What the public health emergency’s end means for COVID-19 data

This past Monday, the White House announced that the federal public health emergency for COVID-19 will end in May. While this decision might be an accurate reflection of how most of the U.S. is treating COVID-19 right now, it has massive implications for Americans’ access to tests, treatments, vaccines—and data.

I wrote about the potential data issues last September, in anticipation of this emergency ending. Here are the highlights from that post:

  • Outside of a public health emergency, the CDC has limited authority to collect data from state and local health agencies. And even during the emergency, the CDC’s authority has been minimal enough that national datasets for some key COVID-19 metrics (like breakthrough cases and wastewater surveillance) have been very spotty.
  • When the federal emergency ends, the Department of Health and Human Services (HHS) may lose its ability to require reporting of some key data, including: PCR test results (from states), hospital capacity information and COVID-19 patient numbers (from individual hospitals), COVID-19 cases and deaths in nursing homes.
  • It’s possible that the HHS and/or CDC will negotiate new data reporting requirements with states and other entities that don’t rely on the public health emergency. They have about three months to do this. I haven’t seen much news on that yet, but I’ll keep an eye out and share updates as I find them.
  • Regardless, I expect that reporting COVID-19 numbers to federal data systems will become even more voluntary than it already is for health agencies, hospitals, congregate facilities, and other settings. We will likely have to rely more on targeted surveillance systems (which compile data from a subset of healthcare facilities) rather than comprehensive national datasets, similar to our current surveillance systems for the flu and other endemic diseases.

At the same time, the public health emergency’s end will lead to changes in the distribution of vaccines, tests, and treatments. The Kaiser Family Foundation has a helpful explanation of exactly what’s changing. Here are the highlights:

  • Vaccines will remain free to all as long as the stockpile of doses purchased by the federal government lasts. However, the ending emergency will likely impact the government’s ability to buy more vaccines—including future boosters that might be targeted to new variants. Vaccine manufacturers are planning to raise their prices, and cost will become a burden for uninsured and underinsured people.
  • At-home, rapid tests will no longer be covered by traditional Medicare, while Medicare Advantage coverage will vary by plan. Most private insurance providers will likely still cover the tests, but prices may go up (similarly to the prices for vaccines).
  • PCR tests are also likely no longer going to be covered by a lot of insurance plans and/or are going to get more expensive. Notably, Medicaid will continue covering both at-home and PCR tests through September 2024.
  • Treatments (primarily Paxlovid right now) will remain free for doses purchased by the federal government, similar to the situation with vaccines. After the federally-purchased supply runs out, however, we will similarly see rising costs and dwindling access.

KFF also has produced a detailed report about how the end of the federal emergency will impact healthcare coverage more broadly.

In short, the end of the public health emergency will make it harder for Americans to get tested, receive treatments, and stay up to date with COVID-19 vaccines. The testing access changes, in particular, will lead to official case numbers becoming even less accurate, as fewer people seek out tests. At the same time, Americans will lose access to the data we need to know how much of a threat COVID-19 presents in the first place.

It’s also worth noting that, on the same day the White House announced the end of its emergency declaration, the World Health Organization announced the opposite: the global public health emergency is continuing, though it may end later in 2023. As Americans largely ignore COVID-19, millions of people around the world are unvaccinated, facing new surges, dealing with new variants, etc.

COVID-19 clearly remains a looming threat at the global level. In the U.S., we technically have the best vaccines and treatments to deal with the disease—but these tools are going underutilized, and the Biden administration’s decision this week will only make it harder for people to get them. Maybe we shouldn’t have to rely on an emergency declaration to get basic data and access to health measures in the first place.

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