Date: May 14, 2021 To: Acting Mayor Austin Quinn-Davidson Thru: Heather Harris, Anchorage Health Department Director From: Janet Johnston, Anchorage Health Department Epidemiologist Subject: May 14, 2021, COVID-19 Risk Assessment Update for the Municipality of Anchorage This weekly report shares data available on the State of Alaska and Municipality of Anchorage (MOA) websites for the period May 6, 2021 – May 12, 2021, with some more recent data. Unless otherwise indicated, this data is for cases reported in the MOA. Anchorage COVID-19 Health Risk Metrics The MOA developed the Anchorage COVID-19 Health Risk Metrics tool to communicate the current level of health risks associated with COVID-19 within the Municipality. The tool includes multiple measures, which are referenced throughout this report. Each metric is assigned one of four categories each week, ranging from Very High Risk to Low Risk. Risk categories are based on authorities' standards, including the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Harvard Global Health Institute.

The Overall Anchorage COVID-19 Risk Level has dropped to the low end of the Considerable Risk category. This Overall Risk Level is a consensus metric derived from individual metrics, with appropriate weight given to the most important metrics – Cases and Health Care Capacity. Additional community- level factors that affect risks associated with COVID-19 within the Municipality are also considered. Average daily new case counts have decreased below 10 cases per day per 100,000 residents, moving us into the Considerable Risk Level for this metric. With just over 50% of eligible residents having completed a COVID-19 vaccines series, Anchorage comprises two subpopulations with very different COVID-19 risk profiles. Unvaccinated individuals continue to fall into the High Risk category, while vaccinated individuals are in the Lower Risk category. With fewer mandated restrictions, individuals – especially unvaccinated individuals – need to assess their own risk and regulate their activities accordingly.

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May 14, 2021 Report, Page 2 of 14

Cases

Case Counts, Hospitalizations, and Deaths • Daily new cases. The current 14-day rolling daily average of 9.27 cases per 100,000 is a 21% decrease from last week and is lower than we have seen since July 2020. • New cases this week. There were 166 new resident cases this week, 47 less than last week. • Racial distribution. Native Hawaiian and Other Pacific Islander people comprised 10% of cases last week, compared to 5% since the beginning of the pandemic while Asian people comprised 11% of cases compared to 7% since the beginning of the pandemic. Race data was missing for 24% of the cases last week. People of color continue to make up a greater proportion of cases, hospitalizations, and deaths than they do of the general population. See Table 1 for a breakdown by race and ethnicity. • Age distribution: Twenty-six (26%) percent of new cases last week were age 19 or younger, compared to 19% for all cases since the beginning of the pandemic. Ages 20 to 29 made up 24 percent of the cases compared to 21 percent of the cases for the entire pandemic and 15 percent of the Anchorage population. These age shifts are likely due to high rates among seniors while children under age 16 were ineligible for vaccine until this week, and children under the age of 12 remain ineligible. See and Table 2 for breakdown by age. • Cumulative cases. As of May 12, there are 30,529 confirmed cases in the MOA. This includes 29,934 Anchorage residents in- and out-of-state and 595 nonresidents testing positive in Anchorage. • Current hospitalizations. As of May 11, there were 19 hospitalized COVID-19 cases. The number of hospitalized cases ranged from 17 to 21 this week. As of May 11, there were 0 hospitalized Persons Under Investigation (PUI). Hospitalizations are similar to last week. • Deaths. There have been 176 Anchorage deaths, 175 among Anchorage residents, and one non- resident. This is the same as last week’s report.

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Table 1: COVID-19 Cases by Race and Ethnicity (excluding cases with missing race or ethnicity data, 24% missing)

