New York is as back to normal as it has ever been since the start of the COVID-19 pandemic more than three years ago. After years of unprecedented disruption, restaurant-goers are squeezing indoors for brunch, catching up on lost time with friends and family. Commuters and tourists are filing back into the subway, rushing to and from work and exploring the city. And with spring in full swing, parks and convention centers are alive with energy once again.
But while many in the city are moving on from the pandemic, there’s one major milestone that signifies a true turning point in America’s fight against COVID-19: the expiration of the federal public health emergency on May 11.
“The end of the COVID-19 public health emergency will mean an end to policies that made access to testing, treatment, and vaccines free or affordable,” Lesley Green-Rennis, chair and professor of health education at Borough of Manhattan Community College (BMCC) tells the Amsterdam News.
While the expiration of the federal public health emergency doesn’t signify the end of the pandemic, which is currently killing more than 1,000 Americans a week, it does mark the beginning of reductions in national emergency support.
Some of these rollbacks have already taken place: in February, Congress reduced SNAP emergency allotments, and President Joe Biden signed a congressional resolution in early April to end the coinciding national emergency that was originally slated to expire with the national public health emergency. On the global stage, the World Health Organization (WHO) recently decided to lift its COVID-19 emergency.
Grappling with these policy changes includes understanding what support remains to carry Americans through a pandemic that still isn’t over, and how to make choices on the best ways to stay safe in the months ahead.
The pandemic lingers on
Three years into the pandemic, much of the anxiety and fear has been quelled since its early days. Case numbers and deaths have dropped to record lows. According to the Centers for Disease Control and Prevention (CDC), the U.S. is now experiencing more than 150 deaths a day and 1,375 hospitalizations a week, down from the most recent peak in early 2022 of about 2,500 deaths per day and 21,525 hospitalizations per week.
Yet Black, Indigenous, Hispanic, and Latinx Americans are some of the most vulnerable. Black people are 60% more likely to die of COVID-19 compared to white people, according to the latest data from the CDC. Similarly, Hispanic and Latinx people are 70% more likely to die of the virus and American Indian or Alaska Native people are twice as likely to die. More than 326,000 Black, Hispanic, and Latinx Americans have died since the pandemic started.
The pandemic also took years off of New Yorkers’ lives. A recent study from the New York City Department of Health and Mental Hygiene found that the average life expectancy of Black New Yorkers is down five and a half years to 73 years, and Hispanic and Latinx New Yorkers are down six years to 77.3 years old. For comparison, life expectancy dropped three years, down to 80.1 years, for white New Yorkers.
In the 1950s, the average life expectancy for Black Americans was 63.6 years. Every fraction of a year in life expectancy can take years to gain. Luisa Borrell, a Distinguished Professor of Epidemiology and Biostatistics at CUNY’s Graduate School of Public Health and Health Policy, says it will take us decades to get those years back.
“Look at how long it [took] for African Americans to have a decent life expectancy,” she says. “And look at how long it took to get to 70.”
It will be an uphill battle to regain lost life expectancy in the years ahead. Green-Rennis says it’s important to be vigilant to protect vulnerable people in our lives. This includes people of color over 50, people who are immunocompromised, pregnant people, or people living with comorbidities that make people vulnerable to COVID-19 like heart disease, high blood pressure, and asthma.
Policy (and cost) changes to coverage and access
The end of the public health emergency will change the cost and accessibility of preventing and treating COVID-19 for many people. Leighton Ku, Professor and Director of the Center for Health Policy Research at George Washington University, says that the three big elements he’ll be watching for will be changes to Medicaid coverage, testing access, and SNAP benefits.
Medicaid recipients will likely see the most drastic change since the health emergency allowed for continuous enrollment throughout the pandemic and prevented states from taking people off of insurance. The Kaiser Family Foundation estimates that between 5 and 15 million people could lose their Medicaid coverage if states no longer deem them eligible. Ku estimates that the number of people losing coverage is likely higher, between 15 to 18 million people, with many of these policy changes affecting Black and Latinx adults and children.
RELATED: Declining access to COVID-19 services will worsen health disparities
This dis-enrollment or “unwinding” of Medicare enrollment lists will take place over the next 14 months, sooner in some states than others. Ku says it is important that people insured through Medicaid have updated their contact information, including their address, with their state so that they don’t miss updates on their insurance.
Vaccines: mostly free for now
On April 18, the Department of Health and Human Services announced a program to keep vaccines free for uninsured Americans. Some of the changes include paying for COVID-19 vaccines if you get your shot out-of-network and likely paying more for future shots. Those on Medicaid and with Medicare Part B will continue to have free shots, thanks to a provision in the CARES Act.
According to Ku, COVID vaccines are still free for anyone who has public or private health insurance. So if you have Medicaid, private insurance, or Medicare, your COVID vaccine will still be covered and insured Americans will not need to pay for that as a preventive benefit. Just make sure to get your shot from an in-network provider, as private insurance companies may require people to pay for COVID-19 vaccines if they are out of network.
New Yorkers can still get a free vaccination by appointment at a NYC Health + Hospitals or Gotham Health center by calling 1-844-NYC-4NYC.
Testing and treatment: costs depends
For testing, private insurance companies will no longer be required to cover up to eight rapid COVID-19 tests per month, as they were during the public health emergency. Most insurance will cover costs for COVID-19 PCR testing, but uninsured Americans – 27.5 million people, or 8% of the national population – will probably have these costs come out of their pocketbooks.
