Hospital capacity is one metric that has stayed relatively stable throughout the pandemic, but in the past month, that's changed as hospitals run out of space and staffing is stretched thinner.
The state is recruiting outside help, but healthcare workers are still feeling the pinch.
At Cody Regional Health, the pandemic is taking its toll on frontline healthcare workers.
Chief Hospitalist Dr. Elise Lowe said caring for COVID-19 patients is not too complex, but it does require a lot of extra work.
"It's tough to have a condition we really haven't seen before," she said. "So we're constantly reading up on new research and trying to follow the newest guidelines and make decisions on something that's pretty novel. Our workload is at least doubled."
Some days are quiet. But at a small hospital like West Park in Cody, that can change in an instant.
"We can be feeling okay and suddenly get five new cases in an afternoon, and we've completely exceeded our capacity to treat those people," Lowe said. "And then we're calling in people on emergency backup and making changes to our entire operating capacity."
All of this puts stress on the physicians, nurses and other hospital staff responding to the pandemic. But the healthcare system itself is also stressed by the rapidly rising demand for hospital space and resources.
Hospitalizations are spiking throughout the state. There were more days in the past week that set a new record for COVID hospitalizations than didn't.
Eric Boley, president of the Wyoming Hospital Association, said the current trend is likely to continue.
"Our larger facilities are definitely feeling the pinch right now," he said. "A lot of them have been close to, if not at, complete capacity. Some of our larger facilities actually opened up additional space so they can take even more patients."
In the past, many of the state's border communities could rely on hospitals in surrounding states for specialized or intensive care not available in town. But with the entire region experiencing an unprecedented surge in both cases and hospitalizations, options for out-of-state care are limited.
Hospital and intensive care capacity are usually measured by available beds, but Boley said that's not the largest hurdle.
"There may be available beds, but we're struggling to have enough staff to take care of the patients if we do admit them," he said. "That's our other big challenge right now."
It's a challenge that gets worse when healthcare workers get sick.
"A lot of our hospitals are really facing some tough times because they've got folks that are either quarantined or are sick with COVID," Boley said. "So the numbers continue to rise as we continue to care for these patients.
The U.S. Department of Health and Human Services will help by sending task-forces to Campbell and Natrona counties, two raging hotspots. Meanwhile, the Wyoming National Guard will be deployed at Cheyenne Regional Medical Center to perform non-medical duties, freeing up medical staff for more direct care.
Boley said the hospital association has helped place 50 healthcare workers across the state. But it's been expensive.
"In normal times, we know what the rates are, but we're having to pay a higher rate in order to secure these folks," he said. "But that's the great part of the governor allowing us to use the CARES funding … It's given us a little bit of latitude to make sure we can be competitive and we can bring in the staff that we need."
Wyoming healthcare workers are also aided by the fact that, for several months, actions taken by the state and residents of Wyoming flattened the curve, which gave state healthcare workers a chance to learn from other places and the trickle of positive cases in-state.
In Laramie, Ivinson Memorial Hospital Chief Nursing Officer Nicole Rooney said that's been helpful.
"Now that we're a little bit less on the unknown side, we know what to expect as far as what symptoms you might see, what type of patients you might see," she said. "And knowing the standard of care for these patients is definitely helping us."
Despite the extra help and knowledge, Wyoming hospitals still face an overwhelming situation. Case counts continue to rise, which means hospitals will continue to be stretched.
And of course, it's almost that time of year when flu and pneumonia cases grow.
Rooney said this is going to take a toll on hospital workers' mental health.
"That's really been the struggle: trying to keep that balance where we're asking them to come in extra, asking them to have a good work-life balance, and asking them to not feel run down at the end of that so they can come back the next week and do the same thing for their patients over and over and over again," she said.
As many warned, all of this robs hospitals of the ability to perform elective surgeries or provide care they otherwise would.
For example, Dr. Lowe said Cody Regional Health can offer cardiac caths only on specific days.
"So if you have a heart attack on a day that we don't have that available then we're looking to figure out where we can transfer you and that process can get very delayed if all the other hospitals are on divert," Lowe said. "This is really a burden on our entire healthcare system that affects everybody's care."
On top of all of this, healthcare workers are facing vitriol from some vocal corners of the populace.
"Early on in this thing, we had a lot of support in this community," Lowe said. "We were being called heroes - and it's kind of ironic because we weren't really seeing patients yet."
Now, the work is harder, that support has dissipated and the community is more divided.
"We're getting accusations from our leadership and from our community that we've overplayed this, or that it's not real or it's a hoax," Lowe said. "To tell somebody who's watching people struggle to breathe that they're making it up and it's a hoax - that's extremely hard on our mental health."
There is no sign of the pandemic improving in the coming weeks, or even decelerating. As winter sets in, healthcare workers and hospitals are bracing for the most brutal challenge they've ever faced.