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The official public health state of emergency in Wyoming tied to Coronavirus has been lifted by Governor Mark Gordon.

Our guest today on Wyoming Chronicle, Dr. Alexia Harrist, was a key consultant in the governor's decision making process.

The COVID emergency in Wyoming is over, officially.

Dr. Harrist will tell us what that means for the state and what it doesn't.

Starting now on Wyoming Chronicle.

Funding for this program is made possible in part by the Wyoming Humanities Council, helping Wyoming take a closer look at life through the humanities.

Thinkwy.org.

And by the members of the Wyoming PBS Foundation.

Thank you for your support.

Hello and welcome to Wyoming Chronicle.

I'm Steve Peck of Wyoming PBS.

Very pleased to be joined today by Wyoming's State Health Officer, Dr. Alexia Harrist.

Thanks for being with us.

- Thanks so much, Steve, for having me.

- A topic of conversation aroun Cheyenne these days is the announcement that the yearlong state health emergency related to coronavirus in Wyoming has been lifted.

What does that mean from your angle of research and knowledge?

- For us, it really is an encouraging signal that we are moving into a different phase of the pandemic.

We've reached a point where many more people now have immunity.

We have many more tools to deal with the virus, ways to prevent infection, ways to treat infection, and many more ways to to test for infection.

So it's really signaling moving into a different phase where we have a lot more of those tools.

And there are some some minor legal implications, some impacts, like we can't bring in temporary providers into the state anymore and things like that.

But overall, the Department of Health, of course, can continue to make recommendations, continue to make testing and vaccines available.

It is an important point, though, that the federal state of emergency is still in place, and that impacts things like Medicaid enrollment, as well as the availability of testing and therapeutics that are under emergency use authorization.

- That sort of gets to a question that I had in mind.

The decision announced by the governor is a policy decision from a chief executive who's also an elected official in a political office.

From your angles, of input, what factors were important for you to make sure that he knew?

- Sure.

Certainly, we looked at the the legal statutes and made sure that by removing the public health emergency, that it wouldn't impact negatively the actions and the recommendations that we could take.

And it really didn't And so that was really our main, main input.

It didn't impact, could we accept resources from from the federal government for public health purposes, etc.

So.

So we were certainly felt good about removing the public health emergency, signaling that we're in a different place.

- A couple of years ago, the state was up in arms over or beginning to be up in arms over COVID when the numbers were not nearly as high as they are now.

In the ensuing two years, what's happened?

Is it just a change of mindset scientific knowledge, a combination of those?

How do you weigh that difference in viewpoint now?

- Yeah, I really think it's a different level of scientific knowledge and a different level of tools and strategies that we have for for preventing severe illness.

Certainly in the spring of 2020, summer of 2020, we didn't know a lot about the virus and the best ways to prevent its spread.

We didn't know who would get the most ill from the virus and potentially develop severe illness, hospitalization and death.

You probably remember we didn't even have a lot of testing resources at that time and we had to sort of limit who who should get tested and who shouldn't.

But now we have, of course, a lot of those tools.

We have testing readily available.

We still offer a lot of free testing as well as you can really walk into any pharmacy at this point and get a test.

We have effective therapeutics both for prevention of illness, but also treatment of illness among those who are at higher risk of severe illness.

And of course, we have vaccines, which is our best tool to protect ourselves against severe illness and death.

And those are readily available to anybody who's five and older at this point.

Our health care providers, of course, also have two years of experience treating this virus, which we didn't have in 2020.

- Well, this means COVID's all behind us, right?

Wrong.

- It's not behind us.

We certainly still have the virus here.

We still have a pandemic, although a different phase of the pandemic.

We know a lot more about how to protect ourselves.

But it's still important that people take those actions to not only protect themselves through vaccination, which is the most effective way, but also to protect those others, especially those others who might be at the highest risk for severe illness and deaths.

