With the Covid emergency ending, the US response is shifting into peacetime mode
Thursday, three years and 100 days after the Trump administration declared the coronavirus a public health emergency, the Biden administration will allow the emergency declaration to expire, ushering in a new era in which the administration will deal with Covid-19 like any other respiratory disease.
If the coronavirus pandemic was a war, the United States is about to officially enter peacetime.
But interviews with senior federal and state health officials — including the Secretary of Health and Human Services and the Commissioner of the Food and Drug Administration — make it clear that while the United States has significantly improved its ability to fight Covid-19, it is not fully prepared. to a radically different future variant or a new pandemic.
State health officials tasked with tracking the coronavirus are burnt out, their departments understaffed. President Biden’s coronavirus response team will soon be disbanded. The White House has yet to comply with Congress’s directive to establish a new pandemic preparedness office, and key officials, including Dr. Ashish K. Jha, the coronavirus response coordinator, and Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, are stopping or plan to do so.
Dr. Jha and other federal health officials have spent months laying the groundwork for the end of the public health emergency, and the Biden administration has launched programs to keep vaccines free for the uninsured and to encourage medical research into new vaccines and support therapies. But the officials say they are operating on a tight budget; Congress has refused to give the government new money for the pandemic response.
When asked if the country was prepared for another pandemic, Dr. Francis S. Collins, the former director of the National Institutes of Health, answered simply, “No.” Xavier Becerra, Mr Biden’s secretary of health and human services, paused for several seconds before answering the same question.
“It depends on the degree,” Mr Becerra finally said, adding: “We learned a lot from Covid. We are prepared to deal with Covid – even some variants as they come. If it’s something completely different, bird flu, I’m a little more concerned. If it becomes some kind of biological weapon, you know, that’s a whole different problem.”
The emergency declaration, Dr Jha said in an interview, has given the government and the national healthcare system the flexibility to take extraordinary measures during the crisis, such as placing hospital beds in a parking lot. Dr. Jha, who has told colleagues he plans to return to his job as dean of the Brown University School of Public Health, said moves like this were no longer necessary.
But he warned that the virus would not go away. More than 1,000 people still die from Covid-19 each week in the United States, according to the CDC
“Covid will be with us, but we know how to live with it in a way that doesn’t have to cause disruption, doesn’t have to put people in the hospital — or worse,” said Dr. yes. “And we know how to monitor and manage this virus so that if it takes a turn, if it does something different, we’re ready for that.”
In the short term, the end of the emergency declaration won’t bring dramatic changes for Americans, though some people may face new coronavirus testing costs. After Thursday, private insurers will no longer be required to cover up to eight home tests per month. Those with Medicare or private insurance may have a co-payment for lab tests.
For now, vaccines will remain free because the government has a stock of them. When they move to the commercial market later this year, they will remain free for most people with insurance. For the uninsured, the Biden administration plans to spend more than $1 billion on a new program to offer free shots, though questions remain about how the initiative will work.
It is unclear when Paxlovid, the leading antiviral medication for Covid-19, will move to the commercial market. For now, it will also remain free due to the government’s stock, although patients may have to pay part of the cost once the stock runs out.
Some experts fear that policymakers and elected officials, who have already put Covid-19 in the rearview mirror, will forget about it altogether once the emergency declaration is no longer in place.
“It will, I’m afraid, be interpreted as a ‘mission accomplished’ moment,” said Gary Edson, the president of the Covid Collaborative, a group of experts that has worked to inform the federal response, adding: “Once we as you take that view, we have given up all hope, all mobilization for defensive readiness.
The country has learned and absorbed some lessons from Covid-19. The GGD is now monitoring the spread of the virus by investigating wastewater. The Strategic National Stockpile, the country’s medical reserve, is significantly better equipped. As of the beginning of this month, it had 352 million N95 masks, 1.3 billion gloves and 150,000 ventilators, and the administration has more than 600 million home coronavirus tests on hand. The department of the Department of Health and Human Services that handles logistics, such as the distribution of tests and vaccines, has been strengthened.
