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The end of the COVID-19 public health emergency: What it means
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Rob Spahr
COVID-19 testing

More than three years after the U.S. Department of Health and Human Services first declared a public health emergency for COVID-19, the emergency is ending. It will expire May 11.

The public health emergency allowed the government to temporarily change specific policies to help provide services that the country needed during the height of the pandemic, such as free COVID-19 testing and vaccination.

Experts from the Rollins School of Public Health discuss what the end of the public health emergency means and what’s next for COVID-19 research.

Q: The COVID-19 public health emergency expires May 11. Why is it ending and what exactly does that mean?  

The expiration of the COVID-19 public health emergency is really a policy change and we need to keep that in mind, said Jodie Guest, PhD, senior vice chair in the Department of Epidemiology.There is something very different from a pandemic being over and a policy change. So, this is a change in the way that the government is going to use money to support COVID-19 testing and vaccination. We are going to go back to health care as it was before the pandemic began in 2020.

Q: Does this mean we no longer need to worry about COVID-19?

Just because the public health emergency policy is ending does not mean that COVID-19 is done. It is not done with us,” Guest said.“We have certainly reached a different stage with it, and that is a very good thing. We are learning to live with COVID-19. But we still want to make sure we are staying up to date on our vaccinations, and we want to make sure we are testing if we have had exposure to someone with COVID-19 or if we have had any symptoms that look like we might have COVID-19.”

Q: How will this impact health care?

“For the healthcare industry, this is a change in the way funding will come. Hospitals that have received extra funding and support to care for people with COVID-19 will not be receiving that. There will also be changes in the way that telehealth can occur. So, depending on how you receive coverage, some of your telehealth options may go away,” Guest said.

The change in the public health emergency will impact people who are uninsured the most. Those who have insurance will be able to turn to their insurance for coverage for most things. Medicaid and Medicare have extensions through September 2024 for most testing, vaccination, and treatment options. But those who are uninsured are going to be back on their own. We need to be very concerned about that. That is about 8 percent of the U.S. population.

Q: What does the end of the public health emergency mean for COVID-19 testing and treatment?

Access to COVID-19 testing may shift for many Americans,” said Aaron Siegler, PhD, associate professor of epidemiology.The requirement that private insurance companies provide free COVID-19 home and laboratory tests will end, and Medicare and Medicaid access to such tests will vary by state. Government programs may continue to fill gaps, and our research indicates this is merited. Our national survey identified that more than 1 in 3 U.S. households used the program, the vast majority rated the experience as acceptable, and the program reduced health inequities by race/ethnicity.

Moreover, one in four persons using the government tests indicated they would not have tested if the program were not available. Given the continued toll of COVID-19, support for making COVID-19 testing easily accessible is a good public health investment.

Q: And what about access to substance abuse services?

Pandemics transform societies. In COVID’s case, it accelerated the move in the U.S. toward more—and more just—harm reduction policies and services," said Hannah Cooper, ScD, Rollins Chair of Substance Use Disorders Research. "For example, buprenorphine and methadone—two vital medications to treat opioid use disorder—became easier to access during the pandemic. Likewise, state and municipal governments loosened some restrictions on syringe service programs, making syringes easier to access.

The pandemic also converged with longstanding movements for prison abolition, and decarcerated some imprisoned people who use drugs. These pandemic-era changes were important for all people who use drugs, and the communities in which they are embedded, and are particularly important for supporting structurally marginalized people, given that the original policies disproportionately burdened them.

A key question for public health as we move forward, is whether the U.S. can sustain its current momentum toward just harm reduction policies after the public health emergency ends. People who use drugs and their allies are fighting hard for that future.

Q: Will researchers and public health agencies continue to track COVID-19?

Research and public health agencies will remain interested in COVID-19 since it's a virus that's still among us," said Allison Chamberlain, PhD, research associate professor of epidemiology. "Tracking of cases won't look the same as it did in 2020 or 2021. Rather, genomic surveillance—monitoring changes in the genetic code of the virus—to find and track new variants will remain one of the most important types of surveillance moving forward.

Public health researchers will be mining historic COVID-19 data for many years to come. For example, we are just getting started on a CDC-funded grant to study COVID-19 vaccine effectiveness in school-aged kids through a collaboration with a large urban school system. We’ll examine data from their district-wide opt-in weekly COVID-19 surveillance testing program to explore COVID-19 infections among vaccinated versus unvaccinated kids. We’re hoping to learn more about the real-world effectiveness of the vaccine in kids across time and place.

Q: Will scientists continue to work on new COVID-19 vaccines?

Absolutely, said Natalie Dean, PhD, assistant professor of biostatistics and bioinformatics. We don’t know in the future what new variants might emerge and there is also room for improvement in existing vaccines. So, there are two major areas that folks are working on. The first is a nasal coronavirus vaccine. Those are a mist through the nose and the idea is that they stimulate the antibodies in the nose, which is the first line of defense against the virus.

The second area is universal coronavirus vaccines. This is a longer-term goal. They take longer to develop. The basic idea is can we have vaccines that are better quipped against future variants or even other types of coronaviruses.

In March, Emory University announced a partnership with Pfizer Inc. to develop the next generation of antiviral COVID-19 treatments. 

Q: How often will people need to get COVID-19 vaccines in the future? 

Policymakers and scientists are still working out exactly what the policy will be for COVID-19 vaccines moving forward,” Dean said. “We are definitely moving in the direction of something simple, using flu as a model. So, something like an annual shot. But it will depend on what the seasonality of COVID-19 looks like, because we have a really clear flu vaccine season but it is less clear for COVID-19 what that will be in the future.

It will also depend on risk groups. Are you 65 and older? Are you immunocompromised? And what happens in the future? Are there new variants? So, we will have to see what unfolds.

Q: How will the end of the public health emergency impact mental health services?

During the COVID-19 pandemic, there was a dramatic shift to telehealth services to mitigate the spread of the virus," said Janet Cummings, PhD, professor of health policy and management.Because the delivery of mental health services typically does not require a physical exam and there is a strong and growing evidence base of the effectiveness of telemental health, the shift to telehealth in mental health care was especially pronounced. This shift was facilitated by new flexibilities in policies and regulations during the public health emergency. 

Some of these new policies, such as several Medicare payment policies governing telemental health services, have been made permanent. Other policies, including some of the Drug Enforcement Administration's policies governing the prescription of controlled substances (e.g., simulant medications) via telehealth, may change after the public health emergency has ended. While the policy and regulatory environment is still in flux, mental health care practice has been forever changed and telehealth will continue to be an essential mode of delivery for mental health services moving forward.

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