Older individuals, individuals with underlying medical conditions.

We still don't have a vaccine for children under five.

So you know, taking those reasonable precautions that we've learned over the past couple of years and implementing them when it's when it's most critical and most important, - I asked that question of course facetiously, but here's here's one that maybe isn't quite so much in that vein.

Will COVID ever be behind us or is one of the realizations we have now as people that this is part of our lives and may well always be.

- So I think the simple answer is that we don't know for sure.

I don't think anyone can predict what the next year will look like or what the next five years will look like.

I think we can say, though, that for the time being, for the foreseeable future, that the virus is going to be with us.

We're in a much better place in terms of protecting ourselves, a lot more immunity in the population.

But, and we may see periods of time where we have lower levels of transmission like we're seeing right now, and we may see periods of time where we see higher levels of transmission and are more concerned about severe illness and hospital capacity and things like that.

I think we're much better prepared for those things to happen.

But I think what we can't do is predict exactly what will happen.

- What was thought to be common knowledge at the beginning was that this is the time of year when the infection rate might be highest.

And in fact, now we're here on a very cold day today.

It's still winter, and this is the time when this the state of emergency is being lifted.

Now, if, as you say, many of the factors that you've that you've talked about vaccination, treatment, prevention, knowledge, but it just goes to the point that we can't be sure when we're dealing with a virus.

- Exactly.

And especially a still relatively new virus, a virus that we know can develop new variants like we've seen with Delta and then Omicron.

But we are in a much better place to deal with them.

- What does Coronovirus mean, exactly?

It's sort of, it's the term that we've come to accept in the COVID shortcut.

But coronavirus is sort of a blanket term for lots of stuff.

Am I right about that?

- Yeah.

Coronavirus is a group of viruses.

They're called coronaviruses because they look sort of, their structure looks similar.

They have a crown like structure around them.

And there were common types of coronaviruses present before this novel coronavirus.

Viruses that cause mild colds like illnesses in in humans.

And there are other types of coronaviruses that cause disease in animals.

But we have seen several types of new coronaviruses over the last couple of decades.

And of course, everyone remembers SARS and MERS, Middle Eastern Respiratory Viruses, another coronavirus.

And so now this is the third one.

And we'll see how it develops over the next several years.

- So inside the lab, what do you how do you refer to it?

Do you say, “Were doing some testing for novel coronavirus, SARS-2 or COVID ”?

Or where does the popular vernacular enter into what you people of science do?

- Sure.

So I'm very fortunate to be able to, as part of my job, supervise the laboratory we have fantastic scientists at the laboratory who know a lot more in-depth about laboratory science and testing for viruses than I do.

We call it SARS-CoV-2, which stands for Severe Acute Respiratory Coronavirus.

Number two.

And SARS, of course, was number one.

- We mentioned the value of the vaccines.

I think that goes without saying.

Of course, as we all know, there have been these political and social disagreements that have sprung up around everything related to to this.

But those things aside, simply speaking from a scientific point of view in terms of the method that the vaccines were developed, the speed, the effectiveness, I mean this has been an incredible scientific accomplishment, hasn't it?

- It is an incredible accomplishment that we really should be proud about and while it certainly did, it was fast, it was faster than we've developed a lot of other vaccines, it was based on technology and knowledge and research that had been going on for decades.

And the reason it was able to happen so fast was not because steps were skipped in the process.

We have one of the best regulatory mechanisms in the United States in terms of the safety and efficacy of our medicines and vaccines.

But it was because, you know, so many resources that were put into the development, so much dedication, and we could build on on that knowledge that we have developed.

So, yes,we should be really proud of these very safe, effective vaccines that we were able to develop so fast and get available to people in record time - You mentioned earlier, its hard to predict in the world in the realm of the virus.

But would you say that what we've learned just in terms of vaccine development would be helpful if another viral agent comes along that we'd be better prepared to develop a vaccine?

- Absolutely.

