The Daily - The End of the Pandemic Emergency in the U.S.

Episode Date: February 3, 2023

The Biden administration said this week that it would end the public health emergency for Covid, a sign that federal officials believe that the pandemic has moved into a new, less dire phase.The move carries both symbolic weight and real-world consequences for millions of Americans.Guest: Apoorva Mandavilli, a science and global health reporter for The New York Times.Background reading: The end of the public health emergency, planned for May, will bring about a complex set of policy changes and signals a new stage in the government’s pandemic response.Among the effects of the change, access to tests and treatment will be more complicated.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Sabrina Tavernisi, and this is The Daily. The Biden administration said this week it would end the public health emergency for COVID, closing this chapter of the pandemic three years after it started. Today, my colleague Apoorva Mandevili explains how it will affect Americans and why it does not mean the end of COVID. It's Friday, February 3rd. So Apoorva, the Biden administration announced that the public health emergency around COVID is ending. Can you explain what that means? Yeah, so almost exactly three years ago, when the pandemic started, on January 31st.

Well, good afternoon, everyone. I have today declared that the coronavirus presents a public health emergency in the United States. Alex Azar, who was then the Secretary of Health and Human Services, said that we were now in a public health emergency. In accordance with the declaration, the United States government will implement temporary measures to increase our abilities to detect and contain the coronavirus proactively and aggressively. And that was an acknowledgement that the virus was spreading in the country. And a public health emergency, which is something that the government does every once in a while when there is one, allows the government to do a lot of different things to cope with this special situation. And since January 2020, this public health emergency has been renewed every 90 days.

But now the Biden administration is saying that that emergency is over and that all of those special things that we did will end on May 11th. So the Biden administration is basically letting this declaration of a health emergency expire, right? But what exactly had this declaration been allowing? Like, how have we been seeing it play out in our everyday lives? For the average person, what it did most importantly is it gave us access to free tests, free treatments, free vaccines. It allowed states, hospitals, nursing homes, various parts of the federal government to deal with COVID outside of the usual framework. It

also gave them extra money. And Medicare and other group health plans were covering out of network as if it were in network. Meaning? Meaning you could go to any doctor and be treated and you would be treated for free. And the federal government barred states from kicking anybody off of Medicaid for the rest of the pandemic. I mean, it basically gave the federal government extra muscle to deal with a disaster that was unfolding all around us, right? Like, lessening all the friction in the system so that we could all get care more easily. Yeah, and it gave a lot of extra money and people power,

and it made it possible for private entities and government entities to really fight the pandemic on every front. And now that's all going away. It's not all going away, but yes, some of it is going away as of May 11th. Anna Porvo, what does that mean? Lay this out for me. What does it mean that it's going away? It means three big things, really. Well, the first thing is that the health care system is now going to treat COVID like it's any other disease, like it's diabetes. thing is that the healthcare system is now going to treat COVID like it's any other disease,

like it's diabetes. So basically it puts COVID into the category of all other health issues. And that means into the category of complicated, right? That is the American healthcare system. Exactly. It's incredibly complicated and it will make your head hurt to figure out what you qualify for and what you don't. And a lot depends on what kind of insurance you have, like it does for everything else. If you have private insurance, you may not even notice a difference. So if you want a test, if you want a PCR test for COVID,

you have to go to the doctor and have them prescribe the test. You can still go to the store and get an antigen test, but you just won't get those eight free tests a month like we were getting. If you want a drug, the doctor has to prescribe it for you and your insurance company has to cover it. still be able to get free tests and free treatments, but only if they're ordered by a physician and you may still have out-of-pocket costs. If you have Medicaid, the tests will only be free till the second half of 2024. And Medicaid may even cover drugs like Paxlovid that are under emergency use authorization, but that will depend on your state. But if you're uninsured, you're not going to be able to get the vaccines, tests, and treatments for free the way that you used to. You may still be able to get some of them through

community clinics, and there are programs to help uninsured children get what they need. But if you don't have insurance, you might very well end up paying a lot of money out of pocket for all of this. And what effect do you think that will have? I mean, that uninsured people won't have free access to tests and treatments. It means a lot fewer people will get tested, even fewer than now. It means a lot more people will probably get sick because they won't get treated. It means the hospitals may be more full with people who are low income, who've been the hardest hit by the pandemic and will continue to be. And a lot more people will be in that category now because, remember, the federal government allowed states to get extra

money in exchange for not booting people off Medicaid. Well, in December, Congress decided that that should end in April. And so starting in April, the states are going to start kicking people off of Medicaid and all those people will lose insurance. And that means a lot of people who are getting all of these things, tests and treatments and vaccines through Medicaid, will now lose them. Oh, wow. So how many people roughly are we talking about? At the moment, there are about 80 to 90 million people on these total. And there's one estimate that says 15 million may lose it. Wow, that's a lot of people. That is a lot of people. I mean, we already have about 30 million people in this country who don't have insurance. And when people start getting kicked off Medicaid, they will add to those numbers.

