Amy Surdam

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By Dan Surdam, MD and Amy Surdam, FNP
Dan Surdam is an Medical Doctor and Amy Surdam is Family Nurse Practitioner. both are clinicians in Wyoming and Colorado.

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 healthcare 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 healthcare 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 promps 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% 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% and Albany County is 45%. 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 healthcare 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 City 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.

• If you work in healthcare, have a family member who works in healthcare, or have a friend that works in healthcare, you should receive the vaccine.

• If you are immunocompromised or overweight, you should receive the vaccine.

• If you have any comorbidities such as diabetes, hypertension, or asthma, you should receive the vaccine.

• If you have a friend or family member who is immunocompromised, overweight, or has any comorbidities, you should receive the vaccine.

• 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.

• If you are over the age of 12, you should receive the vaccine.

And to our healthcare 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 healthcare providers. Perhaps if enough of us say the same thing in different ways, they will hear us and help.

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By Amy Surdam, guest columnist

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 health care 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 ranchers’ 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 groove 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 doughnuts, 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.

(Note: Amy Surdam and her husband operate Stitches Clinics in several cities and towns in Wyoming.) 

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