​1. When did you first hear about telehealth? How did you feel about it then? How do you feel about it now?

Dan and Amy Surdam: We first heard about telemedicine more than a decade ago. Initially, it was very sporadically used. The technology was clunky and expensive. Now, we are happy to see the rapid advancement since 2020! Covid helped advance the technology and patient adoption of this technology when receiving healthcare.

2. When did you begin offering telehealth services? What prompted the need to offer these services?

Dan and Amy: We began offering telemedicine in 2016. We have always thought that there is a great opportunity to advance healthcare through technology. Wyoming is a very rural state and recruiting and retaining providers, and especially specialists, in remote areas can be challenging. We felt that telemedicine could help bridge this gap and provide increased access to health care.

3. What motivates you to continue offering telehealth services?

Dan and Amy: The need for healthcare is never going away. There will always be a need for healthcare, for accessibility, for earlier detection and intervention. We believe that telemedicine will continue to offer more and more solutions for people to become engaged and proactive in their health. As healthcare providers who have spent careers in Emergency Medicine and Urgent Care, we understand the value of keeping people out of the ER by screening, triage, and education. We want to be a part of the bigger picture of shifting healthcare to these strategies rather than a typical reactionary approach to medicine.

4. What is your proudest accomplishment with telehealth?

Dan and Amy: We were offering telemedicine several years before the pandemic started. In the first few weeks of COVID, our telemedicine use went from a handful of patients a day to 30 to 50 visits a day. Additionally, patients began to use our telemedicine services from our parking lots as they waited to be tested. We moved quickly to and deployed providers to answer these calls. We also developed an app that allowed patients to access our telemedicine platform more easily from home and the parking lot. We feel like we were prepared and responded well to the pandemic and the challenges that came with it especially as it pertains to telemedicine. Our proudest accomplishment was offering a safe alternative to traditional office visits at a time when so many people were scared and confused.

5. What advice would you give patients wanting to try telehealth?

Dan and Amy: Just do it! We have always thought the first visit is the hardest, but once you log in once, you will realize it is no different than Facetiming a friend.

6. What advice would you give providers wanting to start offering telehealth?

Dan and Amy: Offering telemedicine may seem intimidating, but it is not that difficult. It’s great for your patients and offers flexibility for everyone. When starting select a platform that is easy to use and costeffective. There is no need to purchase an expensive cart or platform initially. Telemedicine can be conducted by utilizing affordable platforms such as Zoom or Doxy.me at an affordable price.

7. What was the biggest barrier in providing telehealth services? Have you overcome it?

Dan and Amy: Internet capabilities in remote areas are a challenge. We are thankful that the state is prioritizing broadband to help combat this. With regards to fully virtual healthcare practices, we’ve also found that obtaining malpractice is a challenge. With patience and persistence, it is possible to find companies that will provide this. We also have found credentialing a challenge as payers often require a physical clinical address. This requirement and lack of understanding of how virtual healthcare operates prevent an unnecessary barrier to patient care.

8. How do you think implementing telehealth now will affect how things will be done at your organization after the pandemic is over?

Dan and Amy: Telemedicine will continue to be an important service line.

9. Is there anything you learned the hard way in telehealth implementation?

Dan and Amy: Initially, we thought patients and insurance companies would have adopted this healthcare delivery system more readily. That being said, it has been a slow and gratifying journey.

10. Do you have any telehealth hacks or tricks?

​Dan and Amy: “Webside” manners matter. Be sure to engage with the patient as you would in a clinic. Be sure to have an uncluttered work area and good lighting as well. It’s also okay to pivot when there are technology challenges. If there is a poor visual connection, sometimes finishing the visit via a phone call will suffice.

It’s Sunday morning and what used to be one of our favorite days of the week is now just another day of angst. We woke up to an email from a physician colleague, which was a cry for help. She was frustrated that there wasn’t more being done to help physicians, providers and health care workers and that more wasn’t being done to help our patients and our community right now. Last night, we had a similar call from a provider in tears asking for more help. We received that same call four other times this week from different folks on our team.
After 18 months of this pandemic, those who have remained strong and in the fight are breaking. This fourth surge has brought along with it a feeling of defeat. Why? Because many people are refusing to do what we know works, which includes receiving the vaccine, wearing a mask when indoors and observing social distancing when possible. It seems many are focused more on ensuring personal liberty rather than protecting the common good. It is extremely unfortunate that this has become a political issue rather than a matter of health and safety for all of us.
Making masks optional for school children took the wind out of us. We have learned much about this disease during the past year and a half and fortunately the disease has not hit children as hard as adults. With the delta variant, we are now seeing an uptick in children becoming more ill. Hospitals are once again filling up with COVID-19 patients. We know masks prevent the spread of this disease. We know that children can pass the disease to other children and adults, including at-risk individuals. We know saying that COVID-19 is just like the flu or a common cold is absolutely false, and we don’t know what the long-term effects of the virus will be on children or adults. We know in-person education is extremely important to children. We understand how important it is to keep our economy open and thriving. So why are we not doing what we know works to keep moving forward? Saying we will just deal with it and watch people dying from the disease is unacceptable in this day in age, and extremely risky behavior. The disease has passed the point of a pandemic and is now becoming endemic.
We know that by not requiring masks at school while inside, our need for testing will increase, our pediatric population needing urgent and emergency care is going to increase and the risk to the teachers will be drastically increased. Bullying to the children who do wear masks will be a real thing. All of this could have been avoided with a simple mask mandate for another school year until children under the age of 12 can receive the vaccine and herd immunity is reached in the community. Instead, we will see increased COVID-19 cases and massive disruption to classrooms and the economy as parents will have to stay home with their exposed children.
Parents, we encourage you to educate your children to wear masks at school while inside. This education will need to be repeated daily and your children will likely be ridiculed for it, but their efforts will help save lives and decrease the burden on the health-care system. Please have the courage to be a leader in your family and in the community.
Regarding vaccines: The Pfizer vaccine has gained FDA approval, which means the vaccine has been studied extensively and the benefit of the vaccine far outweighs its potential outweighs risks. While these vaccines are new, and were developed quickly, the technology is not new and has been studied for years. The mRNA technology of Pfizer and Moderna prompts our cells to make a protein, for a limited time, that triggers an immune response in our bodies. This immune response produces antibodies and other memory immune cells that are called to action later when you are exposed to COVID-19, protecting you from the virus. Is the vaccine 100-percent effective? No, but it is close. More importantly, those who do contract COVID and are vaccinated are far less likely to require hospitalization or respiratory support once hospitalized.
If you do not receive the vaccine, you will get COVID-19 at some point. Chances are you will be fine, but there will be some, even your loved ones, who will die from COVID-19. COVID-19 is a new disease and we aren’t sure how any one individual will react to it. We do know that those with risk factors such as obesity, hypertension and diabetes are at a higher risk for poor outcomes and even death and that vaccination will give you protection when you are exposed to COVID-19. In Wyoming we have had roughly 70,000 cases of COVID-19 and 809 COVID-19-related deaths thus far. That number of deaths doesn’t sound like a lot but put in context for our state, it is downright scary. That’s the census of many high schools across the state, or more people in many towns across the state. Currently, the vaccination rate of Laramie County is about 35 percent and Albany County is 45 percent. We can do better. We need to do much better.
This is all we have right now for prevention. We know masks and vaccines work, and more importantly are safe. These are the only tools in our toolbox that will shift the burden on health care away from the hospitals and clinics and alleviate some of the massive pressure that healthcare teams are experiencing.
This is a call for action. Please wear a mask in public when you are indoors and please receive the vaccine today. You can easily receive the vaccine by making an appointment at County Health and various other places. If you are unsure of if you need the vaccine, we have made a list of who specifically should receive it.

