EXHAUSTED—Michelle Tom, Stebbins community health aide level 3, is resting at a patient’s bedside after a 24-hour day doing COVID tests, contact tracing and responding to an overnight medical emergency.LOW TECH SOLUTION— A handwashing station made out of two five-gallon buckets, a foot pump and a copper spigot  allows for relatively easy handwashing in places without running water and sewer.

Infrastructure deficiencies hamper COVID-19 response in Stebbins

With 64 total cases as of Monday, November 9, Stebbins continues to face the worst COVID-19 outbreak the region has seen. As the crisis approaches the two-month mark, first responders are strained and longstanding inequities present difficult barriers to getting the virus under control.
“When you take essentially substandard housing without running water and you pack a lot of people into it, all these things that are otherwise easy to do – in-home distancing, one individual separate from the others – none of that stuff is feasible,” said Mark Hayward, a physician assistant who’s part of Norton Sound Health Corporation’s response team in Stebbins.
The first case of the Stebbins outbreak was identified on September 19, and as the weeks dragged on and the case number climbed, exhaustion has begun to set in among the entire community. “We’re all a hell of a lot more tired,” Hayward said.
Part of the challenge is the nature of the virus itself, explained NSHC Medical Director Dr. Mark Peterson.
Because a patient’s most infectious period is usually two days before they test positive, it’s easy to spread the virus without even knowing you have it. But he added that another huge hurdle is the village’s overcrowded housing. Most houses don’t have space for a single close contact to quarantine away from the rest of their family.  “So, if you’re a household with six, seven, eight people and you’re a close contact, your whole family has to quarantine with you for 14 days,” Peterson explained. “And that’s just difficult for people to do.”
It also means the number of people in isolation or quarantine tends to skyrocket, as a single close contact brings their entire household into quarantine with them. As of Friday, Hayward said that more than 90 people were in quarantine, in a community of less than 600.
On top of that, Stebbins has no piped water or sewer infrastructure. To get water, residents have to go to a communal washateria where they go inside, fill up buckets of clean water, and transport them back to their homes. The system not only makes regular handwashing near impossible, but it also creates potential risk for infection.
To get water to those in isolation and quarantine, a city employee loads buckets of water onto the back of a 4-wheeler and delivers them from house to house. Then, someone else goes from house to house collecting full honey buckets.
 “And God help us, if these people get sick or go into quarantine – because there are only so many people!” Hayward said. The pressure of delivering food and water and removing waste has strained a system already buckling under the pressure of dozens of COVID cases on top of all the regular medical issues and emergencies faced by the community.
So far, no one has gotten so ill that they need to be evacuated to the Nome hospital, Hayward said. But even “mild to moderate” symptoms can be debilitating. “Plenty of people have gotten coronavirus and will report back that it’s not in the least fun,” he said. On top of that, the long-term health risks of even mild COVID infections are not fully understood, so no one knows how Stebbins will be affected years from now after more than 10 percent of the population has been infected.
While the massive infrastructure deficits facing Stebbins will take years to rectify, NSHC’s Sanitation Construction Project Manager Sean Lee has been working to develop some quick solutions.
He and remote maintenance worker Stosh Labinsky have developed a simple handwashing station made out of two five-gallon buckets and a few other parts readily available in local communities. The system uses a foot pump and a copper spigot to allow for relatively easy handwashing.
 “This handwashing station uses a lot less water, it’s a touchless mechanism, and it provides enough water to wash your hands thoroughly for the 20 seconds that are recommended,” Lee said.
NSHC distributed buckets and instructions to communities without running water across the region, including Stebbins, and tasked local water operators with manufacturing the stations. The system, while spartan, is meant to be inexpensive and easy to repair if a part breaks, unlike other handwashing stations available online which tend to go for $90 or more and are usually made of solid plastic, Lee said.
So far in Stebbins, a batch of 20 stations have been distributed to public areas, and another round have gone to Elders’ homes, according to Lee. He’s heard positive feedback about the public stations, and it waiting to hear more about the stations in individual homes.
In addition to the handwashing stations, the City of Stebbins has ordered a water hauling truck and a number of 55-gallon drums using federal CARES money, Lee said. They plan to install the water drums in certain homes and use the truck to deliver large quantities of water more effectively, but the system has yet to be fully set up.
 “The intent is to provide larger quantities of water to Elders’ homes and the most vulnerable people,” Lee said.
He added that the crisis has highlighted the dire need for water and sewer infrastructure faced by much of rural Alaska. A preliminary engineering report for a water system in Stebbins has been approved by the state, but the actual system has yet to be designed.
All told, the cost cited in the report is about $68.1 million, a daunting price tag that may not be approved by funding organizations. And even if it is, Lee said it would be five years at the earliest before any homes could be connected to working pipes.
That’s not much help to the people of Stebbins today, who are struggling to deal with the massive challenges of the outbreak on a daily basis. Hayward had nothing but praise for the Health Aides, city workers and other citizens of Stebbins who work long, sometimes 24-hour days to keep their community safe.
 “My respect for the people of Stebbins is through the roof,” he said. “The folks up here are amazing. They are kinder, gentler, and bigger-hearted than I am.” He also said that he’s frustrated and disappointed with the larger system that has allowed rural Alaskans to eke by without basic modern infrastructure for decades. “I guarantee you that we would be able to deal with this faster and better and in a way that worked better for people if we had running water, flushing toilets, and a reasonable amount of square footage per person,” Hayward said. “Bottom line.”

 Funding for this coverage provided in part by a grant from the Alaska Center for Excellence in Journalism.

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