April 18, 2023
In January 2023, the Biden administration announced its plans to end two COVID-19-related emergency declarations — a “public health emergency” declaration and a “national emergency” declaration — on May 11, 2023. That same month, the Administration also opposed two GOP-led resolutions to end both declarations before May 11, calling the resolutions “a grave disservice to the American people”. Last week, on April 10, 2023, the Administration changed course, as President Biden signed a GOP-led resolution to end the COVID-19 national emergency. The related, but distinct, public health emergency remains in effect until May 11, 2023. Ending either emergency is premature and shortsighted given the lingering threat of COVID-19 to public health. Doing so also lends legitimacy to pandemic minimization efforts, instead of reckoning with the danger COVID-19 continues to pose.
The national and public health emergency declarations are among the few remaining formal components of the US’ strategy to combat COVID-19. Both declarations have granted federal, state, and local governments significant flexibility to expand, and more inclusively administer, social programs for the duration that the orders are in effect. The end of the national emergency means an end to extended COBRA healthcare coverage, which will sunset on July 10, 2023. The end of the public health emergency next month, meanwhile, will have a wider reaching impact on programs like Medicaid/CHIP, Medicare, SNAP, and many others. Ending the public health emergency could also impact access to telehealth services, and will end the requirement that private insurers cover COVID related healthcare costs such as vaccines, tests, and treatment.
COVID-19 continues to kill, disable, and disrupt to an extent that would not have been tolerated prior to the pandemic. The CDC reports that over 3,000 people in the United States died from COVID-19 in the last two weeks, and more than 40,000 people have died in 2023 thus far. To put this in perspective, nearly two and half times as many people have died of COVID-19 in just the last month than died in the 9/11 attacks over twenty years ago. While the death rate has come down from its peak in January 2021, it is still at a level that would have been considered alarming and unacceptable in 2019. Meanwhile, worrying rates of excess mortality and shifts in reporting mean that official statistics may be undercounting COVID-19’s impact. Research increasingly implicates COVID-19 as a contributing factor in deaths attributed to other causes, and repeat infections may be especially dangerous.
The focus on acute deaths also discounts the disease’s lingering impacts, which can be debilitating. Experts increasingly acknowledge the COVID-19 pandemic as a mass disabling event. Symptoms that appear or persist after an acute COVID-19 infection are colloquially referred to as “Long COVID.” Commonly reported Long COVID symptoms include difficulty concentrating or thinking (“brain fog”), difficulty breathing, crushing fatigue, post-exertional symptom exacerbation, and muscle and joint pain, among others.
As of January 2023, 28 percent of people in the United States who have ever had COVID-19 have experienced Long COVID symptoms. Studies suggest that the risk of Long COVID increases with each reinfection. In Fall 2022, nearly 17.2 million adults in the US said they were experiencing Long COVID symptoms. Of these, 13.7 million reported that their symptoms disrupted their daily activities, a measure commonly used as a proxy for disability. Long COVID may explain the rising tide of disability among working-age adults in the United States. And despite the tendency to dismiss COVID as something only “the vulnerable” need fear, the truth is that all of us are vulnerable. The dismissal of our shared risk and responsibility is a disservice to everyone, especially those whose health problems persist.
If the focus were on protecting the health of the population, the end of both the national emergency and the public health emergency would coincide with the neutralization of the threat to which they were meant to respond. This is not what has taken place. Policymakers are attempting to end a public health crisis by decree rather than taking meaningful steps to address the problem.
Some progress has undoubtedly been made with vaccines and antivirals like Paxlovid. Other pharmaceutical tools, like monoclonal antibodies, have fallen in the face of variants and are no longer authorized as effective treatments. This includes Evusheld, which once offered immunocompromised people some additional protection against COVID-19 infection but lost effectiveness as the virus mutated. Variant-proof non-pharmaceutical forms of mitigation, such as respirators and improved indoor air quality, have remained lacking or been phased out in many places, even in medical facilities.
The end of the public health emergency will further shrink the toolbox for many by turning COVID-19 vaccines, tests, and treatment over to the commercial market. This will put these lifesaving medical items out of reach for many, and especially for the 27.2 million uninsured and 50 million underinsured people in the US. The rush to end the declared emergency jeopardizes the security of even the minimal policy gains enabled by the emergency orders.
The premature ending of the national and health emergency declarations threatens the health and safety of millions of US residents. It also undermines the progress made in response to the pandemic in many areas of social policy that are a testament to what is possible when the force of the US government is aimed at improving the lives of everyday working families. Research finds huge benefits resulting from COVID-related social policy reforms like expanding SNAP benefits, implementing continuous Medicaid enrollment, expanding the Child Tax Credit, and eviction moratoria. The decision by the Biden administration to accede to Republican demands to end the national emergency adds legitimacy to GOP efforts to roll back these milestone achievements.
Despite this disappointing news, there are some bright spots. State and local governments with unspent American Rescue Plan State and Local Fiscal Recovery Funds (SLFRF) still have time to invest those resources to fortify their public sectors. This includes, but is not limited to, state and local public health infrastructure. The Biden Administration has also announced a new initiative to expedite the development of next generation COVID-19 vaccines, ones that are better equipped to reduce transmission and harder for new variants to outpace.
These promising new developments are a great start, but lawmakers must do more to ensure everyone can be ‘Davos safe’. Following the lead of the Biden Administration’s Clean Air in Buildings Challenge, stricter indoor air quality standards would reduce transmission of SARS-COV-2 and other viruses in shared indoor spaces, with a host of other health benefits besides. Paid family and medical leave would cut down on workplace transmission and allow people to fully recover from illnesses and to safely care for loved ones. Better access to vaccines, tests, and treatments — regardless of ability to pay — would help control transmission and ensure equitable medical treatment for those who contract COVID-19. Treatment and care for those with Long COVID and other complex chronic conditions must become more of a priority, and Long COVID research must include patient voices. This is by no means an exhaustive list, but collectively these things would go a long way towards keeping people safer and healthier.
Further dismantling the US’ limited public health infrastructure and rolling back pandemic policy gains leads to a harsh new normal: one that bakes in more suffering and more marginalization in a country that has already seen tremendous slides in life expectancy. A better way forward is possible. The United States can and should do more to protect people and invest in public health. Prematurely sunsetting some of the few remaining pandemic countermeasures is a step in the wrong direction.