Five months after COVID-19 vaccinations were opened to all Wyoming adults, nearly as many people are hospitalized with the virus here as were a month before the shots arrived.
On Wednesday, there were 233 people being treated for COVID-19 in Wyoming hospitals. Nearly 3,500 Wyomingites had active COVID-19 infections, up from about 2,000 a month earlier.
But this surge differs from last year’s in that the state has the tools it needs to fight the virus. Vaccines are widely available; masks and other personal protective equipment are no longer in short supply.
There’s another key difference this time around. The delta variant is now the dominant strain in Wyoming, and it’s twice as contagious as the original virus.
Meanwhile, Gov. Mark Gordon has promised the state will no longer intervene with sweeping measures. There will be no statewide mandates, no lockdowns, no interventions.
This time around, hospitals, schools and local businesses are largely on their own, left to grapple with a new environment of personal choice.
Hospitals nearing their limits
At Cheyenne Regional Medical Center, all but one intensive care bed was full as of Thursday night as COVID continues to surge and the delta variant sends people to the hospital with more severe, longer-lasting cases.
Chief Medical Officer Dr. Jeff Chapman said Friday morning that the hospital has had to move some patients into its emergency department, adding 11 beds there to deal with the influx.
If things get worse, Chapman said, the hospital is developing a contingency plan that could put patients in hallways or auditoriums generally used for meetings.
“To my knowledge, that has never happened at Cheyenne Regional,” Chapman said.
In Sweetwater County, Memorial Hospital has also needed to expand to deal with the influx of coronavirus patients that peaked over Labor Day weekend. A second COVID ward has been opened in what was the hospital’s same-day surgery unit to provide extra beds — a measure that spokesperson Deb Sutton said the hospital didn’t have to resort to in last year’s surge.
As of Friday, the state’s two largest hospitals — Cheyenne Regional and Casper’s Wyoming Medical Center — were treating 50 and 38 COVID patients, respectively. Smaller facilities like the one in Sweetwater and Ivinson Memorial Hospital in Laramie have also seen their numbers of active COVID patients climb into the double digits since July. In Jackson, St. John’s Medical Center is reportedly having its second-busiest month of the pandemic, second only to the first surge in November 2020.
“We honestly didn’t think last year would be a trial run, you know, we all hoped that was it,” Sutton said. “The difference is, now (cases) are more severe. And in the first one we had a PPE shortage, now we’re dealing with a nursing shortage.”
Even as beds and ICU spots fill up across the state, many Wyoming hospitals have still been able to transfer their patients out for more complicated care, either out of the state or to larger in-state hospitals. The wait times may just be longer — which isn’t a huge problem while ventilators are still readily available in Wyoming, but could become a bigger concern if equipment starts to run out.
Cheyenne and Rock Springs’ hospitals have stopped performing less urgent and elective surgeries in recent weeks to free up those employees for the influx of COVID patients and to keep infection risk down at those facilities. Visitors were also banned from the Rock Springs hospital last week in response to rising cases.
Some facilities, including WMC, St. John’s and Rock Springs are still accepting limited transfers — for COVID and other patients — on a case-by-case basis.
The ability to accept transfer patients relies a lot on staff availability. And with staffing shortages wracking facilities across Wyoming, hospitals hope some recently announced federal money meant to address those shortages can help pay for highly-paid travelling nurses, offer competitive wages and provide bonuses to health care workers halfway into their second year of serving on the pandemic front lines.
But many nurses are still leaving their posts, either to make more money with those travelling jobs that are in such high demand or to take a break from health care altogether. Wyoming hospitals are already relying on traveling nurses — Cheyenne and Jackson in particular say they need them to round out their workforces and avoid grinding their existing nurses to the bone.
Cheyenne Regional has around 90 traveling nurses helping out right now, Chapman said. In Jackson, finding housing for traveling workers in the area’s pricey and competitive market has made it that much harder to bring outside help in.
“(Nurses are) really tired,” said Sutton. “People are so mean and unkind, family members are getting mad about the treatments. It’s hard, it wears on you, I’ve seen some of them in tears. So I don’t blame them for stepping back.”
Vaccination rates among staff at Wyoming hospitals are already higher than the state at large, with most facilities hovering between 60% and 85%. But some hospital leaders, including Chapman, worry that the national vaccine mandate announced Thursday — which applies to any health care workers at facilities accepting Medicaid or Medicare funding — will drive even more employees out of their jobs if they’re set on not getting the shot.
“Many people have kind of chosen their sides, for lack of a better term. They’ve either been vaccinated or they’re still making the decision to not be vaccinated,” Chapman said. “I certainly wish that we could convince people, because I think that is the biggest key.”
Eric Boley, president of the Wyoming Hospital Association, said the state saw nurses start to leave their jobs at long-term and senior care homes in August immediately after the Biden administration announced a vaccine mandate for employees at those facilities. Some of those nurses switched to hospital jobs that didn’t require the jab, Boley said, so the concern now is there will be an even larger exodus.
