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David Rosner, who studies public health and social history at Columbia University, spent 10 days in the hospital in November because he contracted respiratory syncytial virus (RSV), which was made worse by his asthma, and developed pneumonia.
“It’s all over now, but there were some moments where it was a little touchy, and I wish people were more aware in general that this can happen,” said Rosner, 76, who has not had Covid -19.
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He now fears that US residents may become even less aware of the continued threat posed by Covid due to the Biden administration’s announcement earlier this week that it would let the coronavirus public health emergency lapse in May.
While other public health experts remain concerned about Covid, some support the administration’s decision because they don’t see a state of emergency as an effective way to fix larger issues with the health care system’s ability to respond to viruses.
“There are far more systemic problems we need to solve than a public health emergency isn’t ready to solve,” said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.
Despite disagreements about whether the public health emergency should continue beyond May, Nuzzo, Rosner and others agree that a Republican push to end the emergency now is irresponsible and that Biden’s lifting of the emergency order in May it could create further problems.
“Looking ahead three and a half months, four months on what the circumstances of Covid will be, is both optimistic and courageous,” said William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine. Revoking the statement “will once again usher in disparities, both in treatment and prevention.”
When the federal government declared a public health emergency about three years ago, it meant the lifting of some requirements for government programs and millions more people enrolled in Medicaid. The government didn’t allow states to remove those people from Medicaid once they were enrolled. The move also allowed most Americans to receive free Covid tests, vaccines and some treatments for the virus.
Once the order is lifted, most Americans will still be able to get vaccines for free. But people enrolled in Medicare or private insurance will have to start paying for lab and over-the-counter Covid tests, according to Reuters. Medicaid or Children’s Health Insurance Program (CHIP) beneficiaries will have to pay part of the costs of testing starting in 2024.
Most people will also start having to pay part of the costs for treatments like the antiviral Paxlovid.
People who don’t have insurance will have to pay full price for the vaccines, and vaccine makers Prizer and Moderna plan to raise the cost of the injections from $30 to $120.
As people continue to be hospitalized and die of Covid, those numbers have steadily declined; most people stopped wearing masks; and Joe Biden declared an end to the pandemic in September 2022.
Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, said her biggest concern is the cost of vaccines.
“What will happen every winter is that we will fight with the insurance,” said Gandhi, whose patients all use public health insurance. “We will say, really this patient is more at risk. He is older. He has HIV. He is immunocompromised. Do you really need to buy the [vaccine booster]and they’ll say, ‘It’s too expensive.’”
Charging much more for vaccines is also unethical, Gandhi said, especially in the case of Moderna, which received $10 billion in government funding to develop the vaccine.
“I really think he’s greedy,” she said. “They’ve had so much public funding.”
Biden declaring the pandemic is over and easing the public health emergency also makes it harder for people to ask friends to take precautions like wearing a mask or getting tested before a rally, Rosner said.
“We still don’t know it’s over, and we see new variants coming out every week, and we have large portions of the American population that aren’t fully vaccinated yet,” he said.
Meanwhile, Republicans have called on the Biden administration to end the filing immediately rather than wait until May.
It would be “disastrous,” Nuzzo said.
“There will be some transitions that need to happen, including making sure people continue to have access to medicines and making sure hospitals can change administratively,” he said.
While Nuzzo is also concerned about the uninsured’s access to medicines, vaccines and tests, he doesn’t think the public health emergency is well suited to addressing wider issues such as children’s hospital closures or staff shortages or problems with people get access to the flu vaccine.
The government should focus on funding public health departments, he said. Such state and local agencies work to prevent the spread of disease and ensure that people have access to health services such as vaccinations, among other responsibilities. Between 2010 and 2020, funding for state public health departments fell 16 percent per capita and spending on local health departments fell 18 percent, according to an analysis by Kaiser Health News and the Associated Press.
“Unfortunately, Congress has not allocated additional resources” to fund health departments, Nuzzo said. “Response work for Covid and all the other pathogens swirling in our mix continues, but we just lack the resources to do it. Unfortunately, I don’t see declaring a public health emergency or rescission as making or breaking this. This was a problem before it happened.
Regarding the concern about changing public attitudes towards Covid due to the end of the public health emergency, Nuzzo said, “We’ve had a lot of these headlines during the pandemic.”
A month after Biden declared the pandemic over in 60 minutes, there has been an 11% increase in the number of people who thought it was over, according to a Gallup poll. Fewer people also planned to get a new booster shot than a year earlier, according to a Monmouth University poll following the Biden interview.
A minor concern about the virus “is always a risk, but we’ve had multiple opportunities” to get recalls, Nuzzo said. “So those communication challenges remain and that definitely adds up, but it’s not the only instigator.”
But Rosner said the order should remain in effect until “the public health community really feels they have a grip” on the virus.
“I think we’re hoping the new strains aren’t more resistant to vaccines, and that’s not clear,” he said. “You will need a sense that the public is responsible, or that the public understands their responsibilities and can act rationally. This is the moment.