NSHC Situation Report Update
April 20, 2020
to the Norton Sound Health Corporation community
There is one confirmed case of COVID-19 in the Norton Sound/Bering Strait Region. There are 319 confirmed cases of COVID-19 in Alaska.

Total people tested in the region: 167; 72 tests performed by rapid testing at NSHC, 95 sent out of region
Results: 122 returned negative, one returned positive, and 44 are pending
Current status: Zero active cases, one recovered case

NSHC has about 500 COVID-19 test kits available; around 200 of which can be run in Nome. Testing is available at each clinic location in the region.

The latest news from Alaska Department of Health and Social Services, including the latest health mandates and alerts, can be found here.

Read NSHC's newsletter on COVID-19 that has been sent to the region's mailbox holders.
Situation Report
After a Test, per DHSS : If you have symptoms and are being tested for COVID-19, you should self-isolate while waiting for your test results. If you test positive, a public health nurse will monitor you. You’ll be allowed to leave isolation once 7 days have passed since your symptoms started and 3 days have passed since recovery. Recovery is defined as being fever-free (without the use of fever-reducing medications) and improvement in respiratory symptoms. Even if you test negative, you should still continue to self-isolate for 7 days from when your symptoms started and until you’ve gone 3 days since recovery. If you have been identified as a close contact of someone who tested positive for COVID-19, you must stay in quarantine for 14 days from your last exposure (certain exceptions may apply to people working in a critical infrastructure sector). A negative test result does not shorten your quarantine.
Drive-Thru Testing: Norton Sound Health Corporation is offering drive-through testing for the COVID-19 virus to patients in Nome and the villages. This service is offered as an option, after review by a health care provider over the telephone, and is provided during regular business hours. If patients have symptoms, they should call the Nurse Call Line at 443-6411 or 844-586-8773, and their testing will be coordinated through the Nome Primary Care Clinic or their respective village.

Nome and village patients who are sick with the following symptoms should call their health clinic during business hours: cough, shortness of breath, difficulty breathing, sputum production, chills, diminished sense of taste or smell, diarrhea, fatigue, fever (measured or subjective), headache, muscle/joint aches, nausea, vomiting, abdominal pain, loss of appetite, rigors, runny nose, sore throat, red irritated eyes (conjunctivitis).
First Confirmed Case: On April 14, NSHC received the results which confirmed the first and only positive case of COVID-19 in the region. The test was performed by a commercial lab. The results were communicated to the State of Alaska Public Health Department immediately, and contact follow-up began.

When patients are tested for COVID-19, they are educated and instructed to self-isolate as if they are infected until results are received. The patient started to self-isolate on the day the test was performed. All patients who have been tested are given accurate information on how to notify anyone with whom they may have had close contact.

Testing for COVID-19 has changed since Friday, April 10, when rapid testing on the Abbott ID Now units began. Rapid testing is now available at NSHC and results are available within the same day for patients with symptoms. Due to changes in testing, NSHC will no longer need to use commercial testing out-of-state. The commercial lab turnaround time averaged seven days, and severn patients were tested using this method. All results have been returned.

The guidance still remains: any confirmed patient must isolate themselves until they are cleared by Public Health Nursing, per CDC guidelines.

