Is Covid Over ?
If you’ve been keeping up with recent news, you might have come across the significance of May 11, 2023. On that date, United States President Joe Biden officially announced the conclusion of both the public health emergency and the national state of emergency related to COVID-19.
However, does this imply that the pandemic has finally come to an end? Should we be celebrating this development?
Regrettably, no. The COVID-19 pandemic continues to persist. What is undergoing a change is the approach taken by the U.S. government. This shift signifies that measures related to prevention, care, and treatment are poised to become more costly within the United States.
We had a conversation with pulmonologist Dr. Raed Dweik to gain insight into the implications of discontinuing the COVID-19 emergency declarations for healthcare providers, insurance firms, the government, and your everyday life.
Understanding the Distinctions: Epidemic, Endemic, and Pandemic
To comprehend the ongoing nature of the COVID-19 pandemic, let’s delve into a quick review of the definitions for “epidemic,” “endemic,” and “pandemic.”
Epidemic: A surge in the occurrences of a particular illness, confined to a specific geographical region, ranging from a single town to an entire country.
Endemic: A disease with relatively stable incidence rates over time, localized to a specific area. For instance, malaria is endemic in India.
Pandemic: An exponential escalation in cases occurring across multiple global locations. Examples include the 2009 H1N1 (swine flu) pandemic, which led to over 280,000 fatalities worldwide within a single year, and COVID-19.
Predicting the conclusion of a pandemic is challenging. On the other hand, it is relatively simpler to determine if an epidemic has concluded or transitioned into an endemic state. The reason is that all epidemiological data is concentrated in a single region.
During a pandemic, the reliance shifts to individual countries, necessitating two distinct actions. Firstly, they must execute an effective public health response to tackle the crisis. Secondly, they are required to collect and disseminate precise data concerning the pandemic’s consequences.
At What Point is COVID-19 No Longer a Pandemic?
So, when is a pandemic “over,” and who decides? Frankly, the answer to that question depends on who you’re asking. U.S. healthcare providers like Dr. Dweik often look to the World Health Organization (WHO) for determinations like that.
“Whether the pandemic is over or not is above my pay grade,” Dr. Dweik explains. “The WHO has to declare whether a pandemic is over because they take into account what’s happening and the number of cases in the rest of the world.”
Right about now, you might be thinking, “Didn’t the WHO say the pandemic was over, too?” Not exactly.
What the WHO Says About COVID-19
As of May 2023, the WHO still considers COVID-19 to be a pandemic. Yes, Director-General Tedros Adhanom Ghebreyesus did declare that COVID-19 is no longer “a public health emergency of international concern (PHEIC).” To use their definition, a PHEIC is: “An extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.”
To qualify as a PHEIC, the WHO says a disease has to:
- Be serious, sudden, unusual, or unexpected;
- Carry implications for public health beyond the affected State’s national border;
- Require immediate international action.
It’s great news that COVID-19 is no longer a PHEIC but, as that definition makes clear, there are plenty of serious medical concerns, including pandemics, that don’t rise to the level of a PHEIC.
In his statement ending the emergency phase of the COVID-19 outbreak, Ghebreyesus clarified that COVID-19 is still a global threat and warned that new variants could still emerge.
Here are a few reasons we can’t say the pandemic is over — and definitely can’t let our guard down.
Reasons the Pandemic Isn't Over
The Number of Cases Remains High
According to the WHO’s COVID-19 tracker, the week of May 1, 2023, saw health authorities around the world report 595,281 cases of SARS-CoV-2. The tracker stopped updating after the WHO suspended the PHEIC designation.
595,281 cases is a huge step down from the virus’ peak, when the number of people reported sick in a week was nearly 45 million. But it’s not a small number by any means — especially when you consider the global decline in reporting.
Take the United States as an example. After the state of emergency was suspended on May 11, 2023, the Centers for Disease Control and Prevention (CDC) stated that it would no longer report aggregate cases and deaths, along with several other important metrics for tracking a pandemic.
The Death Rate is Still High
It’s sobering to think about: 6,927,378 people have died of COVID-19 since the start of the pandemic that we know about. The real number is far higher.
While the death rate has dropped significantly from its peak in January 2021 — when more than 102,000 people died in a single week — thousands of people still die of COVID-19 every week. At least, they did when the WHO was still reporting COVID-19 deaths.
COVID-19 Looks Different Country-to-Country
From the beginning, the COVID-19 pandemic has looked dramatically different based on where you’re living and the information being made publicly available. Recently, China faced a major surge in COVID-19 cases — a side effect of lifting public health restrictions and poor-quality vaccines.
Why does that variation impact COVID-19’s pandemic classification? Simply put: If the virus is circulating, it’s also mutating. As we learned during the delta variant surge, some of those mutations can have devastating consequences.
