Just as the highly infectious omicron variant arrives in Teton County, residents will no longer be required to wear masks in indoor settings.
Public Health Order No. 21-5 expires Dec. 31, and Teton District Health Officer Dr. Travis Riddell isn’t immediately planning to issue a new mandate, the Teton County Health Department announced Tuesday.
While the decision was framed as one based on emerging tools against the virus, including booster doses, pre-exposure prophylaxis treatments and antiviral drugs, it was also influenced by political tension.
Riddell and Public Health Director Jodie Pond sent a private statement to elected officials on Dec. 14 explaining their plan not to immediately renew the mandate.
“We still believe the scientific evidence supports mask wearing as one of the community mitigation measures against COVID-19,” they wrote. “We will therefore continue to recommend mask wearing for everyone in the community as long as transmission remains ‘high’ or ‘significant.’”
The letter did not explain reasons to drop the masking requirement, only developments that “have allowed us to feel more comfortable with the mask order ending.”
In a subsequent interview with the News&Guide, Pond suggested there wasn’t political will from the county commissioners to extend a mask order, making the point that Public Health wouldn’t go through all of the effort to draft a health order if it would expire after 10 days.
Commissioners Mark Newcomb and Luther Propst, who had previously supported the mask mandate, both expressed aversion to a new mandate in interviews with the News&Guide. Without their votes, Riddell’s order would fall flat.
Health officers in other Wyoming counties have been similarly thwarted.
“My decision making on public health measures has been and will continue to be more about science and pandemic conditions than about any political winds,” Dr. Riddell said on Tuesday.
Teton County is one of only two Democratic counties in the state and was the only county to issue a mask mandate during the delta surge. A significant 20,695 residents — 88% of those eligible in Teton County — are fully vaccinated. Both safety measures, health officials said, helped protect the populace from COVID-19.
This year five residents died from COVID in Teton County (nine died in 2020). All were unvaccinated.
Critics of the mask mandate pointed to the county’s risk of transmission, which remained high throughout the delta surge. But it’s also not clear how much worse infections would have been if people had been masking less.
Compliance was also mixed, depending largely on how strictly businesses enforced the health order. Some business owners, like Teton Toys’ Wes Gardner, who spoke at an Oct. 25 commissioner meeting, said the order gave them ground to stand on, and many businesses put “countywide ordinance,” right on their signs.
On Monday employees at Wyoming Outfitters just off the Town Square were diligently asking if unmasked customers needed a face covering. Some shoppers took one from the bucket; others left the store.
At the October meeting, Jackson’s top health officials all said masking needed to continue, and that was before omicron.
The new variant is significantly more infectious than delta — with some reports suggesting it is two or three times more transmissible — which means more people will be infected. In a highly vaccinated population the risk of severe infections that could overwhelm hospitals appears to be low.
The pandemic has already been an “enormous burden” for St. John’s Health, CEO David Robertson said via email.
COVID-19 patients require intensive treatment by staff, who isolate along with their patients. As a result, those nurses can’t care for as many patients, exacerbating the present health care worker shortage that Robertson called “the worst that we have seen in this country for decades.”
That said, St. John’s has several tools to manage a surge: It can expand negative pressure rooms as caseload increases, shift personnel to assure that critical patient needs are met, increase testing and outpatient capacity and take steps to bolster the supply chain.
Robertson was careful in describing the hospital’s limitations.
“[The] question is somewhat dependent on how you define ‘overwhelmed,’” he said. “It is true that SJH has not ever been ‘overrun’ with COVID patients, meaning that we never had so many COVID patients that we could not have limited our services to ‘COVID-only’ care and had sufficient beds and staff to deal with these COVID-only needs. However, treating virtually only COVID patients, as some hospitals have been forced to do, significantly results in a failure to meet the overall health needs of the community.”
