EVANSTON, Wyo. — Steven was finally getting his Covid-19 shot because Mama told him to. And nobody crosses Mama.
Standing between the fried bread and slushie stands at the Uinta County fairgrounds in southwestern Wyoming, the 42-year-old in the Trump 2020 hat said “Mama” — his wife — forced him to get vaccinated because of the Delta variant.
“The missus is worried about me going out on a trucking trip,” said Steven, who declined to give his last name. “I don’t need it. I have red hair and blue eyes and the blood type that says I probably won’t get it. But number one rule? Mama’s always right.”
Since the coronavirus emerged in the U.S. in early 2020, Steven has believed he is safe from infection — and not just because of falsehoods spread on social media about protective hair colors or blood types. He’s assumed that he and his family members, many of whom have little reason to go beyond the county border, are safe because of where they live.
But Delta has turned that idea on its head. In Uinta County — twice the size of Rhode Island, but home to only 20,000 people — cases have spiked from six to almost 70 in just a few weeks. While small, the numbers highlight how Delta can permeate even the tiniest, most remote enclaves. The rising infection rates are propelling vaccine holdouts to get the jab. The question now is whether enough people in Uinta and other rural counties across America will get vaccinated before virus spread in their communities becomes uncontrollable, and small local hospitals are overwhelmed.
Senior Biden health officials have for weeks worried internally about the low vaccine uptake in rural, conservative counties across the country. Federal experts have predicted those communities would experience large increases in Covid-19 cases where access to sufficient health care is limited. To address the issue, the White House last month announced it would send $100 million to rural communities to help local health officials convince people to get vaccinated.
With Delta spreading rapidly nationwide, fears about hard-hit rural areas are becoming realities in many states, including Arkansas, Louisiana, Alabama — and now Wyoming.
“There are times where I’ve seen what’s happening in other counties or other states, and I think, ‘Maybe the rural nature of our community is protecting us to some extent,’” said Kim Proffitt, the public health nurse and county manager for Uinta County. “And then things like the last three weeks happen and I think, not so much. Delta can spread in a rural community just like it can in an urban community — and especially if, in those rural communities, people are not being very cautious.”
Wyoming’s case positivity rate has increased by 80 percent in the last two weeks. It now stands at 13 percent, making the whole state a “high transmission area” according to the Centers for Disease Control and Prevention. Covid-19 outbreaks have popped up in counties along the borders of Montana and Utah along major throughways often occupied by long-haul truckers coming in from out of state.
By late last week, state and local health officials were predicting that sharper case and hospitalization spikes could be just days away — and not enough people were signing up for the shot to stave off that surge. Clay Van Houten, Wyoming’s infectious disease epidemiology unit manager, said that small, household gatherings, summer parties and graduation get-togethers have fueled the current spread, helped along by Wyoming’s 33 percent vaccination rate.
Even now, many Wyomingites believe they can evade the virus’ wrath because they live in areas where ranches and farm fields stretch as far as the eye can see. During the darkest days of the pandemic last fall, that line of thinking inspired a popular GIF with the tagline “Wyoming, social distancing since 1890.”
“There’s just this sense that we’re a frontier state, we’re tough, we’re strong, we can do anything,” said Lanette, a nurse helping Profitt put shots in arms in Uinta who did not want to give her last name. “That’s just the way people in this state think.”
That sense of invulnerability is present in Uinta County, Profitt said. Gov. Mark Gordon, a Republican, dropped the statewide mask mandate in March, which precipitated the unmasking of even the unvaccinated, Proffitt said, noting that most residents in her county did not adhere to public health measures.
“When the CDC says indoor masking is recommended if you’re in an area of high transmission, and you know, obviously we are, I don’t think that’s made a difference to anybody,” she added.
Throughout the pandemic, many residents here did not believe Covid was real in part because the community is secluded and those who became infected did not talk about it with their neighbors, officials said.
“We’ll call someone to tell them that they need to isolate and they say, ‘Well, I don’t even think it’s real. I don’t feel sick at all, you’re overblowing this,’” Proffitt said.
That resistance, which exists across Wyoming, is a growing challenge for local and state public health officials and physicians who are trying to curb the spread of the virus.
“We’re in a small town, we don’t interact with a lot of people. And that’s great logic if there’s no one in the small town. But all it takes is one person. You can infect your family members. And if all you do is hang out with your family members or friends, people will get infected,” said Jeffrey Chapman, the chief medical officer at Cheyenne Regional Medical Center. “So, you don’t see the big numbers or the super spreader events, but you’ll see much smaller, almost micro-spreaders.”
Wyoming is struggling to track the spread of Delta, in large part because the state health lab is weeks behind in sequencing Covid-19 samples. Proffitt said she’s not sure if all of the cases the Uinta county is seeing are attributable to the Delta variant — she’s still waiting on a batch of Covid-19 samples to return from the state lab. The first batch, sent about three weeks ago, showed the Alpha variant was spreading in the community.
