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 will treat Covid-19 like any other respiratory illness.
If the coronavirus pandemic was a war, the United States is about to officially enter peacetime.
But interviews with senior 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 greatly improved its ability to fight Covid-19, it is not so prepared for a radically different future a variant or a new pandemic.
State health officials tasked with tracking the coronavirus are burned out, their departments understaffed. President Biden’s coronavirus response team will soon disband. The White House has yet to comply with a directive from Congress to establish a new Office of Pandemic Preparedness and key officials, including Dr. Ashish K. Jhacoronavirus response coordinator a Dr. Rochelle P. Walenskydirector of the Centers for Disease Control and Prevention, is leaving or about to do so.
Dr. Jha and other federal health officials have 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 to support medical research into new vaccines and therapies. But officials say they are working on a tight budget; Congress has refused to give the administration any new money to respond to the pandemic.
When asked if the country is ready for a new pandemic, Dr. Francis S. Collins, former director of the National Institutes of Health, answered simply, “No.” Mr. Biden’s Health and Human Services Secretary, Xavier Becerra, paused for a few seconds before answering the same question.
“It depends on the degree,” Mr. Becerra said finally, adding: “We learned a lot from Covid. We are ready to deal with Covid – even some variants as they come. If it’s something else entirely, bird flu, I’m getting a little more concerned. If it becomes some kind of biological weapon, you know, that’s a whole other problem.”
Declaring a state of emergency, said Dr. Jha in an interview, gave the government and the national health care system the flexibility to take emergency measures during a crisis, such as placing hospital beds in parking lots. Dr. Jha, who has told colleagues he intends to return to his job as dean of the Brown University School of Public Health, said those kinds of steps are no longer necessary.
But he warned that the virus will not disappear. More than 1,000 people still die of 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 have to cause disruption, doesn’t have to put people in the hospital — or worse,” said Dr. Yoke. “And we know how to monitor this virus and manage it so that if it changes, if it does something else, we’re ready for it.”
The end of the declaration of a state of emergency in the near future will not cause dramatic changes for Americans, though some people could face new costs for testing for the coronavirus. From Thursday, private insurance companies will no longer have to pay for up to eight home tests per month. Those with Medicare or private insurance may have co-pays for lab tests.
For now, the vaccines will continue to be free as the government has a stockpile of them. When they move to the commercial market later this year, they will remain free for most people with insurance. For the uninsured, the Biden administration plans to spend more than $1 billion on a new program to offer free footage, although the question remains as to how the initiative will work.
It is unclear when Paxlovid, the leading antiviral drug for Covid-19, will move to the commercial market. It will also remain free for the time being due to government supplies, although some of the cost may have to be picked up by patients as supplies run out.
Some experts fear that politicians and elected officials, who have already put Covid-19 in the rearview mirror, will forget it entirely once the state of emergency is over.
“I worry that this will be interpreted as a ‘mission accomplished’ moment,” said Gary Edson, president of the Covid Collaborative, a group of experts who worked to inform the federal response, adding: “Once we take that view, we’ve given up all hope , all mobilization for defensive readiness.”
The country has learned from and absorbed Covid-19. The CDC is now tracking the spread of the virus by examining sewage. The strategic national stockpile, the national health reserve, is considerably better equipped. As of earlier this month, it had 352 million N95 masks, 1.3 billion gloves and 150,000 ventilators, and the administration has more than 600 million at-home tests for the coronavirus at its disposal. The branch of the Department of Health and Human Services that handles logistics such as distribution of tests and vaccines has been strengthened.
Yet an estimated seven million American adults are immunocompromised remain particularly vulnerable to Covid-19. Key monoclonal antibody treatments that were once critical to protecting this population are no longer FDA-approved for use because they are ineffective against current variants. The administration is leaning heavily on Paxlovid, which can reduce the severity of Covid-19.
“We need an effective monoclonal against current variants,” said Dr. David A. Kessler, who he left the Biden administration in January after overseeing her vaccination and treatment program. “We need a more resistant vaccine. And we should never rely on just one highly effective oral antiviral.”
All told, more than 1.1 million people in the United States have died from Covid-19 — more than the number killed during both world wars. But while the military builds warships and fighter jets 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 led the commission that investigated the 9/11 attacks, says Congress and policymakers must view infectious disease threats through a national security lens. The group spent two years researching the pandemic response and recently published their findings in the book “Lessons from the War on Covid”.
Top federal health officials said the military preparedness analogy is apt.
“What if we funded public health the way we funded the military?” asked Dr. Nirav D. Shah, CDC’s senior deputy director: “We would have a system that has built-in flexibility, just like the military can respond very flexibly.”
Instead, Biden administration officials say they are raising money for pandemic preparedness. One fear is that the end of the state of emergency will reduce the economic incentives for drug companies to develop new drugs, treatments and vaccines because there will no longer be a guaranteed government buyer.
“One of the most important parts of Warp Speed and the whole pandemic response was to reduce uncertainty for the industry by getting money from the government,” said Dr. Robert M. Califf, FDA Commissioner, in an interview referring to Operation Warp. Speed, the Trump administration’s vaccine initiative. “Because what you’re basically asking the industry now is to make the investment and take the risk.”
The Biden administration intends to encourage innovation spend $5 billion as part of a new initiative called Project Next Gen, which aims to develop a new generation of vaccines and treatments for Covid-19. Officials have said little about how that money will be spent. The Biden administration has been unable to convince Congress to pay for the program, said Dawn O’Connell, the top emergency preparedness official at the Department of Health and Human Services.
“We asked and asked and asked for additional funding to do Next Gen,” she said. When money from Congress didn’t arrive, federal health officials decided to use unused funds to respond to the coronavirus.
For now, federal regulators are content with a more incremental strategy — redesigning annual Covid boosters to target newer Omicron variants. The reformulated shot will most likely be launched in early September.
With the end of the public health emergency, local and federal health officials will have less insight into who has Covid-19 and where the virus is spreading. The CDC and local health departments used this information to guide communities to wear masks and other precautions.
But when the state of emergency ends, labs will no longer have to report coronavirus test results to the government. Last week, the CDC announced that it does no longer tracks community levels Covid-19 or the percentage of tests that are positive.
Instead, agency officials said they will rely on sewage samples and hospital data as metrics to track the virus. Hospitals will still be required to report coronavirus cases after the emergency is over, although not in as much detail as before.
After Dr. With Jha gone, the leadership of the federal response to Covid may function more as a committee effort between agency heads, with Ms O’Connell as the central coordinator. Ms. O’Connell said last week that she had spoken to White House officials about the new pandemic office but was unaware of its leadership’s plans.
“We’re waiting to see where it lands,” she said.
In recent weeks, Dr. Yoke spoke to leading virologists gauge the likelihood of another Omicron-like variant. One of these scientists, Dr. Dan H. Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, said in an interview that Dr. Jha that the way the coronavirus mutates means it’s almost impossible. to offer more than an “insider” forecast that he estimated at around 20 percent over the next two years.
Mr. Becerra insists that whatever comes, his department is ready.
“You don’t let your guard down completely at the end of any major war,” he said. “Because even though it may seem like it’s over, it could easily flare up. So we may be leaving a public health emergency, but we haven’t left a public health emergency.”