Cases in the Last Week All Cases Hospitalizations Deaths Hosp. rate per Death rate 100 per 100 Race Cases % Rate* Cases % Rate* Cases % cases Cases % cases American Indian or Alaska 17 14% 67 4,018 19% 15,722 149 21% 3.7 47 27% 1.2 Native Asian 14 11% 54 1,451 7% 5,586 82 11% 5.7 25 14% 1.7 Black or African American 5 4% 33 992 5% 6,523 39 5% 3.9 9 5% 0.9 Native Hawaiian or Other 12 10% 149 1,144 5% 14,227 1 0% 0.1 19 11% 1.7 Pacific Islander White 50 40% 28 7,940 38% 4,402 236 33% 3.0 69 40% 0.9 Other Race 16 13% 247 3,257 16% 50,185 44 6% 1.4 - 0% - Two or More Races 10 8% 38 2,188 10% 8,306 165 23% 7.5 5 3% 0.2 All Cases (race known) 124 100% 43 20,990 100% 7,288 716 100% 3.4 174 100% 0.8 Ethnicity Cases Percent Rate* Cases Percent Rate* Cases Percent Rate Cases Percent Rate Hispanic 10 15% 37 1,485 13% 5,502 43 8% 2.9 13 8% 0.9 Non-Hispanic 55 85% 21 10,375 87% 3,975 514 92% 5.0 158 92% 1.5 All Cases (ethnicity 65 100% 23 11,860 1 4,118 557 1 4.7 171 100% 1.4 known) * Per 100,000

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Table 2: COVID-19 Cases by Age and Sex

Last Week Cases All Cases, All Time Hospitalizations Deaths Hosp. Death rate per rate per 100 100 Age Cases Percent Rate* Cases Percent Rate* Cases Percent cases Cases Percent cases 0 to 9 17 10% 44 2,010 7% 5,172 6 1% 0.3 - 0% - 10 to 19 25 15% 66 3,657 12% 9,620 7 1% 0.2 - 0% - 20 to 29 39 24% 90 6,408 21% 14,779 37 5% 0.6 3 2% 0.0 30 to 39 34 21% 73 5,863 20% 12,640 73 9% 1.2 2 1% 0.0 40 to 49 16 10% 46 4,076 14% 11,830 90 11% 2.2 11 6% 0.3 50 to 59 11 7% 31 3,742 13% 10,651 137 17% 3.7 13 7% 0.3 60 to 69 15 9% 48 2,613 9% 8,339 166 21% 6.4 32 18% 1.2 70 to 79 7 4% 46 1,057 4% 6,938 176 22% 16.7 59 34% 5.6 80+ - 0% - 479 2% 7,745 112 14% 23.4 55 31% 11.5 All Cases 164 100% 57 29,905 100% 10,349 804 100% 2.7 175 100% 0.6 Sex Cases Percent Rate* Cases Percent Rate* Cases Percent Rate Cases Percent Rate Female 71 44% 49 14,619 49% 10,169 364 45% 2.5 69 39% 0.5 Male 92 56% 63 15,278 51% 10,522 440 55% 2.9 106 61% 0.7 All Cases (sex known) 163 100% 56 29,897 100% 10,346 804 100% 2.7 175 100% 0.6 * Per 100,000

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Health Care Capacity

• ICU beds. On average, between May 5 and May 11, 19.5% of staffed adult ICU beds at the three acute care hospitals in Anchorage were available. This is similar to the 17.1% available on average the week before and keeps us in the “Lower Risk” category for the Anchorage COVID-19 Health Risk Metrics. Between May 5 and May 11, the number of staffed adult ICU beds ranged from 66 to 70, and the number of available staffed adult ICU beds ranged from 10 to 18. • Non-ICU beds. As of May 12, there were 77 available adult non-ICU beds out of 521 total staffed adult non-ICU beds. • Ventilators. As of May 12, there were two COVID-19 patients on ventilators in Anchorage. • Hospital Impact: As of May 12, 3.3% of all hospitalizations and 3.0% of Emergency Department (ED) visits at the three acute care hospitals in Anchorage were related to COVID-19.

Projected Health Care Capacity

• CDC COVID-19 Surge model: The CDC COVID-19 Surge model has been updated with data through May 12. The model indicates sufficient ICU capacity to meet demand from COVID-19 cases under current conditions through at least the next three months. Increases in virus transmission after May 13 that are 56% or more above our current Rt could result in ICU capacity being exceeded in Anchorage within three months. Adjusting for the effect of COVID in Anchorage reduces this likelihood substantially, indicating that increases in transmission of ≥180% would be required to exceed ICU capacity. This is a similar risk to that reported last week and keeps us to the “Lower Risk” category for the Anchorage COVID-19 Health Risk Metrics (Appendix 1).

