THREAT LEVEL — On May 10, the United States will be under a public health emergency. On May 11, it won’t. But the coronavirus that necessitated that government-declared emergency does not have a calendar. This week’s White House announcement that the PHE is winding down won’t transform Covid-19 at the stroke of midnight, like some viral Cinderella. What it means is that some of the core public health tools to contain the coronavirus — notably free vaccines, free treatment and free testing — will go away. Few would argue that the threat from the pandemic hasn’t lessened. May 2023 isn’t May 2022, and it’s certainly not May 2020. Between vaccination and infection, or both, the population has considerable immunity against severe disease, at least for now. Science has advanced. “There’s a big difference in what life is like. It’s fundamentally different, what we know about the disease, our treatment armament, our preventive armament,” said Kedar Mate, the president and CEO of the Institute for Healthcare Improvement, which has helped hospitals navigate the crisis, including programs to boost resiliency of health care providers. But Mate and others stressed that less threat doesn’t mean no threat. About 500 people are still dying each day. Even in “good times,” before the uptick in cases after the holidays, roughly 300 were dying on typical days. It’s been that way for months. People who are elderly, un or under-vaccinated, or immune compromised are most vulnerable. At the rate we are going, the death toll this year is likely to be well over 100,000, possibly closer to 200,000. And — even though you hear all the time that Covid is “just like the flu” — that’s considerably higher than the amount of lives lost to flu in a typical year. Flu deaths vary a lot from year to year but only twice in the last century has it exceeded 100,000 . And Covid also raises the risk of blood clots, stroke, diabetes, heart failure and other dangerous conditions, and that’s not widely appreciated amongst the public. That aftermath is getting a lot less attention than all the bogus reports of “sudden death” from vaccines flooding social media. For public health workers and health care providers, the normalization of this high death toll is jarring. “I never thought that a million deaths of Americans would be trivialized,” said Brian Castrucci, head of the health-focused de Beaumont Foundation. But as a society, he noted, we’ve basically decided: emergency over, time to move on. Castrucci said pandemic response has to be calibrated; treating it like an on-off switch ”just reinforces this misinformation narrative that is out there.” That downplaying of disease, that acceptance of deaths that actually could be prevented, makes him worry not just about the response to Covid “but for everything in the future.” Congress late last year took steps to blunt the impact of ending the public health emergency — one of them was making sure that Medicare can cover Paxlovid, an oral medication particularly important for older people. Lawmakers also extended some telemedicine provisions. Much of the CDC preparation and surveillance work was funded in separate legislation, apart from the emergency declaration. (For more on how PHE provisions affect individuals, the POLITICO health team has a run-down .) Congressional Republicans have rejected White House requests for more Covid funding, including proposals to create a program to cover low-income adult vaccination, similar to immunization programs for children. The lack of free vaccines, medication and testing starting in May will create new challenges. Poor people, uninsured people — including those who live in conservative states that have resisted expanding Medicaid under Obamacare — and minority communities will be most at risk, said Julie Morita, the executive vice president of the Robert Wood Johnson Foundation and the former public health commissioner of Chicago. “Exactly the same people who were disproportionately impacted at the beginning of the pandemic will again be more vulnerable,” she said. Disparities that had narrowed will widen; risks of bad outcomes will grow. Even people who are insured might face copays or deductibles that make tests and treatments a financial burden. (Health plans have to cover vaccines at no charge under the Affordable Care Act’s preventive care rules.) When the declared emergency ends, the vaccine distribution system will be turned over to the private sector. That means supply might be spotty in areas with low vaccination demand, including rural areas. People who want shots, or tests, may have trouble finding them, said Celine Gounder, an infectious disease specialist and editor at large for public health at Kaiser Health News. It’s not just individuals who are at risk in the post-PHE era. The health system hasn’t recovered from the last three years, financially or in terms of its effect on the workforce. That leaves it vulnerable to another variant, another surge, or another kind of public threat altogether, said Gounder. “You’re dealing with a health care and caregiving workforce that is really burned out,” she said. Understaffed nursing homes can’t take in new patients, some of whom end up remaining in hospitals, which in turn backs up emergency departments. “Health care systems are still going to have difficulty coping,” she said. Even without a formal public health emergency declaration, the next phase of the pandemic could be manageable — if we find the will to manage it, to balance a “return to normal” with an ongoing layer of collective self-defense. Public health surveillance. Health system readiness. And access to vaccines, tests and treatments — particularly for the most vulnerable among us. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com . Or contact tonight’s author on Twitter at @JoanneKenen .
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