Maddy Gauthier spends most of her days at work trying to focus on what is going well. As a house supervisor at Central Peninsula Hospital in Soldotna, Gauthier has been on the front lines of the region’s response to the COVID-19 pandemic.

“It’s hard not to feel stressed or anxious or sad about some of the things that you’re seeing on the floor, especially with some of these patients,” Gauthier said.

More than 45,000 people have been diagnosed with COVID-19 in Alaska since the pandemic began, including 3,585 on the Kenai Peninsula. Hospitals have felt the effects of a surge of cases statewide and on the peninsula in recent months and CPH is no exception. In addition to treating their own COVID-19 inpatients, CPH also experienced an outbreak at Heritage Place Skilled Nursing facility, where more than half of all residents tested positive.

Gauthier said that CPH tries to be very conscientious about the time and resources that go into caring for patients who are COVID-positive, especially when it comes to personal protective equipment (PPE). Before entering a COVID patient’s room, health care workers put on a gown, a face shield, N95 masks or PAPRs and gloves, which they must take off between each patient. When treating non-COVID patients, Gauthier said, the process is a lot simpler because nurses can use hand sanitizer when switching between rooms.

This additional step proves most challenging when treating COVID patients who are confused, Gauthier said. When COVID patients trigger bed alarms, it takes longer for health care workers to get into their room and respond.

“It’s super challenging as a nurse or a CNA to get in the room as quickly as possible, but also be safe as possible so that you’re not exposing yourself to COVID,” Gauthier said. “But it’s hard to shut off that part of your brain that’s trying to get into the room as fast as possible.”

To help ease the PPE challenges of treating COVID-positive patients, Gauthier said they try to have one worker treat only COVID patients. Gauthier said they try to keep the nurse to COVID patient ratio at 1:4, meaning one nurse treats four patients during their shift, but there are days where CPH has more than four COVID inpatients. On a bad day, Gauthier said, the nurse to patient ratio can rise to 1:7.

The strain is also being felt in the emergency department, where an “extra layer of work” is being put on workers who are responding to people who have COVID-19 as well as people with other emergencies.

“Our nurses are still seeing all the regular emergencies that walk through the door, but then we’re also seeing these patients who are coming in that have tested positive for COVID, who are scared and don’t really know where else to go,” Gauthier said.

Like other hospitals throughout the country, though, Gauthier said the hospital being pushed to capacity has forced workers to make difficult decisions, such as which patients will receive what COVID treatments.

Gauthier said that CPH has five “really great” ventilators and three that require a person to be in the room with the patient at all times. Once most of the machines were in use, Gauthier said that they had to decide which patient would be put on what type of ventilator.

“I am so proud to work at this hospital, because we have prepared and adapted and pivoted to every single wave that has come through our doors,” Gauthier said. “We’ve learned a lot but, you know, we have had a few moments that we’ve had to get very creative, trying to figure out how we can care for all the patients that are coming through our doors.”

One of the biggest challenges with using ventilators that require constant supervision is that it further strains a delicate pool of available staff. Like at other hospitals and medical centers throughout the country, CPH has struggled to keep the hospital staffed throughout the pandemic, which has seen an increase both in patients needing care and in health care workers having to quarantine. Gauthier said she will spend hours on an almost daily basis trying to find coverage and asking people to come in for extra shifts.

At one point in time, 87 of CPH’s total staff of around 1,000 were in quarantine either from having contracted COVID-19 or from having been identified as a close contact.

A light at the end of the tunnel, she said, has been the arrival of the COVID vaccine in Alaska.

The first doses of Pfizer and BioNTech’s COVID-19 vaccine arrived in Alaska on Dec. 14. A tray of 975 doses was delivered to CPH on Dec. 16, and the hospital began administering vaccines on Dec. 18. Gauthier said that she volunteered to be in the first group of people to get the COVID-19 vaccine and that people were excited about the vaccine’s arrival.

“I would say that that was one of the best morale days I’ve experienced at the hospital in a while. … It just gave us some hope that there’s a light at the end of the tunnel,” Gauthier said.

The state received 35,100 initial doses of Pfizer and BioNTech’s vaccine and 26,800 initial doses of Moderna’s vaccine. Both the Pfizer and Moderna vaccines, which have efficacy rates of more than 90%, require two doses to be fully effective. Pfizer’s doses must be administered 21 days apart and Moderna’s doses must be administered 28 days apart. As of Dec. 25, 11,845 initial doses of both vaccines had been administered in Alaska, including 11,285 of Pfizer and BioNTech’s and 560 of Moderna’s.

Vaccine allocation is divided into three phases. Those phases are divided into sub-phases. Those sub-phases are then divided further into tiers. In determining who is prioritized into which category, the state considers recommendations from the CDC Advisory Committee on Immunization Practices.

Front-line health care workers, along with residents and staff of long-term care facilities were given first priority in Phase 1a, Tier 1. During their first vaccine clinic on Dec. 18, CPH administered 112 initial doses of the Pfizer vaccine. This included doses for 11 residents and seven staff at Heritage Place.

Phase 1a, Tier 2 includes front-line EMS and Fire Service personnel frequently exposed to COVID-19 patients, community health aides/practitioners and health care workers providing vaccinations. Vaccinations for people in Phase 1a, Tiers 1 and 2 began on Dec. 15.

On Dec. 17, the Alaska Vaccine Allocation Advisory Committee met and unanimously determined who would be included in Phase 1a, Tier 3. Phase 1a, Tier 3 includes workers in health care settings who are at highest risk of contracting COVID-19 and who are essential to the health care infrastructure. Vaccinations for people in Phase 1a, Tier 3 are expected to begin on Jan. 4.

While others await their own opportunity to be vaccinated, Gauthier emphasized the role of the community in helping mitigate the spread of COVID-19.

“We will continue to show up and do these things and get the job done, but the real work is no longer done on the front lines of the hospital,” Gauthier said. “It’s done in their own homes, preventing this from going any further.”

Gauthier said that two of CPH’s COVID patients died on the same day during her most recent week at work, and that people shouldn’t try to downplay the severity of COVID-19 by citing the virus’ 1% mortality rate. Gauthier said that 1 percent of Kenai and Soldotna’s combined population of around 12,000 would be 120 people.

“When people quote that 1% mortality rate, it’s like, do you really think that our community can handle that kind of loss? I don’t think our health care workers can,” Gauthier said. “I couldn’t imagine losing 120 people over the course of a few months.”

Gauthier said that the hospital has worked to provide resources for health care workers in order to help alleviate some of their stress throughout the pandemic. This includes making counselors available for workers who want to talk to someone, having the hospital chaplain check in with workers on a regular basis and having a “self-care cart” make occasional rounds.

In recent weeks, the number of COVID-19 cases statewide has plateaued. On Saturday, the state saw a weekly case increase of 1,775. That number was 3,361 last Friday and 4,206 the Friday before that.

“What I want the community to know is that, you know, I understand that they have a choice when it comes to wearing a mask or not, or social distancing or not, but I just want them to, you know, be open to considering the fact that the health care workers in this community are carrying the weight of that decision. And we’re tired too,” Gauthier said.

More information about COVID-19 in Alaska and vaccine rollout can be found on the Alaska Department of Health and Social Services website.

Reach reporter Ashlyn O’Hara at ashlyn.ohara@penisulaclarion.com.