• 1) If you work in health care, have a family member who works in health care, or have a friend that works in health care you should receive the vaccine.
• 2) If you are immunocompromised or overweight, you should receive the vaccine.
• 3) If you have any comorbidities such as diabetes, hypertension or asthma, you should receive the vaccine.
• 4) If you have a friend or family member who is immunocompromised, overweight or has any comorbidities, you should receive the vaccine.
• 5) If you have a child who is under the age of 12 or you are around any children under the age of 12, you should receive the vaccine.
• 6) If you are over the age of 12, you should receive the vaccine.

And to our health-care colleagues, please be bold in speaking with your patients and friends and families about the vaccine and its importance. Be bold in speaking to the community. We would encourage you to also write an op-ed or letter to the editor that can be published then shared on social media. We need a collaborative effort to educate the public on the value and importance of the vaccine. Vaccination and masks are the only thing that will ease our volumes and lower acuities, and once again flatten the curve. Perhaps the public will listen to their health-care providers. Perhaps if enough of us say the same thing in different ways, they will hear us and help.
Dr. Dan Surdam, MD, is an emergency medicine physician at Cheyenne Regional Medical Center and Amy Surdam, FNP, is the COO of Stitches Acute Care Clinics and Lt. Col. in the Wyoming Army National Guard.

When Dr. Daniel Surdam, my husband, returned to Wyoming from his Emergency Department residency, he knew there was a need for urgent care in Laramie. Little did he know what a critical role urgent care would play in the current COVID pandemic.
When COVID started in China less than a year ago, we watched the news just as stunned as everyone else. It was like a foreign film. It seemed like overkill.
 As more and more people contracted COVID, we realized that the inevitable would happen: COVID was going to come to the United States. In early January, we received our first indication that there would be supply chain issues. Masks were in short supply and already on allocation with orders only permitted every five days. At that time, we didn’t know what we needed, but we knew we need more, and we knew we would run out of something.
Our teams started ordering items we thought we would need for a heavy flu season: gloves, masks, IV fluids, albuterol. By the time March rolled around, we had a small stockpile of supplies that saved us in the early days. On March 13, we started car testing via a private lab in Cheyenne for COVID in full PPE. It felt surreal for our patients and our healthcare team alike. Testing was minimal at the time and difficult to procure.
 On that first day, one woman said she felt her privacy was violated; then, she drove away. Despite that, we continued to car test. For seven months, our teams have worn snow pants, tank tops, and rain gear under protective paper gowns as an effort to keep patients as safe as possible.
Our supply chain issues have become desperate at times, yet, our community has graciously donated all that they could. The boxes of N95’s from rancher’s sheds have helped keep us safe.
Likewise, we have shared with others when we could. When gowns were hard to obtain, we gave what we could to home health agencies, long term care facilities, and others. For a while, we traded PPE like it was part of an underground market. We texted, swapped, and shared protective equipment with competitors and other healthcare friends.
There was a lot of unclear communication at first. It wasn’t easy to know where and how to find information. I think we have all gotten into our grove of fighting the COVID battle in whatever way we can fight it. The counties have done a phenomenal job of contact tracing and providing PPE as they are able. The State Department of Health has been an innovative and fantastic partner that has provided free testing to many citizens.
Our constant mantra as a way to decrease cases has been “mass testing, mass isolation.” Like so many others, we have tried to educate the public: wear masks, wash hands, social distance. Despite that education, masks are still being resisted and not worn by some. Change is slow, even during a pandemic.
We were heroes at first, with donuts, pizza, and lunches delivered daily. Our communities embraced us. As the months have worn on, the novelty has worn off, and COVID has become deeply politicized. We all want things to go back to “normal”; however, there is great debate on when and how that should occur.
 The drastic spike we see in Wyoming is a result of two things:

