The end of the pandemic?
The coronavirus might now be endemic, rising and falling with time, managed by vaccination and vigilance. In this new phase, in Albany County, is it safe to reenter the world?
If you’re reading this, you might have survived the worst of the COVID-19 pandemic.
There could be deadlier and more contagious variants incubating this moment in other humans and non-human animals. You or a loved one could still be killed by the omicron variant or its cousins. At the very least, you will likely need to stay up-to-date on vaccinations and keep an ear to reliable sources as coronavirus transmissibility ebbs and flows.
But we are likely entering a new phase of the pandemic, during which healthy individuals can move around more freely and less cautiously. The pandemic is not over, and it might never truly be finished, but the days ahead look brighter than they did during the delta and omicron spikes.
The dawn of a new phase means nothing to the 1,749 Wyoming residents who died, nor those who died during this time of suicide or overdose or lack of access to healthcare. And survivors did not come out unscathed. The brutality and ugliness of the past two years exposed fundamental flaws in the American healthcare system, while exploiting and entrenching political divisions across the country and here in Albany County.
Gov. Mark Gordon will end Wyoming’s public emergency declaration tomorrow, almost exactly two years after the pandemic truly hit Wyoming and started altering life for many of its residents.
It was an angry time. The pandemic tested the government’s ability to effect meaningful change, it tested doctors’ and journalists’ ability to coherently communicate difficult science, it tested every resident’s commitment to their community and every individual’s capacity for isolation.
But there could be a better tomorrow. At the very least, Albany County now has a brief respite, a free moment to reflect on the horrors witnessed and the lessons learned, and to consider our role as humans the next time we stare down a deadly pathogenic enemy.
On the ground: Is it safe to reenter the world?
Case counts and hospitalizations have fallen off steeply since the height of omicron last month. According to the Wyoming Department of Health, there are just 228 active confirmed cases in the whole state and only 32 hospitalizations. In Albany County, there are just 10 active cases among a population of more than 38,000.
“Certainly the pandemic is at a new low point,” said Christine Porter, a public health expert at the University of Wyoming. “Which is very exciting after it being at what seemed like a new high point. There was a day (during the omicron surge) when 1 or 2 percent of Wyoming was positive for COVID. The risk of transmission has dropped precipitously and it makes sense to me to reduce the precautions while that’s happening.”
That means that if you’re otherwise healthy, vaccinated and boosted, it’s probably fine to go out for dinner, see a movie, hit the bars, or visit family. Of course, like any other activity in life, it depends on how much risk you’re comfortable with. It is still possible to catch COVID-19, and possible to be hospitalized or die, but it’s very unlikely now – and extremely unlikely if you are inoculated against the disease.
But social contact and interaction is also important for our health. Porter said it might be a good time to do as much of that as we can — especially because we don’t know if or when another dangerous COVID wave will hit. And we never know when the next pandemic will emerge.
“I don’t think that continuing the same level of precautions is a good use of people’s time and energy and trouble,” Porter said. “A good question will be how long will it last and what do we do if we get another wave?”
Wyoming has seen a lull in case counts and hospitalizations before – during the early summer months of 2021. For a brief time, it was safe for vaccinated individuals to go maskless, to travel, and engage in the other social human activities denied them since the beginning of the pandemic.
“I wouldn’t recommend comparing (now) to last year or other periods,” Albany County Public Health Officer Dr. Jean Allais said. “A lot has changed since a year ago. More people are fully vaccinated, and more treatments are available. We have tools to use related to COVID-19 now and know much more about it.”
Allais said this is “a time of transition,” into a completely new phase of the pandemic.
The reality might be shifting from active public health emergency to endemic disease, as the coronavirus becomes our fellow passenger through the years, rising and falling in prevalence in the habit of influenza, never separate from human civilization.
Allais said even the CDC has changed its approach to safety guidance.
