Norton Sound Health Corporation is a tribally-owned and operated health care system in the Nome Census Area/Bering Strait Region of Alaska. Our system serves 16 remote communities and approximately 10,000 patients across a 22,000 square mile region. Our region has seen 3 cases of COVID-19 to date including 2 health care workers in the Nome facility. Nearly 1/3 of our 10,000 residents live without running water or sewer in their homes. Homes in our region are very small and overcrowded. Unemployment had risen to over 25% before the current crisis struck, with the majority of families living below the AK Poverty thresholds.Currently we have had only 3 cases of COVID-19 in our region, however, we remain very concerned that this disease could explode rapidly due to the crowded conditions and poor sanitation. To date, NSHC has tested over 2,000 patients at least once with a total of nearly 5,000 tests, through very dedicated testing outreach programs. In Alaska as a whole, there have been over 450 confirmed cases. We have high rates of chronic disease which unfortunately pre-dispose more of our patients to negative outcomes. We have reduced services during this time to reduce crowding in our facilities, however we have kept all of our staff paid at full pay during this time. We are trying to implement more tele-medicine services yet are severely limited by the lack of reliable high speed internet access in most communities and most of our patients not having access at all. We have moved to more home visit based services in some communities. In our largest community, Nome, we erected an external tent to allow walk up testing and screening away from the harsh arctic weather/winds.In a community without running water, where all water must be hauled by hand every day, where families all wash hands in the same bowl of water for a whole day, where basic sanitation standards known in public health for more than a hundred years are impossible, how can a
community even hope to withstand a contagious illness to which none have any immunity. The communities of our region lost up to 90% of their residents during the 1918-1920 Spanish Flu pandemic and the communities are very concerned the same could happen 100 years later. Yet despite this fear, our communities have come together to fight this invisible enemy, through travel restriction, tight quarantine requirements, and dedication to help each other through. Our smaller communities are planning for "when" not "if" COVID-19 comes to their community and are working to be as prepared as possible. Norton Sound continues to try to be the support for our communities, we are working to provide supplies to treat water to provide for clean hand-washing and sanitizing, supplies for waste disposal and to allow community members to clean their homes.Through this grant NSHC wants to promote hygiene for our staff and patients inside and outside our healthcare facilities. We want to purchase hand sanitizer for those in the region, especially those in homes without water/sewer. For our facility in Nome, NSHC will purchase a Xenon germ-zapping robot to allow UV sanitation of our facilities to allow another level of cleaning to help decrease risks to staff and patients.