“At SJH, we have attempted to maintain our full spectrum of services throughout the pandemic,” Robertson added. “And in this respect on multiple occasions we have been ‘overwhelmed’ from both a bed and staffing standpoint.”
The hospital continues to strongly encourage vaccination as the most effective intervention to mitigate COVID.
Public health officials will be closely following hospitalization data and are prepared to recommend “more aggressive public health interventions,” this winter if the hospital starts to fill up, according to Pond and Riddell’s letter.
Robertson said it is “impossible to predict” if St. John’s will be overwhelmed by omicron.
“If the number of hospitalized COVID patients due to the omicron variant exceeds the peaks that we saw with the delta variant, it might force us to temporarily halt the provision of some non-COVID services in order to maintain the COVID capacity that is required,” he said.
Teton County has remained at high risk for COVID-19 since delta became the dominant variant in early August. The county is currently averaging about 30 weekly cases (down from 40 cases in mid-November, and over 100 cases at the height of delta’s surge).
“As we progress in this, and it’s clear that COVID is not really going away, we therefore sort of need to learn to live with it,” Riddell said last Thursday.
“I think that means not only taking the community’s transmission level into account in terms of decision making, but also your own sort of individual risks.”
In announcing the mask mandate expiration this week, the Teton County Health Department issued new guidance on holiday travel and gatherings, based on a new framework of “individual risk.” It’s not entirely clear what that decision matrix looks like or how it jibes with the pandemic imperative to protect the vulnerable.
Since the onset of the pandemic, 80% of Wyoming’s 1,500-plus COVID deaths have been residents 60 or older. A significant portion also had an underlying health condition. Regardless of vaccination status, people in those demographics are at higher risk. Thousands of Wyomingites have also put themselves at higher risk by declining to get vaccinated.
All of which puts Teton County residents in a tough spot.
Most of the county is vaccinated, but because vaccinated people can still contract and transmit the virus, they can pass it on to people with less protection, either because of age, health factors or refusal to get the vaccine.
The conundrum is epitomized by the new omicron variant, which is rapidly infecting vaccinated people, even those who received their booster. While cases tend to be mild, the mutations of the new variant mean it’s never been easier to infect others.
The more infections, the more likely someone will become severely ill.
In Houston, where omicron doubled COVID cases overnight, restaurants are shutting down, and the city’s regional hospital is urging caution.
After an omicron surge at Cornell University, the school moved all finals online and canceled on-campus events. Cornell was 97% vaccinated at the time.
The first two cases of omicron in Wyoming were detected in fully vaccinated Albany County residents last week. In response, the University of Wyoming voted to extend its mask mandate at least until February.
From a political standpoint, public health officials said removing the mandate in Teton County could give them more bargaining power if the omicron surge is indeed severe.
It’s not clear if increased hospitalizations would sway county commissioners.
“I see no rationale to dispute or disagree with Dr. Riddell’s decision to let the mask order expire,” Commissioner Luther Propst said via text on Tuesday. “With the opportunity to get a vaccination and booster, and more effective treatment, I endorse letting the order expire.”
Chairwoman Natalia Macker did not respond to a request for comment by press time.
“I would not support a comprehensive communitywide mandate based on the same metrics [as Public Health Order No. 21-5],” Commissioner Mark Newcomb told the News&Guide on Tuesday.
A longtime mountain guide, Newcomb used the analogy of a tourist scared about exposure: On ledges far off the ground, visitors often get uncomfortable, he said, even though they’re anchored in.
Whether or not that’s the situation with vaccines against COVID, Newcomb said it’s time for the community to accept a higher level of risk.
“I believe we as a community are building a tolerance where we don’t need as many nonpharmaceutical interventions,” he said, acknowledging that statement was going out on a limb.
The commissioner said he’s heard some “thoughtful perspectives” from the Mountain Freedom Alliance, which has publicly criticized the mask mandate. He also trusts members of the community to be more cautious when visiting more vulnerable people.
It’s not clear if nature’s new variant will be equally discerning.