“We believe in the mandate, we’re just really concerned that it’s going to exacerbate an already difficult situation,” Boley said, “and it could have really terrible unintended consequences where we’ll actually see an increase in the staffing shortages around the country.”
During the beginning of the pandemic, and into the winter surge, most cases in Wyoming hospitals were among people 65 years or older.
Now, most unvaccinated patients are between 30 and 60 years old. In Cheyenne, Chapman said the hospital recently saw a 28-year-old die from the disease, its youngest COVID death to date.
Officials say that with the delta variant likely responsible for around 90% of COVID cases in Wyoming, younger patients have been coming in with more severe cases.
“Unvaccinated patients in the ICU are increasingly younger with the delta variant,” St. John’s CEO David Robertson said in an email. “Forty percent (of unvaccinated patients are) under the age of 50.”
In the state’s largest hospitals, including Wyoming Medical Center, around 90% of current COVID cases are among unvaccinated people. The patients that have been fully inoculated, hospital representatives say, often have underlying conditions including autoimmune disorders or obesity that contribute to their cases.
Robertson said that 90% of breakthrough cases at the Jackson hospital have been in people older than 63. Those unvaccinated cases also tend to be more mild, even in older populations.
But among the vast majority of hospitalized patients who haven’t been inoculated against the virus, the delta variant is making their cases worse than the initial novel coronavirus.
“There’s no question these people are sicker, and it’s taking longer for them to get better, which backs up the hospital,” Chapman said of the COVID patients he’s seen in Cheyenne.
And with schools recently back in session with varying mask guidance across the state, pediatric beds are filling up more and more. In addition to the increased rates of COVID appearing in kids, hospitals say they’re also seeing cases of croup and respiratory syncytial virus (RSV) earlier this year than normal.
There’s been a slight uptick in people getting their shots as the current surge takes hold, vaccine numbers show, but there are tens of thousands of shots to give before the state reaches any level of herd immunity. Even as entire families are getting sick and sent to the hospital with severe cases, officials say there’s still widespread hesitation to get vaccinated.
“No one outside these walls believes it’s real, or knows what’s going on,” Sutton said. “It’s disheartening. It’s not knowing that there’s an end in sight.”
The state’s second surge coincides with the start of the new academic year. So far, it’s been a rocky beginning, with hundreds of students in quarantine and a slate of districts changing their policies to address record-breaking absence rates.
The Goshen County school district recorded its highest ever absence rate this school year, with more than 19% of the student body out in the second week of classes.
The district has had just three days since classes began Aug. 24 without a positive virus case. There were 26 active cases in that district as of Friday.
“That’s an impact, but along with those positive cases is the impact of quarantines,” district superintendent Ryan Kramer told the Star-Tribune.
While just 26 cases were active Friday, 126 students were being quarantined. Catalyzed by the high number of quarantines, the district this week instituted a mask requirement for all staff and students. The county’s health officer is actively trying to reverse that decision, stressing that it should remain a parent’s choice, according to reporting from the Torrington Telegram.
Kramer said he and other district officials knew the mask decision would not be popular, and wasn’t an easy one to make, but it was necessary “in order for us to try to stay face-to-face, which we do feel is the most important.”
Several Wyoming school districts have made similar policy changes in recent days. Contentious school board meetings are taking place across the state. Schools in Albany, Laramie, Goshen and Sheridan counties have all implemented new mask requirements in recent days.
“We saw the numbers almost from the very start of school increasing dramatically,” Kramer explained. In the first week of school, absences hovered just below 6% of the student body, “then it just ballooned.”
He shared one anecdote of a 46-person classroom in which one student was COVID-19 positive. Just five students were masked, and so 41 people were quarantined after being exposed.
Situations like that also create instructional hurdles. Forty-one students now need to be taught virtually, while the five who were masked are still able to attend school.
He said since the new mask mandate went into effect, quarantines have been declining.
Al Sparkman, principal of Big Horn High School in Sheridan, said he will be the first to share his distaste for face coverings. But the issue this year is not about the politics of masking.
“Because of how the quarantine rules are written, it bodes well for all of your staff and all of your kids to be masked up,” he said.
That school district instituted a new mask requirement last week as well, after superintendent Pete Kilbride shared with trustees that a week into the school year, 63 kids were out of school between positive cases and quarantines.
The state’s largest school district in Cheyenne has quarantined more than 1,000 students since the year began — roughly 7% of their student body.
In Natrona County, 120 students tested positive for the virus in the first two weeks of school, causing 339 student quarantines. Among staff, 26 have been positive and 31 have been quarantined.
The reason for the high number of quarantines statewide, and why they weren’t felt in the same way last year, ultimately comes down to the statewide mask mandate in place last year and how schools are supposed to handle student and staff exposures.
