ANCHORAGE (NYTIMES) - Alaska, once a leader in vaccinating its citizens, is now in the throes of its worst coronavirus surge of the pandemic, as the Delta variant rips through the state, swamping hospitals with patients.
As of Tuesday (Sept 21), the state was averaging 117 new cases a day for every 100,000 people, more than any other state in the nation, according to recent data trends collected by The New York Times.
That figure has shot up by 42 per cent in the last two weeks, and by more than twenty-fold since early July.
On Wednesday, the state said it had activated "crisis standards of care," giving hospitals legal protections for triage decisions that force them to give some patients substandard care.
The state also announced an US$87 million (S$117.76 million) contract to bring in hundreds of temporary health care workers to support hospitals.
Governor Mike Dunleavy, a Republican, said that while hospitals are strained, he did not see a need to implement restrictions aimed at curbing transmission. Still, he encouraged people who had not yet received a vaccination to seriously consider getting it.
"We have the tools available to us for individuals to be able to take care of themselves," Mr Dunleavy said.
While the state led the nation in vaccinations early in the year, it has been lagging in recent months, with under half of the state's population fully vaccinated, compared with 55 per cent for the nation as a whole, according to federal data.
Dr Jared Kosin, the head of the Alaska State Hospital and Nursing Home Association, called the surge "crippling" in an interview on Tuesday. He added that hospitals were full, and health care workers were emotionally depleted.
The crisis has reached the point that patients are being kept waiting for care in their cars outside overwhelmed emergency rooms.
There is growing anxiety in outlying communities that depend on transferring seriously ill patients to hospitals in Anchorage that can provide higher levels of care, Dr Kosin said. Transfers are getting harder to arrange and are often delayed, he said.
"We are all wondering where this goes, and whether that transfer will be available, even tomorrow," Dr Kosin said.
Critically ill people in rural areas, where many Alaska Natives reside, often have to be transported by plane to a hospital that can provide the treatment they need, said Dr Philippe Amstislavski, an associate professor of public health at the University of Alaska Anchorage.
"Unlike in the lower 48, you don't have that ability to move people quickly, because of the distances and remoteness," said Dr Amstislavski, who was formerly the public health manager for the Interior Region of Alaska, focusing on rural and predominantly Alaska Native communities.
Dr Kosin said that if case counts continue to rise and drive up hospitalisations much further, hospitals and clinics around the state could be forced to apply crisis standards of care and more extreme triage decisions. "That is the worst-case scenario we could be heading to," he said.
Dr Amstislavski said many hospitals have struggled to bring in reinforcements from other states because of the long distances and travel times.
He added that Alaska's vaccination rate has been lagging in recent months.
The state's Canadian neighbours to the east, Yukon and British Columbia, have not suffered such severe outbreaks, Dr Amstislavski said, possibly because of that country's stricter travel restrictions and less strained health care system.