US Announces Plan to End Declaration of COVID-19 Public Health Emergency

The White House announced [1] that the US declaration of a Public Health Emergency (PHE) for COVID-19 is coming to an end on May 11, 2023. This will have a wide ranging impact [2-4] on US citizens’ access to COVID tests and vaccines as well as to Medicaid [5] and food supplement benefits (i.e. SNAP [6,7]).

Estimates indicate: 15 million individuals including 5.3 million children will lose Medicaid and Children’s Health Insurance Program (CHIP) coverage [5], 40 million SNAP recipients will suffer benefit cuts with many seniors reduced from $281 to $23 per month [6,7], and that the emergency funding kept 4.2 million people from falling below the poverty line in 2021. Meanwhile, over the past year, grocery prices have skyrocketed over 11% and are expected to continue to rise this year by almost 8% [8,9], reducing buying power by 17%.

The Public Health Emergency declaration, which began on January 20, 2020, enabled the government to provide support for individuals to prevent and mitigate health and financial impacts of SARS-CoV-2. Eliminating these provisions will increase those impacts as COVID-19 continues to be widespread [10].

Other protections against the virus also now have reduced efficacy. The virus has evolved into variants [11] that have diminished the effectiveness of treatments [12] and vaccines [13]. The virus continues to cause disease and deaths, including both acute [14] and long-term [15] health damages. These impacts have caused over 1.1 million confirmed [16] COVID-19 deaths and increases in excess deaths [17]. The CDC recently stated that long COVID organ damage causes deaths that have not been previously counted [18].

The end of the PHE also affects public health tracking and emergency preparedness, including:

CDC/HHS will no longer have the authority to require reporting of test, vaccine and hospital data, potentially compromising the accuracy and frequency of reporting;
Some FDA COVID-19-related guidance affecting clinical practice and supply chains will end unless they are extended;
FDA’s ability to detect early shortages of critical devices related to COVID-19 will likely become impaired.

Some governmental actions are expected to remain in place [2], including:

FDA’s Emergency Use Authorization (EUA) for COVID-19 tests, vaccines and treatments;
Medicare and Medicaid telehealth flexibilities;
Access to opioid disorder treatments.

The impacts of ongoing transmission of COVID-19 have significantly compromised the health and economic conditions of many individuals and families compared to conditions prior to the pandemic. Vulnerable populations and those who have or will become medically or financially close to losing the ability to provide for themselves through the effects of COVID will be most profoundly affected by the loss of government support. These changes will have society-wide impacts.

Sources:

[1] Washington D.C. EXECUTIVE OFFICE of the PRESIDENT OFFICE of MANAGEMENT and BUDGET; January 30th 2023. https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf
[2] Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap. HHS.gov. https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html
[3] What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/
[4] Public Health Emergency to End May 11. AHA. https://www.aha.org/special-bulletin/2023-02-07-public-health-emergency-end-may-11
[5] Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches KEY POINTS. https://aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf
[6] Temporary Pandemic SNAP Benefits Will End in Remaining 35 States in March 2023. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march
[7] Effect of the Reevaluated Thrifty Food Plan and Emergency Allotments on Supplemental Nutrition Assistance Program Benefits and Poverty. https://www.urban.org/sites/default/files/2022-08/Effect%20of%20the%20Reevaluated%20Thrifty%20Food%20Plan%20and%20Emergency%20Allotments%20on%20Supplemental%20Nutrition%20Assistance%20Program%20Benefits%20and%20Poverty.pdf
[8] Consumer Price Index: 2022 in review. https://www.bls.gov/opub/ted/2023/consumer-price-index-2022-in-review.htm
[9] Food Price Outlook, 2023. https://www.ers.usda.gov/data-products/food-price-outlook/summary-findings/
[10] Covid-19 Wastewater Monitoring in the U.S. https://biobot.io/data/
[11] The New XBB.1.5 Variant: What You Need to Know. WHN. https://whn.global/newsletter/xbb115-variant-need-to-know/
[12] Update – AstraZeneca’s Evusheld no longer authorized as COVID-19 preventative for immunocompromised | Immune Deficiency Foundation. primaryimmune.org. https://primaryimmune.org/news/update-astrazenecas-evusheld-authorized-covid-19-preventative-immunocompromised
[13] Substantial Neutralization Escape by SARS-CoV-2 Omicron Variants BQ.1.1 and XBB.1. New England Journal of Medicine. doi: https://doi.org/10.1056/nejmc2214314
[14] COVID-19 Clinical Features. UpToDate. https://www.uptodate.com/contents/covid-19-clinical-features
[15] Acute and postacute sequelae associated with SARS-CoV-2 reinfection. https://www.nature.com/articles/s41591-022-02051-3
[16] Worldometer. United States Coronavirus Deaths. https://www.worldometers.info/coronavirus/country/us/
[17] Estimated cumulative excess deaths during COVID. Our World in Data. https://ourworldindata.org/grapher/excess-deaths-cumulative-economist-single-entity?country=~USA
[18] Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19) Expanded in February 2023 to Include Guidance for Certifying Deaths Due to Post-acute Sequelae of COVID-19. https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf