Debate over distancing orders heats up as doctors await surge

Debate in Wyoming is increasing over whether Gov. Mark Gordon closing some businesses but stopping short of a stay-at-home order is inadequate or a threat to liberty, even as a top doctor contends a hospital surge is still on the horizon.

The growth of confirmed cases slowed last week, though a wave of new confirmed cases over the weekend brought the state’s case load to 275. Of those cases, 140 have recovered, according to the Department of Health.

But Dr. David Wheeler, the head of the Wyoming Medical Society, said case counts might grow faster this week as results come back from commercial laboratories that take longer to process tests than the state’s lab.

“We had exponential growth that really only slowed three days ago,” Wheeler said in a Friday interview. The slowdown aligns with a new directive by the Wyoming Department of Health diverting more tests to private laboratories, he said.

Scarce testing has made for a tense waiting game. Unable to adequately track the virus’s presence, the state is left to hunker down and hope officials have set the right course. Health officials eye the statistics and wonder to what degree the state could see a surge in hospitalizations that could overwhelm Wyoming’s thin healthcare system.

“The social distancing we’ve done has been helpful and it may turn out to be enough to not be very taxing on healthcare resources,” Wheeler said. “Or it might not.”

As health care providers wait, debate over the government’s response and what it should do next simmers. Though they praise aspects of Gov. Mark Gordon’s response — like orders closing schools and many businesses early on in the crisis — Wheeler and many of his colleagues continue to wish Gordon would issue more stringent orders and close more businesses, he said.

Some political groups in the state, however, cheer the governor for not issuing a broader stay-at-home order. Others accuse him of government overreach for the measures he has taken.

Last week, right-wing protesters gathered in a Casper park to oppose orders designed to slow COVID-19’s spread by limiting social interactions. The orders have had mounting economic consequences.

The protest was organized by the Wyoming Campaign for Liberty, according to a Facebook post from the group. Around 20 protesters held signs criticizing measures that closed businesses and accused officials of government overreach, according to a report in the Casper Star-Tribune. Though police were present and members of the group violated one of Gordon’s orders that prohibits gatherings of 10 or more people, no enforcement action was taken, according to the newspaper.

To the state’s healthcare professionals, the demonstration was “super offensive,” Wheeler said. “Watching them all standing close together and not maintaining reasonable distances from each other, it kind of makes you sick to your stomach … us health care workers are doing everything we can to keep everyone safe as possible.

“There are times in our lives when the needs of the community and the state are more important than the needs of the individual,” Wheeler said. “If you can’t wrap your head around that then I don’t consider you a very good American.”

Meanwhile, some workers say the lack of a stay-at-home order has put them in the difficult position of risking losing their job or putting themselves and their family at risk of contracting the virus.

In an April 8 press conference, Gordon said he has “continuously pushed to make sure stores do their best to protect workers.” Some businesses were operating better than others by limiting the number of people in the store, ensuring employees wear face masks and urging customers to do so as well, he said.

“There are heroes and there are zeros,” Gordon said. “I continually urge people to shop at the places they see the heroes who take care of their workers.”

One such worker, at a lumber store in Pinedale, said he believes his work selling lumber is needlessly risking increased COVID-19 spread. The worker, who asked not to be named to avoid reprisal from his employer, said the store still sees sizable crowds on weekends.

“Everyone who is coming out, they are just doing little projects here and there,” the worker said. “It’s not like they have to do this.”

Though he and his fellow yard workers take precautions to create distance from customers as they load lumber into cars and trucks, many customers still want to get out of their vehicles and approach workers, he said.

“We’re getting exposed to so many people,” he said, “that’s what I really don’t like.”

The worker is taking care of his mother, who has cancer, he said. Doctors told her she was in a high risk group for severe complications from COVID-19, and the worker fears bringing the disease home to her. He hoped for a stay-at-home order from the governor that would have shuttered his business, he said. The lack of such an order has forced him to weigh his livelihood against the safety of him and his mother, he said.

