The coronavirus has spread into the most remote villages, a reminder of earlier pandemics that ravaged the state. Now there is a rush to deliver vaccines in time.
As the turboprop plane rumbled to a halt at the edge of a frozen landing strip, Vennessa Joseph and her fellow villagers were racing to meet it, their snowmobiles kicking up a flurry of powder behind them.
Within minutes, six residents of Birch Creek, Alaska, bundled in parkas and gloves in the 25-below-zero afternoon; had piled into the fraying seats; and the engine was roaring again. As the plane lifted off to the north, headed toward Fort Yukon, Joseph looked out across the vast wetlands, where stunted spruce trees cast long shadows in the winter sun.
Vaccination day had arrived.
With a population of about two dozen that relies on a subsistence life, fishing pike in the summer and hunting moose in the fall, Birch Creek operates like numerous villages in Alaska, with no road access, no running water and no neighbours for miles. But despite the natural isolation — more than 160km from Fairbanks and on the edge of the Arctic Circle — the coronavirus had still managed to find its way in. In the fall, Joseph was laid up for days with illness. People in two of the nearest villages died.
In a state where the Indigenous population has been ravaged by global disease outbreaks for generations, the coronavirus pandemic has killed Alaska Natives at quadruple the rate of white residents. The virus has taken hold in remote communities, setting up an urgent race between infections and vaccinations during a season in which weather can limit travel; the sun may only wink above the horizon; and large, multigenerational families are crowded indoors.
When the pandemic began a year ago, Alaska's isolation was an asset that provided villages an opportunity to set up lockdowns, testing requirements and controls on travel.
But as the virus has slowly seeped across the state, the rising infections have demonstrated how quickly isolation can turn into a liability. In Pilot Station, a 37-year-old man died after weather prevented a medevac plane from reaching him. The virus has raged in some communities that have minimal sanitation, in some cases infecting more than 60 per cent of residents.
Yet thanks to the steady supply of vaccines available to Native Alaska tribes and a massive delivery effort involving bush planes, boats, sleds and snowmobiles, 16 per cent of the population has received a second dose of the vaccine, the highest in the nation. One of the regional operations, Operation Togo, harks back to the gruelling 1925 sled dog run that rushed diphtheria antitoxin across the state to an outbreak in Nome.
The villages also have resources they lacked a century ago, when the 1918 flu wiped out more than half of some communities. A network of tribal health aides provide front-line health care and critical testing, treatment and telemedicine links with faraway hospitals — a network being considered for replication in the contiguous US.
In Birch Creek, the vaccine effort fell to Debra McCarty, director of the medical clinic in Fort Yukon, who had to figure out how to reach the settlement on the other side of 40km of roadless trees and bogs. Initially, she planned to ship a vial of vaccine on a commercial flight to Fairbanks, then charter a plane that would pick up a health aide in Beaver before crossing back over the Yukon River to Birch Creek.
But there was a hang-up. Only six people in Birch Creek were willing to get the vaccine. Since the vial of Moderna vaccine carried 10 doses, and the doses had to be used within a matter of hours, McCarty worried that four doses would potentially go to waste.
So the plan changed: The charter plane would bring the people of Birch Creek to the vaccine vials in Fort Yukon.
At the landing strip in Fort Yukon, McCarty and others were idling in pickup trucks one day last month, ready to whisk the Birch Creek passengers to the clinic. Within 30 minutes, the shots were done. They headed back to the plane.
A flashback to 1918
Alaska already had seen how quickly viruses from the other side of the world could become deadly.
In the early morning hours of October 20, 1918, the steamship Victoria slogged into the port of Nome, carrying passengers, packages and a strain of influenza that was killing millions around the world.
Within days, mail carriers on dog sleds moved through villages to the north, according to accounts compiled by Matt Ganley, who interviewed elders during research in the 1980s. Seal hunters who encountered the mail carriers traveled east. A man who had gone to Nome to purchase a fur for his wife navigated his way home, only to die upon arrival.
The illness, isolation and frigid conditions combined for mass death, sending people with fevers out into the cold seeking relief, only to die of hypothermia. Others froze inside, unable to tend fires.
Some Alaska Native communities lost more than half their population.
One of the few places spared was the barrier island community of Shishmaref, where the village locked down, posting guards to confront those who might try to visit or depart.
This past year, as the coronavirus surfaced, Shishmaref returned to a strict lockdown, said Lloyd Kiyutelluk, president of the local tribal council. The village, which has no running water for hand-washing, largely halted travel. Those who did come to the village had to first get tested.
