Originally reported by Andrew Graham – WyoFile
As larger Wyoming communities marshal limited resources to confront COVID-19, sparsely populated rural counties are particularly reliant on a critical strategy to keep residents safe — slowing the spread.
Sublette County has roughly 10,000 residents spread over nearly 5,000 miles and no hospital. It does not have a documented case of COVID-19 yet. Healthcare officials there, however, like doctors all over the nation, say the virus could be present in the county and just hasn’t been documented.
“Because we aren’t testing people much,” Sublette County Health Officer Dr. Brendan Fitzsimmons told a Pinedale radio host on Friday, “We are in a situation where this could be very widespread and we just aren’t aware of it.”
Fitzsimmons asked citizens to embrace recent orders from Gov. Mark Gordon and other officials to close businesses and maintain distance from each other in an attempt to staunch the highly contagious COVID-19’s spread.
“It’s important for us to maintain a situation for us to be able to handle this medically when we start having serious cases, which we will have in Sublette County and Wyoming,” Fitzsimmons said. “Everything is geared toward that.”
Handling severe cases means maintaining access to ventilator machines and other types of advanced care available in hospitals — a worrisome prospect in areas with already low baseline level of services.
Serious cases of COVID-19 require hospitalization, including admission to intensive care units, according to the U.S. Center for Disease Control and Prevention. As of Monday, there have been more than 15,000 deaths globally and more than 400 in the United States. Health experts and officials are working to prevent deaths by “flattening the curve” of people seeking healthcare to avoid flooding hospitals.
Fitzsimmons expressed the cost of failure in such endeavors succinctly. A serious case “is still very survivable but it requires specific care in a hospital,” he said. “If too many people come at it at once and we’re unable to deliver that care then more people will die.”
A rural county with no hospital like Sublette not only needs to hope for limited spread within its borders, but also appears dependent on such prevention working in larger nearby population centers as well. Sublette would send patients to either Rock Springs or Jackson’s hospitals, according to officials there. In a surge, space in either facility might be limited.
Sweetwater County has 115 hospital beds and 44,117 residents, with 4,721 over the age of 65, according to data recently compiled by Montana-based research group Headwaters Economics and the news outlet High Country News. Teton County has 48 beds for 23,059 residents, 3,135 of whom are older than 65, according to those organizations’ report.
Sublette County is the only Wyoming county without a hospital, according to the report, but hospital beds are scarce across the state.
Such bed numbers aren’t representative of hospital capacity, some officials said, given that some beds are occupied and that hospitals are prepared to take reactive measures. Bed availability numbers “do not include surge capabilities, where cots and unused beds can be used as a surge response,” Kim Deti, a spokesperson for the Wyoming Department of Health, wrote in an email.
The numbers could poorly illustrate another reality as well: “It’s also important to realize that it’s not the beds alone; you need healthcare workers,” Deti wrote.
Unlike other more localized events that might necessitate a surge of medical care in just one area, COVID-19 is “spread over the country,” Deti wrote, putting stress across the system.
For Sublette, that could mean the hospitals that usually receive local patients might also face surges from outside if COVID-19’s presence in the state increases and there are more severe cases.
The federal Emergency Medical Treatment and Active Labor Act requires all emergency departments that accept Medicare payments to examine anyone who shows up seeking treatment. A hospital can’t turn away a patient just because they live in another county. Whether a given facility has the resources to provide ideal treatment, however, is a different matter.
Rates of the disease are increasing both nationally and in the state. As of Monday, Wyoming had 26 confirmed cases, according to the Wyoming Department of Health. The first confirmed case in the state was in Sheridan County and was reported by DOH on March 11. The virus’s presence has now also been confirmed in Campbell, Carbon, Fremont, Natrona, Laramie, Park and Teton counties.
Over the weekend, the number of confirmed cases in the U.S. jumped from less than 20,000 to more than 35,000, according to USA Today. Globally, the number of confirmed cases has exceeded 350,000, according to the Johns Hopkins University data dashboard.
Questions and creativity
“We are very aware that we have limited capacity to provide hospital care if our surrounding counties are restricted,” Sublette County Public Health Nurse Manager Jana Lee said during the live-streamed interview with local radio station KPIN 101.1 FM. “But we have developed a medical plan and we are finding creative ways that we can expand services and take care of patients here in Sublette County at different levels if needed.”