The global risk remains high unless and until all countries are able to prevent, test, and treat equally. The WHO is taking the current inequalities into account when they say the pandemic is still ongoing.
Healthcare Systems Around the World Remain Stressed
The COVID-19 crisis pushed healthcare systems and providers around the world to the brink. Despite valiant efforts to rise to the occasion, no country’s health infrastructure escaped unscathed.
While COVID-19 admissions are down in U.S. hospitals right now, the combination of COVID-19, respiratory syncytial virus (RSV), and the flu means most hospitals are still operating at (or over) max capacity. Healthcare providers have left the profession due to burnout. Many hospitals had to close their doors or were bought out. The same is true in healthcare systems around the globe.
The WHO has concerns about what will happen if COVID-19 deals the world another body blow. They’re concerned, in part, because countries aren’t collecting enough data for health officials to know exactly how stressed their pandemic-response infrastructure is.
What the End of the U.S. States of Emergency Means
Given the available information, it’s unlikely the WHO will declare the COVID-19 pandemic over any time soon. While they’re the ones who decide if a disease rises to the level of a pandemic, each nation has its own public health infrastructure and its own designations.
In the United States, President Joe Biden announced the end of both the national state of emergency and the public health emergency declarations on May 11, 2023.
It’s important to note that those emergency declarations are federal. Depending on where in the United States you live, there may still be state, municipal, or county states of emergency in place. While local regulations made a big difference in the early months of the pandemic, the suspension of the federal declarations has a far greater impact on your day-to-day life at this stage.
“The federal emergency declarations back in 2020 affected all of us,” Dr. Dweik notes, “but we may have not known what they really meant.” He breaks down the changes we can expect to see in our daily lives, in healthcare, and in government, in a post-emergency United States.
How Will the Change Impact Things?
First things first: We need to re-emphasize that — for all that’s changed— one thing hasn’t: COVID-19 isn’t going anywhere. In the weeks before May 11, 2023, the CDC was still reporting more than 100,000 cases in the US every week, resulting in hospitalizations and deaths in the thousands. It’s probably safe to assume numbers are continuing to decline — especially as we move into the summer — but the virus isn’t in the rearview mirror by any means.
What’s changed isn’t the virus, but our country’s response to it. In other words, our experience of the virus will now look very different. Here are a few of the things you can expect now that May 11, is behind us.
Cost and Coverage
The most immediate impact you can expect to see is on your wallet. “The cost of COVID testing, treatment and vaccines — all of that has been free at point-of-service because the federal government was paying for it,” Dr. Dweik reminds us.
Now, those costs are borne by insurance companies, Medicare, Medicaid … and you. How much you end up paying will vary based on the kind of coverage you have. If you don’t have any form of coverage, you’ll be paying 100% out of pocket for all COVID-19-related expenses.
State Expenses
In the United States, individual state healthcare budgets are not all the same. Dr. Dweik explains that during the state of emergency, the federal government put Medicaid coverage-matching programs in place. The pandemic made Medicaid a much bigger expense than usual, as people’s employment statuses changed. The matching programs meant states wouldn’t go bankrupt trying to care for their residents.
The end of the state of emergency puts more burden back on individual states. How this change affects residents of a given state depends on their governor and legislature, but most of us can expect to see some impact as state budgets are rebalanced.
Telehealth
The COVID-19 pandemic made telehealth a necessity, not an option, for millions of people. If you’re one of them, you probably know that there have been several pandemic-era updates to the rules governing how and when you can access remote care.
The state of emergency meant a lot of rules and regulations were temporarily waived so that people could continue getting care when in-person visits weren’t possible. While telehealth is here to stay, many of those waivers have expired, or will soon. You may need to update your care plan and establish new policies with your provider.
Healthcare Providers
“Most healthcare providers knew this was coming,” Dr. Dweik says, “so they’re prepared.” Even so, the end of the state of emergency creates logistical changes in the healthcare system, and as we’ve seen, that system is already stressed.
You should be able to access the care you need, but you might need to call around and ask questions. Dr. Dweik’s advice? “Don’t make assumptions. Double check that what you need is available when you need it, especially if you have insurance.”
A Less Structured Future
“We’re in a very different place than we were in 2020, in a good way,” Dr. Dweik says. “Our treatment is much better and more effective. Vaccines have done wonders to prevent severe illness, hospitalization, and death.”
That doesn’t mean COVID-19 is going away — or that it will feel the same as other endemic illnesses. Unlike other illnesses, like the flu or common cold, we’ve yet to establish a seasonal pattern for COVID-19, and we don’t know for sure if or when that might happen.
The lack of pattern means an unpredictable future, so it’s more important than ever to stay on top of health news and be ready to pivot if and when things change.
In short, COVID-19 is here to stay, and its variants will remain with us for a long time. But as Dr. Dweik pointed out, we’re in a better place now than in 2020. With the right information, we’ll keep moving in that direction.