I think so.

Obviously, every different pathogen every different virus has its own characteristics and challenges when you're thinking about vaccine development.

But absolutely the MRNA technology, some of the other vector technologies that that have been used during this pandemic, I think we can certainly use for the next one, which I hope will be a very, very long time from now, but absolutely makes us much better prepared.

- I don't want to delve too much into this The realms of social and political debate, which are not that's not your field.

You're a person of science.

One of the things that often is said in that context, though, was that COVID was just just the flu or just the common cold.

Now, those are viral illnesses, of course.

But what's the difference between those and this?

- Its really the degree to which we saw severe illness and death from this virus.

With the flu, with other viruses that cause the common cold, those viruses have been around a long time.

Most of us have some level of immunity.

For influenza, we have a vaccine.

For coronavirus, When it came we didn't and we were very susceptible and we saw a lot of people die.

Many unfortunately, more people die than than we've seen in any flu years in recent history.

So that's really the difference.

And while it's true that most people who get COVID19 do recover and are fine many people didn't.

And we know certain people are more susceptible to severe illness although really anybody we've seen can develop severe illness from COVID 19 - Just part of the nature of the virus and of people is that not everybody gets it.

I could be sitting right next to someone who does get infected and I don't and not everybody gets sick and not everybody stays sick for as long.

Is that something as you understand it, that where will ever change?

Or is that just always going to be part of what the living with a virus is all about?

- Yeah, there are so many different factors when it comes to, you know, the likelihood of you having the virus.

And we sitting here get it, how infectious you are, what the ventilation is like in the room.

But I think it has changed already in that, again, that we have much more immunity from vaccination mostly, but also from previous infection.

And so I think that reduces the likelihood that most of us will get severe illness, although we certainly know that there are individuals who just don't have the same strength of immune system for whatever reason.

It could be age, it could be based on underlying medical conditions and that those are the people we we should be looking out for at this point.

- I remember a conversation I had with a leading pest control official, of all things, where I lived, and he had sort of become the de facto health officer for the county.

This was at a time when West Nile virus was of concern at a much smaller level of intensity and frequency as we realize now.

But at the time, people were concerned about it.

He made the argument that, well, I think everybody who's got, who can get it, who's going to get it and be affected by it, may already have got it.

We're still seeing the carrier mosquitoes, but we don't see the level of infection.

Do you find that as a physician and epidemiologist a frustrating thing, or is it just as a person of science, this is just part of the experiment, of the research of the about the analysis of it?

-F rustrating that we can't sort of predict who's going to have a severe illness?

Oh, of course.

It would be so great to be able to tell people if you get COVID, this is what you're going to experience.

These symptoms mean you have COVID versus the flu or something else.

Or allergies.

I think we'd all love to be able to do that as a physician or a public health professional.

But we're dealing with pathogens and with viruses that have their own sort of strategies.

And and some of them you can't predict.

All we can do is ensure that the knowledge we have gets passed on to people so that they can take the precautions that they feel they need to take and they have the knowledge they need to to protect themselves, know when to get tested, know when they might qualify or benefit from certain treatments.

- Do you think this discrepancy among individuals has played into the larger social, political kind of controversy that's come to surround the virus, vaccines, etc.?

- I think it probably has somewhat,just that, you know, some people can look at their own experience and say, well, I had very mild illness.

It didn't seem to affect me at all, or I was asymptomatic.

And so why are we so worried about this?

Why are we taking these actions when when in my experience, it's not so bad?

But of course, we have people on the other end that really have had devastating experiences.

And that's where public health, I think, plays an important role in collecting that data.

And being able to show that data so that people can know what we know.

It's on a population basis rather than just go by personal experience.

And of course, very valuable, but might not tell the whole picture.

- The public health officers around the country have taken a beating in this respect that I'm talking about.

I'm not trying to embroil you too deeply into this conversation on this topic.