Lee did not detail those plans. A spokesperson for the Sublette County Rural Health District, the publicly funded body that runs clinics in Pinedale and Marbleton, declined on Thursday to tell WyoFile how many available beds the clinics had. “It’s a rural clinic so it’s not built to house people,” the spokesperson, Emily Ray, said. She also declined to say how many COVID-19 tests the clinics were able to perform a day.
Ray questioned how the public might react to such information in a media report. “It’s been a really interesting response for people overall with this situation,” she told WyoFile in a phone interview. “We’re not disclosing numbers and so we’re just going to test people where we feel it’s medically necessary.
“There are people that are asking for tests that don’t need them,” she added.
On the radio, the Sublette County public health professionals suggested testing has been limited in the area, and that results have been hard to come by.
“We have tested some people in Sublette County but not a large number,” Fitzsimmons, the county health officer, said. Testing results were also delayed, he said: “First test came back in a day and a half but now for us, for Jackson, for Sweetwater County, it’s taking five to seven days.”
In Rock Springs, at the Sweetwater Memorial Hospital, 140 swab tests had been performed as of Friday, according to the facility’s website. 122 of those had been sent for COVID-19 testing. Nineteen of those tests had come back negative for COVID-19, the spokesperson wrote in an email. Five were positive for the flu and 21 were positive for other viruses.
The hospital was also hunting for more personal protective equipment for its employees, a hospital spokesperson said. “It is a concern; one that we tackle daily,” she wrote. “Like most healthcare agencies nationwide, we have people who are constantly on the phone trying to secure more PPE. I’m guessing, like most healthcare professionals, our healthcare workers are concerned.
“If and when we get our first COVID-19 patient, we have plans for proper bed placement based on the number of patients we receive,” the spokeswoman wrote. “If one area overloads, we have plans in place to open the next area to accommodate regular patients and COVID-19 patients.”
Other public health providers around the state have publicized testing numbers and have widely said they’re falling short both on testing and protection. Officials in Fremont County, for example, told WyoFile they had used 19 tests out of 50 between two clinics in that county as of March 18.
The chief of staff at the Wyoming Medical Center in Casper also worried about testing scarcities, and whether it meant doctors were missing the full extent of the virus’s spread, according to a Friday report in the Casper Star-Tribune. Natrona had tested 30 people as of March 18, the chief of staff said.
In a “fireside chat” live-streamed to Wyoming residents on Thursday evening, Gordon alluded to a national shortage of both testing supplies and protective equipment for health care workers. National news outlets have reported frustration by state governors around the country at the lack of federal supply lines. South Dakota’s governor had called Gordon and other states searching for supplies this week, Gordon said.
“That’s the kind of thing we’re facing right now,” he said.
A pair of private clinics in Cheyenne and Laramie were also unable to conduct as many tests as necessary because of a lack of swabs to collect samples and vials of solution in which to ship them, according to their owner and chief operating officer. “We have labs that can process more tests than we have swabs,” Amy Surdam told WyoFile on Thursday.
Surdam worried about the state’s numbers of intensive care unit beds, she said. Other health emergencies won’t go away if serious COVID-19 cases begin to strain the state’s hospitals, she said. “People are still going to have heart attacks and strokes that need higher echelon levels of care and we are not going to be able to provide it,” she said.
North of Sublette, Teton County has two confirmed cases. The clinics in Pinedale and Marbleton would first rely on hospitals in Sweetwater and Teton if people needed intensive care, Ray, the Sublette County health district spokesperson said. If both fill up, officials would look farther afield, she said.
“If our closest one can’t take them, we just move on to the next,” she said. “That is an issue being rural, but we deal with that all the time.”
Ray, and other officials in Pinedale, remain optimistic about their ability to respond. A wide swath of local agencies and leaders are working together to prepare, they said.
Ray also described a small silver lining. “We’re always working towards getting a hospital here, and this is a really big eye opener here for our community,” she said.
But for now, health officials in Sublette urge residents to follow guidelines for staying home in hopes of halting the virus’s spread before hospital capacity becomes a problem.
“This is our one big tool that we can do at this point in the process to prevent and try to really hopefully decrease the spread within our county and our state,” Lee, the county health nurse, said.