1. Failure to be proactive in protecting oneself and others.
2. Increased exposure.

Employers call continuously and ask what to do about exposures at work. My first question is always, “Do you require masks at work?” Often the answer is no.
After seven months.
There are events, large family gatherings, BBQs, trick or treating, and more. All of these events and being in the workplace without a mask lead to increased exposure. Increased exposure leads to an increase in COVID cases. The desire for human connection often wins over the sound reasoning of wearing a mask and social distancing. This is perhaps the most significant dichotomy of the pandemic that I have seen.
 Now, we are starting to see reinfections. The waning of antibodies causes pause and concern that an anxiously awaited vaccine won’t provide an immediate solution. The seasonality associated with most coronaviruses may apply to COVID 19 as well.
 Wyoming cases have surged, and there is no end in sight. We have seen a record number of patients day after day for months, and the community hospitals are filling up.
This last month was incredibly trying. We literally cannot hire and train people fast enough. Even if we could, there are only so many parking spaces, only so many computers, only so much PPE. Our phones ring endlessly, and often people can’t get through. The paperwork involved with COVID testing is cumbersome and maddening. In a highly technologic world, the rudimentary processes involved in healthcare are more exposed than ever.
Getting through the next few months, let alone days will be mentally challenging. Other logistical challenges lay ahead, such as delayed shipping as we compete with online holiday shoppers, rapid COVID tests no longer being provided by the State come January, the Federal Cares Uninsured Program possibly ending at the end of the year.
We anticipate some positive future developments, such as saliva testing, the continued adoption of telemedicine, and ongoing safety measures that help prevent other diseases.
For the most part, our patients have been very understanding. They say thank you, are kind, and give our teams the smiles they need to keep going.
Our healthcare team is a “well-oiled machine,” as Katie Sanne, FNP, likes to say. They work to their maximum capacity day after day and continuously adapt to every change made and every type of weather that Wyoming gives them.
This is their new normal.
None of us have experienced a pandemic such as this. The virus is still very new, and we don’t know its lasting health effects. It will be years before we understand the actual economic and social impacts our collective responses have had. Lost wages, businesses closing, increased abuse, and the elderly spending their last months alone are only a few examples of the negative impacts our society has endured.
We know that hospitals in Wyoming and throughout the nation are reaching capacity, and many more COVID related deaths will occur. We know that while healthcare workers have risen to the COVID occasion, they are tired and worn out.
My 92-year-old grandmother, who lives in a nursing home, contracted COVID and recovered. We know that most of us will get to the other side of this. May we get there with compassion, kindness, and a newfound appreciation for human connection and solemn remembrance of those who did not survive.

I'm extremely humbled and honored to be named this year's Women of Influence in Healthcare. My team is incredible and they make me look good :)

During the past several months, your Stitches team has done everything in their power to make sure we have been on the leading edge of the pandemic in an effort to keep our communities as safe and healthy as possible.  We have made the decision to offer antibody testing and have been doing so for the past week with some remarkably interesting results.  We are still sorting through what the results really mean from a public health perspective.
What Are the Different COVID-19 Tests Being Offered?When looking for evidence of an infection, we have two tests we can use.  The initial test released to the public was the molecular test where we collect a nasal swab and look for the virus’s RNA (part of the genetic code inside the outer protein covering of the virus).  This is the best test to see if there is an active infection. 
The second test is to look for antibodies and is collected through a blood draw.  Antibodies are produced by our immune system in response to an infection.  The presence of antibodies can be a sign of an active, recent, or past infection.  It is important to remember that it takes time for these antibodies to develop.  In the first 5-10 days of the infection, antibodies will show up in only about 50% of the patients tested, but waiting two weeks from symptom onset, the test is more than 95% accurate.
What Does the COVID-19 Antibody Test Tell Us?Also known as the SARS-COV-2 AB, the test checks for presence of antibodies to this specific Coronavirus in our blood.  As above, these antibodies are in response to the COVID-19 infection which we start to see approximately 7 days after onset of the illness.
Which Antibodies Will Be Tested?We are utilizing the Cellex qSARS-CoV-2 IgG/IgM rapid test (https://cellexcovid.com/). It will test for both the IgM and IgG antibody for COVID-19.  We usually see the IgM antibody show up first, usually within 7 to 14 days of the infection and can last for several months.  The IgG shows up a little later and tends to persist for over 6 months (and maybe years).  If you have the IgM antibody, this can mean you still have an active COVID-19 infection, or you have just gotten over the infection.  The IgG antibody usually indicates past infection. 
Who Can Get Tested?Stitches is offering the molecular tests to both asymptomatic and symptomatic patients. We are also offering antibody testing to anyone who requests the test, and recommend it for those who either are asymptomatic but think you may have had the infection or have been ill for more than two weeks.  Also, if you are already in the clinic and for a completely different reason, we can offer this test to be done on-the-spot.
Where is the COVID-19 Antibody Test Done?Stitches offers the blood test to patients at any of our locations.  Convenience for our patients is of upmost most importance, and since this requires a blood draw, we have found it more efficient to schedule an appointment. Simply call our office to schedule.  If you didn’t schedule an appointment, no big deal, we have extended hours and open on the weekends, walk in anytime we are open, and we will take care of you!
How Long Do the Results Take?Expected turnaround time today is 4-7 business days.  Since this test is very new, this may change with time.  As soon as we receive the results we will call you to discuss the results. 
Is it FDA Approved?We are utilizing the first test to receive Emergency Use Authorization (EUA) from the FDA.  No antibody testing has received the official stamp of approval from the FDA, but they have stated it may be used under the EUA premise. From the FDA, “Results from the antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status.  Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E.”
Does Having COVID-19 Antibodies Mean Immunity?We’re not sure.  First, there are test results that can be falsely positive.  This may be due to a cross-reaction with other non-SARS-CoV-2 coronavirus antibodies.  Secondly, the assumption that you cannot get COVID-19 twice is at best a scientific guess and not a proven fact yet.  More data will be needed to determine what immunity these antibodies convey.  We also don’t know how long they will last.  This is why we encourage everyone to have both the molecular test and the antibody test done to provide us with the most information possible.
Prevalence of COVID-19Why test at all? This blood test is currently of utmost importance in estimating the prevalence of COVID-19 in the general US population.  By testing the presence of the antibodies, we will have a better understanding of approximate percent of the population who has already been exposed or had COVID-19 and recovered.  The information is vital to our public health for both prediction of when we may see herd immunity, as well as validation and interpretation of future serological tests.  If you have the IgG antibody, you may also be able to donate plasma to help patients who are actively fighting the disease.
Herd ImmunityWe need population level antibody information (seroprevalence) in order to predict just when herd immunity may develop.  Generally speaking, 60% of a population being immune to the virus will act as a firewall slowing or stopping the virus from effectively spreading to the remaining 40% of the population who is still susceptible.  Actual numbers of course depend on the how infectious the disease really is.
How Much Does It Cost?For COVID-19 related illness and testing, most insurance companies have stated they will cover the entire cost, including testing.  We will bill your insurance company for the office visit, and the private lab will bill your insurance company for the lab tests.  If you do not have insurance, at this time through the CARES act, the office visit and lab test will likely be covered while funding remains (if funding runs out from the Federal Government, you may receive a bill). 