How much have you allowed yourself to notice that, to respond to it, to be concerned about it, or have you been able to focus more on your your actual task?

- You know, I think I'm extremely lucky to have the team that we have here, both at the Department of Health and really statewide as a health official.

I have always been able to depend on the experts on my team and had support from leadership really around the state.

You know, certainly it is difficult, right, to hear criticisms.

And, of course, knowing that things like state public health orders really do impact people's lives.

And impact them negatively.

And that's difficult.

And I was always, as we all were, trying to find that balance of where we could protect the public health but also ensure that people could do the things that they needed to do just just in a safe, safer way, as safe way as possible with this virus present.

- Two people in my immediate family tested positive.

Anyone close to you get infected?

- I was lucky enough to escape infection for these couple of years.

I certainly have had family members get the virus.

You know, some, again, felt relatively fine and recovered quick, some felt quite ill and were out of commission for a while.

So, you know, certainly seen it impact my family in my personal life.

I have a grandmother who's 90 years old.

And we all very much try to make sure that, we want to see her, but protecting her as much as we can when we do that.

- Where are you from originally?

- I'm from New England, originally, outside of Boston.

- Where did you get your training?

Where'd you go to college?

- I went to college in Connecticut at Yale, and then I did medical school and graduate school at the University of Pennsylvania.

- So these are major credentials that you bring to the job.

What brought you to Wyoming?

- After I did my pediatric residency, I joined a fellowship at the CDC called the Epidemic Intelligence Service.

And I was extremely lucky to get assigned to do my two year fellowship here at the Wyoming Department.

- And CDC sent you to us?

- Yep.

- Now, since then, that's not the job you have now.

You've become a state official to a degree.

When you came on, as epidemiologist, I mean, the job was plenty big before this all happened.

Correct?

What were some of the things that, I mean the lab that we're sitting in now is concerned with more than just coronavirus.

What are other things that are issues in your job?

- Sure.

Well, of course, we have other infectious diseases and infectious disease outbreaks that we investigate.

You know, there's routine surveillance for G.I.

diseases, or vaccine preventable diseases.

But then we always have some sort of outbreak that we're trying to investigate.

We also do surveillance for and have prevention programs for chronic diseases, things like heart disease, diabetes, cancer, because we also know that these, of course, have large impacts on people's lives.

We have epidemiologists looking at maternal and child health, asking women about their experiences before, during and after pregnancy to better understand how those public health systems can be improved.

And then, of course, there's substance use and suicide and all of those other very important public health issues.

Our laboratory does a variety of testing.

We are prepared to test for agents of bioterrorism or rare diseases.

We diagnosed plague this year in a Wyoming resident, as you might have heard.

We do toxicology testing for other states, some other state partners, as well as testing for a variety of infectious diseases.

- In recent years, one of the very, very few rabies cases in the whole nation was in Wyoming.

And for a long time, there really hadn't been one.

Was your lab involved in that diagnosis?

- For that diagnosis we go to CDC for human human rabies diagnoses.

But certainly a lot of other infectious diseases were involved in.

- All that's going on as well the department has had to deal with this COVID pandemic, then that hasn't stopped that other activity.

- That's absolutely right.

And one of the challenges, of course, is being able to do all of those other things while focusing on COVID.

And I can't say enough about the staff that I have and how hard they worked on both COVID 19 as well as these other other issues.

And we are certainly looking forward to being able to give these other issues the attention that they deserve.

- Were you able to bring on more staff as you needed to through the toughest of the pandemic phase?

- We were absolutely, yes.

From from my standpoint, both at staff on the epidemiology side to help with things like contact tracing and outbreak management, as well as on the laboratory side, really just amazing people that made us be able to respond the way we were able to.

You and I both used the word epidemiologist.

What is that exactly?

Epidemiologist is really somebody who tracks diseases of public health importance as well as response to them.

