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October 23, 2020

What will Covid-19 look like this winter? Alaska may serve as 'an early warning' sign.

Daily Briefing

    As people grow fatigued with epidemic-related social restrictions, public health experts are concerned that colder months may further exacerbate already rising infection rates in America—especially if Alaska's current struggles are any indication of what to expect, Mike Baker writes for the New York Times.

    Alaska's successful summer

    According to Baker, Alaska this summer managed to keep the coronavirus "largely in check," despite "fill[ing] up" restaurants, "invit[ing] tourists to come explore," and allowing "fisheries workers [to] arriv[e] by the thousands to live in crowded bunkhouses."

    To carry out this success, the state not only leveraged its "isolation and wide-open spaces," Baker writes, but also "developed a containment effort unlike any other in the country. For instance, Baker writes that Alaska conducted more testing than almost every other state" and contact-traced every person who tested positive, "following up with daily phone calls for those infected and all their close contacts."

    In addition, the state ultimately decided to go ahead with its fishing season—a time of year that pulls in thousands of people from elsewhere to the state—by implementing strict testing requirements and restrictions, including fences that quarantined workers to their processing facilities to prevent any potential infections from spreading to the local communities. In addition, the state imposed strict requirements at its airports, mandating that people entering the state either present proof of a recent negative test or pay for a test while waiting in quarantine for results.

    'An early warning'

    Now, however, as temperatures cool and people shift to socializing indoors, case clusters are popping up throughout Alaska, straining the state's contact-tracing system and providing the rest of the country "an early warning that winter could bring the most devastating phase of the [epidemic]," Baker writes.

    As Anne Zink, the state's chief medical officer, put it, "We've been markedly concerned about what the fall and winter will look like, and I think playing out that it's highly concerning."

    According to Baker, the state's weekly case average on Friday hit its highest peak of the year so far, with the percentage of people testing positive doubling in recent weeks. In several areas, tribal villages have been required to lock down and self-quarantine, Baker writes, and certain activities—including a tournament in Anchorage among the state's youth hockey organizations—has resulted in case clusters.

    Alaska's experience mirrors trends in the continental United States: According to Baker, cases have hit new highs since fall began, with at least 12 states—many of which are in northern areas—adding more cases in the past seven days than in any other week-long period so far.

    According to Mohammad Sajadi, who studies infectious diseases at the University of Maryland and who has examined the relationship between the pandemic and weather trends, the advent of cooler temperatures is worrisome. Not only are people moving their social activities indoors, but evidence suggests that the new coronavirus is more severe in colder temperatures and lower humidity.

    Sajadi outlined several potential reasons for the virus' greater virulence in colder weather, including research that indicates certain viruses live longer in cold, dry conditions, that aerosolized viruses may be more stable in colder temperatures, that viruses in these conditions can replicate more quickly, and that human immune systems may react differently in different seasons. According to Sajadi, "The conditions will be prime" for the coronavirus' rapid spread in the coming months—and a possible need for new lockdown requirements.

    Alaska's unique challenges

    Zink, Alaska's CMO, noted that the state also has individual challenges that may make these conditions even more dangerous—namely, the remote nature of many of the state's communities. Many villages in the state are not connected to Alaska's primary road system, and poor weather conditions have already prevented officials from getting supplies to one community, dealing with an outbreak, that doesn't have access to running water.

    Meanwhile, according to Ferdinand Cleveland, a tribal administrator, 68 individuals in the Native village of Kwinhagak have tested positive for the coronavirus, including four people who required medevac flights to Anchorage. The village itself has been in lockdown, which is expected to last about four weeks, and residents have struggled to access masks, gloves, and other supplies. 

    And more broadly speaking, according to Zink, the state's contact-tracing system has been strained by the recent surge of cases. While officials have a goal to reach each infected person within 24 hours of their diagnoses, the actual time frame in recent days is closer to 48 hours.

    In addition, Zink said people in the state are growing fatigued with mask and social-distance requirements—mandates that, at the moment, are under the purview of local jurisdictions. As a result, different areas of the state have different requirements. 

    For his part, Gov. Mike Dunleavy (R) has said he expected the state's case rate to increase as winter started, and that the state has kept building out its supplemental hospital capacity in case there's increased demand. "It's going to be a very tough fall and winter for the entire world," he said (Baker, New York Times, 10/21).

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