Okay, so the first big effect is if you don't have insurance and the number of uninsured is about to really expand, you may be paying more for treatment. What's the second big effect? The second biggest effect is that pharma companies are now going to charge a lot of money for vaccines and for treatments. Pfizer and Moderna have both said that they'll charge somewhere between $80 and $130 for a vaccine dose. The government was paying $30 per dose and we were getting it for free. Oh, wow. So that's a huge markup. That's a huge markup. But I thought that taxpayers themselves were the ones who paid for the development of this thing, right? Through that Operation Warp Speed that happened under the Trump administration. Like, why are these publicly paid-for vaccines

now going to make a lot of money for pharmaceutical companies? These agreements were made in the fog of war. And my conversations with people who were involved say that the government did not get all that it could for its money. And they built in some things that made it very difficult for them to compel companies to do anything. That means the companies are now free to charge whatever they want, and they are free to develop anything new that they want. Wow. So it all, again, just goes back to the market. That's right. So is this basically the government acknowledging that, yes, this will mean fewer people will have access to the vaccines and that's okay because, you know, the vaccines are just not as important as they once were because most people have gotten

at least a few doses already. They're not saying that. What they're actually saying is that vaccines are really important and they're making sure that every insurance, every kind of insurance will have to cover vaccines. So if you have insurance, you won't really notice a difference. What is changing is that these manufacturers can now set the price for where they want it, sort of like they do for everything else. And then your insurance company is going to have to negotiate with them to figure out how they'll cover it. Okay, so what's the third big effect? with them to figure out how they'll cover it.

Okay, so what's the third big effect? The third big effect is something called Title 42, which is a policy implemented by the Trump administration way back in March 2020. And it allowed Border Patrol officers to send back migrants who were crossing the border from Mexico, sent them back to Mexico. And it was a public health order because the thinking was new people coming into the country increases COVID risk. It's one of the ways in which we could contain the epidemic. Remember, in March 2020, things were pretty bad.

So we were trying everything. But what the Biden administration is saying now is if there is no public health emergency, then there's no need for Title 42 either. And so Title 42 will go away. So the Biden administration is effectively now saying, you know, we're not in that public health emergency anymore. We can no longer justify Title 42, the rule that allowed the U.S. to keep people out because it was a global pandemic. Right. And so what that means is that more people may now come to the border and seek to come into the United States because that rule is no longer in place.

the border and seek to come into the United States because that rule is no longer in place. Okay, so it sounds like with the end of the public health emergency, a few things are staying the same, but a lot of things are changing in pretty significant ways. But why is President Biden doing this? And why now? Well, why is because it's an acknowledgement that we are not in a public health emergency anymore. Why now? The answer to that has a lot to do with politics.

We'll be right back. So, Apoorva, before the break, you said that the timing for the administration's decision to end the public health emergency is in part because of politics. What are those politics? Well, this public health emergency was set to expire in April anyway. And the expectation from a lot of people was that it would either be allowed to finish then or that the Biden administration might extend it for a few more months, but certainly sometime this year, it would end. Why this week? Thank you, Mr. Speaker. Today, I rise to push for immediate and overwhelming passage of my legislation, H.R. 382, the Pandemic is Over Act. On Tuesday, the House passed a bill called Pandemic is Over.

As you know, Republicans have been saying now for many, many, many months that the pandemic is over. This week, we are voting on several bills designed to do what we all in America have known for some time. Americans have moved on from the pandemic. Georgians in my district went back to work and back to school over two years ago. Emergency executive authority should be limited and only for extraordinary circumstances. And this is no longer an extraordinary circumstance. And this bill was meant to end the public health emergency the second it was signed into law. The pandemic is over. Action is a loud and clear message to President Biden. The American people are tired of living in a perpetual state of emergency, and it's long overdue for Congress to take back the authorities

granted under Article 1 of the Constitution. Now, that was probably never going to happen because the Senate wouldn't have passed it, but this was their way of saying, we think the pandemic is over. But what it would have meant is that everything that the public health emergency put into place would have ended immediately the second this became law. The Biden administration has always said they would give at least 60 days warning for everything to unwind because they put so many complicated things into place. The system needs time to undo all of those things. And so this was the Biden administration's way of saying, we agree with you, the pandemic is over, but we're going to do this on our terms.

So the decision to do this now was not based purely on some public health calculation about COVID. Well, there's no real public health metric that these things can be based on. But the administration has been saying for quite a long time now that we are not in the same state of crisis that we were in. And the numbers do show that, you know, we did not have anywhere near the kind of deaths or even hospitalizations that we saw the previous two winters. And we weren't taking precautions this year. So this is really an acknowledgement of something that the administration and a lot of experts have been saying for quite a while, which is this is a new phase. But that said, I do want to note that we are still seeing somewhere around 500 deaths a day.