And so not only looks at the data in a whole and thinks about how we can prevent these conditions and diseases from happening, but also on an individual level sometimes too, and trying to figure out where someone might have gotten that infectious disease, how can we help make sure nobody else does and help prevent the spread to others.

- And you can cite cases where this work has been effective.

The situation has improved because of epidemiology.

- Yeah.

I think going back to the plague case, plague in certain forms is transmissible from human to human.

It's very serious and can be a deadly disease.

But if you're able to locate those people who had that contact and were at risk and give them appropriate antibiotics, you can then prevent that severe disease in another person.

And so that's one sort of very clear example but we have situations like outbreaks of gastrointestinal diseases in certain settings.

And and we can help identify where that might have come from or recommend measures to help stop the spread and make sure everyone can return to their activities safely.

- How do you and your lab and your staff become aware of a case of plague for example?

Was that Let's immediately call Dr. Harrist, or how did that come, for example, to your attention?

- So we have a list by statute.

We have a list of diseases that are reportable.

We call the reportable diseases to the public health.

And these are diseases of public health importance that we can then take action on.

And there's really a whole page of them, infectious diseases like plague are on there, cancer is on there.

We have a cancer registry as well as things like, you know, elevated blood lead levels.

So if we have a child exposed to lead, we can do that follow up and try to identify the source and make sure that the child has been referred to appropriate services and mitigation measures where we're taken.

- This could begin anywhere, I suppose.

- So providers and laboratories are required to do that reporting, but we certainly get reports from all sorts of different groups or people, and we really do try to follow up on everything that we can.

- I was a newspaper man for a long time, and I realized about two or three months into the pandemic in 2020 that this was the biggest story I had ever covered.

In our local daily community newspaper.

Just in terms of all the implications of it, it was global and also microscopically local and its effect on practically everything for everybody, not just health, not just economy.

Not just education, but on society and behavior and politics.

I don't know if you rank things in that way, but if I asked you to, where would the COVID pandemic rank in terms of what you've had to deal with in your career?

- For me, it's absolutely the highest as well.

And for a lot of the reasons you you said.

It really impacted everybody.

You know, there wasn't a specific group of people or town that was impacted.

It was everybody.

And it impacted so many different aspects of our lives.

And so we're obviously trying to work from the public health standpoint, but there's so many other different factors that were affected.

As you mentioned, the economy, education, etc.

And so we had to work to try to find that balance where public health fits in.

But considering all of these other factors, certainly, of course, the morbidity mortality from this virus are nothing like I've ever seen from any other disease.

And we really were had a couple of points during this pandemic where our hospitals were full.

And that we were worried about that we might have to start making decisions about who could receive lifesaving care and who wouldn't have have access to that.

And of course, the length of time, having this go on for for two years, most of our outbreaks, or at least from the infectious disease standpoint are nothing like that long.

- When something like this occurs and you are confronted with it, do you go in with confidence, feeling, 'This is what I do.

I can help.

I'm going to help.

We're going to get results.'

Or is it, 'My gosh, what am I going to do now?'

- I think it's a mix of both.

I mean, you you have to have confidence in your education and your experience that you can take what you know and apply it to do something new.

Even though there's not a lot known about the virus, you have knowledge about infectious disease and virology and transmission of diseases and apply that.

But I think there's also humility, right?

You have to know what you don't know as well and make sure that you recognize that when you're recommending or taking actions or speaking to the public, that you do have to acknowledge that there are things you do not know.

And that's okay as long as you're upfront about it and recognize that.

We've been speaking with State Health Officer Dr. Alexia Harrist.

Thank you for being with us.

And we appreciate the work you're doing and the time you spent with us today.

So long from Wyoming Chronicle.

Funding for this program is made possible in part by the Wyoming Humanities Council, helping Wyoming take a closer look at life through the humanities.

Thinkwy.org.

And by the members of the Wyoming PBS Foundation.

Thank you for your support.