“The CDC has moved to looking at what they call ‘COVID-19 Community Level.’” she said. “Their recommendations are based on those levels, as well as personal risk and comfort. Albany County is currently rated as a low or ‘green’ risk area. When one looks at their personal risk at any point, they need to consider risk of severe illness and hospitalization, as well as risk of long COVID syndrome after an infection. They should also consider the risk of infecting someone in their household who may be at higher risk.”
So at least for now, and maybe for a while, it’s safer than it has been to go out, to socialize, to visit the family and friends who miss you.
But the last two years have taken a disastrous toll on healthcare infrastructure, the community itself, and the people tasked with providing health information to an audience radicalized against them.
Disinformation and death: The toll on people and science
Since March of 2020, Wyoming has lost more than 1,700 residents to COVID-19 — 1,700 residents who will not get to celebrate the newfound freedom of the communities they left behind.
The pandemic took grandparents and spouses. It orphaned children, sometimes young children, and even killed young people in their 20s.
Porter said the 1,749 deaths are not even the pandemic’s true death toll.
“Our excess death rate was much higher than that,” she said. “We lost more like 2,700 of our friends and neighbors and loved ones. The majority of that would have been preventable with the right precautions. I hope we can do better next time. And if there’s another wave, I hope we can do better in the next wave.”
Globally, more than 6 million people have died. Inequalities and greed kept humanity from eradicating the coronavirus – an end goal it could only have accomplished by vaccinating the earth’s population as quickly and as thoroughly as possible.
“In Wyoming, in the country, in the world, we created ideal conditions for variants to multiply by not protecting everybody as well as we could as fast as we could,” Porter said.
Stateside, existing flaws in the American healthcare system were exacerbated by the pandemic. Porter said even our underlying assumptions about health played a role in giving the U.S. the world’s worst COVID-19 death toll.
“This country has tended to think of health as an individual decision or problem or responsibility,” she said. “And our horrifically high chronic disease rates and our very high COVID death rate and our inability to respond to COVID as a public, a country and a community really highlight the suffering that causes.”
The coronavirus was also helped along by the deep divides in American politics. Red states were hit harder than blue states in great part because Republican and right-wing leaders downplayed the threat posed by COVID-19; many of them dismissed the overwhelming evidence that interventions like vaccines reduce negative outcomes. (The partisan trend is so strong that even blue counties fare better than red counties, because blue counties have greater vaccination rates.)
Since vaccines became available, the vast majority of people dying of COVID-19 in Wyoming hospitals have been unvaccinated. The vaccination rate in Wyoming is only about 45 percent, which is almost the lowest rate in the country. Albany County’s rate is higher, at 55 percent, but still falls well below the national average of 65 percent.
Wyoming, in general, has not been interested in taking precautions. At every stage of the pandemic, activists resisted school and business closures, mask requirements in educational institutions, and even vaccine requirements in hospitals.
“The biggest lesson I learned was that politics would override public health even during a pandemic,” Allais said. “I didn’t anticipate that polarizing politics would have such an impact on so many levels of the pandemic response.”
The public health officer also came face-to-face with the public’s lack of understanding about science. In general, scientists seek to refine their conclusions in the light of new evidence — a habit that doesn’t sit well with a society suspicious of authority and needing answers.
“Instead of recognizing changes in guidelines as a reflection that more had been learned about the virus, many people seemed to feel they’d been deliberately misled by the earlier advice,” Allais said. “I also learned how powerful misinformation and disinformation can be.”
The World Health Organization has identified misinformation as a public health crisis all its own, one that has worsened the COVID-19 pandemic, and one that is killing people.
Of course, the silver linings cannot be ignored.
Public government meetings are now more accessible to the masses, given that they are nearly all streamed on Zoom and available on YouTube forever after.
Money from the American Rescue Plan Act may help save and fortify critical infrastructure at a time when most communities in the United States desperately need the help.
