What Hasn't and What's Next: How Alaska's healthcare system is adapting to this pandemic--and preparing for the next.

• Author: Kreilkamp, Danny
• Position: HEALTHCARE SPECIAL SECTION

The novel coronavirus pandemic has demanded that healthcare professionals worldwide take a long, hard look at the way their systems are facilitating or hindering their ability to deliver care. For Alaska's Chief Medical Officer, this period has been an exercise in making the most of the state's available resources.

When preparations were being made at the beginning of the year, Dr. Anne Zink was focused on two areas where Alaska appeared short-staffed.

"I was particularly concerned about our ICU capacity: nurses, respiratory therapists, ICU doctors, and technicians in that space," says Zink. "Early on in the pandemic, there was a big emphasis on intubating people quickly. There was a tot of talk about ventilators and the amount of supplies, and that really requires a very subspecialized group of personnel to make sure you can run those machines well."

Advanced technology requiring specialized care was the other area in which Zink felt Alaska was illequipped. Extracorporeal membrane oxygenation, or ECMO, is one example of a technology that has proved useful in combatting COVID-19 but which the state simply doesn't possess the means to employ.

A process like ECMO requires the expertise of cardiothoracic surgeons, which Zink says have proved difficult to attract. "You just can't recruit people to work in the state to do that, and you need a whole team to be able to pull that off. Something like that is a 5- to 10-year process to build up."

Though valid, Zink's initial concerns have only been a drop in the bucket of the many disruptions brought about by the virus. And almost a year into the pandemic, Alaska's healthcare system continues to find new ways of responding and adapting.

What (and Who) Has Worked

Alaska's infrastructure and technology limitations have required its healthcare system to adopt new approaches to providing care. An increased rote in telehealth, onboarding new healthcare workers via conferencing software, and old positions taking on new responsibilities--all part of the everchanging equation.

"I think there was a lot of focus initially on hospital capacity and alternative care sites, but as we've been able to slow this pandemic, it has required a whole different skill set," says Zink.

She points to the contact tracers, quarantine workers in rural communities, and other less celebrated positions that have played vital roles in the state's response strategy.

And in many cases, new positions are being created entirely to cater...