The end of the federal government’s public health emergency today will not end COVID-19 or the necessity of taking precautions to minimize its risk.
There are still 1,000 Americans dying from COVID weekly, predominantly individuals who have preexisting health conditions or are older and are not up to date with vaccinations. In addition, there are over 75,000 weekly cases, a likely undercount given reductions in testing and reporting, and a portion of these cases will lead to long COVID. Vigilance and preparedness remain essential.
The SARS-CoV-2 virus continues to evolve, with the latest Arcturus subvariant, XBB.1.16, the most transmissible strain yet, though it is unlikely to be more severe. The virus will continue to mutate in attempts to evade our immunity, and new subvariants will come and go over time. At the Food and Drug Administration, deliberations on the makeup of an updated fall vaccine are underway — similar to the process used for adjusting the yearly influenza vaccine.
Remaining vigilant in the near term requires Americans to use the tools — vaccines, antiviral medications and tests — acquired during the pandemic. Fortunately, today will not immediately change most individuals’ ability to obtain these tools, given existing government supplies and prior congressional action. One exception is mandatory coverage for over-the-counter tests, which will end for Medicare beneficiaries and individuals with private insurance.
Over time, access to these tools could become more problematic. Once government stockpiles run out, Medicare and private health insurers may start to require cost-sharing for antiviral medications and tests; state Medicaid programs may begin doing so after September 2024. It is clear that cost-sharing on high-value services leads to fewer people receiving services, and therefore, increases the risk for transmission and illness.
The circumstances for the uninsured in the U.S. are even more concerning. On top of the nearly 30 million Americans who are currently without health insurance, states have started Medicaid redeterminations to confirm whether beneficiaries still qualify for the program, a process that will potentially cause between 5 million and 14 million to lose coverage. The administration announced a public-private partnership program that, with community health centers, pharmacies and other stakeholders, would provide the uninsured access to vaccines, tests and treatments through December 2024. It is imperative that the government follow through with the execution of this program.
Congress must also remain vigilant, not only in tracking COVID but in preparing for the next pandemic, as it’s not a question of if but when the next one will occur. Both the House and Senate are holding reauthorization hearings on the Pandemic and All-Hazards Preparedness Act. This is an important bipartisan vehicle that enhances federal public health emergency coordination, supports medical countermeasures development and deployment and improves state and local preparedness and response capacity.
While the current debt ceiling crisis and fiscal climate make new investments challenging, Congress cannot push off shoring up the nation’s public health infrastructure, promoting data sharing during an emergency and investing in next-gen vaccines and therapeutics. Congress should also step up its oversight of the nation’s pandemic preparedness efforts. The Bipartisan Policy Center has suggested a National Board on Pandemic Preparedness which would establish a set of metrics for evaluation of federal and state pandemic preparedness capacity and capability, gauge how the nation is fairing against these metrics and report to Congress on the state of pandemic preparedness with specific recommendations.
Moving forward, the government has a role to protect its citizens and facilitate making healthy choices more accessible, but personal responsibility is critical to disease prevention as well. Millions of high-risk individuals have yet to receive an updated bivalent COVID vaccine. Staying home when we’re not well (a federal paid leave benefit would help with equity), testing, wearing a high-quality mask when symptomatic and respiratory etiquette will continue to be critical.
History will likely remember today as both a solemn date, given the over 1 million American lives lost during the pandemic, as well as an important marker of the emergency response that saved millions. Vigilance in protecting ourselves from COVID or similar threats, however, has no end date.
Anand Parekh, MD, MPH is chief medical advisor for the Bipartisan Policy Center, former deputy assistant secretary of health at the U.S. Department of Health and Human Services, and author of “Prevention First: Policymaking for a Healthier America” (Johns Hopkins University Press, 2019).