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

Dr. Jeremy Gitomer at Providence Alaska Medical Center in Anchorage realized last month there weren’t enough dialysis machines to treat the flood of Covid patients suffering from renal damage.

One intubated 70-year-old woman, who was also battling kidney failure and was on dialysis for six days, wasn’t likely to make it, he recalled.

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

“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 at Anchorage’s three hospitals for the Kidney and Hypertension Clinic of Alaska. “I’ve been doing this 25 years.”

Doctors at Providence have been forced to choose who might live and who will likely die as a crush of Covid patients stretches the hospital’s limited resources to capacity.

Alaska is in the thick of a surge of cases fueled by the highly contagious delta variant, which devastated the continental U.S. over the summer. To alleviate the burden on the state’s health-care system, Alaskan officials on Oct. 2 activated “crisis standards of care” across 20 hospitals, a measure that gives them some legal protection if they have to choose who will get a bed or ventilator that may save a patient’s life while they forgo treatment for others who are less likely to survive.

Anchorage hospitals, where nearly all of the state’s dialysis machines are located, have been forced to reject transfers of patients who have a low chance of survival from other in-state medical centers, Gitomer said. It’s not just putting Covid patients at higher risk. Hospitals are now struggling to treat non-Covid patients with a range of life-threatening conditions, including cancer, accident injuries and organ failure. Patients with brain tumors face extended emergency room delays, prolonging their ability to get an MRI and see a neurosurgeon, doctors say.

Mat-Su Regional Medical Center, located some 40 miles northeast of Anchorage, can’t just transfer renal and heart failure patients to Anchorage like it usually does. The hospital now has to keep some of them overnight and “well enough to make it for outpatient dialysis the next day,” said Dr. Anne Zink, the state’s chief medical officer and an emergency room physician at Mat-Su.

“Instead of one nurse being able to care for four or five emergency department patients, they might be caring for 10 emergency department patients,” Zink said of Mat-Su, where Covid patients occupy almost half of the hospital’s 100 beds. “Patients having to board in the emergency department wait for a really extended period of time.”  

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

Alaska’s sheer geographic vastness further complicates the state’s ability to battle the outbreak: Health-care centers are so spread out that the average Alaskan must travel about 150 miles one way for medical attention, Zink said. Mat-Su Regional Medical Center alone services an area the size of West Virginia.

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

A combination of school resuming, snow falling and people spending more time indoors has made Alaska particularly vulnerable to the highly transmissible delta variant this fall, Zink said. Many communities also lacked access to running water and sewers and faced high rates of respiratory diseases before the pandemic even began, she explained, elevating their risk for a Covid outbreak.

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

Vaccine hesitancy runs high in Alaska, making monoclonal antibodies a popular Covid treatment, Ramirez said. But as the supply of antibodies dwindled with the surge, Ramirez said Foundation Health was forced to reserve the lifesaving treatment for only the most vulnerable patients.

“When it became scarce, we had a choice to make,” Ramirez said. “And our choice was we could either use up all we had and simply run out, or we could choose to look at who was using it and make decisions off of it at a community level as to who would most benefit from it and limit it to those individuals.”  

Staffing crunches at Foundation Health have reduced capacity, Ramirez said. The hospital has been postponing non-emergency surgeries and discharging pneumonia patients earlier than usual, equipping them with at-home oxygen treatments once doctors are comfortable with their recovery rather than holding them until they’ve fully recuperated, she said.  

Ramirez blamed the surge in Fairbanks on the region’s low vaccination rate and public resistance to wearing masks. And even though Ramirez said the surge began before schools started for the year, she said she expected the return to in-person learning would exacerbate the outbreak.

Alaska has vaccinated more than 51% of its population against Covid, ranking 35th in the nation among all states and Washington, D.C., as of Wednesday, according to the CDC. Misinformation and anti-vaccine sentiment have proven significant obstacles in the push to immunize more Alaskans, said Charlee Gribbon, a nurse and infection preventionist at Bartlett Regional Hospital in Juneau.

“Viruses are a hard pathogen to control,” Gribbon said. “So when we pull out all the stops, we just need everybody to help us out with whatever they can do to avoid spreading the illness.”

— CNBC’s Nate Rattner contributed to this report.