Quitting would leave him ineligible for unemployment and out of work at a time when he fears job scarcity could become the norm.

In lieu of an order closing such businesses, questions arise about what obligation employers have to protect their workers. Workplace safety laws administered by the Occupational Safety and Health Administration require employers to protect their workers against risks that include COVID-19, some experts say.

In Jackson, six confirmed COVID-19 cases sprung out of a business one health official there said should have been closed by health orders. The first case in the business appeared on March 28, Teton County Public Health Nurse Jodie Pond said in an interview with WyoFile last week.

Gordon has criticized stay-at-home orders in Colorado and elsewhere for carrying a long list of exempted businesses that he says make such orders little more than lip service. Such orders accomplish little or no more than Wyoming’s orders shutting down restaurants, schools, bars and gyms — places where large numbers of people gather — the governor contends.

Pond said a stay-at-home order proposed by Jackson officials included a list of essential workers that local officials had chosen using national guidance. “We chose the ones that fit our community,” she said. The state would not approve it.

In lieu of a stay-at-home restriction, Teton County Health Officer Dr. Travis Riddell has imposed an order limiting gatherings in the county to individuals within the same household. The state approved it March 30. The order allows workers to leave their homes to travel to their jobs.

It “leaves some businesses open that would not be open on a stay-at-home order,” Pond said.

Pond declined to name the business that she said played host to a “mini-cluster” of the virus, but did say it was one she did not believe was essential. “That’s our point,” she said. “A true stay-at-home order, you identify the businesses that are essential and then everybody else closes.”

The business with the mini-cluster has since shut its doors until the end of the month, Pond said. Health officials had traced contacts of the positive patients and ordered other business employees into quarantine, she said.

The nature of the work there made social distancing difficult, Pond said. In a press conference last week, she called on workplaces that can’t implement social distancing to close.

To doctors, the equation is fairly simple, Wheeler said. Keeping people apart stops the spread of germs from one person to another. “The more that happens, the more slowly the disease will spread,” he said. “There’s several centuries of data backing up that hypothesis.”

Suggestions that Wyoming, with its sparse population, is a natural at social distancing miss the point, he said. The disease still spreads person to person in rural areas, it just does so slower than in packed cities, he said.

The surge in patients will come at some point and in some level, he said. “There’s nothing magical about Wyoming,” Wheeler said. “It’s just going to take us further to get there.”

In recent weeks, widely used national models have shifted to predict that Wyoming’s small hospitals won’t run out of bed space during a surge. Celebrating that metric is “narrow minded” because the state’s true limiting factor are doctors and nurses to treat the patients in those beds, Wheeler said. The shortage in staff is particularly acute given the expertise needed to confront the frightening respiratory impacts of severe COVID-19 cases, he said.

“If we use all the beds that would be an utter catastrophe,” he said. “There’s no way we can take care of all of those people.”

Wheeler understands the governor has a far wider range of considerations than just the advice of the state’s doctors, he said. He worries, however, that the sliver of optimism that appeared nationwide last week has lent strength to arguments in Wyoming to open the economy back up immediately.

From a public health perspective, social distancing measures should continue into the summer, Wheeler said. “If everyone starts congregating together again, we are going to see steeper growth,” he said. “It would be a huge shame to stop too soon, go back to work too soon and make it so all the sacrifices that we’ve made collectively are for nothing.”

Gordon and Wheeler speak frequently, the doctor said. “I am extremely proud of our governor” for the steps he’s taken and the messaging he’s delivered encouraging people to keep their distance from each other and practice good hygiene, Wheeler said.

Though the governor faced public heat for his disagreement with the Wyoming Medical Society, the governor continued to encourage doctors to speak up, Wheeler said.

Doctors do not have the same political concerns as the governor, Wheeler said. “Our being outspoken is helpful to him.”