ANCHORAGE, Alaska — Over a roughly three-year period beginning in March 2020, 1,564 Alaskans died from COVID-19.

That's according to a new report from the Alaska Department of Health, which provides a detailed review of data on how the state fared dealing with the coronavirus between March 2020 and the end of the the federal public health emergency in May 2023.

"This report ... represents the first comprehensive, retrospective analysis that brings together epidemiological data across the full course of the COVID-19 pandemic in Alaska," Department of Health spokesperson Shirley Sakaye wrote in an emailed response to questions.

"While the pandemic's impacts extended far beyond what can be captured in an epidemiological summary, this report provides a consolidated, data-driven account of Alaska's COVID-19 experience."

Epidemiologists looked at death records, hospitalizations, demographics, infections, vaccination rates and public health responses, producing an analysis that evaluates the different phases that played out as Alaska weathered the pandemic.

Approximately 1 in every 500 Alaskans who died in the period of review were killed by COVID-19, they concluded.

"Seventy-four percent of those who died and were eligible for COVID-19 vaccine had opted not to receive it‚" states the report, published earlier in December by the state's Section of Epidemiology.

The report provides a chronological review of how the virus impacted Alaska, broken down into seven distinct phases determined by developments in the public health response and viral mutations.

"Over time, it became clear that simply aggregating numbers across multiple years did not adequately reflect the reality of the pandemic, because the context was continually changing," Sakaye wrote of the impetus for the analysis.

"To better capture that complexity, the report organizes Alaska's experience into distinct pandemic 'eras.' This approach more accurately reflects how conditions, risks and public health responses shifted over time. One of the key takeaways is that a pandemic is not a single event, but an extended and evolving experience."

Alaska's former chief medical officer, Dr. Anne Zink, who helmed the state's response to the coronavirus, said the report is valuable for public health officials and policymakers.

"I think it's really for the future," said Zink, who no longer works for the state. During the pandemic, she said, she regularly consulted old epidemiological reports on Alaska's response to previous epidemics like influenza, which informed public health measures to COVID-19.

Zink did not author the new coronavirus report but did review it and provide feedback. She said she found the delineation between phases to be particularly useful.

The first era, for example, was the "pandemic onset," from March until May 2020, a time when the state saw a low number of cases and people were still largely obeying government public health orders such as business closures, physical distancing and limited travel.

"Alaska's geographic location and the implementation of (non-pharmaceutical interventions) prior to the first detected case prevented widespread community transmission. This resulted in a smaller initial COVID-19 wave and lower rates of morbidity and mortality compared to many areas in the contiguous U.S. for the same period," wrote report author Katherine Newell with the Alaska Section of Epidemiology, who no longer works for the state.

Alaska started seeing more infections in the summer of 2020, as prevention measures started to be relaxed in some jurisdictions. The state and its health care partners were aggressive about virus testing for critical infrastructure employees, travelers and the public. By August of that year, Alaska was "the most tested state (per capita) in the nation," according to the report.

Later eras are defined by rising levels of viral transmission and hospitalization, the arrival of effective vaccines and subsequent waves of coronavirus variants that pushed Alaska's health care system close to collapse.

Two points of interest highlighted in the report are the disproportionately high toll the disease inflicted on particular groups of Alaskans, and the severity of the delta variant, which caused almost half of the state's total COVID-19 deaths within a six-month period between July and December 2021.

"Despite these increases in statewide testing and contact tracing capacity, COVID-19 community transmission continued to increase during this era, resulting in Alaska's first notable surge in cases, hospitalizations, and deaths," the report continues.

Many of of those outbreaks spread through congregate settings like "seafood processing plants, correctional facilities, long-term care and assisted living facilities, and healthcare institutions."

As the virus spread, it hospitalized and killed two groups at a particularly high rate: "American Indian/Alaska Native persons, and Asian/Pacific Islander persons," according to the report's review of state demographic data in death and hospitalization records.

Prior to the arrival of widespread vaccination in January 2021, the disparities in health outcomes grew large.

"Mortality rates among AI/AN and Asian/PI persons were 5.5 and 3.6 times as high as the rate among White persons," the report states. "These racial disparities in both COVID-19 mortality and hospitalizations continued for the entirety of the pandemic in Alaska."

Zink said she wished there had been more demographic nuance in reporting the results. Even though Asians and Pacific Islanders are assessed as part of the same group, the Pacific Islander community in Alaska fared far worse, she said.

The report does not explain the reasons for the disparities. Zink said many of the patterns that played out from the coronavirus mirror trends from other diseases that have spread through Alaska.

"Alaska Natives have worse health outcomes," Zink said, offering several socioeconomic factors that likely play a role, including household overcrowding, lack of water and sewer infrastructure in many communities, and inconsistent access to emergency medical care.

But, she added, much about the coronavirus's transmissibility and pathology is still being studied.

"I don't want to pretend we know what we don't know," Zink said.

Delta devastation

Once vaccines arrived, Alaska vaccinated early and rapidly. At least at first. In a five-month period, 289,287 Alaskans got their primary vaccine dose.

"This marked the largest state vaccination campaign ever undertaken," the report states.

By July of 2021, though, the delta variant had become the dominant coronavirus strain in Alaska, and it devastated many communities. By the end of the year, 719 people died of COVID-19, 46% of the total killed during all three years of the pandemic in Alaska.

The virus was the "leading cause of death in Alaska during this era," more lethal than cancer, heart disease or other common killers. Those who died were overwhelmingly older: The median age of death during the delta era was 75. They were also overwhelmingly unvaccinated: 80% of those who died, 575 people, "were unvaccinated against COVID-19 at the time of their death," according to the report.

In that same six-month period, 2,021 Alaskans were hospitalized because of COVID-19, putting "unprecedented strain on staff and bed capacity" at hospitals around the state, and prompting officials to coordinate bringing more than 400 health care workers up from outside to assist.

When the omicron variant replaced delta as the dominant strain, it proved far more transmissible, but less potent. The number of confirmed COVID-19 cases increased, but hospitalizations and death rates declined.

The data included in the report's analysis has limits, particularly when it comes to the efficacy of certain public health measures, and the disease's relationship with other lethal health factors. The author steers away from attributing COVID-19 deaths that might have technically been caused by factors like heart disease, underlying conditions or drug overdoses, but were exacerbated by pandemic conditions like social isolation or restricted health care access.

"These excess deaths reflect the broader consequences of the pandemic on the public's health. Further research is necessary to fully understand the factors driving excess mortality and the broader public health impact of the pandemic in Alaska," the report states.

Fully vaccinated Alaskans still got sick with COVID-19 and some, particularly those who were older or in poor health, still succumbed to the disease. But one of the repeated conclusions in the analysis is that the state's early vaccine uptake helped protect residents during the later waves of highly transmissible variants.

"Based on the significant difference in age-adjusted mortality rates between vaccinated and unvaccinated persons, high vaccine uptake during this era likely saved numerous lives in Alaska," the report notes.

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