Originally reported by Andrew Graham – WyoFile
As medical professionals around the state prepare hospitals for a surge of patients they hope won’t arrive, many say COVID-19 has spread here well beyond what the official numbers indicate and that without adequate testing they’re planning in the dark.
Doctors last week called testing capacity “poor” and “limited.” Some worry the limited screening creates a false sense of security about the virus’s spread in Wyoming that could hurt efforts to limit social contact and stop COVID-19’s spread.
Officials in Fremont County estimated hundreds of people there have contacted health providers with symptoms indicating they have the disease. Doctors in Laramie and Rock Springs told WyoFile they also believe COVID-19 instances in their communities are much more widespread than DOH’s test numbers indicate.
State officials share that concern.
“In an ideal situation we’d be able to test everyone with symptoms of COVID-19,” Gov. Mark Gordon said Monday. But the state doesn’t currently have that capability, he said, nor does any other state.
Wyoming doesn’t have the capabilities to stave off a surge in hospital needs for long, either, one doctor said at Gordon’s Monday press conference.
“If we wait until people start to show up in our emergency rooms gasping for breath we have waited too long,” said Casper doctor David Wheeler. “If we do not act now it is certain that we will use up all of the available resources for healthcare in our state in just a matter of weeks.”
Wyoming is limited in hospital space but also its medical workforce, Wheeler said. “When our doctors and nurses start falling ill, and this will happen, there will be no backup.”
In Fremont County, where the virus hit hard, tests have confirmed 24 cases of COVID-19. Eight patients with the disease are currently hospitalized there, Fremont County Incident Management Team Public Information Officer Mike Jones said. Sixteen COVID-19 patients have been hospitalized in Wyoming since the crisis began, state officials said on Monday.
But the numbers don’t accurately reflect the scale of the problem, Fremont County Public Health Officer Dr. Brian Gee said during a Friday press call. Using numbers from health providers around Fremont County, Gee said around 200-300 people had contacted doctors with illness symptoms “suggestive of COVID-19.”
In a press release issued on Friday, Fremont County officials said more than 400 people in the county had been asked to self-isolate.
At the same time, flu’s prevalence in the community is declining, Gee said. “The primary virus in our communities right now is this COVID virus,” Gee said.
Many people with COVID-19 recover at home. Public health officials’ worry is that the number of people who get sick enough to require hospitalization will overwhelm hospitals’ capacity to care for them.
The current testing regime “does not let us understand if there are any seriously ill patients with this disease,” Gee said. “This is potentially problematic because it does not truly express what is going on in our community and our state.”
State officials are ramping up efforts to increase testing capabilities. A private doctor in Jackson is also trying a workaround, WyoFile reported last week.
Gee hoped firmer messaging, like the estimate of 400 cases health professionals in Fremont County put together, will encourage people to follow recommendations and orders for social isolation, he told WyoFile in an interview. “I think it’s harder for people to grasp [the extent of the problem] when you don’t have a bunch of positive test cases,” he said.
Sweetwater County had its first confirmed positive test on March 24. As of Monday morning, the number for Sweetwater County remained at one, according to the Department of Health. But doctors in Rock Springs were gearing up for an onslaught nonetheless.
“We’re pretty convinced there are more cases out there,” Kim White, the head of Sweetwater County’s COVID-19 incident command team, said. “I don’t think we even have a clue of how many people here actually have it.”
White described taking a phone call on a COVID-19 hotline her hospital, like many around the state, has set up to field questions from people worried they have the virus.
The patient “had symptoms similar to COVID, it got better, than worse again,” White said. “I could hear he was wheezing on the phone … as an ER nurse by trade, it kind of scared me.”
But Rock Spring’s Sweetwater Memorial Hospital has not seen an influx of patients from the disease, White said. “We are braced” for one, she said. When it comes to contagious diseases, it’s typical that Rock Springs will see a wave of illnesses around two to four weeks after Salt Lake City, the metropolis 190 west miles down the highway. As of Monday afternoon, the Salt Lake area — population of around 1.3 million — had 360 confirmed cases and had suffered 2 deaths according to the Johns Hopkins Coronavirus Resource Center.
It is difficult to assess how many cases of COVID-19 there might be in Rock Springs, Dr. Melinda Poyer, Sweetwater Memorial Hospital’s chief medical officer, said. The hospital and its hotline (Sweetwater Memorial also has a special clinic set up to receive patients) have seen a “reasonable flow” of patients, Poyer said. In Fremont County, “they are in the middle of a very challenging situation,” she said. In Sweetwater County, “we are monitoring,” she said.
Poyer is hopeful the Rock Springs community follows guidelines from public officials for social isolation. “I have tremendous confidence that our community is listening and I believe that will matter,” she said.
