Since the state’s public health disaster emergency declaration expired on Feb. 14, health care facilities have been left to figure out how to navigate the pandemic with decreased federal funding and less flexibility in how they respond to the virus.
Karl Hertz, the administrator at Providence Kodiak Island Medical Center, said the hospital is strictly regulated by the federal Centers for Medicare and Medicaid Services and Joint Commission. Under the emergency declaration, hospitals were granted special waivers to the regulations to adapt to the needs of their community.
“All those little waivers allowed us to be very flexible in how we care for patients within the hospital on the island, and without that, those things go out the window,” Hertz said.
Those waivers allowed health care institutions to augment care with out-of-state providers for more complex patient needs through telehealth. However, without the state’s emergency declaration, that is not able to continue.
“We are definitely in new territory. There is no game plan for how to respond for a once-in-a-generation event,” said Emily Ford, the director of government affairs at Providence Alaska Medical Center.
She said the emergency declaration had allowed hospitals to adapt to the changing needs of the community during the pandemic — from reimbursing providers for telehealth visits to using operating rooms for positive COVID-19 patients and creating alternative care sites in Anchorage.
Ford said that Providence is reviewing how operations have changed over the past year, and is currently working to make sure the hospital has the authorization to continue with the modified processes.
Providence Kodiak Island Medical Center added special air filters that sit in the rooms and clean the air, making enclosed spaces safer for patients and staff. They also added zippered walls around some of the rooms and utilized telehealth methods to meet with some of their patients.
When the hospital temporarily closed its surgery and specialty clinics after transitioning to red, or high-risk, status, it used federal COVID relief money to make up the lost revenue. Hertz said that some of the decrease in revenue was offset by an increase in inpatient care.
He said that without the emergency declaration in place, the hospital does not have access to federal dollars to pay for pandemic-related costs. However, with Kodiak’s low positive COVID-19 rate, he thinks the hospital will soon move to yellow status from orange.
This will allow for easier movement in the hospital, he said.
“As we go into 2021, because we are able to move down to yellow status and open our surgery schedule and specialty clinics, hopefully we won't depend on those funds,” Hertz said, referring to federal COVID-19 relief money.
The waivers also allowed the hospital to switch staff from their traditional roles to other areas in the hospital where they were needed most, meaning that specialty medical professionals like physical therapists helped nurses or did other necessary jobs.
“Without the emergency declaration, you can’t use the labor pool,” Hertz said. “It starts to put these pre-COVID hospital regulations back into place, which makes it hard for us to adapt to the changing environment.”
Although case numbers are currently low in Kodiak, the hospital will still have COVID-19-related responsibilities like administering the vaccine.
Municipalities will still retain their health authority and policies despite the expiration of the emergency health declaration, but Kodiak’s local Emergency Operations Center is learning to navigate the pandemic with fewer state resources, such as testing supplies.
Kodiak Economic Services Director Mike Tvenge said free COVID-19 testing is still offered on the island, but with fewer resources available through the state, uncertainty looms.
“The resources available through the state are probably not available any longer. We are still trying to sort out what this means,” Tvenge said.
While ESC members keep an eye on state and national levels of COVID-19, for now they will continue with the policies they have already put into place.
“We're staying with the recommendation for mask wearing, we are going to continue to look at (business) occupancy rates, we are going to take all these precautions that we have been doing,” Tvenge said.
Without the state health emergency declaration, non-residents are no longer required to be tested upon arrival in Alaska, but they may choose to be tested free of charge at Ted Stevens Anchorage International Airport.
Tvenge said the ESC will soon reevaluate policies about boats quarantining upon arrival in Kodiak. According to the harbor-use agreement, vessels arriving to the island must quarantine for 14 days if they have not yet quarantined.
Despite the relaxation of state-ordered COVID-19 regulations, Tvenge expressed his faith that people will protect themselves with proper safety protocols.
“The reality is, there is still a risk of the virus. We don't want to blow the efforts that we have already accomplished,” he said.
“I think people are understanding how to protect themselves better and better.”