Wyoming techies team up, take on challenge of coronavirus
By Margaret Austin, Wyoming Tribune Eagle, picked up by the Denver Post
CHEYENNE, Wyo. — Across the state of Wyoming, there are web developers who specialize in coding mobile applications, makers who use 3-D printers to bring ideas to life and mapping professionals who use GIS to show data visually.
So as Array School of Technology and Design CEO Eric Trowbridge watched coronavirus impact communities around the world, he started brainstorming ways to bring Wyomingites in the tech community together to find solutions.
With Array leading the charge, the Wyoming Technology Coronavirus Coalition was formed March 17. Since then, the network has grown to more than 200 volunteers with different ideas to help the people of Wyoming in the midst of the coronavirus outbreak.
“We need to bring the tech community around the state of Wyoming together once and for all, and all collaborate and work together,” Trowbridge said.
“This pandemic has really given us a way to solidify that.”
In Laramie, the University of Wyoming’s Engineering Education and Research Building Student Innovation Center has almost $1.4 million worth of brand new equipment, including 3-D printers.
Now, under the leadership of Makerspace Coordinator Tyler Kerr, those 3-D printers are being used to make surgical masks for hospitals across the state as part of the coalition. On one day in March, they provided 115 masks for the staff at Cheyenne Regional Medical Center, the Wyoming Tribune Eagle reported.
“This absolutely felt like something we had to do,” said Kerr, considering the resources they have at their fingertips. “I think it’s really in our power and should be expected of us to help.”
Kerr first heard about the possibility to 3-D print surgical masks from a registered nurse at CRMC. Working at the direction of health care professionals, UW students and staff have printed masks they know those in the medical field can utilize.
Kerr said they have to be cautious in what they produce, making sure they’re up to health care standards. They’re currently in the process of creating face shields, in addition to surgical masks.
“Anything were producing is what the medical community is asking for,” Kerr said. “We’re letting their teams, their experts drive the conversation.”
While UW is the main point of contact for 3-D printing, the coalition’s utilization of Slack, an online messaging system, has allowed individuals and hobbyists with 3-D printers to join the efforts and provide help as they can.
Within a day of creating the Wyoming Technology Coronavirus Coalition Slack channel, Slack donated $800 to help with their efforts.
Due to the sheer amount of residents willing to step up and help, the coalition has created a team of four or five volunteers to sort through the submitted ideas and decide which projects should take priority. Ryan Alford has taken on the role of community manager, pairing up people with similar skills to help increase efficiency and meet the community’s needs.
“We truly want to be able to support all of Wyoming,” Alford said.
Already, the coalition has put together a website where residents can tip service industry workers and delivery drivers directly using money transferring apps such as Venmo and Cash App. Thanks to techies across the state, businesses can now contact the coalition to set up a VPN so their employees can work from home. Volunteers have arranged a medical supply drive at UW and are in the process of creating a GIS map with up-to-date information on coronavirus cases in Wyoming.
“I’ve never been part of a group like this in my life,” Alford said. “It’s really exciting to see people just step up and say, ‘I’m here. I want to help. Can you give me something to work on?’”
The idea of the coalition is that collaboration will lead to better ideas and faster execution. Out of a partnership with Array and Stitches Acute Care Center, a new telehealth mobile application for Stitches was launched to provide medical assistance to those who can’t get into the clinic.
While telemedicine visits aren’t new to Stitches, the app will provide “an easier way for patients to access telemedicine in Wyoming and Colorado,” according to Stitches co-owner Amy Surdam.
“Now, more than ever, offering telemedicine to patients to keep them home and keep them away from health care facilities — it’s critical,” Surdam said.
While the main focus is projects that will assist in the fight against coronavirus, some of the endeavors such as the Stitches telehealth app will continue serving Wyoming residents once things return to normal. The Wyoming Technology Coronavirus Coalition serves as an example of the difference one person or idea and make during a time of crisis.
“At the end of the day, it felt like the right thing for Array to do — to get involved and to make an impact,” Trowbridge said.

