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On Thursday, three years and 100 days after the Trump administration declared the coronavirus a public health emergency, the Biden administration will allow the emergency declaration to expire, ushering in a new era in which the government treats Covid-19 like any other respiratory disease.
If the coronavirus pandemic were war, the United States is about to officially enter peacetime.
But interviews with top federal and state health officials — including the Secretary of Health and Human Services and the Commissioner of the Food and Drug Administration — make it clear that while the United States has vastly improved its ability to combat Covid-19, it is not perfect. Prepared for a radically different future variable or a new epidemic.
State health officials, who are tasked with tracking the coronavirus, are overstretched, and their departments are understaffed. President Biden’s Coronavirus Response Team will soon be disbanded. The White House has yet to meet congressional directives to create a new Office of Epidemic Preparedness, and key officials, including Dr.. Ashish K. JhaCoronavirus Response Coordinator, W Dr.. Rochelle Bdirector of the Centers for Disease Control and Prevention, is stepping down or intends to do so.
Dr. Jha and other federal health officials spent months laying the groundwork for ending the public health emergency, and the Biden administration has created programs to keep vaccines free for the uninsured and support medical research into new vaccines and treatments. But officials say they are working on a shoestring budget. Congress refused to grant the administration any new funds for the pandemic response.
When asked if the country was prepared for a new epidemic, Dr. Francis S. Collins, former director of the National Institutes of Health, “No.” Mr. Biden’s Secretary of Health and Human Services, Xavier Becerra, paused for several seconds before answering the same question.
“It depends on the degree,” Mr Becerra finally said, adding: “We’ve learned a lot from Covid. We’re prepared to deal with Covid – even some variants as they come. If it’s very different, bird flu, I’m getting a little more anxious. If It became a kind of biological weapon, you know, that’s another problem entirely.”
Dr Jha said in an interview that the emergency declaration gave the government and the country’s healthcare system the flexibility to take exceptional measures during the crisis, such as placing hospital beds in a parking lot. Those kinds of steps are no longer necessary, said Dr. Jha, who has told colleagues he plans to return to his job as dean of the Brown University School of Public Health.
But he warned that the virus will not go away. More than 1,000 people still die from Covid-19 in the United States each week, according to the CDC.
“Covid will be with us, but we know how to live with it in a way that doesn’t need to create disruption, doesn’t need to put people in hospital – or worse,” said Dr Jha. “And we know how to monitor and manage this virus so that if it takes a turn, if it does something different, we’re ready for that.”
In the near future, the declaration of emergency ends It will not cause drastic changes For Americans, though, some people may face new coronavirus testing costs. After Thursday, private insurers will no longer be required to cover up to eight home tests per month. Those with Medicare or private insurance may participate in the lab test co-pay.
For now, the vaccines will still be free because the government has stockpiles of them. When they move into the commercial market later this year, they will still be free for most people with insurance. For the uninsured, the Biden administration plans to spend more than $1 billion on New program to offer free footage, though there are questions about how the initiative works.
It is unclear when Paxlovid, the leading antiviral drug for Covid-19, will hit the commercial market. For now, it will also remain free because of the government’s stockpile, though patients may have to bear a portion of the cost once supply runs out.
Some experts fear that policymakers and elected officials, who have already put Covid-19 in the rearview mirror, will forget about it entirely once the emergency declaration ends.
“Take that view, we’ve lost all hope, all mobilization of defensive readiness,” said Gary Edson, president of the Covid Collaborative, a group of experts who worked to inform the federal response.
The country has learned and absorbed some lessons from Covid-19. The CDC is now tracking the spread of the virus by examining wastewater. The Strategic National Stockpile, the country’s medical reserve, is better equipped. As of early this month, it had 352 million N95 masks, 1.3 billion gloves, and 150,000 ventilators, and the administration has more than 600 million coronavirus tests in place. The branch of the Department of Health and Human Services that handles logistics, such as distributing tests and vaccines, has been beefed up.
