Public health law experts Lawrence Gostin and James Hodge explain the importance of declaring a public health emergency as Covid cases and hospitalizations begin to rise.
This past Friday, on November 11, the federal government indicated that it would renew its declaration of Covid-19 as a national public health emergency, which was due to expire in January. Most states have already ended their own states of emergency, with only nine states retaining them. Federal continuation of the emergency now probably through April 2023 is sensible, as the ramifications of withdrawing the public health emergency for the Covid-19 emergency could have been very bad. Here’s why.
First, SARS-CoV-2 still poses a major health threat to Americans. With new subvariants becoming “more adept” at evading immune defences, many people are still vulnerable, especially a large proportion of unvaccinated people.
Vaccination and booster rates in the United States lag far behind most of our peer countries. Hospitalizations due to Covid-19 increased by 6% in the first week of November compared to the previous week alone. The United States continues to experience extraordinary Covid-19-related mortality, averaging nearly 340 deaths per day over the past month. Covid-19 remains among the CDC’s seven leading causes of death nationwide. Almost all Covid-19 deaths would be preventable if only more Americans were fully vaccinated and boosted.
Worse still, the triple threat of infectious respiratory disease hangs over Americans. Rising rates of annual influenza and respiratory syncytial virus (RSV) infections are filling emergency rooms, especially in pediatric hospitals nationwide. The impacts of RSV in infants and adolescents led the CDC to issue an official health alert on Nov. 4 and may warrant a separate public health emergency declaration through the federal Department of Health and Human Services (HHS) more later this month. On Saturday, November 12, Colorado Governor Jared Polis added RSV to the ongoing Covid-19 emergency in his state.
And let’s not forget the ongoing national PHE declaration regarding monkeypox with nearly 30,000 cases spread across all 50 states, nor New York’s state of disaster over identified cases of polio, a re-emerging disease marked for eradication. world at the beginning of this century.
From a purely epidemiological point of view, moving away from the national PHE by almost three years for Covid-19 seems inappropriate. Additionally, the major legal and political repercussions of HHS’s potential withdrawal from its PHE significantly raises the stakes, though it may not happen until the spring. The PHE has already been renewed 10 times for periods of 90 days. Declaring a national PHE is not a simple political stunt (despite the intense politicization of Covid-19).
The HHS emergency authorizes sweeping legal powers to bolster the nation’s public health and healthcare systems in times of crisis. Coupled with Presidential Emergency Declarations, which still remain in effect, and complemented by previous Congressional actions, the Emergency Declaration greatly facilitates response efforts and the transition to crisis care standards. The resulting adaptations in health care delivery and public health response can quickly unravel when the PHE ends.
On the one hand, getting rid of the emergency puts the health insurance status of millions of people at risk. Many Americans have been temporarily enrolled in Medicaid and children’s health insurance programs during the pandemic, largely at federal expense, to help provide immediate access to care. More than 15 million Americans could lose coverage within a year of PHE ending without further federal insurance. At the same time, food insecurity will invariably increase once the benefits that millions of Americans have temporarily received under the federal Supplemental Nutrition Assistance program wear off when the emergency ends.
Additional fallout may occur. Important innovations in healthcare services, including telehealth initiatives and flexibilities for healthcare workers, could cease or be severely reduced within months. Improved access to vaccines through pharmacies, which has been greatly facilitated by HHS in accordance with its separate statements through the Public Preparedness and Emergency Preparedness Act, can be thwarted.
The ability of the Food and Drug Administration (FDA) to expedite the approval of drugs, vaccines, tests and protective equipment against Covid-19 rests largely on the legal underpinnings of a national emergency. Ending the public health emergency can effectively suppress FDA emergency use authorities and thwart liability protections for manufacturers, distributors, and retailers of these life-saving medical countermeasures. The FDA is currently evaluating how to disentangle dozens of emergency powers.
Public health surveillance activities to monitor Covid-19 cases, already vastly underfunded, would be severely affected. The CDC has used emergency powers to ask states to report Covid infections, hospitalizations and deaths. It could go away. In the absence of effective real-time data, the risks of continued spread of Covid-19 variants nationwide increase exponentially.
Ending those healthcare, public health, and social welfare programs and benefits legally tied to the HHS public health emergency can rightfully present its own crisis. Clearly, the national emergency surrounding Covid-19 cannot last forever (although an existing PHE published in 2017 regarding opioid abuse extended for five years). As Covid-19 infections are on the rise, public officials are buying time and thinking hard about how best to manage a transition.
For now, compliance with emergency measures in the context of continued national threats from emerging diseases warrants careful consideration by HHS. An “all or nothing” approach would be unwise. What is needed are definitive national guidelines on gradual de-escalation steps to ensure that millions of Americans, already battered by the worst infectious disease threat in US history, do not suffer the loss. of their livelihoods or their lives upon the abrupt end of the government. authority and support.
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