Owners Transform Clinic Into Hub For COVID-19 ResponseBy COOPER MCKIM • MAR 20, 2020
On March 12, Amy Surdam and her husband Dr. Dan Surdam waged war on COVID-19. The two Wyoming residents own Stitches Acute Care - a clinic in Laramie, Cheyenne and Wellington, Colorado. The clinics have transformed into a testing and treatment center for the global pandemic at a local level as well as an information hub for the whole state. Amy and Dan Surdam tell the story of how their world has changed in just a week.
Amy Surdam: The view of our patient population, I think has definitely changed. I think a week and a half ago, we viewed our patients as the people who sought care from us at Stitches and now we very much view our patients as the entire population of our communities that we serve and are really just trying to protect as many people as we can.
Cooper McKim: One of the biggest things that I hear is that testing has been hard to come by that, that the state and most states are underprepared when it comes to ventilators, and just beds available. Have there been those challenges? And have they improved?
Dr. Dan Surdam: So, yes, those challenges are all the realities that we're facing, I think when this first started to come our way, so to speak, there was announcement made that the federal government said the government's going to make a million tests available. And to the layperson, well, that sounds like a lot. But when you try to distribute that throughout the country, that really doesn't go very far. Our biggest frustration up to today, still, that we can't test people who we want to test because when people are scared, and they don't feel well, you know, they want to know if they have the virus or not. And we can we have very limited tests, so we have to be... we felt we're following the CDC guidelines in terms of who gets a test and who doesn't get a test... but those are changing very quickly.
And so we've we've had to be very kind of prudent in terms of who we're testing, who we're not testing. Initially Wyoming was allocated zero tests when this all began in California received 200 tests. So, it gives you an idea of kind of the woefully inadequate initial response. And now we're chasing our tails, so to speak. But we are ramping up. Private laboratories are kind of ramping up their ability to test for this virus. And so, we're seeing more more tests, kits available coming our way. It may take two weeks, before we're able to really kind of test everybody that needs to be tested.
And in terms of protective equipment there's a huge shortage. People initially were hoarding supplies and people were actually stealing supplies. And so the people on the front lines that needed the supplies that that we just simply don't have them. So, we're doing everything we can. We've gone to Home Depot to buy masks that will protect our employees and our patients.
CM: What do you want ideally, from the state of federal government right now, and maybe what would you have wanted from the beginning?
DS: You know, I think that that's a great question. And I think once we come out the other side we'll have maybe a better answer. I think, you know, if anything, we needed more transparency and the state and federal government really aren't... they're not set up to deal with a pandemic like this.
"The people on the frontlines, you know, a lot of times are not communicated with in terms with the state and federal agencies."We have the technology and the capability to quickly test people and to get those results out into the community and let our citizens know how widespread the diseases. But the fact is, we weren't able to test in a timely manner. The people on the frontlines, you know, a lot of times are not communicated with in terms with the state and federal agencies. I'll give you an example: there's counties that have a stockpile of certain supplies, but can't be released because they're controlled by the federal government, and these local agencies have not been given In the green light by the federal government to release the suppressed supplies to EMS responders and frontline workers.
I think when the dust settles, we will have learned a lot, and in the future will be better prepared for novel viruses like this that, at this point, we don't have any immunity against.
CM: A lot has changed in the past week. Do you feel like the community is ready to help handle what's going on in that we're in a better position now?
AS: Yes. When we decided to take definitive action last Wednesday, so a week ago, it was very unnerving even internally to say, "We have to make a decision right now, are we, are we going to separate sick from well? Are we going to do this like, right, from lessons learned from other countries and and go forward with this or not?" And so we implemented on Thursday, six days ago, we segregated sick from well and we initiated car testing and really pushed people to utilize telemedicine and those first few patients, that first morning, when we were going out to the cars in our PPE and swabbing and screening... there was a lot of hesitancy and a lot of looks from drivers-by... and I think we were all like, is this really happening? Is this really what we're supposed to be doing? And there were some people questioning the necessity of it and... but I think, in the short six days that have passed, people are accepting of this and grateful that there's a separation and we're limiting as much exposure as possible for our staff and community members and patients
"I think there are still some people who are at Walmart or getting together with others in a social setting, and that's just not safe for a lot of people in our community."CM: What are the big remaining issues to tackle for you guys going forward?
AS: Our immediate issues are supplies, protective equipment, N95 masks and also enough swabs that we can truly test, you know, every every one or the people who need tested right now... we have to be very picky about who we test. The results that we have received, the patients have that have been positive, have had fairly mild symptoms in that they did not need hospitalization or anything like that. So, I think this is much more prevalent than then we are aware of just because we have had such limited testing. So those are our immediate concerns.
I think the other immediate concern we have is for people to take this seriously. It's not a game. It's not an exercise. This is real time, this is happening. This is here and we have to protect our community members, I think there are still some people who are at Walmart or getting together with others in a social setting, and that's just not safe for a lot of people in our community. And so we would hope that people would take this very seriously, and everyone would social distance and self isolate as quickly as they possibly can.
Have a question about this story? Contact the reporter, Cooper McKim, at cmckim5@uwyo.edu .

In a span of 24 hours, Wyoming health officials identified seven more cases of coronavirus, four of them in Cheyenne. As of early evening Wednesday, the state’s new total for confirmed cases of the respiratory illness stands at 17.
The new cases are four in Cheyenne, including one service member on F.E. Warren Air Force Base; a Park County woman who works for the Cody hospital; and two Sheridan County residents whose cases are linked to previous cases there.
Details vary from case to case; for the first time, entities other than the state Department of Health have confirmed cases, with the military and the city of Cheyenne each identifying one Wednesday. The Cody health care worker is a woman who’s not hospitalized and is self-quarantined at home. One of the Cheyenne cases is a woman in her 40s who was described as “healthy.”
The state’s total stands at 17 patients, all of whom have been identified in the past week. According to the New York Times’ daily tracker, there have been more than 8,000 cases across the United States as of Wednesday night. At least 143 patients have died as a result of the respiratory illness, which causes fever, shortness of breath and cough.
There have now been 68 deaths in Washington state, where a cluster tied to a nursing home has led to more than 100 people testing positive. Every state in America now has a confirmed case. In Colorado, 33 new cases were confirmed on Wednesday alone, bringing the state’s total to 216, according to state data.
In Wyoming, many of the cases are linked to others. Eight patients in Lander are either staff members or patients at an assisted-living center that’s under quarantine. Four Sheridan County cases, including the two new patients, are linked together.
Last Wednesday afternoon, F.E. Warren confirmed one of its service members had contracted the virus after traveling out of state.
“The safety and security of the men and women of F.E. Warren AFB remains our top priority,” Col. Peter M. Bonetti, 90th Missile Wing Commander, said in a statement. “I can assure you that our operations remain unaffected. We will continue to work with our local and federal partners to actively combat the spread of COVID-19.”
In Park County, a spokeswoman for Cody Regional Health confirmed in an email that the Park County patient was an employee of the hospital.
“As per national protocol The Wyoming Department of Health and Park County Public Health are leading the investigation and providing guidance to Cody Regional Health upon next steps,” spokeswoman Annalea Avery said in an email to the Star-Tribune. “CRH Incident Command is actively involved in taking measures to ensure continued employee and patient safety.”
The state has continued to change its testing guidelines as the situation in Wyoming evolves. In a Wednesday notice sent to providers, the Health Department said it was now prioritizing tests for health care workers, hospitalized patients, those living in communal settings, those who may develop a serious case of the illness and those who’ve been in contact with someone confirmed to have COVID-19

That same message told providers to send non-priority tests — like those of patients with mild symptoms — to private labs. It also told hospitals to “enact plans for enhanced surge capacity.”

