Amid a surge in coronavirus cases across southeast Wyoming, Laramie’s Ivinson Memorial Hospital is feeling the heat.
Throughout the pandemic, one vital measure of how well a community is responding to the virus has been its available intensive care unit beds. As of Wednesday, none of the hospital’s four ICU beds were occupied — but for a short period last week, all were taken, three of them by patients with COVID-19.
County Public Health Officer Jean Allais said the spike is concerning, but manageable.
“The continued spread of Novel Coronavirus (COVID-19) is concerning for the community,” Allais said via email. “Early on in this pandemic, the Public Health Response Coordinator and I worked closely with Ivinson Memorial Hospital on surge capacity in both their ICU and medical floor. There is a plan in place, and the plan is working.”
County Commissioner Pete Gosar said the news is not surprising, given the return of students to the University of Wyoming, local attitudes about the seriousness of the virus, and the onset of colder weather bringing people together indoors.
“I’m concerned, I really am concerned,” Gosar said. “We know how to help as a community. There are really straightforward, reasonable approaches: wearing a mask, washing your hands, staying out of large groups, especially staying out of large groups indoors. We can do this as a community to drive these numbers down.”
Ivinson Memorial Hospital has seven critical care beds, which include the four ICU beds. The remaining three beds are classified as “acuity-adaptable,” and can be used as additional ICU beds or as the more common beds for the medical-surgical unit, but are usually on stand-by.
All three of these acuity-adaptable beds remained free last week when the four ICU beds were full.
However, the hospital sent three patients during that time — one on Thursday and two on Friday — to Denver for treatment.
The decision to transfer a patient takes multiple factors into account, Chief Nursing Officer Nicole Rooney said.
“There are times when maybe somebody needs an intensivist or a specialty that we do not provide here at Ivinson and we want to ensure that they get the best care possible,” she said. “So we do on occasion send people out, whether we’re at capacity or not.”
Available beds are one measure. Available staffing is another. As beds begin to fill up at the hospital, Rooney said she must consider the intensity and degree of care each patient will require.
“When I look at numbers like that, I try to think about the long term, like how long will the patient potentially need to be in ICU,” she said. “I want to ensure that we have all of the resources for that patient for the period in time.”
Outside of the intensive care unit, the hospital has an additional 22 medical-surgical beds. As of Wednesday, about half of these were occupied, four of them by COVID-19 patients.
For now, the hospital is even continuing to do elective surgeries, a service it paused in the spring when the coronavirus first came to Wyoming, Rooney said.
“And if we got to the point where we were nervous about capacity, we would start evaluating whether or not we would do elective procedures,” she said. “And we don’t feel that we’re at that point right now.”
Dr. Allais would not say if the community should expect to see ICU beds hit capacity again.
“Case counts are only one indicator of the amount of disease in our community,” she said in her email. “Hospitalizations are a ‘lagging metric,’ which means that hospitalizations represent exposures that occurred possibly three to four weeks ago.”
A number of factors could be contributing to the recent spike in cases in Albany County. The University of Wyoming is open for in-person classes and has experienced several isolated outbreaks.
But the failure of some elected officials to take action — or even to take seriously — the global pandemic could also be contributing, Gosar said. What should be a united and unifying response to the virus is instead another arena for partisan debate, he said.
“We all should be working together as a community in a public health crisis,” Gosar said. “You know, 220,000 Americans are dead, 57 Wyomingites are dead from this disease, at a minimum. I just wish we would leave the politics out of it.”
While not medically trained, Gosar is keyed into the public health realities of the county, both as executive director of the Downtown Clinic and as a member of the hospital’s Board of Directors.
He said it takes the community to protect the community.
“If we want our schools to continue to be open, if we want our businesses to continue to be open — if we want life as normal as can be during a worldwide pandemic — we all have a duty as a member of the community, we all have a role to play, and can we do that,” Gosar said. “I understand the frustration with the virus still being here, but it’s going to be here quite a bit longer in my opinion.”
Allais echoed this emphasis on personal responsibility.
“Slowing the spread is incumbent upon every individual,” she said. “Continuing to follow CDC guidelines regarding face coverings, hand washing and social distancing is a good start. Further, limiting social gatherings and staying isolated when you don’t feel well is also good advice.”
Some city officials are also concerned about the county’s recent surge. Laramie City Council member Paul Weaver said it’s not his place to tell county officials how to do their job, but he is concerned by what he sees.
“Our hospital is not a large hospital and it seems like we could very easily find ourselves in a situation — and I hope not — that we will have more people in need of that kind of care facility that we won’t be able to provide,” Weaver said.
He added communication about the state of the virus in Albany County has not been easily accessible. It is a complaint he hears frequently from constituents.
“I wish that, at this point, our public health authorities and the hospital would be a little more forthcoming with information and plans about what we’re going to do so the public can be more informed,” Weaver said. “I would think in our situation, we would want our citizens to have access to as much information as possible for their own decision-making, for their own piece of mind and perhaps even help encourage behaviors that will help us have fewer COVID cases.”
There is some information available.
The Wyoming Department of Health tracks positive and probable cases, deaths, recoveries and other information, which can be viewed on the department’s official website. The state department even breaks down those figures by county.
Also available through the department’s website are fairly up-to-date, self-reported statistics on hospital capacity.
The Laramie City Council failed to pass a resolution regarding face masks in July. The resolution would not have implemented a mask mandate, but would have requested that Allais work with state health officials to institute a mask mandate.
Weaver said the city has limited tools for stemming the spread since public health decisions are largely in the county’s wheelhouse.