Sun, March 29, 2020

Note from an ER doc to the backcountry community in regard to COVID-19 spread

A note from an ER doc to the ski and snowmachine community:

Thanks CNFAIC for doing such a great job not only forecasting but also promoting social responsibility. You are amazing.

So why does this social distancing thing matter, and why should young healthy skiers and snowmachiners care? And for that matter old healthy skiers and snowmachiners?

The short version:

This is real. Skiers travel and congregate in groups. So do riders. That is how coronavirus is spread. More people will die in Alaska, what we do now will determine how many. Stay local. Small groups. Wash your hands lots. Don’t touch your face. Don’t carpool. 6’. Don’t cause a SAR. Self isolate if sick. Short of breath go to the ER. Be kind.

The long version:

There are multiple reasons, but the primary reason is to slow transmission. It’s not about you. It’s about all of us. In case you have been so deep in the backcountry that you missed it we are in the middle of a pandemic, with a virus that spreads more easily than flu, and is deadlier than flu. It’s a new virus to humans so none of us have immunity, and there is no vaccine. Nor is there any real evidence any medication works on this virus……despite the fact that overwhelmed docs in hot spots are trying all kinds of meds. Alaska is doubling cases every 3 days right now, so while we don’t seem to have much COVID in Alaska at the moment, that is changing rapidly, and the confirmed cases are a gross underestimation of the actual number of cases. It is spreading here, and more people are going to become critically ill and some will die.

Ok, back to why you should care. Skiers and snowmachiners are a community of people that recreate in groups, mingle with lots of other people who have the same passion, and many of us travel all over to pursue cool mountains and excellent snow. Places like Japan (I haven’t been there, but I heard the food is awesome and I really want to see a monkey in a hot spring), the Cascades (isn’t that near Seattle?), Colorado, the rest of the Rockies on both sides of the border, and that continent with lots of disease right now….Europe.

The ski community is a community that has been spreading this virus, including to Colorado, where the initial phase of the outbreak was centered in the mountain towns, thanks to some traveling skiers. Snowmachiners, don’t act all high and mighty, just because I don’t have an example for you we all know in the lower 48 riders are driving from the Midwest to the Rockies all the time. Many of you went outside for spring break… kids did. We, until a few days ago, had lovely people from all over the world flying in helicopters, and sharing beers and high 5’s after their amazing steep skiing experience…..and if you don’t think some coronavirus got to AK via returning spring break travelers, and the heli ski scene you are dreaming. It did. Why do you think the timing of our cases started just after spring break? We are vectors. Politicians and the rich and famous are getting this too, for the very same reasons… and congregation.

The average person who gets the virus gives it to 2.3 people. Some will spread to more, some will spread to less. The virus very likely is shed starting a couple days before symptoms, so isolating after symptoms start is great, but doesn’t stop spread. The way to stop spread is to stop moving all over the place and interacting closely with other people. This virus is a respiratory virus, so likely infects us through our mucous membranes……nose, mouth and oropharynx, and eyes, but it survives on surfaces, both skin and off the human body, so when you touch someone’s hand who just blew a hockey snot….I mean just touched their nose or wiped their eyes, or coughed into their hand, and then touch your face you can transmit the virus. And then you share it too……maybe to a young healthy person who does fine, or maybe to your parents or a friend with health problems who does not. And make no mistake…..being young and healthy is not a guarantee, there are a number of intubated and dead people who are younger than 50. A friend of mine who is in his 30’s and as athletic as most of you, was on the edge of coming into the hospital for breathing support for a number of days and was using a borrowed CPAP mask at home….not a person I thought would have struggled with this disease.

Please take this seriously. Social distance (6 feet is how far a respiratory droplet can go with a cough), don’t carpool outside your household, pull off the trail for breaks, pick a quieter trailhead, wash your hands or use hand sanitizer after every interaction, and every door you open, and your trips to the grocery store or gas station. Clean your hands before you eat or wipe your eyes or pick your nose.

Stay local. Do not fly via a small community to explore a cool spot this season. Don’t do a long sled trip up the Iditarod trail, to Skwentna, or out the Yukon. Leave Cantwell, Paxson, Glennallen, and Valdez alone. Don’t wander the road system getting gas, buying groceries, or meeting ski friends for laps in a distant range.

Do not mess up…..your local first responders are seriously busy right now, working tons of shifts, and they don’t have time or the energy to do a SAR. And SAR takes large groups of people, which we don’t want gathering right now. We are all in a no fall zone right now.

You don’t want to end up in the ER right now, while it’s the calm before whatever is gonna happen at this moment…..guess where all the sick people with COVID gather? In the hospital, and if you don’t work there you would rather not be there.

If you start having cough or cold like symptoms seriously self isolate, even from others in your house, encourage everyone else in your house to have impeccable hand hygiene, stay the heck out of the kitchen unless you live alone, and if you start having shortness of breath please seek medical care! Self isolate for 14 days from onset, or if you still have symptoms, 3 days after the last fever as long as you are no longer coughing and sneezing and spewing virus. I know that’s longer than the state says….but it’s what is being promoted in areas that have more disease and experience with the disease.

Lastly, treat each other kindly……the tone lately in the community has been amazing. We are in this together. It’s not the time for petty trail disputes or backcountry ethics discussions. Its not the time to worry about your climbing goals for this summer…..that’s on hold, sorry. Yeah, there have been some folks who probably gathered groups for a week longer than they should have….but that’s done, and we are moving forward into a potentially intense however many months that will change some lives in our community……whether it be lost jobs or serious health consequences…….be kind.

Take care,

One of your local skiers who is useless on a snowmachine who happens to be an ER doc

Please excuse the stream of consciousness….I’d rather be skiing with you all instead of planning how to approach intubating a sick COVID patient without the nurses, respiratory therapists, techs and docs I work with getting coronavirus too. Like everyone I want normal back. Even the weird ER normal.


We’d like to send a big thank you to Andy Elsberg for taking a moment out of his busy life in an Anchorage ER and conveying his stream of consciousness.