“While we don’t know exactly how widespread this illness will become and how many residents will require hospitalization, we do believe it’s a good idea for facilities to be ready,” Health Departments spokeswoman Kim Deti told the Star-Tribune. “This is a quickly changing and unpredictable situation.”

How to publicize?After the second Cheyenne patient was confirmed Tuesday night, Cheyenne Mayor Marian Orr criticized how the news got out. An hour before the Health Department announced the four new cases, Amy Surdam, who owns an acute care clinic in the capital, tweeted that the facility’s “first COVID test came back” and that it was positive, referring to the Laramie County woman who would be one of the four cases announced by the state.
In her tweet, Surdam identified the female patient as a 49-year-old “healthy female.” She added that her clinic hoped to have additional results Wednesday.
Just after 9 p.m. Tuesday, Orr tweeted that Surdam breaking the news over Twitter before the department was “simply unacceptable.”
Earlier in the day Tuesday, after the first Laramie County case was announced, Orr tweeted that the Health Department had taken it “upon themselves to release information to the press regarding our first presumably positive case in Cheyenne,” expressing frustration that the department hadn’t included any city or county responses in the release.
“I expect better in the future,” she said, tagging Gordon.
Deti, the Health Department spokeswoman, said the Laramie County health department was notified of that first case before the state announced it. As for the second case, the one announced by Surdam, Deti said the clinic had let the state know about the results, which — Deti said — were from a private lab, not the state-run facility.
“(If) a provider gets results from a private lab, they do need to let us know,” she told the Star-Tribune. “That did happen. But then if a private provider chooses to share that information publicly on their own, that would be that provider’s decision.”
She added that the state Health Department “will stick to our standards and practices necessary both to share relevant health information and protect patient privacy.”
The press releases from the Health Department over the past week announcing positive cases are typically relatively bare bones; they confirm the case, identify the county and gender of the patient, and sometimes generally describe the patient’s age.
When the Department of Health announced four new cases Tuesday night, that made 12 new Wyoming COVID-19 cases confirmed in 24 hours. Late Monday night, the Wyoming Department of Health reported that seven new patients had been identified, all in Fremont County. All seven were tied to an earlier case involving a man living at a Lander assisted-living center. A health official in Fremont County said all were either residents or staff members at Showboat Retirement Center. Others tied to the facility and potentially exposed to the disease have been tested.
The addition of two more patients Wednesday add to this week’s mounting total.
Beyond the two from Wednesday, four from Tuesday night and the eight in Lander, three other cases have been identified by the state over the past week. The most recent was the Cheyenne man, who was reported on Tuesday afternoon. Last week, two Sheridan County residents also tested positive for coronavirus. One, a woman, was recovering at home. The second was a man who was tested while visiting Colorado. Officials say those two Sheridan cases are linked.

By Wednesday morning, the state had run more than 180 tests. Wyoming Medical Center had seen nearly 300 patients in its respiratory clinic and tested 14 of them for COVID-19. The hospital itself tested another four.
COVID-19, which is the disease this new coronavirus causes, can result in respiratory issues. Symptoms include fever, cough and shortness of breath.
Anyone who is concerned that they may have COVID-19 is asked not to immediately head to the emergency room unless they’re having significant breathing problems. Instead, they’re asked to call their health care provider and get guidance on how to move forward.
There is no vaccine for COVID-19. Most people, those who don’t require hospitalization, will self-isolate at home for a couple of weeks. More than 80 percent of patients will have mild symptoms from the disease.
Officials have urged all residents to practice social distancing, which means minimizing close contact with others to cut down on the spread of the highly contagious COVID-19.