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Infection Rate

• The consensus Rt of 0.86 is similar to last week’s consensus estimate of 0.84 and keeps us in the “Lower Risk” category for the Anchorage COVID-19 Health Risk Metrics (Appendix 1). See Table 3.

Table 3: Reproductive Number Estimates

Geography, Source April 29 April 29 (updated) May 6

Anchorage, COVID ActNow 0.86 0.85 0.87

Anchorage, SOA model, (in-state residents only) 0.82 0.86 0.86

Alaska, COVID ActNow 0.91 0.87 0.81

Alaska, SOA model, (in-state residents only) 0.92 0.9 0.84

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Testing

• Percent positivity: o On average, between April 30 and May 6, 1.65% of COVID-19 PCR and antigen tests had positive test results. This is down from last week’s percent positivity value of 1.95% and keeps us in the “Lower Risk” category for the Anchorage COVID-19 Health Risk Metrics. o The State reports test results according to the date when the sample was collected. This metric is lagged by seven days to allow most test results to be reported to the State. • Test volume: o As shown in Table 4, the testing volume has decreased slightly from last week but remains well above the White House task force's target level. o Test volume is calculated using a seven-day lag to allow for sample processing time. Because some tests take more than five days to process, the average daily counts for more recent weeks will increase as more test results are received.

• Test turnaround time: As shown in Table 5, average test turnaround time for the commercial and facility labs have decreased and the turnaround time for the Alaska State Public Health Lab has increased.

Table 4: Weekly Test Count Measures

White House Target (>2,000 per 100,000 Metric April 16 - April 22 April 23 - April 29 April 30 - May 6 population per week)

Total tests in the 17,494 16,842 15,846 >5,779 week

Average daily 865 833 783 >285 tests per 100,000

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Table 5: Average Turnaround Time Measures

Lab May 6 May 13 Change

Commercial 1 0.8 Decrease

Alaska State Public Health Lab 1.1 1.6 Increase Facility 0.5 0.3 Decrease

Additional Community Factors

Risk associated with additional contributing factors is decreasing but still in the High Risk category. More transmissible and more virulent variants continue to spread nationally and in Alaska. Case counts remain high but are decreasing as vaccination coverage increases. The following community factors present high levels of risk currently within the Municipality: • To date, five COVID-19 variants of concern have been identified in the Anchorage/Matsu economic region: B.1.1.7 variant (UK), B.1.351 (South Africa), P.1 (Brazil), B.1.429 (California), and B.1427 (California). The total number of these variant cases almost doubled since the last report with 32 new B.1.1.7 cases, nine new B.1.429 cases, and one new P.1 case. See Table 6.

Table 6 Variant cases identified in Anchorage/Mat-Su region by month of test date

Variant Dec Jan Feb March April Total 2020 2020 2021 2021 2021 B.1.1.7 1 2 0 13 36 52 P.1 0 0 6 1 0 7 B.1.351 0 0 0 1 0 1 B.1.427 0 0 0 1 0 1 B.1.429 0 1 11 9 5 26 Total 1 3 17 25 41 87

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• While vaccination coverage continues to increase, hundreds of appointments remain available daily. Approximately 60.2% percent of Anchorage residents aged 16 or older have received at least one vaccine dose, and 53.1% have completed the series. Including children under the age of 16 in the denominator, approximately 47.5% of the entire Anchorage population has received at least one vaccine dose, and 41.9% have completed the series. Children aged 12 to 15 became eligible to be vaccinated this week, but children under the age of 12 remain ineligible. • Data for Mat-Su continues to indicate high levels of disease transmission, with average new daily case counts per 100,000 residents decreasing but still more than twice that in Anchorage. Vaccination rates in Mat-Su and on the Kenai Peninsula are lower than in Anchorage. The large number of people who travel between these communities and Anchorage daily makes these discrepancies a concern for the MOA.

