A sign outside a hospital advertises COVID-19 testing on November 19, 2021 in New York City.
Spencer Platt | Getty Images
The public health emergency in the United States, declared in response to Covid-19, ends on Thursday, more than three years after the pandemic began.
The Biden administration’s decision to end the state of emergency comes at a time when deaths and hospitalizations have fallen dramatically due to the availability of vaccines, antiviral treatments and widespread exposure to the virus.
The number of Covid deaths has fallen to its lowest since March 2020, when the rapid spread of the virus across the United States overwhelmed the healthcare system and led to widespread closures of schools, businesses and public facilities.
Hospital admissions due to the virus have also fallen to their lowest since data collection began in the US in August 2020.
The end of the state of emergency will bring significant changes to how the US is responding to the virus. Hospitals are losing the flexibility to quickly add bed capacity as patient admissions increase, and the Centers for Disease Control and Prevention will scale back efforts to track the virus.
After the emergency ends, the CDC can no longer compel labs to report Covid test results. The agency does not have the power to force states to report new cases.
CDC Director Dr. Rochelle Walensky, who is set to step down at the end of June, warned Congress last week that the agency still has to negotiate data-sharing agreements with individual jurisdictions, a time-consuming process that puts the nation at risk.
“That should worry us all, mostly because of the visibility we’re going to have in the next outbreak,” Walensky told the Senate Health Committee. “We’re back to square one and need to build and negotiate surveillance capabilities while fighting a pathogen.”
While public health experts agree the US now has many more tools to combat Covid, they warn the virus will continue to pose an ongoing threat to the elderly, vulnerable and the country’s fragmented, ailing healthcare system.
“I think we’re through the worst now, but there’s going to be a steady drumbeat of hospitalizations and deaths for many years to come,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University.
The virus still kills
The US public health emergency has been extended 13 times since the Trump administration first declared it on January 31, 2020, when there were only six known cases of Covid and no known deaths in the US
In the three years since, Covid has killed more than 1.1 million people and hospitalized millions more in the United States, in the worst public health crisis since the flu pandemic more than a century earlier in 1918.
The virus was the fourth leading cause of death in the US in 2022 – two years after Covid first emerged, behind only heart disease, cancer and unintentional injuries.
The World Health Organization declared the end of the global Covid emergency on Friday. But WHO chief Tedros Adhanom Ghebreyesus warned national governments against dismantling the systems they had built to fight the virus.
“This virus is here to stay. It still kills and it still changes. The risk remains that new variants will emerge, leading to new spikes in cases and deaths,” Tedros said.
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More than 1,000 people are still dying from Covid each week in the US, the vast majority of whom are aged 75 or older, as the public has largely lost interest in staying up to date on vaccines.
Only 42% of seniors are up to date on their Covid vaccinations, according to CDC data. Only 17% of the entire US population has received the latest booster shot.
“You have to stay current to have proper protection,” said Dr. James Lawler, an infectious disease expert at the University of Nebraska Medical Center.
“Similar to immunity from a vaccine, surviving Covid confers immunity, but that immunity does not last,” Lawler said.
The Biden administration says the end of the state of emergency will have no impact on access to Covid vaccines and antiviral treatments because there is still federal stockpiling, but many consumers will have to start paying for Covid testing.
Gostin said a misinformation campaign against vaccines, particularly in conservative states, as well as a general vaccine fatigue, have put the country’s health at risk.
Meanwhile, millions of people are at risk of losing coverage through Medicaid, the public health insurance program for people on lower incomes, as states are allowed to review eligibility for the first time in years. Congress banned states in principle from barring people from Medicaid during the pandemic, but those protections expired in April.
“We’re going to see the social and health safety net unraveling over the next few months,” Gostin said. “There will be an increase in uninsurance and people will not have access to health care,” he said.
health system ailing
Hospitals have been hit by repeated waves of Covid over the past three years and many healthcare facilities are suffering from staff shortages as many doctors and nurses suffer from burnout.
With the end of the emergency, hospitals are losing the flexibility to quickly add beds in unconventional settings and resort to interns to help with increasing patient intake.
Leading medical associations warned the Biden administration last fall that emergency rooms were at a breaking point, and patients were being kept waiting due to insufficient bed capacity and understaffing.
And hospitals now face the ongoing threat of Covid, in addition to the flu and respiratory syncytial virus, which was already straining capacity during a period of poor respiratory viruses before the pandemic.
“We really have lost so much healthcare capacity in this country with the loss of beds and healthcare workers,” said Michael Osterholm, a leading epidemiologist and director of the Center for Infectious Disease Research and Policy in Minnesota.
“We better hope that we don’t see a big surge in infectious diseases of any kind in the coming months to years,” Osterholm said.
Lawler, who advised the Bush and Obama administrations on biodefense and pandemic preparedness issues, said hospitals may need the flexibility the public health emergency offers if large Covid surges return in the future .
“I’m not optimistic that anyone in Washington will be willing to declare a new emergency, even if warranted, once the public health declaration is lifted,” he said.