Here’s how K-12 quarantines are supposed to work, according to the Wyoming Department of Health. When both someone positive with COVID-19 and their close contact are masked, only the person positive for the virus needs to isolate.
Conversely, if someone infected with COVID-19 is unmasked, all of their unvaccinated close contacts must be quarantined regardless of if the close contacts were masked. Those fully vaccinated only need to quarantine if they develop virus symptoms, but vaccines have not been approved for children under 12 years old.
This means that if an unvaccinated student comes to school without a face mask and then tests positive for COVID-19, every unvaccinated person who they were within six feet of for more than 15 minutes will need to be quarantined.
The practice is meant to ensure kids unwittingly carrying the virus after being exposed don’t spread it to their classmates and teachers, explained health department spokesperson Kim Deti via email.
“Quarantine for close contacts of people who tested positive is important for people who do not have obvious symptoms because some people can be infected without symptoms and may still be able to spread the virus,” she said. “Someone can be infectious in the day or two before they have symptoms. So they can spread the virus before they realize they are ill.”
When the 2020-21 school year began, face masks were required for everyone in K-12 settings.
This time around, school districts have been left to their own devices to curtail outbreaks and keep kids in their physical classrooms. Gordon has pledged no public school face mask mandate will come from his office.
While some districts have opted to institute their own mask requirements, others are handling the problem by simply no longer requiring students to quarantine.
At least three Wyoming school districts have passed policies that allow close-contacts to choose between quarantining or wearing a mask to school for the duration of time they were meant to quarantine.
Districts in Lander, Loveall and Worland have all passed such policies, which Deti called “inconsistent” with state guidelines. While quarantine orders are enforceable, Deti said that job falls to local officials.
One parent in the Guernsey school district who spoke to the Star-Tribune on the condition of anonymity said she prefers the latter policy. While she dislikes face masks, her main priority is keeping her two kids in school.
She has two children, one in elementary school, the other in junior high. The older student is fully vaccinated, but the younger isn’t old enough yet.
Five days after the start of the school year, both her children were exposed to the virus, but only her younger child needed to be quarantined.
“I heard so many times … that we should leave it up to the parents if they want to mask or not mask, but my choice was to mask my child and that still wasn’t enough to protect him,” she said.
Her child learns best in-person, but the likelihood that he will need to quarantine again if exposed to another virus-positive student is a huge source of anxiety for the family.
Sparkman, the principal in Sheridan, said he hasn’t noticed masks getting in the way of student instruction, and that most of his students were proactively wearing them anyway.
With 85% of students involved in student athletics or other extra-curriculars, they don’t want to miss games or practices because they’re quarantined, he said.
Kramer, too, said students and parents have learned to compromise.
“We can all agree we want to see their child in school,” he said. “But we haven’t changed minds.”
A dwindling workforce
As COVID-19 tears through schools and childcare facilities, businesses are also expected to take a hit. On Sept. 1, the day Casper schools opened for the fall, the Casper-Natrona County Health Department advised parents and employers to prepare for a labor shortage that could last months.
The more kids in quarantine, the more working parents will have to stay home with them, the department said — prolonging the already serious financial strain the pandemic has dealt the local economy.
For parents, that could mean more missed wages opposite heavier lifts in the workplace as businesses try to absorb the blow, department spokesperson Hailey Bloom said.
Not unlike last year, smaller businesses will likely suffer the most, she added.
Meanwhile, workplaces across the board are weathering outbreaks of their own. For now, infections don’t seem to be plaguing certain kinds of businesses over others, Bloom said.
“It’s kind of over the map,” she said.
Workplaces nationwide are still reeling from last year’s infections, as well as a monthslong labor shortage that’s left scores of lower-paying jobs unfilled. Workers dissatisfied with stagnant wages are flocking away from jobs in myriad industries, including retail, hospitality and manufacturing.
“Some folks didn’t even come back to full strength,” said Jason DeWitt, president and CEO of the Casper Area Chamber of Commerce.
If staffs continue to thin out, employers may again cut operating hours, or if it comes to it, join the growing number of businesses forced to shutter since the pandemic’s start, Dewitt said.
To prepare for the crunch, Bloom recommends employers arrange options for employees to work remotely if possible.
Vaccination is the best way to curb the spread of COVID at work, she added. Practices like mask-wearing, testing and quarantining also remain effective.
On Thursday, President Joe Biden issued an executive order instituting new federal vaccine regulations that could affect up to 100 million Americans nationwide. Any employer with 100 or more workers must either require all employees to be vaccinated against COVID-19, or test unvaccinated staff members every week, the regulations stipulate.
Biden also ordered a blanket mandate for all workers at Medicare or Medicaid-funded health care facilities to be vaccinated, as well as executive branch employees and federal contractors.
Gordon announced plans to challenge the new federal vaccine mandate later that day, calling it an “egregious example of big government overreach.” Legislative leaders chimed in with a similar message the following day.