"We are doing like what our grandfathers did," Kiyutelluk said. "We kept that in mind; that's the only way to keep our community safe."
But even the most remote corners of the state are far less isolated than they were during the 1918 pandemic. Fishing season drew thousands of workers from outside the state, and tourists poured into hunting lodges and national parks.
Alaska has continued to tally low infection numbers and one of the nation's lowest death rates, with 292 people dead. But the virus has flared in unexpected places.
In Chevak, Mayor Richard Tuluk said the community locked down to keep people in their family bubbles after the first cases surfaced in the fall, but some restrictions have recently been eased. Many young people attend school on iPads, and an all-terrain vehicle pulling a sled carries homework and lunches from house to house. The traditional Cup'ik dancers gather over Zoom.
To the north, in Teller, Joe Garnie, 67, a lifelong resident, said the village has been in a "Russian roulette" situation as people continue to haul water in buckets from a laundromat or a creek and rely on public showers.
In Birch Creek, Joseph said, a worker likely brought the virus in after visiting Fairbanks. It soon spread through Joseph's family — six people.
The village shut down travel and handed out boxes of cleaning supplies, tissue paper and food.
In her home, Joseph brewed "pitch juice" made with the resin pulled from spruce trees — a traditional remedy to clear infections — and they soon recovered.
"It's been working for hundreds of years," she said.
A lifesaving plane couldn't make it
Nine hundred and sixty kilometres to the west, in Pilot Station, Joe Xavier, 37, patrolled the streets as part of a volunteer group making sure people were not mingling. Xavier had spent much of his life in service to his community, cutting trees or knocking down fires.
But by the end of November, Xavier started showing symptoms, as did his sister. Within days, their conditions worsened.
A medevac flight was not able to get through the stormy weather, and Xavier died.
That part of the state, along the Yukon and Kuskokwim rivers, has seen some of the worst effects of the virus, its hospital nearing capacity at one point. It lies within the Bethel census area, which has recorded more infections per capita than places like Los Angeles County, and its death rate is three times higher than that of the borough around Fairbanks.
Older residents have been hit the hardest, said Dr. Ellen Hodges, chief of staff for the Yukon-Kuskokwim Health Corp. "The elders in the villages are really, in this culture, just very valuable to the survival of the villages and the survival of the culture."
One of them was Minnie Michael, who had worked in the community of Kwethluk as a teacher and later as a judge. She taught her family how to cut a fish, schooled village children in the Yup'ik language and frequently instructed others throughout the community in the values of compassion and productivity.
At age 79, Michael was healthy and active, still doing her own berry picking, but as the coronavirus began taking hold in Kwethluk in the fall, she became one of three in the village of 800 to succumb.
When a death occurs, everyone visits the family during a days long period of celebration and grieving. Homes are filled with mourners, neighbours and the smell of food — traditional meats such as moose or caribou and maybe some fish ice cream known as agutuk.
But this year, such gatherings were not possible.
"Having lost my mother is huge," said Veronica Winkelman, a daughter of Michael. "Having not been there to receive everyone and cook in honor of her has been devastating."
A race between infections and vaccinations
For months during the pandemic, McCarty in Fort Yukon has been operating many days on just a few hours of sleep, directing the clinic, serving as part of the ambulance team and dressing the bodies of the dead.
Now, bundled in a red parka with vaccine doses in hand, she was starting to gain an advantage, navigating snow-packed streets to the homes of some of the most vulnerable people in the Gwich'in Athabascan community.
But after also making some stops to conduct nasal swabs for a series of residents on their front porches, McCarty's testing equipment blinked news that two of them were infected. The village's recent outbreak was still percolating. Later, a phone call came in with word that two other people were showing symptoms.
It was a race between infections and vaccinations — and there was not yet enough of the latter.
"You just want it to be over, but you know it's not," said McCarty. "There's probably 10 or 20 more that are positive. It's like it's never going to end."
With the vaccine, there are extra challenges: Health crews must coordinate flights out to villages and arrange for someone to pick them up at the runway by vehicle or snowmobile. They need to make sure someone has started up the wood stoves to warm up the tribal halls where shots will be administered.
One team recently landed in a village as the temperature hit 61 below.
On scene at the tribal hall in Nenana, a woman who cared for an aged parent broke into tears as the vaccine was gently pushed into her arm. Johanna Coghill, a community health practitioner, said people often become emotional, recalling stories passed down about epidemics of generations past.
These days, she said, they are making new stories. "It's one of those things we'll talk about 100 years from now."
Written by: Mike Baker, Serge F. Kovaleski and Ash Adams
Photographs by: Ash Adams
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