Dr. Grace Gosar said the Downtown Clinic in Laramie, where she is a medical co-director, was forced to grow its telehealth capabilities, while sanitizing and cleaning every inch of the clinic became “reflexive.”
“The pandemic strengthened the relationships within the DTC, asking us to use our unique skill sets and experiences to allow us to safely operate and even to more creatively operate,” Gosar said. “Each staff member was a leader and, collectively, our solutions and responses were formulated by ‘group think.’ Rather than this being a pejorative term, ‘group think’ was collaborative, informed and respectful. We have managed well as individuals and as an organization. We will likely continue with this approach.”
Of course, these gains at the Downtown Clinic came at the cost of cutting interns to reduce contact, and completely closing the physical clinic to patients for a time. And it was born out of necessity — Gosar said the clinic received little useful guidance from state and national leaders and clinic staff had to troubleshoot and generate solutions themselves.
The politicization of questions like “does the vaccine work?” and “is the pandemic real?” — both of which have a correct answer — also took its toll on the relationships between patients and providers.
“Born, raised and educated in Wyoming, with 30 years of practicing medicine in rural Wyoming, I have never had a professional experience anything like what I have witnessed in the last two years,” Gosar said. “I feel dispirited by what has happened, most specifically by the many in Wyoming who are arrogant, having contempt for my profession and other scientific practitioners like me.”
Gosar said she hopes people show greater care for their community during the next wave, or during the next pandemic. She also hopes they rely on better sources of information.
“For me, and not speaking for the DTC, I would hope that our community relies much less on their social media feeds and much more on their established relationships with healthcare providers,” Gosar said. “I encourage the Albany County community to find a clinician that you trust and believe in, asking that person or their organization to guide your healthcare decisions – not crossfit trainers, not your friends or your neighbors. These folks may be intelligent and well-meaning but they are over-their-collective-heads when it comes to guiding your health decisions.”
Allais — whose address to an auditorium full of parents in September was cut short by yelling, howling and swearing — also hopes community members will start to respect and care for each other more. She said simple acts of kindness, such as shopping for an elderly neighbor, go a long way.
“I hope the community learned how important our community is,” Allais said.
Possible futures: A sign of the end, or temporary lull?
Of course, no one can say exactly what the future has in store. There could be another disastrous wave of COVID-19 — highly transmissible like omicron or highly dangerous like delta.
And if there is another wave, just how bad it will be — and how we should respond to it as a society — will depend on the variant. Porter said, for example, if the next big variant is an offshoot of the familiar omicron, a recent infection could afford an individual greater protection from such a genetically similar variant. (On the other hand, if the variant is different enough to earn its own Greek letter, one’s recent omicron infection will mean less.)
And a staggering number of Americans have had a recent infection.
“Based on antibodies in the blood, the CDC says that 42 percent of Americans had a coronavirus of one variety or another,” Porter said. “So there’s some protection from that, even if you’re not vaccinated.”
In Wyoming, the figure is 53 percent.
“Over half of people in Wyoming have been, at some point, infected with coronavirus,” Porter said. “So, even if there’s another wave, and even though we have the second lowest vaccination rate in the country, that would offer some protection. The question is what variant infected folks, and whether that variant would protect them from the next one.”
If this is the end of the COVID-19 pandemic, and what we’re seeing is the beginning of a shift to endemic disease, it’s worth noting that other viruses are sure to threaten us in the future.
Porter is certain of it.
“There will be another pandemic,” she said. “There is no question about that at all. And we are especially vulnerable to it in Wyoming and in the United States because pandemics are public and we act like health is private.”
If humans want to lose fewer loved ones in our inevitable next brush with a ruthless pathogen, Porter said we will have to embrace our capacity for community.
“We’re capable of so much more,” Porter said. “Wyoming has a really strong culture of neighbors taking care of neighbors. That didn’t always extend in this case to wearing a mask for your neighbor, or getting immunized for your neighbor, but people took care of each other with food and kindness in many cases. But if you want to prevent death, it takes more than that.”