But more recent national data shows that the highly transmissible Delta variant has rapidly supplanted Alpha and other older versions of the virus throughout the country. In early May, Delta accounted for fewer than 3 percent of cases nationwide, according to the CDC; by late July, that figure had rocketed up to 83 percent.
Other states with low vaccination rates — including Louisiana, Alabama and Missouri, where rural transmission is occurring — are already battling sharp increases in new cases and hospitalizations attributable to the Delta variant. Now health officials in Uinta County are preparing for the worst as their numbers begin to rise each day.
“That’s what is really concerning me right now,” Proffitt said. “If we’re not even seeing Delta yet and these are our case numbers, we’re in trouble.”
State public health officials believe Delta is already driving transmission throughout Wyoming, although without real-time genomic sequencing they can’t prove it. They are increasingly concerned that the state’s summer festivals, also known as Frontier Days, where people travel from across Wyoming to participate in rodeos and other fair events will spur transmission.
“In the past week or so, we’ve seen in the entire state that increase in cases, increase in hospitalizations, usually concentrated in our two biggest counties because that’s where the most people are,” said Alexia Harrist, Wyoming’s state health officer. “I do think the evidence shows that the Delta variant can explain a lot of it.”
News of the uptick in Delta cases and hospitalizations has driven people in southwest Wyoming, including Uinta County, to sign up for the shot.
“We had a gentleman come in today saying he’d seen what’s being reported in terms of numbers and Delta,” said Mike Whisenant, a response coordinator for the county. “It causes more concern. It is not going away. So, now he’s forced to get it.”
Proffitt and her team have had tough luck getting people to sign up for the shot until this last week, when 10 people came by the state fair vaccine tent on August 3. It was the highest number they’d seen in one day since earlier this year.
“I think it could be the concern over the Delta variant and the negative health outcomes that people are seeing with those who are unvaccinated and hospitalized,” said Stephanie Pyle, a senior administrator at Wyoming’s health department.
The latest surge has sent more, and sicker, Covid-19 patients to Cheyenne Medical Center. With Delta, “when people get sick, they get sicker, and they get sicker quicker from our experience,” Chapman said. “I actually was up on the floor and literally talking with someone … he was struggling. And the next morning I went to check on him, and he had died. He just made such a rapid change.”
Those images splashed across local and national news is what is concerning people in Uinta County, many of whom rely on traveling across the state or to neighboring states to make a living. The majority of people who showed up to the county fair vaccine tent last week wanted to know whether the shot would prevent them from contracting Delta.
Answering that question has been tricky for frontline vaccine administrators, who say they have struggled to explain the CDC’s recent warnings about breakthrough infections without scaring people off from getting their shots.
“The woman I just spoke to said this shot didn’t protect against Delta,” Steven said to his wife, Tara, while waiting in line. “It does. I just went in, and the woman said the shot I got did help protect against it,” said Tara, who also declined to provide her last name. “Well, that’s not what she just told me,” Steve huffed before heading into the vaccine trailer to get the jab.
Proffitt said she’s trying hard to clearly explain that with any vaccine, there is risk of infection, and that the Covid-19 vaccines work well to prevent severe disease that could land someone in a hospital.
Three other families who swung by the vaccine tent the same day, including a mother and her teenage daughter, asked questions similar to Steve and Tara’s and said they would not get the shot if the team only had Johnson & Johnson available. “Oh no, we don’t want that one,” said Jean, another fair-goer who stepped into the tent.
The federal government’s decision to briefly pause the Johnson & Johnson rollout in May due to concerns over reports of rare but severe blood clots in recipients pushed many people here to avoid getting the shot altogether, Proffitt and other local health workers said.
As local health officials in Wyoming brace for what could be yet another wave of infections and hospitalizations over the next several weeks, they are also worrying about how best to treat severe Covid-19 patients who live far away from the closest medical center.
“While we don’t have large concentrations of people, that ruralness, the frontier-ness presents a lot of challenges like people sometimes needing to go out of state for care,” Harrist said.
It’s a problem officials here in Uinta County have struggled to deal with throughout the pandemic. But it’s more acute now with the Delta variant sending case numbers soaring and producing more severe symptoms in those who are ill. Referral hospitals across the border in Utah, which in normal times would take overflow patients from this corner of Wyoming, are filling up.
“Often when patients become a certain level of acuity or our hospital is unable to care for them they are referred and sent to several major hospitals in Salt Lake City that we refer to. And that’s kind of what’s scary,” Proffitt said. “The Utah Department of Health is essentially at critical capacity. I have elderly parents, and I think what if my mom had a severe heart attack or something … it would be very frightening right now as far as accessing care in a timely manner.”