Alaska’s Top Health Official Battens Down for a Difficult Winter

(Bloomberg) -- For a glimpse of what Covid-19 may look like for some other places in the U.S. later this year, just look north. Alaska’s in-person schooling reopened a month ago. Temperatures are already dropping in the state, where only about 56% of adults and teenagers are fully vaccinated.  And the virus is surging. 

Anne Zink, Alaska’s chief medical officer, has a unique view of the crisis. In addition to her role at the state’s Department of Health and Social Services, she’s a practicing emergency medicine physician, president-elect of the Association of State and Territorial Health Officials and mom to an eighth-grader who is back in the classroom this year. 

Zink spoke to Bloomberg News about the state’s already-limited health-care systems straining under rising hospitalizations and and what it’s learned about reopening schools and shifting public-health goals. The interview has been edited for clarity and length.

Bloomberg: You’re ahead of the rest of the country. What are you seeing that might help predict what Covid may look like in the coming months? 

Zink: We’re seeing the same pattern we did last year. It started to cool here, and our cases started to take off before the rest of the lower 48. 

I do think that when we move indoors we have more opportunities for Covid to spread. There’s snow on the top of the mountains here. 

School is also the big factor. Last year many of our schools took very aggressive mitigation efforts and this year, mainly because of fatigue from parents and community members, many are choosing not to take significant Covid mitigation efforts. We’re seeing more kids in school than we ever had before.

And then, honestly, delta is different. I hope that people can start the school year with mitigation efforts and not wait until many of their kids are infected and sick. Because once it gets started and going, it’s much harder to control. 

Bloomberg: Alaska has had kids back in school for about a month. How has that been going? 

Zink: We have independent school districts, and their school boards have authority to make decisions on how they want to run their schools. We try to provide support and resources. We see everything from very little mitigation, so no masking, maybe offering symptomatic testing and no surveillance testing, to schools with robust mitigation, including regular surveillance testing, masking. 

Schools that are doing a lot of mitigation are keeping their kids in school better and keeping things moving forward, and those who are doing less are seeing more cases. 

Bloomberg: You just sent your daughter to school this morning. Was she wearing a mask? Does her school require masking?

Zink: Her school does not require masking. She is an eighth grader. I ask her every day to wear her mask. 

It’s hard to ask a kid to take on that responsibility when their health teacher is not wearing a mask, when their principal isn’t always wearing a mask, when the rest of the adults in that space aren’t wearing masks and when she is one of the very few children wearing a mask.

But she’s 13 and she needs in person education. She home schooled last year and she needs that social connection. And so we have decided as a family that it’s worth the risk of having her in school, but I wish we weren’t making that decision. She’s fortunate that she’s 13, so she’s vaccinated. 

Bloomberg: You’ve been working at a local hospital during the pandemic. How stretched is the state’s health-care system? 

Zink: It is stretched in a way I have never seen it stretched: difficulty transporting patients across the state, having to hold patients that you typically send in to a referral hospital at much more rural hospitals. 

We have been increasingly unable to transfer to Seattle and Oregon, which are places that we typically send patients to. We don’t have the ability to do [extracorporeal membrane oxygenation, or ECMO, a type of artificial heart-lung device] in the state at all, so some of the most critical, life-saving work we’re unable to do. If we don’t have access to ECMO beds in Seattle or in Portland or another facility, the patients just don’t get that care. 

A lot of our communities, too, are supported by community health aides. They oftentimes are caring for and helping to support patients in remote and rural areas with very limited supplies. We unfortunately have had cases where people have passed away in rural villages because they’ve run out of oxygen. We’ve been unable to transport them in or out. 

Bloomberg: Alaska ranks in roughly the bottom third of states by vaccination rates, near states like Arkansas and Missouri experiencing severe surges. Are you seeing vaccination rates pick up at all? What are the challenges and opportunities here? 

Zink: Some communities are highly vaccinated, and highly engaged in the process. Fairbanks, Mat-Su, Anchorage and Kenai, they’re all connected by a road, we call it a “road system,” versus the rest of Alaska you’ve got to fly to. The road system tends to be less vaccinated. It’s more urban. In general there’s more mistrust and fear of everything from government to pharmacies to vaccines. We have a large libertarian streak.

We are seeing an increase in vaccines. We probably do between 200 and 300 vaccines a week at our airports, while we’re doing somewhere between 8,000 to 9,000 total across the state. I don’t know any other state that’s vaccinating at the airport. We thought we would set it up for the summer, as a lot of workers were coming in, seafood workers and others, that may be their only opportunity to get vaccinated. But what I’ve been surprised by is how many of them are Alaska state residents and how that demand has continued. We have to fly a lot of places in the state to get places, so I guess it’s just a convenience. 

Bloomberg: This pandemic has lasted a long time. What is the goal of public-health measures at this point in time? 

Zink: That’s probably the number one question I get asked by school boards and city councils. 

Within the department, our mission is to promote the health and well-being of Alaskans. From a larger state perspective, our goal within Alaska has always been to not have systems collapse, so law enforcement systems, school systems, health-care systems. Some countries chose a Zero Covid approach, like New Zealand. We chose a flattening the curve approach. 

Right now we are pushing above our health-care capacity. And so the reason for more state and national involvement is because we are looking at systems collapsing. 

Bloomberg: In some parts of the country it looks like the Covid surges may be abating. Are there any signs of that in Alaska?

Zink: We’re not seeing any slowing down of this current surge of cases. And we know hospitalizations and deaths follow cases. 

We have surpassed the total number of people in the hospital at one time for Covid this year compared with any other surge that we’ve had previously. So I think it’s going to get worse before it gets better.

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