Yet an estimated seven million immunocompromised American adults remain at particular risk from Covid-19. Key monoclonal antibody treatments that were once critical to protecting that population are no longer approved for use by the FDA because they are ineffective against current variants. The administration relies heavily on Paxlovid, which can reduce the severity of Covid-19.
“We need an effective monoclonal against the current variants,” said Dr. David A. Kessler, who left the Biden administration in January after overseeing the vaccination and treatment program. “We need a more sustainable vaccine. And we should never rely on just one highly effective oral antiviral.”
All told, more than 1.1 million people have died from Covid-19 in the United States — more than the number killed during both world wars. But as the military builds warships and fighter jets in peacetime, public health has long been caught in what experts call a cycle of panic and neglect.
The Covid Crisis Group, a panel of experts led by Philip D. Zelikow, a University of Virginia historian who led the committee investigating the September 11 attacks, says Congress and policymakers need to look at infectious disease threats through a national security lens. The group has spent two years researching the response to the pandemic and recently published the findings in the book Lessons From the Covid War.
Top federal health officials said the military preparedness analogy was apt.
“What if we fund public health the way we fund the military?” asked dr. Nirav D. Shah, the chief deputy director of the CDC: “We would have a system that would have built-in flexibility, just like the military can respond very flexibly.”
Instead, Biden administration officials say they are clamoring for money to be prepared for a pandemic. One concern is that the end of the emergency will reduce economic incentives for drug companies to develop new drugs, treatments and vaccines, as there will no longer be a guaranteed government customer.
“One of the most important parts of Warp Speed and the whole pandemic response was reducing uncertainty for the industry by raising the money from the government,” said Dr. Robert M. Califf, the FDA commissioner, in an interview, referring to Operation Warp Speed, the Trump administration’s vaccine initiative. “Because what you’re really asking the industry right now is to make the investment and take the risk.”
To encourage innovation, the Biden administration intends to do just that spend $5 billion on a new initiative called Project Next Gen to develop a new generation of Covid-19 vaccines and treatments. Officials have said little about how that money will be spent. The Biden administration was unable to convince Congress to pay for the program, said Dawn O’Connell, the top emergency preparedness official at the Department of Health and Human Services.
“We’ve asked and asked and asked for additional funds to be able to do Next Gen,” she said. When Congress failed to release funds, federal health officials decided to use unused funds to fight the coronavirus.
For now, federal regulators are settling for a more incremental strategy: redesigning annual Covid booster shots to address newer variants of Omicron. A reformulated shot will most likely be rolled out in early September.
With the end of the public health emergency, local and federal health officials will have less visibility into who has Covid-19 and where the virus is spreading. The CDC and local health departments have used that information to guide communities on mask wearing and other precautions.
But when the state of emergency ends, laboratories will no longer have to report coronavirus test results to the government. Last week, the CDC announced it would no longer track levels of Covid-19 in the community or the percentage of tests that come back positive.
Instead, agency officials said they would rely on wastewater samples and hospital records as benchmarks for monitoring the virus. Hospitals will still be required to report coronavirus cases when the emergency is over, but not as detailed as before.
After dr. Jha has left, the leadership of the federal Covid response can function more like a committee effort among bureau chiefs, with Ms. O’Connell as the central coordinator. Ms. O’Connell said last week that she had spoken with White House officials about the new Office of Pandemic Preparedness but was unaware of any plans for its leadership.
“We’re just waiting to see where it lands,” she said.
In recent weeks, Dr. Jha spoke to leading virologists to gauge the likelihood of another Omicron-like variant. One of those scientists, Dr. Dan H. Barouch, the director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, said in an interview that he told Dr. Jha said the way the coronavirus mutates meant it was almost impossible. to offer more than a “gut” forecast, which he estimated at about 20 percent for the next two years.
Mr. Becerra insists that whatever happens, his department is prepared.
“At the end of a great war, you don’t just let your guard down,” he said. “Because even though it seems like it’s over, a flare-up can easily come. So we may be exiting the public health emergency, but we haven’t exited the public health threat.