Read NSHC's press release on the first positive patient here.
Rapid Testing: NSHC was among 21 regional tribal health organizations statewide on the receiving end of rapid testing machines and test kits for diagnosing COVID-19 in rural Alaska. The Alaska Native Tribal Health Consortium distributed 40 of the machines and 2,400 test kits in an effort to ensure that remote areas of the state can get quick test results for patients.
NSHC received three of the Abbott ID Now units, which will remain based in Nome. Patients around the region can be swabbed for the virus in their home clinics, and the test can now be run in Nome for quicker results.
In addition to this in-region testing, NSHC may still utilize other testing options through the State of Alaska, the Alaska Native Medical Center or private labs out-of-state.
The addition of testing possibilities allows NSHC to test more patients. According to NSHC medical staff, if patients exhibit any symptoms of COVID-19 (cough, fever, shortness of breath, etc.), they may be tested.
Entering the Hospital: In order to better direct the flow of traffic in the Norton Sound Regional Hospital, NSHC requests patients who are sick (experiencing a cough, cold, fever, etc.) use the back entrance by the Emergency Department. If you are not sick and come to the hospital for information or an appointment, you may use the main entrance. If you are not sure whether you are sick, please call the Nurse Call Line at 907-443-6411 or 844-586-8773 so you can be directed which entrance to use.
Cloth Face Covering Guidance: T he State of Alaska now recommends wearing cloth face coverings in public settings. There are a few things everyone should know about cloth face masks that will help ensure you are wearing them appropriately and effectively.
  • Make sure the face covering covers both the nose and the mouth
  • When removing the face mask, avoid touching the front of the mask (because it may be contaminated). Remove it by grasping the ear loops, ties, or bands and immediately discard of place in a designated container for laundering
  • Wash your hands as soon as you can after removing the mask
  • Face coverings should be washed with hot, soapy water between uses
  • Do not wear N-95 or surgical masks unless you a health care worker using them for your job
  • Do not rely on face coverings as the primary way to prevent COVID-19 transmission. Social distancing and frequent handwashing remain the most effective ways to prevent infection.
You can read more about frequently asked questions about cloth face coverings on the CDC website .

Scroll down to the " How the Public can Help " section for more information on making cloth face masks. NSHC recommends people first make masks for themselves and their loved ones and then consider donating to NSHC locations around the region. One yard of fabric can yield about six face masks.
Quarantine Preparations: NSHC has designated its quarantine leader as Amy Hollis. If you have medical travel quarantine questions, she can be reached at 907-434-0654 or by email at adhollis@nshcorp.org .

For other quarantine resources, look here:
Service and Program Updates:

VILLAGE HEALTH SERVICES: In order to protect communities and health care providers in the villages, NSHC will be locking doors to local clinics. The clinics will remain operational during normal hours. When a patient calls to schedule an appointment, they will be asked a series of screening questions by a Community Health Aide to determine any exposure to COVID-19. If no exposure or symptoms, their chief complaint will be brought to a PA/NP/MD/DO to determine if an appointment can be completed over the phone or scheduled in clinic. If a patient answers “yes” to any screening question, they will be asked to call the Nurse Call Line (907-443-6411 or 844-586-8773) for further screening. If you are concerned about COVID-19 infection, you may call the Nurse Call Line directly at the same numbers.

PRIMARY CARE CLINIC TELEHEALTH: The Primary Care Clinic (PCC) in Nome is operating with reduced hours from 8 a.m.-5 p.m. daily. PCC is currently seeing patients that require face-to-face visits, determined by their doctor. However, you can talk to your doctor under PCC’s new telemedicine program. Norton Sound Health Corporation now offers telehealth direct-to-home video and telephone appointments for Nome and Village customer-owners and patients. This new service delivers health care to you in the comfort of your own home, or wherever you may be.

This new service allows customer-owners to have the choice of a video consult with NSHC physicians using their smartphone, tablet (iPad), or computer. You can see a physician for most medical problems that you would typically come to the primary care clinic for. Some of the common issues addressed with telemedicine include:
  • Upper Respiratory Infection
  • Medication refills
  • Otitis Media (ear infection)
  • Allergy symptoms
  • Sinusitis
  • Sore throat
  • Bronchitis
  • Rashes
  • Acne
  • Urinary tract infections (UTI)
  • Smoking cessation
  • Behavioral health consults (Depression, Anxiety)

Nome and Village patients with a chronic medical condition such as diabetes or hypertension may be contacted by the telehealth team to schedule a follow-up visit by telemedicine soon. Your provider will send you a unique link that you can use on your device, which we may have to test before your virtual visit. We may ask you to go to the hospital to have lab tests done before your visit.

