What It Means as the U.S. COVID-19 Public Health Emergency Comes to a Close?

The U.S. government declared COVID-19 a public health emergency in January 2020. As coronavirus cases and deaths decline, the declaration is set to expire on May 11. The goal was to slow the spread of the virus, leading to temporary measures like quarantines for those exposed to the virus and allowing federal officials to offer FDA-authorized tests, drugs, and vaccines to the public. As President Joe Biden signed legislation to end the national emergency for federal health insurance programs that included coverage for telehealth visits, researchers and health policy experts fear that ending the public health emergency may cause a delay in controlling the virus’s spread. However, tests, drugs, and vaccines will be crucial in helping stop the spread.

COVID tests that were authorized by the FDA over the three years will remain available for home and lab use. These tests were granted Emergency Use Authorizations (EUAs) by the FDA, allowing access to the public for tests that are not formally approved. The FDA can end individual EUAs even after the public health emergency ends, and it can issue EUAs for any new tests that may be developed. However, how diagnostic tests will be covered is subject to change based on insurance coverage under different circumstances.

There may be changes in terms of who pays for at-home and lab tests, depending on individual insurers, for those with private insurance. For Medicare Part B users, lab tests ordered by health professionals will still be covered. Medicaid users will receive free at-home and lab tests until September 2024, but costs may vary by state after that point. Uninsured individuals pay full price for at-home and lab tests. States will be able to disenroll people from Medicaid, leading to an increase in the number of uninsured individuals.

Uninsured individuals may still have access to testing at free clinics, and the CDC Increasing Community Access to Testing program will continue to offer tests to those without insurance. However, millions may soon join this group of individuals and may not be able to afford testing, putting disadvantaged and minority populations at risk of virus spread.

Despite the end of the national and public health emergencies, access to vaccines and antiviral treatments will not be affected, according to the U.S. Department of Health and Human Service (HHS). The Food and Drug Administration (FDA) will continue to issue Emergency Use Authorizations (EUAs) for new vaccines and treatments to combat future variants. However, Congress has decided not to fund efforts to stockpile COVID-19 vaccines and treatments any further, and they are expected to run out by summer or fall. After this, healthcare providers will need to buy vaccines directly from pharmaceutical companies at commercial costs, estimated to be between $110 to $130 per shot for the widely used mRNA shots manufactured by Pfizer and Moderna. Costs for patients will vary based on their insurance coverage, but COVID-19 vaccination will be covered without co-pays by most private insurance companies due to a recommendation by the CDC's Advisory Committee on Immunization Practices.

While antivirals initially purchased by the government will remain free for as long as stockpiles last, pharmacies will have to buy them directly from manufacturers after. Medicaid will continue to cover treatments until September 2024, and after that, costs may vary by state. The CDC's Vaccines for Kids program will continue to provide COVID-19 vaccines to uninsured children. The bulk of the funding for coronavirus research wasn't tied directly to the public health emergency, so ongoing and future studies will continue. However, reporting of COVID-related hospitalizations and lab test results may be less frequent, making it more difficult for people to track new surges of infections. In the face of immunity decline and emerging variants, the Biden administration has allocated more than $5 billion for "Project Next Gen" to accelerate research for variant-proof vaccines and treatments, such as mucosal vaccines that provide additional protection against infection in the nose and throat.

Another objective is to develop long-lasting, lab-engineered antibodies that could be used to treat infected people. Such monoclonal antibodies proved effective at preventing severe disease in newly infected people in clinical trials but no longer work because the virus has changed too much (SN: 1/13/23). Now, the plan is to develop new ones that attack parts of the virus that don’t often change as the virus evolves.   

Also on the wish list is to craft universal coronavirus vaccines that protect people from not only newly emerging variants but also other types of coronaviruses (SN: 9/29/22). The virus that causes COVID-19 isn’t going anywhere, and there are plenty of other coronaviruses circulating among animals such as bats that might also pose a threat to people.