The community needs to stay focused on avoiding the worst case scenario, White said, referencing scenes that are playing out in hospitals in New York City and other overwhelmed areas. In those places, relatives have not been allowed to visit patients on their deathbeds and hospital staff have been forced to make brutal decisions. Wyoming is not immune to such scenes if the virus takes hold, White said.
People are “not going to be there with their loved ones should they die from this,” White said. “Things that people don’t think of on a regular basis and don’t want to think about are things that we could potentially be facing.”
There has been one confirmed case of COVID-19 in Albany County, and the patient is recovering. A doctor at Ivinson Memorial Hospital said on Friday that the facility was not seeing an influx of COVID-19 patients.
“We’re still on the preventative side, we’re trying to reduce exposure and gather up supplies,” Dr. John Byers, a medical director at Ivinson and member of its COVID-19 response team, said. Still, a COVID-19 hotline set up by that hospital was seeing around 70 calls a day, Byers said. It’s difficult to sort out if the symptoms people describe are from the regular flu or COVID-19, he said.
“It’s hard to interpret because we’re just not seeing a massive influx of patients with respiratory illness,” he said. He urged against treating low numbers of confirmed cases as a sign that all is well in Albany County, however.
“You look at the numbers and it’s easy to get carried away,” he said, but “it seems like the calm before the storm.”
A different Laramie doctor said she’d seen patients with symptoms correlated to COVID-19 a week ago but was unable to get them tested. Between March 18 and 24, Dr. Tracey Haas saw 17 patients whose symptoms qualified them as “suspected” COVID-19 cases at the clinic where she works, she wrote to WyoFile last week. She sent the three most severe cases to get tests at Ivinson Memorial Hospital and Stitches Urgent Care, a separate clinic.
“All three were more severe and/or had clearly exposed many through their job/school,” Haas wrote. None of the three were given tests at the other medical providers, she wrote. She believes the virus has been circulating in Laramie since the end of February “at a minimum,” she wrote. “The good news, those I am seeing are getting better… I’m just unsure how many each has exposed.”
Haas stopped trying to get her patients tested, she said. The tests, she believed, were too hard to get and the results have come back too slowly to be helpful in tracking the virus.
“Relying on identifying positive cases through early testing – well, that would have been ideal, but that ship has sailed,” Haas wrote. People who have spread the virus might recover without ever getting a test. “This leaves newly infected people (and those of us trying to stop viral spread) to guess how and where they were exposed,” she wrote. “The cat is out of the bag, so to speak.”
Across the different hospitals, health workers are preparing for the disease by planning what beds to use for COVID-19 patients if they begin to show up. Ivinson Memorial is listed as a 99-bed hospital, Byers, the doctor there, said: “We don’t normally use the full 99 beds so we’re converting rooms that normally would have other purposes back into inpatient-capable beds.”
Sweetwater Memorial was making similar preparations. “We have determined different areas within the hospital where COVID patients would be treated… first here, then there,” White said.
And incident teams at the hospitals were desperately trying to stock up as much protective equipment for health workers as they could. “We are no different than anywhere else in the nation right now,” Poyer, also at Sweetwater Memorial, said. Though there is no wave of COVID-19 patients, doctors and nurses are already “actively conserving personal protective equipment,” she said.
A nationwide shortage of proper masks, gloves and other protective equipment has left health workers at personal risk. Increasing numbers of doctors and nurses are getting COVID-19 in New York, and health care workers in heavy hit countries like China, Italy and Spain have fallen sick as well.
“I know how physically demanding it will be and emotionally demanding it will be if we end up like a lot of the other hospitals,” White said. “That concerns me for [frontline health workers] but I also know that we have very resilient staff.”
Hospitals in Wyoming are reaching out to both community members and officials in an effort to stockpile supplies before they might need them.
The state recently received a shipment of supplies from the Strategic National Stockpile, a national supply of medical supplies, the director of Wyoming Homeland Security Lynn Budd said at a press conference last week. The state received 27,100 N95 masks, 34,450 surgical masks, 24,400 gloves, 1,728 face shields and 3,215 isolation gowns, she wrote to WyoFile. Supplies were then distributed to county and tribal health officials, and from there to hospitals, Budd wrote.
A second shipment of supplies from the national stockpile arrived this week, officials said on Monday. The state is still trying to secure more ventilators, the equipment used to help severe patients breathe, State Health Officer Alexia Harrist said.
Sweetwater Memorial got 800 of the first shipment’s N95 masks, which the Center for Disease Control and Prevention recommends as most effective at preventing contagion, White said. “We were ever so thankful for that,” she said. “It gives us a good stash but … that may last a week, maybe two. It really depends on how many patients we get.”
-WyoFile editor Katie Klingsporn contributed reporting to this story.