However, an estimated seven million American adults are immunocompromised remain at particular risk of contracting Covid-19. The main monoclonal antibody therapies that were once critical to protecting these populations are no longer approved by the Food and Drug Administration because they are ineffective against current variants. Management relies heavily on Paxlovid, which can reduce the severity of Covid-19.
Dr. David A. Kessler, Mn He left the Biden administration In January after supervising the vaccination and treatment program. “We need a more durable vaccine. We should never rely on a single, highly effective oral antiviral.”
All told, more than 1.1 million people have died in the United States from Covid-19 — more than the number killed during both world wars. But while the military builds warships and fighter planes in peacetime, public health has long been caught in what experts call a cycle of panic and neglect.
The Covid Crisis Group, a panel of experts led by Philip D. Zelikow, a University of Virginia historian who directed the commission that investigated the 9/11 attacks, says Congress and policymakers should view infectious disease threats from a national security lens. The group spent two years investigating the response to the pandemic and recently published its findings in a book, Lessons from the Covid War.
Top federal health officials said the analogy to military readiness was appropriate.
“What if we funded public health the way we funded the military?” Dr. Nirav d asked. Shah, the CDC’s principal deputy director, said, “We’re going to have a system that has built-in resilience, in the same way that the military can respond with great resilience.”
Instead, Biden administration officials say they are looking for funds for pandemic preparedness. One concern is that the end of the emergency will reduce the economic incentives for pharmaceutical companies to develop new drugs, treatments and vaccines because there will no longer be a guaranteed government buyer.
FDA Commissioner Dr. Robert M. Calif said in an interview, referring to Operation Warp Speed, the Trump administration’s vaccine initiative. “Because what you’re asking the industry to do now is make the investment and take the risk.”
To encourage innovation, the Biden administration intends Spend $5 billion In a new initiative, called Project Next Gen, to develop a new generation of Covid-19 vaccines and treatments. Officials have not said much about how that money will be spent. Don O’Connell, the chief emergency preparedness official at the Department of Health and Human Services, said the Biden administration could not get Congress to pay for the program.
“We asked for and asked for and asked for supplemental money so that we could do the next generation,” she said. When the money was not forthcoming from Congress, federal health officials decided to use unspent coronavirus response funds.
For now, federal regulators are settling on a more incremental strategy — redesigning annual Covid booster shots to target newer variants of Omicron. A remastered screenshot is likely to be released by early September.
With the public health emergency over, local and federal health officials will have less visibility of who has Covid-19 and where the virus is spreading. The CDC and local health departments have used this information to guide communities about wearing masks and other precautions.
But when the state of emergency ends, there will be no need for laboratories to report the results of coronavirus tests to the government. Last week, the CDC announced that it would Society levels are no longer tracked Covid-19 or the percentage of tests that have come back positive.
Instead, agency officials said they will rely on wastewater samples and hospital data as metrics to monitor the virus. Hospitals will still be required to report cases of coronavirus when the emergency ends, but not as detailed as before.
After Dr. Jha leaves, the federal COVID response leadership may function as a committee effort among agency heads, with Ms. O’Connell as central coordinator. Ms. O’Connell said last week that she has spoken with White House officials about the new pandemic preparedness office, but that she is not aware of plans to lead it.
“We’re just waiting to see where it goes,” she said.
In recent weeks, Dr. Jha Talk to leading virologists To measure the likelihood of another Omicron-like variant. One of those scientists, Dr. Dan H. Baruch, director of the Center for Virus and Vaccine Research at Beth Israel Deaconess Medical Center, said in an interview that he told Dr. Jha that the way the coronavirus has mutated means it is near impossible. to make a more than “intuitive” prediction, which he estimated at about 20 percent in the next two years.
Mr. Becerra insists his administration is ready for whatever is coming.
“At the end of any major war,” he said, “don’t let your guard down completely.” “Because even though it may look like it’s over, there could easily have been an outbreak. So we may be on our way out of a public health emergency, but we haven’t left the public health threat behind.”
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