“Take this as an alert, a time to start being prepared for the next pandemic.”
- Dr. Margaret Dalcomo, respiratory physician and member Brazil National Academy of Medicine
“The country may move on for now, but unless it faces up to the root causes of the harm COVID-19 did in the USA—health inequities, lack of access to health care, noncommunicable diseases, a poisonous political discourse, and mistrust in public health institutions—it will likely find history repeating itself when the next pandemic comes.”
- The Lancet
Last week, the World Health Organization (WHO) declared an end to the “Public Health Emergency of International Concern” caused by COVID-19. On May 11, 2023, the “COVID-19 Public Health Emergency” is officially set to expire in the U.S. These events caused New York Times journalist David Wallace-Wells to ask, “The emergency is over, but are we better off?” In today’s Germ Gems post, I provide an update on what happened, where we are now that the “emergency” is over, and also respond to Wallace-Wells’ question.
Brief recap of the COVID-19 pandemic. The first cases of infection by the novel coronavirus called SARS-CoV-2 emerged in Wuhan, China in December 2019. (Its origin is still hotly debated.) The events that unfolded in rapid succession since then seem like a blur. By March of 2020 the WHO declared COVID-19 a “pandemic,” meaning it had spread throughout the world. And by May 3, 2023, the WHO confirmed 765,222,932 cases of SARS-CoV-2 infection, including 6,921,614 deaths.
COVID-19 caused a devasting number of infections, deaths, and hospitalizations. In addition, a dizzying number of SARS-CoV-2 genetic mutants cropped up around the globe: Alpha, Beta, Delta, as well as scads of Omicron subvariants. The latest Omicron subvariant, XBB1.16 (called Arcutura), is causing a fresh wave of infections in India.
In the early phase of the pandemic there was some (naïve) hope that SARS-CoV-2 could be eliminated, if not eradicated, as had been accomplished with the global vaccine campaign that ended smallpox. But it quickly became clear that the best we could hope for with COVID-19 was a stalemate—much like that experienced when influenza became endemic. We are not there yet.
Some experts think a pattern of seasonal COVID-19 cases similar to influenza may yet emerge; others suggest we’ll see repeated “mini-waves” of the virus. It’s just too soon to know. But we do know this: while the “Public Health Emergency” is over, the COVID-19 pandemic is not.
What does the end of the COVID-19 pandemic emergency mean? On May 11, the Biden administration will end its requirements that most international travelers, federal workers and contractors, health-care workers and Head Start educators be vaccinated against SARS-CoV-2. Nonetheless, vaccines for the prevention of COVID-19 as well as tests for the virus and drugs for treatment will remain important tools to control the spread of SARS-CoV-2. What may change is who pays for tests, diagnostics, and treatment as the U.S. governments support for these things will be discontinued.
Access to free at-home tests may go away. And while vaccines and treatments will still be covered for now, this is likely to change. Ultimately, it will all come down to your insurance as to what is covered and what is not. It is therefore important that you check with your insurer.
The good news is that the federal government plans to continue to do and fund research on variant-proof vaccines and treatments. This proposed research includes development of universal coronavirus vaccines that would broadly target coronaviruses. The plan, called “Project NextGen,” takes a public-private partnership approach similar to that behind “Operation Warp Speed”—an approach that in 2020 brought vaccines to the marketplace in less than a year’s time. In the opinion of Dr. K. Srinath Reddy, who led India’s Public Health Foundation through the pandemic, the end of the public health emergency status should be appreciated as a moment of human achievement, a “celebration of science.”
Moving ahead. By now, SARS-CoV-2 has infected a large majority of the global population. In the U.S., it’s estimated that 94% of the public has experienced at least one infection, and the country’s official COVID-19 deaths are finally going down.
Americans can be proud of the role the U.S. played in development of highly effective and safe vaccines. But we should be ashamed that we have had higher COVID-19 death rates than other wealthy countries. Insights into the explanation of this disturbing fact is provided in an April 22, 2023, publication in The Lancet. In this study, the authors assessed the impacts of socioeconomic status, income inequality, race, behavioral responses, policy mandates, and support for political candidates on COVID-19 infection and death rates in all 50 states. Poor outcomes were highly correlated with poverty, income inequality, level of education, and government and interpersonal trust.
So, at the end of three-plus years of a COVID-19 Public Health Emergency, are we better off? The answer depends on many factors, some of which are out of one’s control, like where one lives in the world, one’s age, and one’s access to good health care. For those like me who during the emergency had ready access to the vaccines and to excellent health care, the answer has to be “yes.”