Alaska conducts more COVID-19 tests per capita than almost any other state in the country, a fact that Governor Mike Dunleavy often mentions at community briefings.
Alaska’s positivity rate, the number of positive tests out of the total number of tests performed, has also remained well below the national average, although it is increasing slightly over time. The state’s death rate among people with coronavirus is the second lowest in the country.
However, the state’s new COVID-19 case counts in communities like Anchorage and Fairbanks at this time. The new cases, especially among younger people, prompted health officials to warn of significant community transmission across the state.
Do the test numbers tell the whole story? Not completely.
Alaska’s comparison to other states is complicated by the state’s unique strategy for evaluating shellfish travelers and workers that adds a large group of healthy people less likely to test positive for the virus.
Alaska’s unique geographic isolation and fragile health-care resources also led state health officials to adopt an aggressive testing strategy from the start.
The positivity numbers are promising indicators that the state is generally doing enough testing, officials say.
But they do not explain the dramatic increases that appear in the new daily cases.
“We believe we have an increasing community outreach, not just an increase in testing,” Dr. Anne Zink, the state’s chief medical officer, said last week.
As of Friday, Alaska was the third most evaluated state in the nation. Only New York and Louisiana evaluate more people per capita.
According to a national data initiative led by the Johns Hopkins School of Medicine, Alaska currently evaluates about a quarter of its total population, or 21,167 tests per 100,000 residents, which is more tests per capita than all but those two states.
Widespread testing is crucial to measure the spread of COVID-19 and to catch potentially contagious infected people with few or no symptoms, health officials say.
The current “best guess” is that about 40% of COVID-19 infections involve people with no symptoms, said Dr. Jay Butler, a former Alaska chief medical officer, who is now deputy director of infectious diseases at the Federal Centers for Disease Control and Prevention.
“That number may well change as we learn more about this disease,” Butler said in an interview from Anchorage, where he worked remotely for a week after helping lead the national COVID-19 response. “Also, there are many very minor illnesses that may go undetected apart from very aggressive testing.”
Alaska tests are certainly aggressive when taken as a whole. But comparing our evaluation rates with those of other states is complicated.
Brennan Martin removes the vial cap for his COVID-19 test swab, taken at the test site at Ted Stevens Anchorage International Airport on July 17, 2020. (Emily Mesner / DNA)
For one thing, the state has adopted an unusually broad testing policy almost since the start of the pandemic to identify cases early and minimize the chances that a surge will overwhelm hospitals with limited resources, authorities say.
A fifth of Alaska acute care hospital beds are in hospitals outside the road system, in hard-to-reach parts of the state, according to the Alaska State Association of Elderly Hospitals and Elders. The ratio of hospital beds to people in Alaska is at the low end of the spectrum. Obtaining smear samples in rural villages can also be a struggle.
Alaska initially struggled, but then took steps to increase testing capacity faster than many other states given our small population size. That distinguishes our rates.
“It makes it difficult to compare our state with other states,” Zink said during a scientific briefing on Wednesday. “But it is also difficult to compare our hospital capacity with other states.”
Another factor that really makes Alaska numbers hard to compare is the large number of relatively healthy people who were tested this summer because of screening mandates for travelers and fishery workers. That generates a greater number of tests, but probably also more people with negative results because they are not sick.
Under a state health mandate that went into effect in June, travelers to Alaska must show proof of a negative test, be tested at the airport, or accept quarantine.
In five weeks, Alaska examined more than 78,000 people as part of the tests at the airport, Zink said on social media earlier this week. More than 27,000 screened before traveling, nearly 27,000 were screened at an airport, more than 8,800 decided to quarantine, and more than 16,000 were involved in a selective industry or in a previous COVID-19 case.
There were a total of only 134 positive results.
The fishing industry and other workers must also be tested multiple times during their stay in Alaska. In March, state health officials estimated that the industry would need between 140,000 and 160,000 tests this summer.
So far, the Alaska Department of Health and Social Services has distributed about 65,000 test kits, said state pharmacist Coleman Cutchins. The industry used most of them, Cutchins said.
State testing data also groups Alaska residents tested out-of-state, Alaska non-residents, travelers and shellfish workers who are tested when they arrive, according to Dr. Louisa Castrodale, manager of the state infectious disease program. But the state can’t separate positive percentage rates for residents and nonresidents, which may be skewing the numbers.
“Those are difficult things to try to solve,” Castrodale said.
Coronavirus cases are on the rise in Alaska, especially Anchorage and Fairbanks, due to a combination of increased travel and group activities including churches, residential facilities, workplaces, bars, and social gatherings, state officials say.
Young people, who authorities say may be more likely to socialize and go to work, and less likely to mask or social distance, are driving the increase: The most recent new cases have been people in their 20s and 30s.
A state update for the week reported that more than a fifth of all infections in Alaska since the pandemic began were discovered last week, “suggesting a large increase in transmission in the state.”
Overall, the worst indicators of the state remain relatively low. Seventeen Alaska residents have died from the virus.
A total of 96 residents have been hospitalized since March, giving the state a relatively good hospitalization rate. But earlier this week, doctors reported an increase in COVID-19 patients who presented in emergency rooms, a potential indicator for future hospitalizations. Nineteen people were hospitalized with the virus in Anchorage on Friday and another 13 patients were categorized as investigated.
State officials say any meeting, especially indoors, presents an exposure risk. They urge people to keep their social circles small, cover their faces, and avoid large groups unless they can stay at least 6 feet away, ideally outside.
Despite the state’s growing cases, Alaska’s positivity rate at the end of this week was 1.78% over a seven-day average, the seventh lowest in the country.
Health authorities track the positivity rate of the tests because it is an important indicator of whether a community or state is doing enough tests to detect coronavirus infections and stop the spread of the virus. The World Health Organization has said that countries with comprehensive tests should have a positivity rate that stays below 5% for 14 days.
A high positivity rate (Fairbanks hit 14% this week) may indicate that only the sickest people are being tested and the milder cases or asymptomatic cases are being lost.
Lower positivity: Alaska’s overall rate this week was 1.85% and Anchorage was 2.2%, may indicate that a community includes people with mild or no symptoms.
Karrington Hamilton cleans the inside of his nostril during a COVID-19 test at the test site at Ted Stevens Anchorage International Airport on July 17, 2020. (Emily Mesner / DNA)
Public health officials have said that further testing is a good thing, as it allows a more complete picture of where and how the virus is spreading. But it doesn’t tell the whole story.
Looking at the positive percentage can be helpful, because it can tell you if you’re testing enough of the population, said Tom Hennessy, director of Arctic Research, a local subset of the Centers for Disease and Control.
A positive rate of more than 10% indicates that it may not be being tested enough, he said, citing the World Health Organization.
“It doesn’t tell us if the test is reaching all the people who need it, or if there are populations that aren’t being tested,” he said.
That’s why looking at a general test positivity rate is just “a crude measure,” he explained.
The state plans to add a metric to the COVID-19 data dashboard that breaks down the percentage of positive cases by region, according to Zink. The more specific the data, the easier it will be to spot trends.
This week, authorities said, they noted that Fairbanks’ positive percentage rate had “crept up to 14%,” despite the 14-day state average being just under 2%.
The high rate prompted state epidemiologist Joe McLaughlin and others to meet with Fairbanks leaders to discuss the tests there “to make sure we are doing a good enough job,” he said.
That’s another story that Alaska numbers don’t tell.
