Three laps around the sun and the COVID pandemic feels to some like science fiction. Local thespian Andrew Munz has reclaimed center stage, school buses are loaded with maskless kiddos, and the Aerial Tram line is as crowded as Walmart on Black Friday.

Lift the curtain, though, and it’s clear the virus has mutated many areas of life, especially in medicine.

The evolution of COVID safety precautions has introduced new technologies and response methods for infectious diseases, as well as expanding telehealth, or remote health care, capabilities. Alternatively, potent government intervention, especially in a state concerned with personal liberty, politicized public health and stimulated legislation.

Local health officials reflect on the lessons learned, or not, in the last three years; whether COVID still affects Teton County and if another pandemic is looming.

Dr. Travis Riddell called himself “someone who quietly went about business as a dad and doctor” before the pandemic. In a matter of days, his role as Teton County Health officer put him in the spotlight, and the hot seat, throughout the viral outbreak.

In an effort to slow the spread of COVID-19, Riddell signed an emergency public health order that, once approved March 17, 2020, by State Health Officer Alexia Harrist, closed scores of valley businesses: bars, gyms, coffee shops, theaters.

Alongside Teton County Health Department staffers, Riddell reinforced COVID safety guidelines put out by the Centers for Disease Control and Prevention. These included non-pharmacological recommendations for the public — like wearing fabric masks to save the limited supply of surgical masks for medical professionals; keeping 6 feet from others; canceling large gatherings and washing hands frequently.

As Riddell became a public figure, he frequently received nasty emails from residents who didn’t want to be told what to do. Inversely, he was regularly stopped on the street by strangers who thanked him and expressed support for his role.

Three years later, Riddell said his life has “very much gotten back to normal.”

“While dealing with this was theoretically something I signed up for as county health officer,” he said, “no one plans on a once-in-a-hundred-year pandemic.”

He’s proud of how well Teton County mobilized to slow the spread of the infectious disease. The first lab-reported case of COVID came to Teton County on March 18, 2020, and by early April there were 29 new COVID cases in one week. A month and a half later, on May 17, 2020, the county’s case rate dropped to zero and would stay that way for close to a month.

While the county would experience COVID surges for the next two years, death rates have hung low compared with the rest of the country. The state’s COVID mortality rate hovers above the national average, at almost 350 deaths per 100,000, while Teton County’s COVID death rate is five times less.

Rachael Wheeler, the county’s public health response coordinator, said that is in part because Teton County has the highest COVID vaccination rate in the state, at 97%. She added that the “healthy, active” community of Jackson Hole and its willingness to cooperate with public health recommendations also helped keep the COVID death toll down.

“From that initial early surge to zero, completely without medical treatment, is another great example of the community coming together,” Wheeler said.

Wyoming had modest increases in its mortality rate before the pandemic due to its aging population. But with a spike in deaths in 2020 and 2021, the state saw far fewer deaths in 2022. Guy Beaudoin, the deputy registrar for the state’s Vital Statistics Services, attributed that to COVID.

“The numbers are still higher than we would have expected before the pandemic,” he said, “but may be beginning to return to a more normal state.”

COVID replaced “unintentional injuries” as the third leading cause of death in Wyoming in the first two years of the pandemic. In 2022, however, COVID shot down to fifth, after “various types of accidents” and pulmonary disease.

Understanding of the virus at a national level has shifted over time, and the virus itself has mutated.

CDC recommendations evolved from advising the use of cloth face coverings and 14-day quarantines to surgical masks and five-day quarantines.

Testing has also changed from waiting for a result from a swab to rapid PCR tests becoming readily available and at-home tests. Testing rates dropped by nearly 400% in December, compared with December 2021, followed by the closing of the Curative COVID testing site in the Target plaza on Dec. 29.

As community members have reverted to at-home testing, the Public Health Department has turned to other methods of measuring community disease spread, such as sewage surveillance. Starting early in the pandemic and resuming in August, the Town of Jackson has been monitoring wastewater to track the prevalence of COVID in the community.

While the county says the COVID Community Level is currently low, the wastewater report of last week shows the highest concentration of SARS-CoV-2, the virus that causes the coronavirus disease, since summer. New cases, hospital admissions and inpatient bed occupation are among the metrics the CDC and county use for determining Community Level.

