This month, the federal government let the coronavirus national emergency declaration expire.
After more than three years and thousands of COVID-19 deaths in Missouri, the end of the public health emergency heralds a new phase in which the virus is present but less dangerous to the general public.
“As we move from this historic pandemic phase of COVID-19 into an endemic phase, we must still be aware of the virus, and that it does not disappear with today’s end of the public health emergency,” said Dr. Mati Hlatshwayo Davis, St. Louis' health director.
What does the shift in policy mean?
The federal government enacted the coronavirus public health emergency in early 2020. The declaration allowed the government to enact certain rules designed to keep the coronavirus from spreading. The rules included allowing more doctors to confer with patients over computers and cellphones and requiring that insurers offer tests, vaccines and other treatments for COVID-19 free to people in the United States.
“It's almost like a special soapbox and that when the president declares an emergency he gets this soapbox,” said Rob Gatter, director of health law studies at St. Louis University. “When he stands on that soapbox, it creates power in the president to be able to take steps legal authority to take steps that the president normally doesn't have.”
The federal government renewed the public health emergency every 90 days. Officials from the Department of Health and Human Services let it expire May 11.
There were multiple emergency declarations at local, state and federal levels. Gov. Mike Parson more than a year ago announced the “end to the coronavirus crisis in Missouri.” The state’s emergency expired in April 2022.
The expiration meant that health workers licensed in other states could no longer work in Missouri and that the National Guard would no longer conduct vaccination drives and other coronavirus pandemic- related tasks
The federal public health emergency was more far-reaching and dictated different provisions across the country.
How will the end of the emergency affect testing and vaccinations?
One of the biggest changes will be potentially higher costs for vaccines and tests. During the public health emergency, the federal government required insurers to offer them free to everyone. That will continue — but it’s unclear how long those provisions will last.
The federal government still distributes free vaccinations and boosters to local clinics and health departments, but free federal vaccine coverage depends on the government’s supply, so health officials are encouraging people to get vaccines or boosters as soon as they can. In the St. Louis region, people can still get vaccinated at St. Louis County's public health clinics.
“We strive to continue to work as we have done over the past three years to provide access to COVID-19 mitigation methods, including vaccines and tests, through our clinics and partnerships,” said Dr. Kanika Cunningham, the St. Louis County health director.
The cost to patients will ultimately depend on a person’s insurance coverage, Gatter said. Some insurers may treat the COVID-19 vaccine like a yearly flu shot, which patients are often able to get for free.
“The short answer is you're probably not able to get it for nothing out of your pocket,” Gatter said. “When this ends, it’s treated more like any other sort of test or vaccination that you might get. If your health plan already was covering various forms of vaccinations at no cost to you, then you might still have that benefit. But it's no longer a requirement.”
Doctors likely will continue to meet with patients via telehealth, he said. Recently passed federal laws will maintain much of the access to telehealth through at least 2024, federal officials said. Before the pandemic, patients often needed to access telehealth on specific secure devices. Many patients now log into virtual appointments on their laptops or phones.
Will the change affect Medicaid for Missouri patients?
Missouri made more than 200,000 more people eligible for Medicaid during the pandemic. But it’s not tied to the public health emergency.
“First, let me say that even though Missouri expanded access to Medicaid during the pandemic, it was not as a result of an emergency requirement,” Gatter said. “It's here, and it's here to stay.”
But the federal government prohibited Missouri and other states from kicking people off Medicaid during the public health emergency. That brought a pause on the annual required renewals for patients enrolled in the health insurance program for low-income Missourians and their families.
Federal officials separated that requirement from the public health emergency earlier this year. That means the state has started requiring people to submit their annual renewal paperwork in order to keep their coverage. Because many new Medicaid patients have never had to renew their coverage, it’s possible thousands could inadvertently lose their coverage.
“So if someone became a Medicaid recipient as a result of Medicaid expansion during the pandemic, or they came onto Medicaid early in the pandemic, they've never had to experience making sure that they stayed enrolled, and now they will,” Gatter said.
Does this mean the coronavirus less of a threat?
“The end of the declaration is not the end of the risk associated with COVID,” Gatter said.
As people need to pay for vaccines and tests, it’s likely the burden of sickness will continue to disproportionately affect uninsured and poor people with no sick leave, he said.
“That will continue to be a risk. And even though the numbers are lower, we probably will see that differentiation. And I think the telltale sign will come this fall and winter,” Gatter said.
Although coronavirus-related hospitalizations, deaths and cases are at the lowest rates in Missouri since the beginning of the pandemic, it’s not accurate to refer to the virus as an endemic — or constantly present — sickness, said Dr. Hilary Babcock, an infectious disease physician and chief quality officer for BJC Healthcare.
“I think we're in this sort of odd interval between pandemic and endemic,” she said.
The flu and other endemic viruses fall into a predictable pattern of rise and fall, something that epidemiologists can’t yet predict about the coronavirus, she said. Missouri and other states with lower-than-average vaccination rates could be hit harder by future outbreaks than other states.
“I think my concern for Missouri and for other states that have been a little bit less willing to go along with safety measures for longer times, a little bit less willing to change behaviors, over the long haul is whether they are ready to flex in response to ongoing surges,” Babcock said.
When case numbers go up, people can wear masks and practice social distancing to protect themselves, she said.
“Emotionally, it's sort of weird, we don't really have the opportunity to say it's done,” Babcock said. “We can look back, we can mourn those we lost, we can think about how we can do it better in the future. Because there isn't a clear line where we can say now it's done.”
