my long Ketchikan career, there have been many times when we could not find an accepting hospital for a patient right a way or had to call multiple large hospitals (sometimes four or five) to find a bed. I anticipate our ability to find out-of-town beds for critically ill patients will be even more limited during this COVID epidemic. Our patients will be vying for beds against patients from the rest of Alaska and Washington. Weather also can delay medivacs, and the winter weather will soon be here. Flight crew rules and jet availability also can limit ability to medivac promptly, and this has happened many times over the years. When any of these things delay a medivac, we are forced to keep a very ill patient in KMC rather than get them to the higher level of care they need.
KMC has a limited number of staff because it is a small hospital in a small town. We need not only doctors and nurses, but lab techs, imaging staff, janitorial staff, central supply staff and respiratory therapists, among others. It takes the whole team to care for patients. If staff gets sick or quits or have days off, there easily could be a staff shortage. We cannot get extra staff to drive in from the next town if there is a shortage. We have relied on traveling staff to fill gaps in the past, but there is a nationwide shortage of travelers due to COVID. A KMC staff shortage in turn would result in exhausted staff and more medivacs. There have been many times in my Ketchikan career in which we had the bed available for a patient but not the staff, so the patient got medivaced.
My purpose in bringing this to the community’s attention now is not to cause fear, but to administer a good dose of reality. Unless we change our behavior as a community, we face more illness, probably some deaths, and a high risk of overwhelming our small, isolated hospital. Our economy will worsen further.
Check out the Alaska DHSS COVID-19 website. It has lots of factual information about COVID and about how to decrease risk of spread.
Now is the time for all citizens to follow Dr. Zink’s advice: Always wear a mask; wash your hands; keep your social bubble small. If you are sick, stay home and get tested. Good citizens care about and protect other citizens, understanding that in this situation, individual prerogatives are trumped by taking action to protect our fellow citizens and our economy.
Dr. Diane Liljegren M.D. is a retired family physician who practiced medicine from January 1992 through July 1, 2020.