Two Wyoming residents who exhibited symptoms of COVID-19 infection said they fear their experiences of denied testing and delayed treatment demonstrate how scarce supplies and a slow response may have exacerbated the pandemic’s spread. 
Both women had fevers, low blood-oxygen levels, coughs and difficulty breathing beginning in late February. One has pre-existing health vulnerabilities, including asthma and heart trouble, and works with vulnerable communities. Both traveled beyond their home towns and had weeks to unknowingly spread contagon. Neither has been tested yet. 
The state’s guidelines for testing and its capacity for processing them has changed several times since the two women first showed symptoms similar to those of influenza and COVID-19, Kim Deti, Department of Health spokeswoman, told WyoFile on Wednesday.
Wyoming issues guidelines that physicians use to determine who is tested and who is not. Initially those with travel histories or contact with people known to have been infected were high priority. People seeking testing had to, and still largely must go first to their primary healthcare provider, who decides whether to proceed, she said.
New guidelines issued yesterday prioritize healthcare workers who have been in touch with infected patients and who also exhibit symptoms; patients who are hospitalized; people susceptible to illness; older people and people who live in communal settings, according to the department . Physicians no longer need state permission before submitting a sample for testing, the new guidelines say.
But guidelines are moot without the materials needed to execute the tests, and that’s not the state’s responsibility, according to the DOH. “The [Wyoming Public Health Lab] does not provide swabs or viral transport media,” the guidelines on the Wyoming Department of Health reads.
Some healthcare providers are short of the swabs and transport vials, making it necessary to select patients for testing according to state guidelines.  
In a video released this week by the Northern Arapaho Tribe, Dr. Paul Ebert, chief medical officer of Wind River Family and Community Health Center in Arapaho, said testing capacity is limited. 
“Despite what you are seeing on TV and what the feds are saying, we still do not have widespread testing available,” Ebert said. “Because we are in a rural area, our testing depends on what’s called viral transport media … there’s a very limited amount of that media available right now.
“Right now we have to pick and choose who we test,” he said. 
In Jackson, one physician told WyoFile he ordered 20 sets of swabs and transport vials from LabCorp, and expects to get them in 24 hours. He had only a couple of sets on hand Wednesday, he said, but doesn’t want to deny testing to those who want it.
“We’re doing testing on-demand,” Dr. Brent Blue of Emerg+A+Care said. “If [patients] want to pay the $80 [for the swabs, vials and lab work], we don’t care.
“The average physician probably has two or three sets,” Blue said of the swabs and vials. “We’ve never been told how to get [them] from the state.”
Amy Surdam, who runs Stitches Acute Care Center in Laramie, Cheyenne and Wellington, Colorado, also is short of swabs and vials. “We’re trying to source the supplies from wherever we can,” she told WyoFile.
“We have some right now but it’s still very limited,” Surdam said. “We think we’re going to get more tests today. We have labs that can process more tests than we have swabs.”
Personal protective gear also is in short supply, she said. “We have one mask per staff member — that’s it.”
“Mass testing and mass isolation is how we beat this and we’re not doing either,” Surdam said.
Nationwide and in Wyoming the inability to roll out widespread testing for the coronavirus COVID-19 has generated expansive debate and criticism. Medical workers have tested 251 people of Wyoming’s estimated population of 579,280 residents, the Wyoming Department of Health reported Thursday.
Most of those were completed at the Wyoming Public Health Laboratory; the federal Centers for Disease control analyzed one test and commercial labs another 12. On Thursday morning, the state reported 17 confirmed cases of COVID-19 spread across Fremont, Park, Sheridan, Laramie and Teton counties.
An early case in Lander It was “like an elephant standing on a lung,” said a 44-year old school district employee in Evanston who asked not to be identified by name for privacy and other reasons. Her problems began on Friday, Feb 29.
A physician disagreed with her assertions that her malady was COVID-19-like and instead ordered tests for blood clots and heart problems. Neither he nor a medical facility instituted what she believed should have been proper hygienic protocols.

A nasal swab to collect a sample for COVID-19 exposure. (Brent Blue)The other patient, 64-year-old Lander health care professional, woke up Tuesday, Feb. 25, “with a very hard coughing — a lung kind of cough.” She has other health problems and didn’t initially think she might have been at risk for COVID-19 infection, she said.
But when her symptoms persisted and worsened, she found little help and no test available, despite her vulnerable health profile. She paraphrased one response to her request for testing: “You don’t need it. We just need to assume influenza — the flu.”
She first noticed her symptoms after traveling to Cheyenne the weekend of Feb. 22. While in the capital, she attended functions with large numbers of people and dined out.
It would be 15 more days before Wyoming announced its first confirmed case of COVID-19 in Sheridan County.
Given her ongoing health problems, including asthma, previous heart attacks and other issues, she knew it would take more time for her to recover from what she figured was a flu than it would other, healthier people.
She cut her hours at work and went home early on Friday, Feb. 28. “I was running a fever in the mornings,” she said. “When I woke up I was drenched” in sweat.
Looking back, she said she should have stayed home. “Because I do get sick very easily, I try very hard not to let those things interfere with my work,” she said.
The week of March 2 she worked short hours again. On Friday, March 6, she called in sick, went to a physician and reported her symptoms.
“They gave me a mask,” she said. “They got me through very quickly. I had shortness of breath.” Her blood oxygen levels were lower than normal.
“You have all of these underlying medical conditions,” she paraphrased her physician. “We’re just going to treat you like you have influenza. Come back if you are not better.” 
It would be five days before Wyoming would announce its first COVID-19 case. It would be seven days before the state announced the first case in Lander, where she lives.
She kept trying to workThe woman again tried to work the week of March 9, again for short hours and behind the closed door of her office. The Department of Health announced the first case in the state that Wednesday. She went home from work early Thursday. She did the same Friday, the day the state announced the Lander case in a resident of the Showboat Retirement Center.
On Monday, March 16, with a confirmed case in her backyard, she again sought medical attention. “I’ve been sick a long time,” she said she told her physician. “I still have these symptoms. I think I need to be tested for influenza or COVID, or whatever.”
The response was, “you don’t meet the criteria,” without having traveled internationally, she said she was told. Even a call to state officials couldn’t provide a test, she said.The Department of Health referred her back to her physician, she said and, if she had a complaint, to the State Medical Board.
“The way they’re handling this is they’re completely disregarding human nature,” she said. “In this particular case they’ve decided ‘we’re not going to give any information at all.’”
“Just give people some information,” she said. “Don’t treat us like we’re stupid — just be honest with me. Say ‘We don’t have enough tests, therefore we’re going to go ahead and treat you for all the underlying conditions.’”
Evanston to Utah, Denver and backIn Evanston, the school district employee said she began coughing Thursday, Feb. 27, three days after she had contact with a person who had been in contact with the Lander health care worker above, and two days after that patient first noticed her affliction.
She traveled to Salt Lake City and mingled with large groups of people the weekend of Feb. 29. “I just felt a little different, run down,” she said. Her temperature rose to 101.
But she soldiered on. “I really was busy and had a lot of things to do,” she said.
After returning to Evanston, she traveled to Denver and again mixed with crowds. She began seeing stories about COVID-19 and suspected the worst. She returned to Evanston on Tuesday, March 10 and saw a physician the next day.
He came in with no gown or smock or lab coat — “just his Tommy Hilfiger polo shirt on,” she said.
“There was no face mask available,” she said. Her blood-oxygen level was low.
The doctor ordered a blood test, a chest X-ray and an EKG or electrocardiogram to measure her heartbeat. She protested but began going through the tests at a medical center.
Waiting for one procedure, she found herself close to six or seven elderly people. She was coughing into the crook of her elbow.
“I was feeling lightheaded,” she said. “This is not a good idea,” she said she thought to herself. “I called my husband to come pick me up.”
Her physician tracked her down by phone and asked why she didn’t complete all the tests he had ordered, she said.
“I don’t want to get other people sick,” she said she told him. She paraphrased his response: “You might have a touch of the flu — sleep it off.”
The next day, she went back to find out one test was negative for blood clots, she said. By then, March 12, the physician’s procedures had changed. Workers asked her to wear a mask.
“I have no protocol on that,” she paraphrased the physician. “At this point, there’s not enough tests in Uinta County. We’re saving those for our elderly patients.”But when she asked whether she should get tested for COVID-19, the answer was no.
The medical center administrator did call her to apologize for letting her walk around the facility while potentially exposing others to an illness, she said.
“I feel like I’m getting better,” she said Tuesday. “My lungs don’t feel as heavy. I still have a cough. I think my [oxygen] levels are higher. I haven’t had a temperature I’m aware of.”
What’s next?Health Department spokeswoman Deti said she’s heard no plans for mass testing in affected areas like Lander.
“I don’t know if that’s a capability we will or will not be able to offer,” she said.
Whether anybody who has symptoms can get tested remains the decision of a person’s physician, Deti said.
“Your health-care provider would have to use their judgement,” she said. “If they did [want to test] they would take a swab.”
The process involves inserting a long Q-tip-type probe deep into a patient’s nose, then withdrawing it and sealing it in a vial for transport to a laboratory for analysis.
Some local health centers have provided drive-up testing, Deti said, pointing to Cheyenne as one location.
Wyoming opened its own laboratory to COVID-19 testing March. 5. Before that, tests had to be sent to the federal Centers for Disease Control.
If a testing bottleneck still exists, however, it’s not with the state laboratory’s capacity, Deti said. 
On a recent day, the laboratory analyzed some 100 swabs from patients’ noses, Deti said. There are 150 or so pending tests entered in the state computer system, meaning a provider has sent samples to the laboratory for processing.
“It’s hard to look back and know what may or may not have happened,” she said of the women’s particular cases. “The testing at the time was limited.”
The state laboratory, “they’ve been keeping up,” she said. “There’s no backlog.”
— Andrew Graham and Katie Klingsporn contributed to this story.

