Laura Triplett was exhausted.

After a trying year of treating hospitalized COVID-19 patients, the toll of the losses — including five people who died in two days — was becoming too much.

She cut back on the after-work wine, took up yoga, got the COVID-19 vaccine, and happily transferred back to cardiac care in search of a normalcy that all Minnesotans are craving after a historically tragic 12 months.

"You don't lose five patients on any unit in two days," the critical care nurse said. "For my own well-being, it was time to go."

One year after reporting its first COVID-19 case — in a cruise ship passenger from Ramsey County — Minnesota still struggles with a pandemic that has caused 6,500 deaths and 490,000 known infections from the corona­virus that causes the disease. The toll on the state's economy has been harsh as well — more than 230,000 jobs were lost due to the pandemic and restrictions put in place to slow COVID's spread.

But there is palpable optimism for the first time in months, as rising vaccinations and declining infections give hope to the return of live events such as concerts, Twins baseball and an open State Fair.

"Walking down ... Dan Patch [Avenue] with a corn dog in my hand is like the happiest thought that I can imagine," said Gov. Tim Walz. "That is within our reach."

The hope is tempered by continued risks, particularly of new and more infectious variants of SARS-CoV-2, and the realization that mental and physical recovery will take months, if not longer.

Many people were braced for one catastrophic wave of COVID-19, but instead got a "chronic year" that wore them down even if they weren't infected, said Dr. Sophia Albott, a University of Minnesota Medical School psychiatrist who created support programs to help medical providers cope with the pandemic.

"As we reach one year, that has been what's most challenging for people," she said. "How do you maintain resiliency over this sort of marathon?"

Vaccine as a finish line

For some, avoiding infection and getting vaccinated feels like crossing a finish line.

Cynthia Ness, 70, of New Hope, said the excitement of getting a shot via the state's random drawing for senior citizens was tempered by guilt that others were waiting, including a brother-in-law battling cancer.

If Ness wakes in the middle of the night, she checks websites for appointments and calls friends no matter the hour if she spots openings.

"I even talked it over with one of my good friends," she said. "We had to tell ourselves that we were lucky and they, too, will get their shot."

Emotional recovery might take more time after a year in which the availability of something as basic as toilet paper was never assured, said Dr. Sophia Vinogradov, chair of psychiatry at the University of Minnesota.

The brain is hard-wired to tolerate some uncertainty, such as the chance that a flight could be delayed, but it doesn't cope as well with the level of confusion that occurred during the pandemic, when nobody knew how bad it would get or how long it would last, she said.

"That volatility in uncertainty takes up a lot of resources in terms of the brain being able to function and has been associated with increased states of anxiety," she said. "And let's face it, that's what we've been facing for the past year."

For a Minnesotan with one of the first COVID-19 cases, finding security meant leaving the country.

Ben O'Donnell's infection was so severe that he was placed on a heart-lung bypass machine and hospitalized for weeks last spring despite being in his 30s and fit enough to complete an Ironman endurance race.

O'Donnell, who lived in Anoka County when he fell ill, said his left leg is still numb but he has recovered to the point where he is planning to set a personal record in an Ironman triathlon in Texas this spring.

He moved to New Brunswick, in Canada, in part because he had more confidence in that nation's COVID-19 response and ability to protect his 4-year-old daughter — who has the same genes that could make her more vulnerable to severe illness. But the move also reset priorities, switching O'Donnell to a happier career and putting his wife closer to family.

"I'm not happy that it happened, but I don't think I'd want to change anything based on where we are at right now," O'Donnell said. "I've never gone through and said 'Thanks, COVID,' you know, but I haven't cursed its name."

Changing guidance stressful

Looking back, state health officials lamented that increased stress came with changing advice on the new virus — even when it represented the best knowledge at the time.

Discouragement last spring of public mask-wearing, in order to preserve supplies for health care workers, might have undercut the success of a state indoor mandate last summer when it become clear that masks reduced viral spread.

Dr. Ruth Lynfield, state epidemiologist, said health officials were slow to acknowledge that SARS-CoV-2 was spread not just by symptomatic patients but by anyone carrying the virus, when they spoke, ate or exhaled.

"We did not have an appreciation for it," she said, "and even when there were some signs of it, I think public health was a little slow to understand the full impact of that."

