Alaska Department of Health and Social Services Weekly Update
November 8-14, 2020

Brief status report

• Virus transmission across Alaska is estimated to have increased for the eighth week in a row.
• Cases diagnosed in recent weeks exceeded the ability of public health to immediately report individual cases. Cases reported this week are an underestimate of true case numbers.  
• A commercial lab in Alaska did not report results for the last four weeks to the State of Alaska until November 25, 2020, also resulting in significant underestimates in case rates. Test results were communicated to the person tested. Of 13,169 tests, 1,636 were positive, including 357 positives in Anchorage and 880 positives in Mat-Su. As these positive tests are checked for repeats and individually added to case counts, cases will rise particularly in those boroughs for the last four weeks. Many of these tests were performed in the last two weeks. These data are not yet included in the data presented below.
• Hospitalizations for COVID-19 continue to rise. Hospital capacity and staffing have become a significant concern.
• Testing is not keeping up with new cases.
• Alaskans should get tested immediately at the first sign of any symptoms. Testing is our best tool for understanding virus transmission and risk in our communities.
• Most Alaskans get COVID-19 from a friend, family member or coworker. Alaskans should avoid indoor gatherings with non-household members, avoid crowds, wear masks when around non-household members and stay six feet from anyone not in their household.

Please note that the leveling off over the last week in this graph likely reflect lags in reporting and data entry, not a true slowing in the increase of cases.

Case trends and predictions

• Nearly four thousand cases among Alaskans were reported last week, reflecting continued high community transmission throughout much of Alaska
• The statewide positivity rate remains at a record high
• Increases in testing are not keeping up with increases in cases. 
• Cases are increasing across urban and rural regions and increased in nearly every region this week. All regions of Alaska have high community transmission and are at a high alert level.
• The estimated daily growth rate is 1.9% and cases are expected to double around every 36 days based on current modeling.
• The largest increase in cases was in the Anchorage Municipality, which again averaged over 300 new cases a day this week for a 14-day case rate per 100,000 people of 108, up from 92 last week. The Kenai Peninsula Borough also experienced a steep rise, with a 14-day average case rate increased from 76 to 94, as did the Interior Region, with a case rate rise from 37 to 62.
• Several regions reported decreases in case rates, including Mat-Su Borough, Juneau City and Borough and the Southern Southeast region. While it is not known whether this primarily reflects a true decline in community transmission levels, a decline in testing, a lag in reporting positive cases or a combination of all three, the positivity rate in each region can help estimate the adequacy of testing. The reported test positivity rate in Matanuska-Susitna Borough exceeds ten percent, well in excess of the state average and double the threshold of 5% below which case counts can be considered more accurate, so it is very likely that the true case rate in Mat-Su Borough is well in excess of that reported. Conversely, Juneau City and Borough and the boroughs and census areas that make up the Southern Southeast Region have much lower positivity rates than the state average, so undertesting is less of a concern.

Vaccine planning and status update

• The State of Alaska is working with federal, local, Tribal and military partners to ensure that infrastructure is in place for distribution of vaccine as soon as it is available.
• Vaccine will be distributed as soon as it is received. A limited amount of vaccine will be available at first with more expected to be delivered in the coming weeks and months.
• Recent announcements by several companies testing COVID-19 vaccines have shown promising safety and efficacy data, including over 90% efficacy for two of the vaccines. The companies said they will pursue FDA authorization and one has already submitted their data. One or more vaccines may obtain authorization from the FDA within weeks if they pass review by the FDA and a board of independent experts, who will review all trial data.
• If authorized by the FDA, the first shipments of vaccine could be available as early as mid-December.
• There are no plans to mandate a vaccine at the state level.
• People at high risk of getting exposed to COVID-19 or of getting very sick may be vaccinated first.  
• ACIP and other groups will provide more details as more data comes out from clinical trials, and states, Tribes and organizations may provide their own guidance to tailor distribution to Alaska’s needs.