Nome customer-owners may request a telehealth visit with their primary care provider by calling the clinic to schedule a video or telephone consult. PCC will make an effort to schedule your appointment on the same day, if one is available. PCC will give you a specific appointment time, just like you would receive for a regular, in-person visit.
Tribal Communication: NSHC began a daily Tribal Leader phone call on Monday, March 23. The call takes place at 11 a.m. and NSHC provides updates and takes questions from callers. Information shared Monday included step-by-step information on how NSHC will identify COVID-19 in patients and treat them thereafter. NSHC also answered frequently asked questions, including questions from the basic symptoms of COVID-19 to NSHC’s level of preparedness to how to quarantine after potential exposure. That information is available in a three-page PDF document you can find here. Minutes from each day's meeting are also available at that link.

The daily call continues every day. Tribal leaders are invited to call into 1-800-315-6338; access code: 03286#. If you have trouble dialing in, an alternative number to call is: 1-913-904-9376, also with access code: 03286#.
Please mute your phone until the end, when NSHC will answer any questions.
Do you have questions in advance? Email Reba Lean, NSHC Public Relations Manager at rlean@nshcorp.org or text 907-434-1927 before 11 a.m., and your questions will be answered during the briefing.
Coping During COVID-19: Every person reacts uniquely to stressful situations. With COVID-19 concerns across the world, you may experience:
  • feelings of fear and anxiety
  • changes in sleep or eating patterns
  • difficulty sleeping or concentrating
  • worsening of chronic health problems
  • increased use of alcohol, tobacco and other drugs
There are different things you can do to cope during this time to make you and your family stronger:
  • Take breaks from watching, reading, and listening to the news, including social media.
  • Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
  • Take online classes, including cooking, art, and other interests you might have.
  • Talk with your children about COVID-19 and share facts in a way they understand.
  • Reassure your children to stay safe and share with them how you handle your own stress.
  • Create learning, relaxing and fun activities for your children.
  • For first responders, allow time for you and your family to recover from responding to the pandemic, and ask for help if feeling overwhelmed or concerned.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.
  • Go outside and exercise. Enjoying outdoor activities in safe environments supporting prevention guidelines is good for your health and family. 
Norton Sound Health Corporation’s Behavioral Health Services (BHS) is ready to serve as a resource. Providers will consult with you by video and phone to discuss any concerns you might have.
Please call BHS at 443-3344 from 8-5 daily and 443-6411 after hours and all weekends.

Click here for more on COVID-19 coping skills.
How the Public can Help
NSHC has received many inquiries from the public about how they can help during this COVID-19 national emergency. In this stressful time, it is important to remain generous and thoughtful. A little extra kindness goes a long way.

There are many ways you can help serve your community, thereby helping your health care system stay under its capacity:
  • Keep your distance from others and avoid gatherings of 10 or more people
  • Purchase food responsibly: make sure you have what you need, and if you have extra, consider donating to folks who need it, especially the elderly or immunocompromised
  • Give working parents some relief by offering to watch the kids
  • Keep walkways shoveled in case of emergencies
  • Support local businesses that may be struggling at this time
  • Write notes or make cards for elders you know (or QCC residents)
  • Volunteer at NEST or the Nome Food Bank (call 443-5259 for more information)

Additionally, there are ways you can help your local health care community specifically. Here are a few ideas:
  • Donate N95 masks if you have a supply that you don't need
  • Sign up to make a meal or snacks for health care workers. Contact Reba Lean at 443-9674 or at rlean@nshcorp.org for more information
  • Are you a former health care worker? NSHC may be able to use your help. Contact Cameron Piscoya at 443-3360 or at compliance@nshcorp.org to learn more about our emergency credentialing procedures
Handmade Cloth Face Masks: NSHC is seeking donations of handmade cloth face masks from the public.

