CASPER — The novel coronavirus is spreading in Wyoming like never before.

The number of active confirmed COVID-19 cases across the state has reached an all-time high in 10 of the last 13 days, and the state’s 10-day average for new confirmed cases has broken records 14 of the last 16 days — all as of Friday. The percent of cases attributed to community spread has also hit a new peak, as has the percent of tests with a positive result in the last two weeks, meaning the spike can’t be explained away by increased testing.

New confirmed cases outpace new recoveries to a degree previously unseen. Hospitalizations are at an all-time high and more deaths were reported in September than in any previous month. As of Friday, 53 people in Wyoming had died from the virus.

“The number of cases right now does reflect substantial transmission within our communities,” State Health Officer Dr. Alexia Harrist told the Star-Tribune on Friday.

Wyoming had looked to be containing the virus better than its more urban counterparts, but over the last week, Wyoming has ranked among the top 15 states in new cases per 100,000 residents, according to the New York Times. Similar spikes have been seen around the Mountain West.

The state’s recent surge supports an early theory, Natrona County Health Officer Dr. Mark Dowell said: that rural parts of the country wouldn’t be insulated from the virus’s toll so much as they would feel the effects later.

One of the main metrics health experts use to gauge what the virus is doing is the proportion of cases that can be traced to a source. Cases that can’t be traced to a specific point of infection are attributed to community spread. This means health officials can’t identify where the person got sick, which in turn means they can’t control that spread. A higher rate of community spread indicates that the virus is spreading unchecked.

That’s currently a concern in Natrona County.

“Many of the new cases in September were due to widespread, community transmission,” the Casper-Natrona County Health Department said in a recent news release highlighting the spike. “Although some cases have remained isolated to certain groups or pockets, many have not.”

Dowell, too, has pointed to community spread as a major frustration. Natrona County’s own case numbers have spiked in the last month. The county confirmed 268 cases in September and recorded its first 11 double-digit caseloads during the month. Only Albany County, where the University of Wyoming has resumed classes, added more cases.

“It’s multiple places in the community,” Dowell said of Natrona County. “That’s how it’s spreading; it’s not just related to some institution.”

Which makes stemming the spread much harder.

Prior to the recent surge of cases, most of Natrona County’s cases could be connected to a facility — whether that be the early outbreak at the Wyoming Behavioral Institute or the more recent one at Elkhorn Valley Rehabilitation. At least in those cases, Dowell said, they knew where the infections were coming from.

Statewide, the percentage of cases attributed to community spread reached new heights this week as well, with nearly 30% of all cases falling into that category.

Harrist and Dowell both attributed the increased spread to a handful of factors. As temperatures begin to dip, people are moving indoors, and schools and colleges are reopening for in-person learning. Dowell said the nature of COVID-19, or any respiratory virus, will cause it to spread more easily indoors. He commended the Natrona County School District’s use of face masks, but said in his experience, he hasn’t seen the precaution observed much in the community. Both health officials said the general public’s exhaustion with prevention measures like mask-wearing and social distancing is certainly a factor in the recent surge.

A University of Wyoming survey supports this notion as well. The university’s Survey and Analysis Center has been polling Wyomingites on COVID-19 and the accompanying prevention measures since late March. The number of respondents who said they felt COVID-19 was a real threat has fallen over time. On March 30, nearly 64% of respondents thought the virus a “real threat.” On Sept. 8, that number had dropped to 45%.

Dowell said he believes that case increases will either stay at their current level or increase unless there is a change in behavior. The consequences of that, Dowell said, could even more severely affect the economy or begin to overburden the health system.

But while the current trends are “concerning,” both Harrist and Dowell said, they aren’t yet dire. The state’s actions reflect that feeling. The state’s latest public health order, despite the growing number of cases, lifts many restrictions on indoor dining in restaurants, allowing for more people inside at a given time with less spacing between them. State officials said they haven’t seen outbreaks tied to indoor dining.

Conversely, the state’s earliest and most restrictive orders, closing a litany of businesses including salons, dine-in restaurants, bars, gyms and similar venues, were partially lifted in May, as the rate of new cases statewide was on a decline. Not all restrictions were lifted but enough to allow for those businesses to again invite customers inside.

The most recent update to the health order affecting dine-in restaurants went into effect Thursday, when nearly every metric — new cases, hospitalizations, community spread and more — was at its highest since the novel coronavirus emerged in the state.

The reason, Harrist explained, is because Wyoming has more tools now to address the spread of COVID-19 than it did when things began.

“We are in a much different place in many ways than March and April,” Harrist said. “We have much-improved testing capabilities; providers are much more familiar with diagnosing and caring for people with COVID-19.”

Indeed, the average number of tests administered across the state is much higher now than in March and April, and the average rate of positive tests is about 3%. The fact that a record number of hospitalizations has yet to threaten Wyoming hospitals’ intensive care unit capacities is also a good sign.

Harrist said as health care providers learn better how to care for COVID-19 patients, it’s less likely those patients will end up in the ICU at all.

The capacity of the state’s health care system to treat everyone who needs treatment, not just COVID-19 patients, is a key factor in state health officials’ level of concern. So far, they said, they aren’t too worried. On any given day, there are about 120 ICU beds statewide, As of Thursday, with a record number of coronavirus patients hospitalized, just 44 of those beds were in use, including both coronavirus and other patients.

As of Friday, nine of Wyoming Medical Center’s 14 ICU beds were in use. Dowell said about three of those beds have consistently been filled by a COVID-19 patient.

Thirty-two people, the most since COVID-19 started spreading in the state, were hospitalized Friday across Wyoming because of the virus. Twelve were at Wyoming Medical Center.

Both Dowell and Harrist said hospital capacity is the factor they’ll look closest at to decide if more restrictive health orders are needed in the future, though both said there have been no conversations or desire to impose more restrictions thus far.

“I think that nightmare scenario is … a situation where we wouldn’t have enough hospital beds,” not only for COVID-19 patients, but for anyone who needed care, Harrist said. “It’s unimaginable to have to worry about that.”

Dowell said right now in Natrona County, that capacity is OK.

But “if it gets really bad, that’s going to be a real problem,” he said, adding that local health providers have the capacity for about 30 ventilators. Five of WMC’s 18 ventilators were in use as of Thursday, according to state data.

While both health officials said it’s not yet time to panic, they did stress the need for community action to reverse the current spikes.

First, both officials said getting a flu shot is one of the most helpful things residents can do to keep the health care system under capacity, both because it lessens the chances of people suffering from both COVID-19 and the flu at the same time, which Dowell said is a real possibility, and because it will help doctors differentiate between the two diseases.

“It’s more important this year than ever,” Harrist said, adding that flu season officially began Thursday.

In addition to getting a flu shot, the prevention measures already recommended — like wearing masks and social distancing — will be critical to reversing the state’s current trends, both officials said.

The county health department is preparing to launch a new educational campaign, and Harrist said the state health department is working on educational efforts, too.

“If you educate the public, tell them why it needs to happen, you do it in a respectful way and they choose not to do it, then they’re writing the story,” Dowell said. “Whatever that story is.”