Alaska doctors forced to ration life-sustaining treatments as Covid patients clog up hospitals

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  • Alaska is home to the sheer number of cases that devastated the continental US over the summer.
  • Alaska officials activated “crisis standards of care” at 20 hospitals on October 2.
  • It provides some legal protection to facilities if they have to choose who will get beds or ventilators who may save their lives to treat others who are less likely to survive.

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Dr. Jeremy Gitomer at Providence Alaska Medical Center in Anchorage realized last month that there were not enough dialysis machines to treat the flood of COVID patients suffering from kidney damage.

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He recalled that a 70-year-old woman, who was battling kidney failure and had been on dialysis for six days, was unlikely to recover.

Gitomer and his medical team decided to end treatment for a 48-year-old man, who was also on a ventilator and given dialysis, to free up the machine. Both patients eventually died, he said, adding that up to 95% of intubated COVID patients on dialysis do not survive in Alaska.

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“It’s terrible that I’m living through this because I’ve never seen more people die in my career,” said Gitomer, a nephrologist who works for the Kidney and Hypertension Clinic of Alaska at three hospitals in Anchorage. does. “I’ve been doing this for 25 years.”

Doctors in Providence have been forced to choose who can survive and who is likely to die as crushes of Covid patients strain the hospital’s limited resources to capacity.

Inspired by the highly contagious Delta variant, Alaska is in the midst of a massive surge of cases that ravaged the continental US over the summer. To ease the burden on the state’s health care system, Alaska officials on October 2 activated “crisis standards of care” at 20 hospitals, a measure that gives them some legal protection if they have to choose which beds. Or who will get ventilators can save their lives to treat others who are less likely to survive.

Anchorage Hospital, where nearly all of the state’s dialysis machines are located, has been forced to decline the transfer of patients who have little chance of escape from other state medical centers, Gitomer said. It is not just putting COVID patients at higher risk. Hospitals are now struggling to treat non-Covid patients with life-threatening conditions including cancer, accidental injury and organ failure. Doctors say patients with brain tumors face delays in the emergency room, increasing their ability to have MRIs and see neurosurgeons.

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Mat-Su Regional Medical Center, located about 40 miles northeast of Anchorage, cannot transfer kidney and heart failure patients to Anchorage as it usually does. The hospital now has to keep some of them overnight and “there is enough for outpatient dialysis the next day,” said the state’s chief medical officer and an emergency room physician in Mat-su, Dr. Anne Zink said.

“Instead of one nurse being able to take care of four or five emergency department patients, they can take care of 10 emergency department patients,” Jink said of Mat-su, where the hospital’s 100 Covid patients occupy about half of the beds. “Patients have to wait for a really extended period of time to climb into the emergency department.”

Alaska, which has managed dozens of Covid cases at any one time during most of the outbreak, reported more than 1,200 new cases on Wednesday — a seven-day average of 1,317 new cases peaking on September 27, according to an analysis of data from CNBC. Johns Hopkins University. Alaska is the third least populous state in the nation, but currently has the highest number of Covid cases per 100,000 residents, at 120 new infections per capita as of Wednesday. And according to data from the Department of Health and Human Services, Covid patients are crowding hospital beds at nearly twice the rate of the national average.

Zink said Alaska’s vast geographic vastness further complicates the state’s ability to fight an outbreak: Health care centers are so spread out that the average Alaskan must travel about 150 miles to seek medical attention. Matt-Su Regional Medical Center serves an area the size of West Virginia alone.

Zink said the state brought in 400 out-of-state medical personnel late last month to help with the boom.

Zink said the combination of reopening schools, falling snow and people spending more time indoors has made Alaska particularly vulnerable to the highly permeable delta variant. Many communities lacked access to running water and sewers and faced high rates of respiratory diseases even before the pandemic began, he explained, increasing their risk for a COVID outbreak.

“We are seeing far more deaths and dying with this surge,” said Dr. Angelique Ramirez, chief medical officer of Foundation Health Partners in Fairbanks. “It’s happening on a daily basis, it’s happening in young people and it’s happening despite everything we know how to do.”

Ramirez said vaccine hesitancy is high in Alaska, making monoclonal antibodies a popular COVID treatment. But as the supply of antibodies grew, Ramirez said Foundation Health was forced to reserve life-saving treatment only for the most vulnerable patients.

“When it became rare, we had a choice to make,” Ramirez said. “And our choice was that we could either use what we had and just run away, or we could choose to see who was using it and make decisions from that at the community level. Who will benefit the most from it and will limit it. Those individuals.”

Staffing crunches at Foundation Health have reduced capacity, Ramirez said. He said the hospital is postponing non-emergency surgeries and discharging pneumonia patients earlier than usual, allowing doctors to keep them at home instead of allowing them to recover, until they are fully recovered. Oxygen treatment is provided.

Ramirez attributed the increase in Fairbanks to the area’s low vaccination rate and public resistance to wearing masks. And even though Ramirez said the boom had started before school began for the year, he said he expects a return to in-person learning as the outbreak flares up.

Alaska has vaccinated more than 51% of its population against COVID, ranking 35th In the nation between all states and Washington, DC, as of Wednesday, according to the CDC. Misinformation and anti-vaccine sentiment have proved significant barriers to pushing more Alaskans, said Charlie Gribbon, a nurse and infection preventer at Bartlett Regional Hospital in Juneau.

“Viruses are a difficult pathogen to control,” Gribban said. “So while we pull out all the stops, we just need everyone to help us do whatever they can to stop the spread of the disease.”

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