At senior living centers, like Sage Living at St. John’s Health, the pandemic rocked the lifestyles of residents. Adhering to the isolation measures required by the Centers for Medicare and Medicaid Services meant no in-person visitors and little socialization for a time.

“The hardest part was for the whole first year of the pandemic, [residents] were pretty much confined to their room,” said Toni Ellis, a certified nursing assistant at Sage Living. “We brought meals to them, which was tough because our biggest social event used to be meals.”

Sage Living has had one COVID-related resident death. Even now, Sage Living administrators face tough decisions to keep their charges safe from COVID.

“We still have outbreaks if just one person tests positive,” said Seth Robertson, the executive director of senior living at Sage. “Thankfully, the impact on staff and residents has been greatly reduced.”

Residents no longer have to mask, visitors can come and go, and more activities for seniors have been reintroduced.

The pandemic has ushered in some positives, Riddell said, like new immunization and testing technologies that could be distributed more quickly should a new rampant, infectious disease arise. He also mentioned how scientists have found masking to be an effective way of combating the spread of respiratory illness.

“I would really like to see a new normal of people wearing masks when they’re sick,” Riddell said. “We know masks work far better as a source of control.”

Another outcome of the pandemic was the growth of telehealth, or the distribution of health services digitally.

“The pandemic accelerated this whole innovation by what we think is 10 years, just overnight, on a dime,” said Dr. Lisa Finkelstein, the medical director of telehealth at St. John’s. “It used to be very difficult to understand what [telehealth] was. ... but now everyone gets it.”

Dozens of medical specialties can be conducted on the phone or computer, Finkelstein said, which is especially important in rural states with fewer doctors.

“There’s 14 urologists in the entire state of Wyoming, compared with 14 urologists in a building in New York City,” Finkelstein said. “We don’t have enough specialists in Wyoming to meet the needs of patients.”

She’s eager to see multistate licensures for physicians to practice telehealth in other states increase, as well as the establishment of safe spaces for patients to access their health care remotely in public libraries and medical offices. She also thinks it’s important to amp up marketing, so patients know where telehealth is being offered.

The pandemic also politicized infectious disease control. At the start of 2023, Wyoming lawmakers wrestled with House Bill 66, which would have banned mask, vaccine and testing “discrimination.”

Some who testified expressed outrage for being denied essential medical services or experiencing forced termination for refusing to comply with COVID protocols at hospitals or places of employment. Though COVID issues were the top priority of several new lawmakers, that legislation failed to pass the state House of Representatives.

Riddell expressed concern about the politicization of public health.

“Legislation in Wyoming and many other states has decreased the ability of public health officials like myself to institute emergency measures, should they ever be needed again,” he said. “Everything is suddenly partisan, so should another pandemic come up, those lines are already in the sand.”

As COVID jargon like “unprecedented,” “quarantine” and “immunocompromised” are words leaving fewer and fewer lips every day, and businesses are mostly running as usual, is it fair to say the COVID pandemic is over?

“At this point it’s almost a semantic question,” Riddell said. “How do you define pandemic?”

His colleague at the Health Department, Wheeler, pointed to the outcome of the World Health Organization’s Jan. 27 meeting, called in response to the third anniversary of WHO’s determination of COVID-19 as a Public Health Emergency of International Concern.

“Since COVID is widespread and not seasonal, [WHO] still defines it as a pandemic,” Wheeler said. “But do I think most people are over COVID and consider it over? Yes.”

But while the global population may be experiencing pandemic fatigue and the federal Public Health Emergency declaration for COVID will expire May 11, the impact of COVID still touches many.

“For people who have lost family members to it, or my patients who still can’t taste or smell two years after infection, it’s still a really big deal,” Riddell said.

And while COVID hospitalizations at St. John’s have dropped by at least 500% from the worst of the pandemic, the hospital still readily receives COVID patients.

“Now it’s just a regular part of our patient care to have isolation rooms for COVID,” said Karen Connelly, the hospital’s chief communications officer. “Whether the public health declarations are over or not, we will continue to have patients with COVID or other infectious diseases.”

So while the coronavirus continues to affect various segments of the community, is another pandemic possible — or even in sight? Wheeler says yes.

With “global travel as easy as it is,” the buying and selling of “exotic animals,” the ease of international shipping and a rapidly expanding human population, Wheeler said “all of those different vector hosts that are harboring a virus can jump to humans.”