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End of national emergencies brings new challenges to US COVID response

Tina Sandri, CEO of Forest Hills of DC senior living facility, demonstrates COVID-19 testing procedures on Thursday, Dec. 8, 2022, in Washington. (AP Photo/Nathan Howard)
Tina Sandri, CEO of Forest Hills of DC senior living facility, demonstrates COVID-19 testing procedures on Thursday, Dec. 8, 2022, in Washington. (AP Photo/Nathan Howard)
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The upcoming end of the federal emergency for the COVID-19 pandemic will bring significant change to the response to the virus and could bring added costs to Americans for treatments, testing and vaccines.

The White House said it would bring an end the COVID-19 national and public health emergencies in May as the country continues to reemerge from pandemic-era lockdowns and countermeasures to mitigate the virus’ spread.

Most areas have already had relaxed masking and social distancing policies for months as the virus has become less deadly and more people have better protection from severe illness and death through vaccination or prior infection.

Part of the ending of the emergencies will be a symbolic change for an American public that has mostly moved beyond the pandemic and returned to some form of pre-pandemic normalcy.

“The switchover of having these emergencies lapse is almost a mindset, and the mindset is for entering what epidemiologists call an endemic period, which means that the disease is going to be around,” said Boris Lushniak, dean of the University of Maryland’s School of Public Health. “We don't have a simple answer of how we're ever going to get rid of it, so now we're going to learn how to live with it.”

COVID is still killing more than 500 people a day and causing an average of about 3,900 hospitalizations every day in the U.S., according to the Centers for Disease Control and Prevention. Those figures are significant improvements from the beginning of the pandemic but still bring concerns for public health officials about the potential for future outbreaks.

One of the biggest changes will be access to free testing. Under the emergency declarations, Americans were eligible for eight free at-home tests each month and could order more through the federal government. How much they cost will vary along with insurance companies and what coverage people have.

“It's unclear what individual plans are going to do but that's a major, major change,” said Jose Francisco Figueroa, assistant professor of health policy and management at the Harvard School of Public Health. “There's concerns that there's going to be a lot less testing happening out in the community.”

How thorough the CDC’s data it uses to track the virus could also change as less free testing is offered. The CDC has already had to adapt with the proliferation of at-home testing, but it adds another layer of difficulty to moving on from emergency status.

“Where we need to make sure that the ball is not dropped is the idea of making sure that we understand what's going on with the strains that are out there in our community,” Lushniak said.

The cost of treatment and vaccines will also be shifted to insurance companies and consumers, with lower-income Americans and the uninsured being hit the hardest. The emergency declarations, along with some pieces of legislation, have allowed more people to have access to coverage or COVID treatments for most of the last three years.

Adding a payment to vaccination is also raising concerns it could further dampen vaccine uptake, which has dropped with every booster that has been approved by federal health officials. Only 15.3% of Americans have received the updated bivalent booster that was approved in the fall, compared to 81% who received at least one dose of the primary series.

“If when they're free, not everyone's taking them, can you imagine if you have to now pay for it?” Figueroa said. “It's going to be less and that will contribute to potentially future outbreaks.”

How insurance companies will handle coverage for testing, treatment and vaccination is still mostly to be determined in the coming months. The industry has decades of experience in deciding coverage and pricing, but it is facing an unprecedented test of having to figure those things out in the middle of a pandemic.

“From the insurers’ perspective, it's not as simple as just saying ‘OK, we're going to figure out a way of what we're covering, what we're not,’ but it's also the uncertainty of what the future holds,” Lushniak said.

Republicans in Congress have been pushing the Biden administration to end the emergency declarations sooner, even lining up votes on bills to require it. The White House has argued that more advanced notice is needed to allow the public, health infrastructure and private sector time to prepare for the next phase of the pandemic.

“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” the White House said in a statement this week.

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