NSHC recommends that if people wish to make these handmade cloth face masks, they do so for the following:
  • Yourself and your loved ones
  • NSHC staff
  • Local businesses whose staff comes into contact with many members of the public
  • NEST and Day Shelter personnel and guests

Norton Sound Health Corporation will accept donations at the hospital’s main entrance lobby during its open hours. Local businesses in Nome can request numbers of masks from rlean@nshcorp.org. If you are in a village and would like to make masks, please advertise what you’re doing and reach out to those who might be in need.
There are many handmade face masks tutorials available on the internet, but NSHC would like to recommend the following specifics:
  • Use a 100% cotton fabric
  • Use a tightly woven fabric
  • Add an extra layer or two to any pattern you find for added protection
  • Wash at high heat after each day’s use

Watch a video tutorial here.
Quarantine Preparations: NSHC knows that patients traveling to Nome or through Nome for appointments in Anchorage will be impacted by statewide travel restrictions. NSHC is preparing to house quarantined regional residents who either came to Nome for medical care or are returning from receiving care in Anchorage and are on their way to their home villages. NSHC would like to make their stays as comfortable as possible in appropriate, isolated housing around the community. In its preparations, NSHC will be supporting local businesses as much as it can but will be requesting help from community members as well.
If you are willing to help support these quarantined individuals, please consider donating the following:
  • New or gently used towels, sheets, blankets, microwaves, and coffee makers
  • New, gently used, or disposable plates, cups, silverware, coffee mugs.

After this national emergency subsides, all items will be sanitized and donated to local/ regional needs.

Please contact Reba Lean at 443-9674 or at rlean@nshcorp.org if you would like to donate. There will be a donations bin set up in the main entrance lobby of the hospital.
NSHC Physician Report
Mark Peterson, MD - Medical Director: "At NSHC we continue the ongoing process of planning and preparation for dealing with COVID-19 in our region. We are fortunate to now have point-of-care testing here in our lab in Nome. We have the ability to test patients from Nome or any of our villages and get same-day results from the time the sample reaches our lab. This will allow us to more rapidly isolate those who get infected, and those who come into contact with infected persons. We are fortunate to have this capability and we feel it well help us greatly in our effort to mitigate spread of the virus. If you have one or more symptoms of COVID-19, which could include cough, runny nose, sore throat, new shortness of breath, fever, chills, muscle aches, new diarrhea, new loss of taste/smell, please call the Nurse Call Line, or contact your clinic or provider to get tested today."

Gary Kulka, MD - Director of Clinical Services: "Norton Sound Health Corporation is offering drive-through testing for the COVID-19 virus to patients in Nome and the villages. This service is offered as an option, after review by a health care provider over the telephone, and is provided during regular business hours. If patients have symptoms, they should call the Nurse Call Line at 443-6411 or 844-586-8773, and their testing will be coordinated through the Nome Primary Care Clinic or their respective village.

Nome and village patients who are sick with the following symptoms should call their health clinic during business hours: cough, shortness of breath, difficulty breathing, sputum production, chills, diminished sense of taste or smell, diarrhea, fatigue, fever (measured or subjective), headache, muscle/joint aches, nausea, vomiting, abdominal pain, loss of appetite, rigors, runny nose, sore throat, red irritated eyes (conjunctivitis)."
Additional Resources
Nationwide: Read up on all COVID-19 information from the Centers for Disease Control and Prevention website.

Statewide: Do you have non-clinical questions about COVID-19? You can utilize the Alaska 211 hotline and speak with a medical volunteer. Find all Alaska DHSS recommendations and mandates here.

Regional: If you are experiencing symptoms of COVID-19 (fever, cough, shortness of breath) and you believe you may have come into contact with the virus, you should call NSHC's Nurse Call Line before going to your provider to be seen: 907-443-6411. All the latest public safety announcements from NSHC can be found on our website.

ANMC: For information on how COVID-19 is impacting services at the Alaska Native Medical Center, including visitor restrictions, visit their website.