Wow. I mean, these are not trivial numbers. They feel like a lot less because they are a lot less than the previous years. But this is still a pretty high level of damage that COVID is able to inflict. Even if most people feel like this is done, the virus is not done with us. Does any of this change the way we should be thinking about how we approach COVID? Like as individuals, what should be my COVID hygiene practices if you will how you feel about the pandemic and what you do really depends on your risk level and your risk tolerance if you are

over 65 if you're immunocompromised if you're pregnant if you have a baby under one and you want to protect that baby the virus is still very much a threat. And those people should still continue to mask everywhere they can to get their vaccine doses on time and to protect themselves every way they can. For everybody else, really, it's a matter of personal choice now because the government is saying we're no longer thinking this is an emergency. You make the decision. So it sounds like you're saying I don't need to get a booster anymore. I mean, I'm a healthy person. I'm done with boosters. It seems that way from this winter. You know, only about 16% of the population got the bivalent booster. And yet this winter, we didn't see anywhere near the kind of deaths we saw the

last two winters. Even this winter, the people who are in the hospitals are older adults who are most at risk from any respiratory disease. Having said that, the FDA has said they would like to go to a system where everybody would get an annual shot, kind of like we do for the flu. So then can we just start treating this thing like the flu? Is COVID the flu, basically, at this point? No, it's not the flu. I mean, it's an endemic virus like the flu in the sense that we're going to live with this forever. But we don't know it anywhere near as well as we know the flu.

Flu is a very old friend, an old enemy. And COVID is still such a mystery to us. It's way more contagious. It's way more deadly. It's way more deadly. And we really have no idea about its seasonality. We know, for example, that, OK, every winter we'll probably see a wave of some size. But we don't know when else in the year it might come. We don't know how big it will be.

We don't know how often it will change, which new variant will come our way. There's just so many unanswered things about this virus that are not the case for flu. That is not the answer I was hoping for. I mean, it seems to kind of behave in the same way roughly, right? Okay, so we don't know what season it comes in, but it's just, it's not changing our lives and turning them upside down in the way that it once was. At the moment, I really hesitate to draw conclusions about what this virus is doing because it has thrown so many surprises at us. It could still come up with a new variant that gets around the vaccines. We may all still need to go get another booster. We may need new drugs.

We are not fully out of the woods. Do you think it will ever get predictable in the way that the flu is? Or are we seriously just living with this unpredictable thing forever? That's the hope that we will understand when this virus comes around. You know, it hasn't been long enough. We've only been in this for three years. And the previous two years, we didn't see other respiratory viruses. This year, we had RSV, we had flu, we had COVID, and we don't know how those viruses really play with each other yet, how they will affect each other's seasonality. So we need at least another year or a couple more years to see what this virus does at different parts of the year.

Up where for the last time we did an episode together, I asked you, if COVID was a road trip from the East Coast to the West Coast, where were we in that journey? And I think at the time, some point last year, you said somewhere in the Midwest. Where are we on the journey? How close are we to San Francisco? We're closer, but San Francisco may never have been the destination. If we thought that we were going to reach herd immunity and be rid of this virus, San Francisco was never in the cards. The GPS was always set to Denver. We just thought we were headed to San Francisco. Apoorva, thank you. Thank you. We'll be right back. Here's what else you should know today.

This resolution is not about engaging in a tit-for-tat with my colleagues on the other side of the aisle. This is about keeping someone with a long record of anti-Semitic and anti-Israel bias off the Foreign Affairs Committee, which needs objective emissaries for our foreign policy. On Thursday, the Republican-led House passed a resolution to oust Representative Ilhan Omar of Minnesota from the Foreign Affairs Committee over her past comments about Israel that were condemned as anti-Semitic. There is an idea out there that I do not have objective decision-making because of who I am, where I come from, and my perspective. But I reject that.

We say there is nothing objective about policymaking. We say there is nothing objective about policymaking. We all inject our perspective, our point of views, our lived experiences, and the voices of our constituents. That's what democracy is about. The move settled a partisan score in the House that had been festering since 2021, when Democrats stripped Republicans of their committee assignments in response to social media posts that endorsed violence against Democrats. And the U.S. announced it would increase its military presence in the Philippines to what will be the largest U.S. presence there in 30 years. The plan allows Washington to station military equipment and build facilities in nine locations

across the country. Some of the locations were bases that it had already been using. The deal comes as Washington tries to reaffirm its influence in the region and to counter what it sees as aggression from China. Today's episode was produced by Michael Simon Johnson, Shannon Lin, and Jessica Chung. It was edited by Lexi Diao and Paige Cowett, with help from MJ Davis Lin. Contains original music by Marian Lozano and Dan Powell, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly. That's it for The Daily.

I'm Sabrina Tavernisi. We'll see you on Monday.