Public Health Capacity

Track and Follow New Cases and Contacts • Positive case outreach. o MOA and State of Alaska (SOA) case interviewers aim to interview or leave a message for each new case within 24 hours of receiving the case assignment. To maximize the effectiveness of case investigations and contact tracing, cases closest to the date of specimen collection are prioritized for interviews, including source investigation for the five days prior to specimen collection. Cases are closed if after two unsuccessful outreach attempts. o Of the 151 Anchorage cases entered into CommCare with specimen collection dates between May 1 and May 7, 135 (89%) completed interviews, similar to 90% last week. Of cases with a completed interview, 132 (98%) were completed within five days of specimen collection. • New contacts. There were 21 contacts newly registered into CommCare between May 5 and May 11 who were still awaiting investigation mid-day on May 13. This is an increase of two outstanding contacts from the week before.

Transmission Trends This section summarizes trends in and transmission found in CommCare or through feedback from the AHD COVID-19 response team. • Clusters. There were nine Anchorage cases opened in CommCare during the past week, May 6 through May 12, that were identified as part of a cluster, compared to 11 the week before. Five were associated with homeless shelters, two with the transportation industry, one with a skilled nursing facility, and one with a different congregate living facility.

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• Exposure source. Of the 151 Anchorage cases entered into CommCare with specimen collection dates between May 1 and May 7, 61 (40%) specified an exposure type. Reported exposure types included household (75%), other (10%), social events (8%), employment (5%), and travel (1%). • Occupation. Of the 115 Anchorage cases, 133 (88%) provided information about occupation. Occupation was categorized into the pre-specified list. The largest group fell into the other category (46%), followed by student (20%), unemployed (15%), retired (8%), health care worker (5%), self-employed (3%), food service (3%), and childcare (1%). • At-risk populations. As of May 13, 556 cases have been identified within homeless shelters, supportive housing locations, and unsheltered homeless individuals, with no new cases identified this week. The number of hospitalizations increased by one to 28, while the number of deaths remained unchanged at five. Regular screening continues at these locations with confirmed cases, and close contacts are moved into isolation and quarantine as soon as cases are confirmed. At least 509 vaccine doses have been administered at the facilities associated with this outbreak and unsheltered individuals, an increase of 15 from last week.

Vaccination

• According to VacTrAK, 128,105 first COVID-19 vaccine doses have been administered to residents within Anchorage, and 113,163 vaccine series have been completed as of May 13. This number is lower than last week because of data de-duplication and cleaning by the State of Alaska. VacTrAK does not include data regarding vaccine doses administered by the VA or DoD. See Table 7. • These numbers may be underestimated as there is often a delay between vaccine administration and reporting to VacTrAK, and some vaccines may be administered by providers who do not report to VacTrAK. We encourage all vaccine providers to report vaccine administration to VacTrAK as quickly as possible. • Vaccination rates vary by age, race, and ethnicity, as shown in Table 8. Only 39% of people aged 20 to 29 have received a first dose, compared to 60% of the general population 16 and older. We have recently added gender to our analysis. The data show that women are getting vaccinated at a higher rate than men. This analysis is limited to vaccine doses reported to VacTrAK.

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• Joint Base Elmendorf-Richardson (JBER) provides vaccine dose counts directly to the MOA. As of May 12, 9,175 first doses have been administered at JBER, and 7,930 vaccine series have been completed. • Combining VacTrAK and JBER data, 137,280 first vaccine doses have been administered in Anchorage, which is equivalent to 60.2% of the Anchorage population at 16 years or older, and 121,093 vaccine series have been completed, equivalent to 53.1% of the Anchorage population age 16 or older.

Table 7: Resident Vaccination by Dose and Population Percentage, Municipality of Anchorage

Series Anchorage Anchorage First Dose Complete Population Vaccinated Individuals 137,280 121,093 288,970 16+ Percent Vaccinated 60.2% 53.1% 228,217 65+ Percent Vaccinated 82.5% 77.8% 35,455 Total Population Percent Vaccinated 47.5% 41.9% 288,970

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Table 8: Vaccinations by Race, Ethnicity, Gender and Age as reported to VacTrAK

