On January 31st, 2020, with six confirmed cases of a new coronavirus in the U.S., a group of federal health officials gathered somberly at the lectern at the White House and declared a public health emergency.
"Beginning at 5:00 p.m. EST Sunday, February the 2nd, the United States government will implement temporary measures to increase our abilities to detect and contain the coronavirus proactively and aggressively," announced then-Health and Human Services Secretary Alex Azar.
More than three years of social disruption, at least 6 million hospitalizations, and 1.1 million U.S. deaths later, that declaration is due to expire this Thursday. Some – including Republicans in Congress who pushed the Biden administration to end the declaration – say it's about time. Others remain concerned about the virus, and worry that the end of the declaration could mean relaxing measures that allow the virus to create new disruptions.
"COVID 19 is still a significant problem, but emergencies can't go on forever," observes Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. "I think we're living in a place where we're treating COVID similar to flu."
Professor Howard Markel, a physician and historian of infectious diseases, is in the camp that's still concerned. "History says that all pandemics end," he says. "But we have never had an infectious event like this – ever."
Concrete changes coming
In the early months of the pandemic, for a brief time, there was remarkable bipartisan unity in quickly marshaling federal resources to fight the new virus. That included major investments in vaccine development, new laws that allowed people to stay on public insurance programs without interruption, and free tests and vaccines for all. Those rules allowed for things like drive-through mass vaccination campaigns, where no one asked for your insurance card, and free curbside COVID-19 testing kiosks.
What is left of many of those programs are now being dismantled. Here's what's changing and what's staying the same, for now.
Vaccines and tests no longer free – now covered by health insurance
The federal government will no longer buy up tests or vaccine doses or treatments to give out to the American public for free. The health insurance system will take over – patients will have to go to the doctor, get a prescription, perhaps pay a copay when it comes to COVID tests and treatments, just like they do for all other illnesses.
It's important to note vaccines will still be free for practically everyone. People who are insured are required to get vaccines with no cost sharing because of the Affordable Care Act. The White House says people without insurance will still be able to get free COVID-19 vaccines – and treatments like Paxlovid – through 2024.
COVID data tracking gets scaled back
For people used to relying on data from the Centers for Disease Control and Prevention for guidance on how much virus is circulating in their community, there are big changes ahead. The CDC announced it will sunset some of its COVID data tracking efforts, including tracking and reporting new infections. It will continue to track COVID-19 hospitalizations and deaths, do genetic analysis to identify worrisome variants, and monitor spread through wastewater surveillance.
"We will continue to keep our eye on the COVID-19 ball," Dr. Nirav Shah, the CDC's principal deputy, told reporters last week. He pointed to a recent CDC analysis of the new approach showing it will be effective.
The changes to how CDC collects and shares COVID-19 data "comes as no surprise at all but is further evidence that these investments were always temporary and not part of a long term strategy to be better public health data stewards," Beth Blauer, who helped run a highly respected COVID data tracker at Johns Hopkins, told NPR.
Telemedicine access to remain in place
Some popular changes to health care brought by the COVID-19 pandemic will remain in place, at least for a time, including more flexibility with telemedicine, access to controlled substances and hospital-at-home programs. The Drug Enforcement Administration has not said how long it will allow telehealth prescribing of controlled substances, but most of the other measures have been extended to at least the end of next year.
Vaccines, tests and treatments emergency use can continue
Another thing that won't change for now is access to numerous COVID-19 vaccines and tests and treatments that were allowed for emergency use by the Food and Drug Administration. That authority comes from a different declaration, which hasn't ended yet – the timing of that is up to Health and Human Services Secretary Xavier Becerra.
The great Medicaid unwinding
A key provision in one of the first COVID relief laws gave states extra federal funding for Medicaid – the public health insurance program for low income people – but required states not to disenroll anyone for as long as the public health emergency was in effect.
Liz Adams, a stay-at-home mom in Plant City, Fla., says it was very important to her and her family to know they had Medicaid throughout the pandemic without having to worry about getting recertified. "It was there – you knew it was there," she says. "I didn't have to worry – I could take my kids to the hospital when they got sick, and not have to stress it."
Medicaid grew to be bigger than it's ever been, with an estimated 95 million beneficiaries, which is more than 1 in 4 Americans. This provision actually ended a bit ahead of the public health emergency – states could start disenrolling people as of April 1.
Although the head of the health agency in charge of Medicaid, Chiquita Brooks-Lasure, has said many times that federal officials are "laser focused" on helping ensure that people who are eligible don't lose coverage, a recent estimate from health research group KFF suggested that as many as 24 million people could lose Medicaid, including millions who are still eligible but fall through administrative cracks.
Adams thinks that's what happened with her kids' Medicaid coverage. Her son, who survived leukemia, recently had a follow-up biopsy appointment canceled because he was no longer insured. Adams is now working with navigators at the Family Healthcare Foundation to help her get coverage back.
Navigators, who help people sign up for health insurance for free thanks to federal grants, have extra funding this year to help people who find themselves without Medicaid coverage. (Navigators strongly suggest Medicaid enrollees make sure their contact information is up to date with their state Medicaid office so they don't miss a notice about their coverage.)
Will we be prepared for future threats?
The end to America's public health emergency declaration comes on the heels of the World Health Organization making the same determination last week.
In the U.S., the bipartisan willingness to marshal resources for the pandemic began to fall apart as the years wore on. The White House and federal health agencies have requested more funding to continue managing COVID-19 and prepare for the next pandemic threat, but Congressional Republicans questioned the need for it.
"One of my biggest worries is that we are losing time in preparing for the next pandemic," Dawn O'Connell, the head of the Administration for Strategic Preparedness and Response told senators last week. "It's the reason why the administration requested $88 billion last year to advance the American pandemic preparedness plan."
That funding never came, despite the fact that many experts believe the next pandemic may come sooner rather than later.
Pien Huang, Rob Stein, and Yuki Noguchi contributed reporting. Editing by Carmel Wroth.
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