On Saturday, Alaska activated emergency protocols that allowed 20 medical facilities to ration treatment if necessary. The state had recently recorded some of the highest COVID-19 diagnose rates in the country. This is straining its limited health care system. Three facilities, including Anchorage's Providence Alaska Medical Center, were already covered by the emergency protocol declaration. The declaration includes two other Anchorage hospitals and facilities in the nation's most populous but small state. "Today's actions recognize that Alaska has an interconnected, interdependent health care system. Therefore, activation of the state’s decision-making framework is necessary. The state health department announced the activation of the framework in a statement. It includes a progression involving conventional, contingency, and crisis standards. "I want to emphasize that Alaska's health care facilities are still open and available to provide care for patients. Adam Crum, the state health commissioner, stated that Alaskans should seek medical care immediately, regardless of their financial circumstances. The state activated the crisis of care standards because of limited medical resources in some facilities, a shortage of staff, and difficulties in transferring patients due to limited bed availability. Limited oxygen and renal replacement therapy are other factors. Johns Hopkins University Center for Systems Science and Engineering data shows that one in every 84 Alaskans was diagnosed with COVID-19 between Sept. 22 and Sept. 29. One in every 164 West Virginians was the next highest. Fairbanks Memorial Hospital was not covered by the state's announcement. On Friday, the hospital activated its own policy due to a shortage in staff, beds and monoclonal antibodies treatments. Also, it was unable to transfer patients. Fairbanks Chief Medical Officer Dr. Angelique RAMirez stated that the move to Crisis Standards of Care was not something they take lightly. "This is to respond to a very serious spike in COVID in the community." It was also announced that the Fairbanks area had reported 1,044 new cases. According to the hospital, 35% of patients were being treated for COVID-19 on Saturday. There have been over 110,850 COVID-19-related cases in Alaska since March 2020. Alaska has an estimated population of 731,000. In September, more than 24,000 cases were reported due to the delta variant. Alaska has never had a state-wide mask mandate. According to the state health department, 23432 people were hospitalized and 557 Alaskans have died. 60% of all eligible residents have been vaccinated in the state. Fairbanks North Star Borough has the lowest vaccination rate in Alaska with just 52% of eligible residents. Ramirez stated that the move to crisis standards was due to many factors including community spread and high waiting times. Ramirez stated that this affects all patient care. He said, "This impacts those with broken bones and traumas, heart attacks strokes, strokes, COVID or any other needing medical attention." "The care that we can provide is fluid and can change day to day, hour to hour depending on stateside resources," Ramirez said. Heidi Hedberg, director of state Division of Public Health, encouraged residents to wear masks and to get vaccinated. Every action you take prevents COVID-19 spreading and protects your family, Alaskans, and the health care system. She said that no one wants to follow the guidelines for crisis care.