Cases Vaccinations** Anchorage Population Cases per Vax per Percent 100, Percent of 100, Age Percent of Race Cases of cases 15+ Vax vaccinations 15+ Pop 15+ pop 4,018 19% 20.7 Race data is 19,431 8% American not Indian or available Alaska Native this week. Asian 1,451 7% 6.7 21,564 9% Black or 992 5% 8.0 12,417 5% African American Native 1,144 5% 22.4 5,114 2% Hawaiian or Other Pacific Islander White 7,940 38% 5.3 150,315 65% Other Race 3,257 16% 60.2 5,408 2% Two or More 2,188 10% 13.5 16,243 7% Races Per Ethnicity Cases Percent 100 Pop 15+ Percent Hispanic 1,485 13% 7.9 6,700 7% 35.5 18,894 8% Non-Hispanic 10,375 87% 4.9 86,000 93% 40.6 211,598 92% Gender Cases Percent Per Vax Percent Rate Pop 15+ Percent 100 Female 14,619 49% 12.7 66,200 52% 57.4 115,269 50% Male 15,278 51% 13.3 62,000 48% 53.9 115,046 50% Per Age Cases Percent 100 Vax Percent Rate Pop Percent 0 to 9 2,010 7% 4.9 - 0% - 40,630 14% 10 to 19 3,657 12% 9.9 6,100 5% 16.6 36,798 13% 20 to 29 6,408 21% 14.3 17,300 14% 38.5 44,884 16% 30 to 39 5,863 20% 12.9 22,900 18% 50.5 45,361 16% 40 to 49 4,076 14% 12.3 20,200 16% 60.9 33,156 12% 50 to 59 3,742 13% 10.2 22,600 18% 61.6 36,662 13% 60 to 69 2,613 9% 9.1 22,700 18% 79.1 28,701 10% 70 to 79 1,057 4% 6.5 12,000 9% 74.0 16,226 6% 80+ 479 2% 8.6 4,300 3% 77.0 5,582 2% Total 29,905 100% 10.4 128,100 100% 44.5 288,000 100% * Total number of vaccinations is undercounted by 5 due to rounding and inconsistencies in the data. Efforts are underway to address these inconsistencies. ** With at least one dose.

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Public Health Messages The Anchorage Health Department advises all Anchorage residents to follow CDC guidance related to masks.

• According to the CDC, people who are not vaccinated should wear a mask when indoors with people they do not live with and when they are unable to stay at least 6 feet apart since COVID- 19 spreads mainly among people who are in close contact with one another. Unvaccinated people should also wear masks at large, crowded outdoor events. • Masks are required for all travelers while on public transportation, including buses, trains, and planes. People must also wear masks while at transportation hubs, including airports and bus terminals. The CDC still recommends vaccinated people wear masks when in health care facilities or in congregate settings such as homeless shelters.

The COVID-19 vaccines protect you, your family, and your community.

• Vaccines only protect against COVID-19 once they are in your arm. The virus will continue to spread and mutate as long as there are unvaccinated individuals for it to spread. Please get vaccinated to protect yourself, your family and friends, and our community. • According to the CDC, fully vaccinated people: - Can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance. - Resume domestic travel and refrain from testing before or after travel or self- quarantine after travel - Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States - Refrain from testing following a known exposure, if asymptomatic, with some exceptions for specific settings - Refrain from quarantine following a known exposure if asymptomatic - Refrain from routine screening testing if asymptomatic and feasible • All people 12 years and older living or working in Alaska are eligible for a vaccine. Vaccine doses are a federal resource distributed through the State and other channels. It is your right as an Alaska to get vaccinated. Do it today.

Testing identifies COVID-19 cases and helps reduce disease transmission.

• Individuals should get tested immediately at the first sign of any symptoms. Tests work best when obtained promptly after symptoms start. Testing early helps people know if they are positive quickly and helps prompt them to take immediate precautions to minimize the risk of transmitting the virus to others.

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• More than half of COVID-19 transmission originates from asymptomatic or pre-symptomatic cases. CDC guidelines recommend regular testing for critical infrastructure workers and other groups at higher risk for COVID-19, even if they are asymptomatic. Fully vaccinated individuals who are asymptomatic do not need to participate in regular testing unless required by their employer. • Testing is strongly recommended for unvaccinated travelers when returning to Alaska from out- of-state travel, with one test at the time of travel and a second test approximately five days after returning to the state. This two-test strategy will help us identify and contain new, more transmissible COVID-19 variants.

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