The recognition was significant, because the risk of asymptomatic spread influenced many of Minnesota's mitigation decisions — including prolonged closures and restrictions on bars and restaurants where people couldn't wear masks while eating or drinking to protect themselves.

The Devil's Advocate bar in downtown Minneapolis first closed per a state shutdown order last spring, then remained closed amid the riots over the death of George Floyd in late May. An attempted reopening was upset by downtown looting in late summer followed by another closure order in response to rising COVID-19 rates in the fall.

"Its like being in a boxing ring and just getting hit left and right. I'm still standing somehow but we're tired," said owner Erik Forsberg, who also hasn't reopened Dan Kelly's Pub or Erik The Red. "No question, though, I'm more filled with hope right now and encouraged. I think the city is going to come out of this thing."

Some public health experts fear optimism is premature because of the growing circulation of more infectious variants that are causing rising caseloads in Europe. Mike Osterholm of the U's Center for Infectious Disease Research and Policy said the variants represent a new threat at a time when states are relaxing their protections.

"The whole country is in pullback mode," he said.

Walz said the variants are concerning but he is encouraged by the increasing rate of vaccination and the latest modeling from Mayo Clinic that shows little chance of a looming third COVID-19 wave in the state.

A year ago, testing supplies were limited worldwide and federal stockpiles of personal protective equipment were nonexistent, he said. Now, health care workers have protection as well as a vaccine, and the state has the testing capacity to finally respond to the pandemic in the right way — with contact tracing following the identification of cases and quarantines to reduce spread.

"Over the next basically a year, we're going to have to still manage hot spots," Walz predicted, "but they should basically be on the periphery of people's attention. And it should impact very few people in their daily lives, in our activities."

More vaccine, better care

Medical knowledge about COVID-19 has increased over the past 12 months, too.

Dr. Bevan Yueh, interim chief executive of University of Minnesota Physicians, recalled how he and other executives were infected in March because they met, unmasked, around a crowded table to plan the conversion of Bethesda Hospital in St. Paul into the nation's first stand-alone COVID-19 inpatient treatment facility.

Yueh ended up being one of the first patients at Bethesda, where he was denied steroids out of concern at the time that the drugs exacerbated COVID-19. Later research found steroids are among the few effective medications.

"We've learned so much," Yueh said.

Among the mysteries that remain one year later is why so many people who suffered COVID-19 continue to experience symptoms such as shortness of breath.

Israel Pliego of Richfield hopes to regain the strength to resume his delivery business after suffering such severe COVID-19 that he was placed on a heart-lung bypass machine for 52 days. The 46-year-old emerged with the withered muscles of someone almost twice his age.

The father of two feels tingling and pain in his extremities but is regaining lung function and can drive on his own. In darker moments, he wonders if his doctors should have let him die, but then he sees his children and gains hope, said his wife, Maria, who also struggles with exhaustion after recovering from COVID-19.

"The therapist is saying it will be a year and a half to two years," she said. "Even if he gets 80 or 90 percent of the lung capacity that he had, he will be able to be fully on board. He will be able to work."

Triplett, the nurse, from the start had worried about one of the cruel aspects of the pandemic — the isolation of COVID-19 patients in hospital rooms that prevented loved ones from seeing them in person until they were dying. To help comfort grieving relatives, she gave them vials containing the monitoring strips showing the patient's final heartbeats.

It made a difference, too.

Joan Johnson didn't make it to St. Joseph Hospital in St. Paul in time to see her husband, Larry, one last time. The retired electrician died at age 63 on Oct. 12 while his wife was en route.

After receiving the monitoring strip, Johnson and her daughter and granddaughter had the image of Larry's heartbeats tattooed to their arms.

"Where I have it now on my arm, I can put it up to my chest and just feel," his wife said. "It's almost like I feel a sense of peace after I got the tattoo."

Triplett said it was gratifying to learn how her efforts made a difference, but that it was tough realizing she had gone through six boxes of vials over the past year.

She has a new enthusiasm working with cardiac patients, and more confidence in Minnesota's ability to weather the pandemic because mask-wearing and social distancing have become habit.

"I feel like COVID is going to be around," she said, "I'm just hoping it's going to be less."