The room was quiet, except for the hiss of the machine forcing oxygen into his inflamed lungs. It was an oddly quiet moment during a hectic day, and we both fought back tears.
My patient (who remains hospitalized) was suffering not just because of the virus, but also because of the deadly combination of misinformation and disinformation in a broken health-care system, in a country of broken trust. As both an emergency physician and Alaska’s chief medical officer, after 22 months of fighting this pandemic, I found myself exhausted as I sat there with him, humbled by this virus and acutely aware of how much work we have yet to do.
Alaska has fared comparatively well overall during the pandemic, but this fall the infection rate soared. Surgeries were postponed, patient transfers were delayed and nursing ratios were stretched as hospitals ran out of staffed beds and almost ran out of oxygen. Our hospitals were like seaside rocks slowly being drowned by a rising tide of covid-19 patients.
At the beginning of the pandemic, when we had few tools and even less understanding of the disease, Alaska’s tragic experience during the 1918 influenza pandemic often came to mind.
During a visit to Bristol Bay’s hospital, originally built for orphans of the “great death,” I heard Thomas Tilden, chief of the Curyung Tribal Council, recall his grandmother’s story of returning to her village to find mainly children and dogs surviving. Many communities were nearly destroyed. The deadly flu left both a painful memory and at times intergenerational trauma, but also strength and resiliency.
The pandemic’s early days could have been similarly devastating for the state. One of Alaska’s main rural air carriers went bankrupt, threatening supply chains and essential travel. On one weekend, amid shortages, the largest hospital had only six swabs and the state government had none. But Alaskans, showing the same spirit that gets them through earthquakes, blizzards and long, dark winters, rose to the challenge.
We addressed the swab shortage by producing 3-D printed versions. We also made our own testing reagents and established alternate care sites for isolated rural residents. When vaccines became available, the state partnered with tribal health-care providers to deliver lifesaving shots in arms, fast and fair. Health-care workers traveled by bush plane, snow machine and dog sled, delivering vaccines. For months, we led the nation with high vaccination rates.
Eventually, as occurred in many other rural states, our vaccination effort stalled. Hesitancy and misinformation made many people underestimate the risk of covid-19 infections and overestimate the risk from the coronavirus vaccines.
During Alaska’s long, sunny summer days, cases plummeted. We were desperate to see friends and family and to get back to normal life. It was easy to ignore the darkening cloud of the delta variant and the festering discontent and mistrust many people felt after months of strain. With little natural immunity from previous covid-19 surges, relatively low vaccination rates and a population weary of mitigation measures — and with temperatures falling and indoor gatherings increasing — Alaska was overrun by the delta variant.
Covid-19 has highlighted an alarming shortcoming in U.S. health care: underinvestment in public health and prevention, resulting — not just with covid-19 — in higher mortality rates for rural Americans, communities of color and working families when illness strikes.
The pandemic reminds us how, even across great expanses like Alaska’s, we are all connected. To thrive, we must come together — urban and rural, left and right, young and old — embracing our strengths and acknowledging our fragility. We must invest in rural health care, train and recruit providers to work in nonurban environments, and expand research to embrace America’s wide diversity.
When the storm passes, recovery begins. The future will depend on how we remake our health-care systems, repair the tattered relationships between patients and providers, between scientists and politicians, and even among friends, neighbors and families. The focus must be on a healthier and more resilient future for all. Ultimately, how we remember and rebuild will be more important than how we responded.