Gordon urges patience in reopening state
Johnson County Health Officer Dr. Mark Schueler extended an exception to three local businesses that will allow them to reopen despite executive orders from Gov. Mark Gordon that forced many businesses across the state to close more than a month ago in an effort to prevent the spread of COVID-19.
The businesses include Penny’s Shearing Shed and the Lacquered Up nail salon in Kaycee, as well as the Buffalo Athletic Club. The Buffalo Athletic Club was open to patrons on Monday.
“Let’s try a few small experiments and see if we have an outbreak,” Scheuler said in an interview Monday. “Then we’ll start doing more and more.”
Schueler said that he received a request last week from a nail salon in Kaycee seeking an exception from the Governors Public Health orders issued in March. The orders permit county health officers to grant exceptions to the closures if effective safety and cleaning measures are documented in writing. That initial request was followed by the requests from the hair salon and fitness club.
Schueler said that he emailed State Health Officer and State Epidemiologist Dr. Alexia Harrist regarding the request for an exception. In a call Harrist held with county health officers last week, Schueler, who listened to the recording later, said that most were opposed to granting exceptions. Some felt it would be challenging to handle requests, he said, while others worried the state could lose control of the pandemic.
As of April 21, the Wyoming Department of Health reported 322 confirmed cases of COVID-19 in the state and 119 probable cases. Of those, 254 are reported as recovered. There have been six deaths, one resident in each Johnson and Laramie counties and four Fremont County residents.
Department of Health spokeswoman Kim Deti said in an email to the Bulletin that Harrist had discussed the exceptions with Schueler but had not conducted an extensive review of the companies’ business practices.
“She also communicated with him that most counties are not approving those kind of exemptions and discussed in general her concerns with such moves,” Deti said.
Schueler said in evaluating the requests for the exceptions, he considered the relative burden of the disease itself on the community – which he characterized as “low” with few deaths and few patients requiring hospitalization.
“I think we’re good enough now, and our position is good enough, that we can start letting businesses return to normal,” he said.
He did not think it appropriate to lift all orders, including an order that prohibits gatherings of groups larger than 10, and encouraged the continued use of hand-washing hygeine and limiting close contact.
“I think we are forecast to see things get a little worse before they get better,” Schueler said. “Our problem is either delayed or milder than forecast. In any case, let’s assume that a lot of folks have learned a lot about handwashing and wearing a mask, and we’ve got a more intelligent population about hand washing and wearing masks.”
Schueler said that he will issue two to three exceptions a week on a “first come, first served” basis. For the salons, Schueler said that owners must screen clients and that both clients and service providers must wear masks. If a client tests positive, the owner must self-quarantine for 14 days. Schueler said that wearing masks would be difficult while exercising at the health club, and he recommended “efforts to increase ventilation with fans and open windows will reduce airborne virus.”
Earlier in the week, Gordon had advised Wyomingites to prepare for a slow transition from current social distancing measures, citing models that showed Wyoming’s peak arriving in early May.
“Our transition into a new phase must be health data-driven, not date driven,” Gordon said. “If the people of Wyoming continue to do the right thing and we see the improvements we need to see, we will continue our transition to a stabilized economy. We need our economy back, but we must avoid a resurgence of this virus.”
Johnson County offers a comparatively small pool of data to aid that decision-making. As of April 20, the county ranked in the bottom third in the state for per capita testing, despite being home to the second-highest rate of per capita infection, trailing only Teton County.
Nonetheless, the county’s health officials did not cite lack of testing supplies as a problem.
“We have plenty of tests now,” said Crystal Smith, director of the Johnson County Healthcare Center’s clinic, during the Friday briefing. “But not everyone meets the requirements, so just keep that in mind.”
Two weeks earlier, Harrist announced that testing at the state lab would be limited to high-risk or hospitalized patients, health care workers and first responders in an effort to conserve testing supplies. Counties that wish to test additional patients were directed to send the samples to private labs for analysis.