At-home test kits are still available all over the city while supplies last. With the end of mobile testing centers, New Yorkers can make an appointment to get free PCR testing at one of the city health department’s express sites, or pick up at-home testing kits at their nearest NYC Health + Hospitals and Gotham Health center. The city’s COVID hotline (212-268-4319) is available to help find free PCR testing and at-home testing kits.
For treatment, New Yorkers can go to NYC Health + Hospitals and Virtual ExpressCare or call 212-COVID19 (212-268-4319) for a free prescription and delivery of the antiviral treatment Paxlovid. The medication will remain free to all Americans as long as government supplies last.
SNAP: likely less access than before
At the beginning of March, SNAP allotments fell considerably for millions of people around the country, Ku says. Emergency allotments made on a sliding scale over the pandemic to meet family needs have returned to pre-pandemic amounts, a difference of up to a couple hundred dollars, depending on your household size. For those close to the poverty line, this amounts to even less than before the pandemic. “As we all know, food inflation is really high right now,” Ku says. It also halted work requirements during the pandemic and the government will be returning to a policy of only non-disabled people being allowed to receive SNAP benefits for three months unless they’re working 80 hours a week.
The Beginning of the End or the End of the Beginning?
Some public health experts are concerned that this might give people the indication that the pandemic is over. The World Health Organization hasn’t yet declared the pandemic over. Sentiments about the pandemic have eased, though attitudes are mixed about the end of the pandemic.
“I think the crisis phase is definitely over,” says Celine Gounder, an epidemiologist and infectious disease specialist and editor-at-large for public health at the Kaiser Family Foundation. “Hospitals are not overflowing with COVID patients [and are] able to now balance COVID care with other kinds of care… but we haven’t really learned the lessons of COVID-19.”
A recent survey found that 59% of adults in America think the public health emergency ending will have no impact on them, and almost half think that it won’t have an impact on the country. The public health emergency ending drew greater concern from groups of Americans who have been more negatively affected by the pandemic.
Medical and public health officials are clear that the virus is still among us, and still mutating, so there’s still some risk, Green-Rennis says. “Our primary concern is that people will forget that, or not believe it and fail to practice preventive measures.”
This includes hand washing, refraining from interacting with others when we are sick, masking, getting tested when appropriate, and staying up to date with vaccinations, especially those who are particularly vulnerable.
Jorge Moreno, a physician and assistant professor of medicine at Yale University, says that seniors should get the latest bivalent booster if they haven’t gotten COVID or had any boosters in the last four months.
“I cannot stress that enough. Get your booster, if possible,” he tells the Amsterdam News. “It’s still time, it’s not gone, it will protect you.”
Gounder says that immunocompromised folks should consider getting vaccine boosters every four to six months. She also recommends masking and opening doors and windows to create better ventilation at home when the weather allows and testing before going to big events. “It’s still a really good tool to reduce risk,” she says. According to the CDC, only 16.9% of Americans have gotten an updated booster.
The antiviral drug Paxlovid continues to reduce the risk of COVID-19 progressing to severe disease, hospitalization, or death. “I think that’s a tool that’s really underutilized,” she says.
Moreno is looking ahead at the next few months with cautious optimism but urges people to stay up-to-date on changes with COVID-19 through the CDC, their state and local public health departments, and their doctors or community health centers.
“Educate yourself, not from Facebook, not from WhatsApp, not from social media,” he says. “There’s still a ton of misinformation out there…. I think getting the right information from the right resources will help you make decisions for you and your family.” New Yorkers, for example, can check local data maps to track COVID-19 trends in their area and follow our reporting on pandemic misinformation.
Moreno says it’s also important to notice when people in your community and schools are getting sick, and take some cues to mask and protect yourself. “Whether it’s kids out sick or more people around [you] getting sick, really [be] aware of that,” he says.
Ku says it’s fine to embrace some of what’s helping people feel normal these days. That said, Ku still carries masks with him wherever he goes.
“When in doubt, fall on the side of caution,” he says. “I have a mask in my pocket. I have masks in my car. So I am ready at any given moment.”
Where do we go from here?
Dr. Gounder, an infectious disease specialist and epidemiologist, says when she thinks back to the early days of 2020, she remembers early conversations with her residents and medical students about a novel coronavirus when she was on service at Bellevue Hospital. At one point, she pulled out the first published epidemiological report of AIDS.
“I said ‘we are at a similar moment with this new coronavirus’,” she says. Her students were skeptical, she recalled. “We haven’t really learned some of the lessons of COVID,” she says. “I think unfortunately, we’re not preparing ourselves for the next pandemic,” she added.
Gounder and others have outlined policy issues and next steps that still need to be addressed to curb this disease, like deciding what level of virus spread that we can live with, fixing our data collection systems for diseases and addressing the ongoing shortage of public health workers.
Epidemiologist and Emeritus Professor of Public Health at Hunter College Philip Alcabes says the pandemic was an opportunity to completely reform the medical care system in America so that people could get access to the care they need. He says that some of his peers want more intensive and extensive disease surveillance systems to help us prepare for the next pandemic, but he’s thinking about how public health systems will be there for us the next time.
“I know there are people… who feel like ‘well, what we have to do is create early warning systems so we’ll know when the new virus is coming,’” he says. “But that seems to leave unanswered the question of, well, what do we do once we know?”
The end of the public health emergency raises many questions about how we will handle the pandemic in the months and years ahead. However, experts agree that our success in dealing with the next pandemic will in large part be due to how successfully we learn, and implement, the lessons from the one we are all still living through.
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For additional resources about COVID-19, visit www1.nyc.gov/site/coronavirus/index.page or call 212-COVID19. COVID-19 testing, masks, and vaccination resources can also be accessed on the AmNews COVID-19 page: www.amsterdamnews.com/covid/.