The pandemic public health emergency declaration ends today in the United States. Here, I share a look back and what to expect going forward. One thing is clear: with this change in designation, the U.S. has revealed that its public health preparedness was always meant to be temporary.
Where we started
It was December 12, 2019 when the first cluster of patients in China’s Hubei Province, in the city of Wuhan, reported a pneumonia-like respiratory illness that did not respond well to typical medical treatment. Less than three weeks later, the World Health Organization (WHO) office in China learned of 40 such pneumonia cases. Shortly after, public health officials in China reported isolating and sequencing the genome of a new coronavirus.
But it took nearly another week for researchers to make the suspected genetic sequences available to the world. By January 19, 2020, China, Thailand, Japan, and Korea had all confirmed cases of the virus. And the next day, the U.S. reported its first case of laboratory confirmed COVID-19 in Washington state.
A cascade of events began to unfold in various nations to slow the spread of the virus. This included a complete lockdown of the city of Wuhan (a city of 11 million people).
Two emergency declarations
On January 31, 2020, the WHO declared the 2019 Novel Coronavirus outbreak a “Public Health Emergency of International Concern.” The same day, the Secretary of the U.S. Department of Health and Human Services (DHHS) declared the outbreak a public health emergency. This enabled DHHS to access emergency funds, hire and staff the agency more nimbly, and modify programs it runs to fit the emergency.
A little over a month later (on March 11, 2020), the WHO declared COVID-19 to be a pandemic following news of more than 118,000 cases in 114 countries, and 4,291 confirmed deaths. By that time, COVID-19 had already killed five times more people than SARS, the next-most recent pandemic in 2003.
Two days later, the Trump administration issued a separate national emergency declaration. This further sanctioned DHHS activities to take action to address the pandemic. It also increased flexibilities for other Departments and enabled the Federal Emergency Management Agency (FEMA) to approve major disaster declarations for all states and territories.
A state-by-state response
Within days of the national emergency declaration, New York state closed its public school system (the largest in the nation). Ohio then became the first state to close restaurants and bars. And shortly after, California issued a stay-at-home order (instructing everyone to only leave their homes when necessary) and closed non-essential businesses. This was the beginning of a mostly state-driven approach to addressing COVID-19 in the U.S.
The national pandemic response under the Trump administration became chaotic, unreliable, and deeply politicized. The economic implications of the virus became clear and worrisome. And growing misinformation and scams marred the success of groundbreaking vaccine development and deployment. As a result, the COVID-19 experience varied widely between red and blue states, and a chasm in deaths rates widened between Republican vs. Democratic leaning counties.
The pandemic public health emergency declaration ends
In response to a slowing of COVID-19 infections and improving outcomes among those infected, Congress moved to end the national emergency. President Biden signed the bi-partisan resolution on April 10, 2023 behind closed doors, despite earlier plans to veto it. This ended the three-year long declaration, and brought to an end some of the key financial initiatives that helped prop-up families during the pandemic (e.g., mortgage protections).
The separate pandemic public health emergency ended today, a week after the WHO ended its pandemic public health emergency declaration for COVID-19. The implications of this are many. Because the U.S. government purchased vaccines and COVID-19 treatments in bulk, they will continue to be available at no-cost while supplies last. But once supplies are exhausted, DHHS plans to transition them back to the market.
Vaccines will remain available to people on Medicare and Medicaid at no-cost through September, 2024, while privately insured people will be subject to rules set by their insurance plans. What you pay for treatments, like Paxlovid, will depend on the manufacturer and your insurance coverage. Similarly, tests for COVID-19 will no longer be free for most people. Health insurers are no longer required to waive the costs of these tests, and so may vary in how they cover them.
The biggest question is about the adequacy of COVID-19 monitoring. The CDC acknowledges that its data collection and reporting will change. The data that are available will be less frequent and less granular. States and regions had already been reporting data less thoroughly and frequently and, as of today, laboratories will no longer be required to report COVID-19 test results at all. The CDC is now working with laboratories to set-up data sharing agreements on a voluntary basis.
Public health preparedness was always temporary
White House COVID-19 Response Coordinator, Dr. Ashish Jha, said the end of the pandemic public health emergency was just a transition to a new phase. It is not the end of the pandemic itself. With virus deaths in the U.S. at their lowest levels since the start of the pandemic, he may be right. But we must be aware that the great unwinding of resources, data monitoring, and protections is evidence that investments in public health preparedness were nearly all temporary. Because of this, there are serious questions worth raising about how well prepared the U.S. is to respond again.
Gregory Stevens