“It doesn’t change anything, how we treat them or what we do moving forward, whether they’re positive or not,” Smith said, noting that in telemedicine and phone consultations, most patients described “mild” symptoms. “As long as we’re doing our due diligence of following guidelines and staying home, it’s working.”
In his press conference earlier in the week, Gordon said that under new Centers for Disease Control and Prevention guidance, a continued ability to identify and alert the close contacts of infected patients will be critical to reopening public places across the state.
“Any plan to scale back orders we have put in place over the last month will require aggressive contact tracing,” Gordon said.
On April 16, the Trump administration released new guidelines, describing benchmarks that communities should meet before beginning phase one of lifting social distancing restrictions. The metrics include a decline in documented COVID-19 cases over a 14-day period, a similar decline in reports of influenza-like illnesses and a sufficient supply of protective gear, beds and ventilators in local hospitals.
While the rate of confirmed infections appears to have begun leveling off in Wyoming, it is unclear if that shift can be interpreted as a decline in the rate of actual infections. An analysis by the Casper Star-Tribune showed that the timing of that flattening corresponded with the directives to limit tests submitted to the state lab.
Smith reported that she has noticed fewer calls from patients concerned about symptoms, though healthcare center CEO Sean McCallister added that the decline in questions could be attributed to more widespread information about the disease’s symptoms and spread.
As of April 21, according to the Wyoming Department of Health, 65 Johnson County residents had been tested at private or state labs, a rate of about 7 tests per 1,000 residents. According to information provided by the Johnson County Healthcare Center, 43 of those patients were swabbed at JCHC. Eleven tests have returned positive results.
Those figures put Johnson County’s rate of testing at about half of the U.S. average, based on testing figures from the CDC.
In the April 17 briefing, Schueler did not express a desire to test more patients as a result of the new federal guidance.
“If we want to see a decline and we change our testing strategy, how do we apply that?” he said. “Then we’re going to see different numbers.”
Schueler said that he felt the number of hospitalized patients or those severely ill and on ventilators is a better metric of how many tests need to be conducted.
“Nationwide, for every COVID death, in terms of jobless claims, there’s been 640 claims for unemployment,” he said. “I don’t know if that’s a high number or a low number, but there’s a significant impact to businesses, families, children going to school. So if we test more and we get more positives and we delay loosening restrictions but we don’t see any more morbidity or mortality, we’ve actually suffered more harm with no change in outcome from a medical standpoint, and I don’t think we want that. I think we want to get back to life as usual as soon as we can.”
Schueler called the low rate of infection in Wyoming “remarkable.” A group of economists led by University of Wyoming’s Linda Thunström explored the financial trade-offs of unemployment and reduced commerce under continued restrictions with the possible death toll of the virus in a recent analysis.
Under estimates of a 60-month gradual recovery, and using the value of a human life at $10 million, “in line with current federal agency guidelines,” the group found that relaxing restrictions and reopening the economy could actually cost the country a net $5 trillion. The researchers noted that the analysis is based on a specific set of assumptions and that the economic impacts would not be felt equally.
Schueler takes a different attitude than other Wyoming county health officials. In a press conference April 15, Natrona County health officer Mark Dowell, an infectious disease specialist, said the data is “falsely low” and that “we have not flattened any curve at all,” the Casper Star-Tribune reported.
“If anyone thinks that simply easing restrictions currently in place will lead to an immediate return to normal, they need to think again,” Gordon said in his April 15 press conference. “It is important to be honest about the economic challenges Wyoming will continue to face in both the short and long term. This will be a slow recovery.”
According to an April 16 report from the Wyoming Survey & Analysis Center, roughly three-quarters of respondents supported current restrictions on restaurants and bars, while more than 80% supported K-12 school closures. Both figures were down slightly from two weeks earlier. At the same time, 74.3% reported that they were very concerned about the impact of COVID-19 on the economy, a slight increase from the previous survey.
“We have got to get this right,” Gordon said in an April 17 press release confirming that current orders will stay in place until April 30. “We are living in a time where the new reality is that COVID-19 will be with us for the foreseeable future. Until we have a vaccine or a treatment, things are going to be different.”