Later this spring, Alaska’s Bristol Bay will blossom into one of the largest annual salmon fisheries in the world.

The regional population of about 6,600 will triple in size with the arrival of fishermen, crews and seasonal workers on jets but also private planes and small boats, many traveling from out of state.

And yet the heart of the health care system in southwestern Alaska, in a corner of the state where the Spanish flu once orphaned a generation, is a 16-bed hospital in Dillingham operated by the Bristol Bay Area Health Corp. Only four beds are currently equipped for coronavirus patients. As of Wednesday, the hospital had a few dozen coronavirus tests for the entire Florida-sized region, tribal leaders said.

If those newly arrived workers need to quarantine for two weeks, as mandated by the state, residents said it’s unclear where everyone will hunker down. Local store shelves are already bare of Clorox, Lysol and rubber gloves.

Dillingham, the largest community in the Bristol Bay region with a population of 2,300, is 320 miles from Anchorage by air.

“We’re scared. … People come from all over the world for Bristol Bay fishing,” said Gayla Hoseth, second chief for the Dillingham-based Curyung Tribal Council. “There’s 7,000 of us who live here, and this hospital cannot handle the 7,000 of us if we get sick. Imagine (when) our population triples and quadruples in the summertime.”

Compounding matters, the hospital executive who ran daily operations for the health care system is out of a job after downplaying the coronavirus threat to colleagues.

A March 16 email from the executive — which repeated a conspiratorial meme suggesting the coronavirus is somehow a politically motivated phenomenon — set flame to a deep anxiety among some tribal leaders over the vulnerability of Alaska villages in a pandemic.

“Just a reminder that FLU kills many every year!” wrote Lecia Scotford, who was the chief operating officer. (The coronavirus is not like the flu. It appears to be more contagious and more lethal.)

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The message soon began to circulate in the Bristol Bay region, drawing a blistering response from some tribal and local leaders.

Robert Clark, president and chief executive of Bristol Bay Area Health Corp., said Scotford’s last day was Monday. He would not say if she was fired, citing “personnel stuff,” but said “she was separated.”

Scotford did not respond to emails, phone calls and Facebook messages requesting comment. Her email to lists of “division managers” and “department managers” within the regional health organization also emphasized the need for calm, common sense and good hygiene, and for the hospital to be prepared to serve the public.

“That (email) was very concerning to me because that kind of lets people’s guard down,” Norman Van Vactor, president of the Bristol Bay Economic Development Corp., said in a phone interview.

Bristol Bay is a magnet for people in the summer, with a seasonal migration of about 13,000 workers for the lucrative fishing season. The commercial salmon fishery here is the largest in the state, but as of 2010, about 60% of earnings went to out-of-state permit holders.

Almost all the major Bristol Bay seafood processing companies are based in Seattle, an early hot spot for coronavirus, and two thirds of Bristol Bay processing workers live in West Coast states at other times of the year, according to the Institute of Social and Economic Research at the University of Alaska Anchorage.

The Alaska Department of Fish and Game forecasts some 34.6 million sockeye salmon will be harvested there this year.

“When it comes to wild salmon, we are over half the world’s sockeye and over half of the Alaska salmon value,” said Andy Wink, executive director for the Bristol Bay Regional Seafood Development Association.

The nonprofit industry group on Thursday issued an advisory urging the fleet to delay travel to Bristol Bay until May 1.

“Keep in mind, it is possible to carry this virus without symptoms and unknowingly infect others leading to overtaxed medical capacity and/or death(s),” the advisory said. “You do NOT want to be the outsider photographed or seen around town in public spaces if this situation turns for the worst,” the group warned its fishermen.

Wink said his nonprofit is working with local governments on a plan to avoid overcrowding Bristol Bay Area Health Corp. clinics and the Dillingham hospital with sick fishermen, processors and support workers.

“We are taking the stance that we don’t want to rely on the local clinics or if we do, the need to be bolstered substantially,” Wink said.

As the health care provider for the region, Bristol Bay Area Health Corp. operates the only regional hospital and the clinics in 21 surrounding villages. It employed 470 people and reported revenue of $76.7 million in 2017, according to a tax form that Scotford submitted to the IRS.

Clark, the health corporation chief executive, said the Dillingham hospital is seeking more equipment to meet the potential for coronavirus patients among the local and visiting fishing industry patients.

Chief nursing officer Lee Yale said the hospital had 37 tests on hand as of Wednesday, and that all tests performed had returned negative. The Dillingham facility has no ICU beds, four negative pressure rooms to treat COVID patients without infecting others, plus two ventilators for the region.

“We have staffing but if they get ill we will be in a tight spot,” she wrote in an email. “(The) fishing industry will devastate our surge plan and we can not support and cover our villages if this season opens.”

Meantime, for many in Bristol Bay, the looming COVID-19 threat recalls family histories of death and loss in the face of past epidemics.

“We are the survivors of the survivors of the orphans of the Spanish flu,” said Hoseth, the Dillingham tribe second chief.

Another member of the tribe, tribal administrator Courtenay Carty, said her great-grandmother was orphaned in Dillingham by the 1919 flu and raised by family members, and her grandfather was orphaned by tuberculosis in the 1940s.

“The fact that all of our contemporary families are descendants of those *****ren and few adults that survived 1919 is one of (the) major reasons why we are so passionate about protecting ourselves from this pandemic,” she said. “What is history to others is our tribal and familial identities.”

Her tribe declared a state of emergency because of the coronavirus on March 24, calling for a stop to all but essential travel to the city.

Clarification, April 3, 2020: This story was updated to more accurately describe who raised tribal administrator Courtenay Carty’s great-grandmother.

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