Sunday, March 1, 2020Re-Ride program entering a new, more expansive phase. And the founders couldn’t be prouderBY RICHARD JOHNSON

The Godfather of the Cheyenne Re-Ride program was a guy named Harry. 
He told me of a program where the police in another municipality would donate the unclaimed bikes to the school district for kids assigned court-ordered community service, They would learn to repair the bikes and put them at local trailheads for bike paths.
I loved this idea. One day I met with Downtown Development Authority director Amy Surdam and told her I was going to start a bike share. She said that a bike share was on the DDA strategic plan and they wanted in. 
I had spoken to George Anadiotis from Rock on Wheels, but the cost for a complete rack set up was out of his budget range. Still, he thought this idea had merit.
In January of 2016, Amy and I told the DDA board at its meeting we had come up with a plan to develop a bike share. I remember their faces when we pitched it. Not much enthusiasm, but they approved for the idea to progress.
Amy, George, the DDA’s Desiree Brothe and I met at Rock on Wheels one morning for a brainstorming session. My assignment was to get bicycles and work with the Police Department and city leaders. Amy was to work on DDA budget issues and with the board on progress. George would outfit the donated bikes and racks.
I put out the notice that I was collecting bikes for Cheyenne's first bike share and asked for donations. Over 200 bikes were donated. 
We worked on the “All parts of the buffalo to be used theory" and stripped all usable parts for our fleet. I thought we were just going to decal them in case of theft. George had other ideas and powder-coated them and made them look amazing. I went to the shop to see the first one and told George, “Man, it’s going to suck when these get stolen." 
Amy asked our small group if it could be called Re-Ride. She liked that these repurposed bikes would now be given a rebirth, revitalized and re-rode. I remember George and I saying we didn’t care what it was called; we just wanted a successful program.
At the February DDA meeting, George rode the first Re-Ride pilot bike around the Asher Ballroom and parked it in front of the board. We told them that George had five bikes complete with another 15 in process. 
The DDA president at the time said, “You guys did this in one month!”  
They has thought our April 1, 2016 kickoff date was farfetched the month before, but now they were all on board.
The program is now in its fourth year. I was worried with the mayor’s budget cut to DDA funding that the Re-Ride program would be cut as low-hanging fruit. I was in for a real surprise.
The DDA had worked on a partnership with Visit Cheyenne to expand the program. To enhance a tourism experience, they wanted to improve on the existing program. 
We had the data to show an increase in ridership over the lifespan of the program. Rock on Wheels was getting so many phone calls for passcodes, it was detracting from their commercial workload. A good double-edge sword. How awesome to know a program you started was blowing up, but bad to have an employee on the phone all the time!
With the new DDA-Visit Cheyenne partnership comes amazing opportunities. They are building off our platform and doing what we were hoping for in 2016.
New bicycles are going to be ordered to create uniformity. This cuts down on repair costs since all bikes would be outfitted with the same thing.New locks are being experimented with that come with an app, so you have 24-hour accessible bikes, not just Rock on Wheels’ business hours.
Expansion into new parts of Cheyenne. With the Visit Cheyenne partnership, new bike centers can be placed at hotels and other tourist-heavy sites as a mobile transportation network. 
More ride-ability on Cheyenne's Greenway, and to other parts of Cheyenne. This is what all of us had envisioned in 2016.
I know some of you might feel this is branching away from the original grassroots effort and will be sad to see the yellow bikes go away. But I’ve talked to George and Amy, and we are all excited about the future. Because we have skin in the game, we still will watch our baby as she grows, and I guarantee I’ll be very vocal if she is abused, or people try to use our vision for their own greed, ambition and ego.
I am very proud of my associates who helped make this happen and look forward to the progression of the vision. Thank you all, once again, who donated, supported and mostly rode Cheyenne's first bike share program

Richard Johnson is a former City Council member from Cheyenne’s east side.