Novel coronavirus

This scanning electron microscope image shows SARS-CoV-2 (yellow)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (blue/pink) cultured in the lab.

Credit: NIAID-RML

A small Interior village is seeing its first outbreak of COVID-19, and local health officials are struggling with what comes next. Fort Yukon, located approximately 145 miles northeast of Fairbanks, has seen 21 cases of the disease in the last week and a half, according to local health officials. 

It remains unclear how the disease reached the village because the community has been largely shut down since the pandemic first hit Alaska in mid-March. 

Dacho Alexander, Gwichyaa Zhee Gwich’in Fort Yukon Tribal Council member, said the council decided March 23 to close down traffic to and from the village in a desperate effort to keep the virus out of the small community of 600. The only people allowed in and out were Village Public Safety Officers, medical personnel and serious medical patients. 

The restrictions have been rolled back for small pockets of time over the four months since to allow for villagers to access essential medical services and shop for food in Fairbanks. 

Nobody knows how the virus got to the village, Alexander said, but it’s spreading quickly. 

Another mystery lingers in the fact that all but one of the nearly two dozen cases were confirmed in asymptomatic people. 

“None of them had shown signs of being infected,” Alexander said, explaining that many had sought testing as an occupational precaution or because they may have been exposed to an infected individual in a neighboring village. “It wasn’t until (Tuesday) we had our confirmed test of someone with symptoms.”

The health care capacity in the small village is nowhere close to meeting the needs of a significant outbreak. 

The village has access to two rapid testing machines, one that was lent by the neighboring village of Venetie.

Since the first cases of COVID-19 began appearing in Alaska in March, the Fort Yukon clinic has performed about 500 tests, Debbie McCarty, clinical director at the Yukon Flats Health Center, estimates.

About 180 of those have been performed in the last week and a half since the first case was confirmed in the community. But the village cannot process all of the results and has been shipping collected samples to state labs.

The 21 confirmed cases represent about 3.5% of the total population and a nearly 12% positive rate of the tests performed in the last week and a half.

The village is waiting on a remaining 50 or so tests that have yet to be returned by the state.

It’s been two weeks, Alexander said. 

“It’s been an issue getting those back,” confirmed Rhonda Pitka, acting chairwoman of the Council of Athabascan Tribal Governments.

In a news conference Wednesday evening, state health officials attributed the delay to an as-yet-unmentioned run on the reagent needed to process the samples. The two state labs had to switch to a heat extraction method of testing that took longer, according to Alaska Chief Medical Officer Dr. Anne Zink. She said the labs should be back to around a 48-hour result turnaround time but did not elaborate on why Fort Yukon’s tests are still delayed.

The council has worked with local and other tribal governments on a virus mitigation plan since the World Health Organization first announced the virus, Pitka said. That included shutting down access to the village.

But now that community spread is apparent in the village, Alexander said the focus has shifted from keeping the community isolated from the rest of the state to isolation within the community.

That presents immediate difficulties as multiple generations often live under one room, and a severe housing shortage means there aren’t empty spaces for sick individuals to quarantine away from family members. 

“We don’t have extra homes to put these folks up in, so when someone test positive, then their entire family is under quarantine,” Alexander said. “It’s really unfortunate.”

The gaps in health care capacity that plague many rural villages have presented difficulties beyond just testing and isolation. Without ventilators or the ability to intubate someone, the village does not have the ability to properly care for patients experiencing serious symptoms. 

Four individuals have had to be medically evacuated to Fairbanks, according McCarty. Once a patient arrives in Fairbanks, the Council of Athabascan Tribal Governments works with locally based Tanana Chiefs Conference to monitor and support the patient.

“We’re just taking it day by day and trying to protect the elderly and vulnerable,” she said. 

Those who have tested positive are directed to quarantine at home, and a limited team of health care workers calls each patient every day to check on symptoms. 

“We sent them home with a little kit of Tylenol and a thermometer and cold medicine and we check in to keep track of temperature and how they are feeling,” she said. 

There is worry that community spread will continue. 

“People are definitely concerned,” Alexander said. “They’ve been concerned from the beginning. That’s one of the reasons we took pretty restrictive measures from the state. With little guidance from the state or anything, we took the most drastic measures we could to isolate from the rest of Alaska. Now it’s here and we have to figure out where to go from here.”

The local clinic only sometimes has a doctor, he said. So for now, the village will hunker down again.

“If you drive down the streets of Fort Yukon right now, you’re going to see very few people out,” Alexander said. “I haven’t seen any children out playing for about a month right now. The playgrounds are empty.”

Contact staff writer Erin McGroarty at 459-7544. Follow her on Twitter: @FDNMpolitics.