The COVID-19 pandemic has grown worse in Wyoming since the state started loosening restrictions last month, and health experts are saying the two are likely related.
Deaths attributed to the virus more than doubled during the last two weeks of May, though they have so far slowed in June. On May 17, the Wyoming Department of Health announced an 8th death for the state. On May 31, the department announced its 17th.
"There's no question that with people,both by their own decisions and by policy, emerging from staying at home, cases do appear to be increasing," said University of Wyoming researcher Christine Porter.
She added it's difficult to see trends in a state with such a small population. But a spike in deaths two weeks after reopening is not surprising.
"You get infected, it's about five days later, on average, that you start to show symptoms," Porter said. "And about a week to two weeks later, if you're going to die, you die."
Executive orders from Governor Mark Gordon relaxed some of the social distancing measures that slowed the spread of the coronavirus during March and April. For many, this meant a return to work or small social gatherings, albeit with restrictions.
But the threat of a large outbreak is still very real. Porter said without widespread testing, everyone should act as though they're infected.
"As many as 80 percent of people who end up infected and can be spreading it have mild symptoms or no symptoms at all," she said. "And about half of cases are transmitted before anybody has symptoms. You cannot rely on symptoms."
Porter said wearing a mask in public is a good way to protect those around you.
"People who are not wearing masks out are risking infecting other people because they could be infected and don't know it," she said. "It's very irresponsible and it's kind of like manslaughter. If you unintentionally infect somebody and they end up dying from it, or they spread it to somebody who then dies - it's not on purpose, but that is the result."
Dr. Mark Dowell, an infectious disease specialist in Casper, agreed that people should be wearing masks.
"No one's going to ask you to wear a mask when you're walking the dog," he said. "But when you're going into the grocery store or when you're getting your haircut, those kinds of places."
In fact, wearing a mask is now more important than ever, as people in Wyoming start to have more personal interactions.
"But unfortunately, we went from people doing a fairly good job of social distancing and wearing a face covering to basically - if you want to be blunt about it - blowing it off," Dowell said. "And there didn't seem to be anything in between."
Dowell said some new cases are not tied to reopening at all, and would have likely occurred regardless.
"But we currently have an outbreak that is at a business establishment [in Casper], which I believe is absolutely related to opening up," he said. "The business establishment had three employees positive and now there are spin off cases. And that location was previously closed so it demonstrates that yes, there is low level virus throughout the state and in the community."
Potentially even more worrying is what comes next. Dowell said the state might be able to keep new cases and deaths low, at least for the summer, if people keep their guard up by continuing to wear masks and avoid crowds.
"You can close rodeos, you can close huge gatherings - and that's what should be done right now - but when it comes down to the nuts and bolts within a given community, if it's not enforced, at least psychologically, in the community, it's not going to happen anymore," Dowell said.
Experts are concerned that both cases and deaths will continue to rise.
The University of Washington's Institute for Health Metrics and Evaluation has been modeling the projected rise of COVID-19 cases and deaths.
The continuously updated model now predicts that Wyoming will see 99 deaths from the pandemic by October. Because of the state's low population, that projection carries a wide margin of error, with a high bar of nearly 1,000 deaths by October.
Dr. Ali Mokdad, the chief strategy officer for population health for the University of Washington, said the projections depend in part on personal behavior.
No one can say what the summer will hold - but no matter how it plays out, reopening schools and campuses in the fall will present a significant challenge.
"All these models right now are agreeing on one simple thing, that this is a deadly virus, it's going to come back again in the fall and we have to be ready for it," Mokdad said.
The likely resurgence of the virus and the probable lack of a vaccine means that testing, contact tracing, monitoring and self quarantine will be even more important in the fall, the health experts said.
Mokdad said a "pulse" method might be the way forward. That means entering short periods of lockdown whenever COVID starts to flare up, shutting down and reopening repeatedly, rather than locking down for a longer, indefinite period of time. It involves "taking the pulse" of the pandemic and the population to determine when those shorter lockdowns are implemented.
"The major issue for many governors and many states is what do you do in September when the numbers are going up in terms of infection and mortality?" Mokdad said.
University of Wyoming researcher Christine Porter said that truly returning to life before the pandemic is only possible with a vaccine. Until one is developed, she said Wyoming residents need to keep up the habits that have kept the state relatively safe so far.
"It's possible. It's hard, it's expensive, but it's possible," Porter said. "And it's really impressive how innovative and thoughtful so many people are being about it. But it only takes a few to break the rules and restart the epidemic."
Wyoming's future is uncertain, but as the state emerges from lockdown, public health experts are hoping residents will keep themselves - and everyone else - safe.
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