How this DO practiced frontline medicine in western Alaska in the early days of COVID-19

The COVID-19 pandemic has affected every community, including those in rural areas. Many DOs worked on the frontlines of the pandemic. As we highlight those who were involved in critical and unique ways, The DO met with Timothy Lemaire, DO, to learn more about his experience working in Norton Sound Regional Hospital, a critical care access hospital in Nome, a small city on Alaska’s west coast, throughout the COVID-19 pandemic. Dr. Lemaire served as a family medicine physician and public health and prevention education incident command at the hospital.

Preparing for the first COVID wave and allocation of resources

As COVID-19 spikes went through the country we were able to prepare. In terms of hospitalization trends, Nome was about two weeks behind Anchorage, and Anchorage was about two weeks behind Portland and Seattle.

The city even shut down the only airport so that there were only two to three flights a week for six months. Normally there would be two to three flights a day filled with passengers and tourists. If someone had to come into town, they needed to have a reason, complete a form, be tested for COVID-19 and quarantine until the results came in. The focus was on transmission mitigation since we did not have any treatments yet. Between the city policies, resources and being able to control traffic into the city, we were successful in keeping our numbers low.

I am most thankful for our leadership, whose focus was prevention. We did everything we could to prepare for the worst-case scenario, but we spent more time on prevention and public health education.

Norton Sound received COVID-19 tests from the state and federal governments as well as the Indian Health Service (IHS), because we are tribally owned. For a time, I would get thousands of test results in my inbox. We were also able to hire physicians to conduct contact tracing remotely. Every time we received a positive result, the person would be put into isolation housing, even in the smaller villages. Close contacts were tested every other day.

Some villages would shut everything down—no dances, potlucks, community meetings or church—for two to three weeks, and testing would ramp up. As cases decreased, so did the social distancing precautions. In contrast, there were other villages that did not practice social distancing whatsoever or mask-wearing. In some of those villages, we saw 60% of the residents get COVID. These are villages that might have a population of around 600. 

Vaccine distribution

Originally, the message was to practice social distancing and wear a mask because once a vaccine comes out, we can go back to normal. Most of the folks in Nome and nearby villages were all anticipating the arrival of the vaccines. Our team led many educational events with the medical staff at Norton Sound. We made phone calls and educated the public so that they could feel comfortable with the vaccine.

Once we received our vaccination allocations from the state and federal governments and the IHS, we made it very accessible for people to get vaccinated. Thankfully our pharmacy has always had a system of delivering vaccines to the region and nearby villages and teaching trained local residents how to administer them.

Every year the pharmacy staff transport flu and childhood immunization vaccines to villages and teach the village health aides how to administer the vaccines. The pharmacy used this same approach when distributing and administering the COVID-19 vaccines.

Much like the response to social distancing precautions, the reception of the vaccine varied from village to village. Some villages are at 95% fully vaccinated, but others are hovering around 30%.

Rural medicine in Alaska and the push for more virtual care

Working in rural medicine means wearing many hats. One week I was a hospitalist, the week prior to that I was in the emergency department, and a month before I was going to clinic in different villages, where I spent a week in each village.

At the beginning and peak of the pandemic, we only went out to the villages when there was an outbreak. We practiced a lot of risk mitigation calculation, between providing chronic care to the villages and avoiding the chance of bringing COVID-19 into the villages.

Although telemedicine was practiced regularly before the pandemic, we went 100% virtual care at the start of the pandemic. Being forced to be fully remote during that time helped us be more creative about getting people the care they needed without requiring them to travel for in-person care.

In other words, a patient may not need to travel 500 miles by air from Nome to Anchorage to see a specialist. They can go to their local clinic health aide, who can collect vitals and lab samples. Then, a remote physician can interpret the vitals and lab results. We can also do basic physical exams remotely. We’ve cut in half the number of patients we’re sending to Anchorage for procedures that can’t be done in Nome.