Travelers with COVID-19

• Test positivity among arrivals at Alaska airports has quintupled over the last few weeks, from around 1% to over 5%.
• Air travel carries risk of exposure in airports, on aircraft, in taxis or rideshares and after arrival at the destination. While keeping 6 feet of distance and wearing masks will help, any gathering with others outside of the household carries some risk, particularly if it is indoors; Alaskans who are traveling to meet with friends and family may be at higher risk of acquiring the virus than Alaskans who do not gather with others.
• Alaskans returning from out of state must follow Health Order 6. Alaskans traveling between the road/ferry system and rural areas must follow Health Order 8.

New cases, hospitalizations and deaths

• During the week of November 15-21, 3,911 new cases in Alaskans were reported, for a total of 26,587 cumulative cases in Alaskans.
• Cumulative hospitalizations increased to 600 with 26 reported as occurring this week; hospitalization reports often lag and only 539 hospitalizations were reported at this time last week, so there are 59 hospitalizations newly reported this week including ones that began during previous weeks.
• Deaths among Alaska residents increased by 4 to 102 total. One of the reported deaths occurred this week and the other 3 occurred prior to the past week. It is common to take more than a week for a death to be reported, and more deaths of Alaskans with COVID-19 occurring Nov 15-21 may be reported in future.
• There were 34 nonresident cases identified this week, for a total of 1,186.

Cases by Week Reported and Age Group

How COVID-19 spreads in Alaska

• Most new infections among Alaskans are from community spread, not from travel. Most Alaskans get the virus from someone they work, socialize, or go to school with.
•  Many cases do not have a clear source, meaning that contact tracers have not been able to identify where the person got the virus. This means that there are cases in our communities that we do not know about.
• Many Alaskans who are diagnosed with COVID-19 report that they went to social gatherings, community events, church services and other social venues while they were contagious but before they knew they had the virus.

Regional case trends

*Insufficient data; low case rate

Positivity rates

• The statewide test positivity rate remained over 8% this week.
• Currently, the national average is 9.8%, up from 4.2% in October. Since Alaska’s per-capita testing capacity is more robust than 90% of states, a positivity rate near the national average is concerning. Source: Johns Hopkins
• Test positivity can tell us if testing is adequate in an area. The goal is a positivity rate <2%. If the rate is over 5%, it means we are likely missing a lot of cases in that area.
• Test positivity is affected by the number of tests performed as well as the number of new cases in an area.

Health care capacity

• Hospitalizations hit record highs for the fifth week in a row.
• Currently, 128 Alaskans with confirmed COVID-19 are hospitalized and 19 are requiring a mechanical ventilator.
• Hospital staffing can change quickly, particularly if a community has many health workers impacted by COVID-19.

COVID-19 and travel

• Travel is not currently thought to be a main factor in most new COVID-19 infections in Alaska, meaning that most Alaskans who get COVID-19 are getting it from social, work or family contacts rather than travel.
• Travel for gatherings remains risky and gets more risky as cases rise across the US. The risk is from being in close contact and enclosed spaces with others while traveling as well as gathering with friends and family members indoors who may have COVID-19 and not know it.
• Alaskans must follow relevant state and local orders when traveling within Alaska and returning from out of state.

What Alaskans should do

• Alaskans should avoid gatherings and crowds, wear masks when around any non-household member, keep six feet of distance from anyone not in their household and wash hands frequently to slow community transmission of COVID-19.
• Anyone with even one new symptom of COVID-19 (fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle aches, body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea), even if it is very mild, should get tested for COVID-19 right away and immediately isolate themselves from others by staying home, staying away from others, and not leaving their house except to seek testing or other medical care. Tests are most accurate in the first few days of symptoms, so testing as soon as possible after the first symptom starts is important, even if the symptom is very mild. Getting tested right away also helps contact tracers move as quickly as possible.
• Alaskans can help contact tracers work to slow the spread of COVID-19 by answering the phone promptly and providing accurate information.

Further information

• The Frequently Asked Questions webpage is often the quickest route to an answer regarding testing, travel, health mandates and other COVID-19 information.
• Please see the State of Alaska COVID-19 information page for more information about the virus and how individuals and businesses can protect themselves and others from transmission.
• For the most up-to-date case information, see the Alaska Coronavirus Response Hub dashboard. Some data may change as more information comes to light through contact tracing and other public health work.
• For questions regarding DHSS COVID response, including mandates and alerts, email covidquestions@alaska.gov.
• For DHSS media inquiries, please contact clinton.bennett@alaska.gov.