Amanda LeDoux’s 3-year-old son has been experiencing pain and numbness in his legs and hands since Christmas Eve. LeDoux worked with the Kodiak Area Native Association to set up an appointment with a pediatric specialist who would travel from Anchorage to Kodiak.
But the appointment was canceled indefinitely last week after Gov. Mike Dunleavy issued a health mandate canceling all non-urgent procedures for three months, to help Alaska medical facilities prepare for COVID-19.
“It’s beyond worrisome,” LeDoux said, adding that the Anchorage physician is trying to set up a video appointment to treat her son. “(It) might be a while before they figure it out.”
LeDoux is one of many Kodiak residents who are feeling the pain of the new mandate.
“This is all very new to us and I don’t think you could ever be mentally prepared for this with how quick it came on and how it would directly affect each and every one of us,” she said.
For Patrick Cummings, the cancellation of a dental appointment could mean psychological challenges as well.
“I am currently missing my two front teeth, and awaiting implants that I have already paid many thousands of dollars to get,” he said in a Facebook message. “I don’t have any idea when I can remedy this. I am really tired of my ‘hockey smile’ and having my speech impacted. Not to mention the psychological impacts of being toothless.”
For Lissa Woodbury Jensen, a canceled double knee replacement procedure, originally scheduled to take place in Anchorage this week, means months more of painkillers.
“I spent months setting it up and was devastated at its cancellation,” she said. “It is ironic. It took me years to finally commit to this surgery. I am tired of all the pain meds.”
Expectant moms on the island are also feeling the brunt of the new health mandate. Alyssa Tuel, at 36 weeks pregnant, faces an indefinite cancellation of physical therapy appointments, and her weekly medical checkups at the Kodiak Community Health Center have been trimmed down to one every other week.
Tuel’s mother, who is planning to travel to Kodiak from Alabama for the delivery, will no longer be allowed in the delivery room because of restrictions on visitors to Providence Kodiak Island Medical Center, Kodiak’s only hospital. Tuel is worried that her mother won’t be able to arrive on the island if additional travel restrictions are put in place.
“The new rules are apparently no visitors (in the hospital) so it will only be my husband and me until we can take the baby home,” Tuel said. “I’m sick of this virus impacting everything.”
Tuel said the coronavirus has increased her level of stress, which may impact her pregnancy.
“Whenever I start getting really stressed, I start getting contractions. I haven’t gone into any stores in worry of getting the virus because there are apparently some studies that say pregnant women can be at higher risk of getting it. I may be getting paranoid, but I’ve been stress-cleaning the house just because of it,” she said.
The goal of canceling non-urgent medical procedures is to allow health care professionals to gear up for the spread of COVID-19, according to the mandate, which states that “given Alaska’s distances and limited health care capacity, it is especially important to open acute health care beds for anticipated COVID-19 care and preserve personal protective equipment.”
However, the mandate does not explicitly say what constitutes urgent health care procedures, leaving that up to the discretion of providers.
“Because the terms ‘non-urgent or elective’ are not fully defined, the state recommends each hospital creates a physician task force that would be available to evaluate on a case-by-case basis and make a determination on borderline surgeries,” the mandate states.
According to Carlie Franz, a communications specialist with PKIMC, the Kodiak hospital has already assembled a task force to ensure that necessary surgeries go on.
“While we are postponing elective surgeries, we do have a physician task force in place to evaluate the need for surgeries on a case-by-case basis. Life-saving surgeries will of course be performed,” she said in a statement.
KCHC Executive Director Carol Austerman said the clinic is now seeing only patients that require in-person care, and has delayed or transitioned all other care to telehealth, a new medium for the clinic.
“We are seeing every patient that has a medical reason to be seen. A lot of the patients that we are seeing are expectant mothers,” Austerman said.
When possible, health care providers try to replace in-person visits with phone appointments. “We are ramping the telehealth platform that we have not really used before,” she said. “That is a major change for us procedurally. It’s taking a lot of effort. The providers are spending a lot of time on the phone to ferret that out. We’re doing a lot more telephone and video encounters right now.”
The clinic has also been working for the past two weeks to account for its medical supply inventory, which has helped them determine how many patients they can see while still keeping the clinic’s health care providers and staff safe.
“We have been making a lot of those procedural changes now in preparation for what we believe is coming,” Austerman said, adding that the clinic is preparing for a spread similar to that seen in Seattle, one of the epicenters of the disease in the U.S.
“A lot of it is making sure that we are not using anything right now that we don’t need to be using, to save supplies for when it will be critical to have them,” she said. “We’re counting every piece that we have.”
The hospital has been working to beef up their stock, but she says it’s been impossible to find additional supplies as supply chains dry up due to demand across the country and the world.
The goal of limiting patients now is to ensure that down the line, if the hospital on the island is overwhelmed with COVID-19 cases, the clinic can continue to see non-coronavirus patients that still need routine care, including expectant mothers, diabetic patients and those with heart conditions, Austerman explained.
“Our goal is to keep patients out of the hospital as much as possible,” Austerman said, adding that it is important to safeguard the hospital’s resources for when the virus hits the island. PKIMC is equipped with 25 beds, many of which will be needed for COVID-19 patients if it spreads in Kodiak. However, the majority of people who contract the virus experience symptoms mild enough to remain at home.
Austerman advised that at this time it is critical for Kodiak residents to heed the “hunker down” order issued by the Kodiak Emergency Services Council.
“We are at an advantage not having any cases here yet. If we can actually make social distancing work, we can slow down the progress of the virus to a level that our medical services can handle,” she said.
With the goal of keeping individuals who have potentially contracted the virus away from medical workers, health care providers in Kodiak have teamed up to create a drive-thru testing center located at East Elementary.
The drive-thru, staffed by employees of the Kodiak Area Native Association, KCHC, and the Coast Guard, tested three individuals on Tuesday, according to Lt. Commander Ashley Frost and Commander Berry Kramp, who help run the testing site. The number of tests in Kodiak has remained low, but they expect it to increase as the number of cases increases across the state. Those tested can expect to learn the result of their test after five days, they said.
According to Elsa DeHart, a Kodiak public health nurse, individuals who feel ill with symptoms compatible with COVID-19, such as cough, shortness of breath and fever, should call their health care provider. The providers will then determine whether or not a test is necessary. Priority in testing will be given to high-risk individuals such as the elderly and health care providers who may be at greater risk of contracting the virus.
The drive-thru, which began operating March 19, is open between 9 a.m. and 11 a.m. Monday through Friday, according to Austerman. Specimens are typically sent to Anchorage for testing on the afternoon Alaska Airlines jet. Specimens collected from high-risk individuals are sent to the state-run lab in Anchorage, while lower-risk specimens are sent to private labs in the Lower 48, where turnaround times can be slower.
“Those hours and number of people staffing (the drive-thru) will be based on need,” Austerman said, emphasizing that individuals who believe they should be tested must first call their health care provider. If individuals arrive without first contacting their provider, they may be putting health care workers at risk.
DeHart said Kodiak does not have enough resources to perform the test on every community member, “but we should have enough to test the people who meet the criteria.”
The governor warned about limited personal protective equipment in the state, such as masks and gowns, which are needed to conduct testing and care for COVID-19 patients. But Carlie Franz, a communications specialist with PKIMC, said the hospital is well-equipped for now, and is taking measures to conserve its equipment.
DeHart emphasized the importance of individuals caring for their health to avoid overloading the island’s health care providers. This includes eating well and getting plenty of sleep. The typical annual flu season usually peaks around this time of year and can last until June, she said, urging community members to get the flu vaccine if they haven’t already.