By Sara McCloskey

The Public Health Emergency for COVID-19 expired on May 11, 2023. This emergency declaration began in March 2020 and made it possible for public health resources to be mobilized to fight the spread of SARS-CoV-2, the virus that causes COVID-19.

You may have seen this through isolation and treatment guidelines, and increased testing capacities in community health centers and hospitals. But these priorities are set to change, as the U.S. Department of Health and Human Services sees this as a time to “transition away from the emergency phase.”

“COVID-19 is now an endemic virus, meaning it is here to stay,” Gonzalo Bearman, M.D., VCU Health infectious disease expert, said. “In other words, COVID-19 is now one of the viral pathogens consistently in our environment. And it will remain this way, just as we’ve seen with influenza and RSV.”

Bearman says most people will not be affected by the change in the public health emergency status. Many are already comfortable not wearing a facemask in public and have taken note that COVID-19 booster shots will become the norm, like flu shots.

Over the past two years, COVID-19 vaccines have been offered for free as part of mass immunization efforts.

“There will still be ongoing messaging about the importance of having COVID-19 and influenza vaccinations, but communitywide vaccine clinics and outreach efforts will likely be less intense in the coming year,” Bearman said.

While vaccines and boosters won't be free anymore with the emergency status lifting, federal health officials say many civilians with health insurance coverage will continue to have no out-of-pocket expenses. Medicaid and Medicare programs are expected to continue to cover COVID-19 treatments and vaccines without costs for customers through September 2024.

When it comes to those who are uninsured, Bearman says access to COVID-19 testing and vaccines will unfortunately be limited.

Populations who face social and economic challenges may feel the effects of the public health emergency being lifted more than others.

As part of the COVID-19 public health emergency ending in May across the United States, continuous enrollment in Medicaid and the CHIP program will be winding down. That means people with lower incomes will not be automatically signed up for state-funded health insurance and other social services, as these programs will need to review individuals’ needs each year.

Studies show that people who face social and economic inequities or are from historically marginalized groups are at a greater risk for a variety of negative outcomes during a public health crisis. That’s because the vulnerabilities these individuals were already facing become exacerbated under the stressors of a prolonged emergency situation.

“The public health crisis may end, but their inequities and vulnerabilities will continue,” said Brittany “Brie” Haupt, Ph.D., associate professor in the Homeland Security and Emergency Management Department of the L. Douglas Wilder School of Government and Public Affairs. “The pandemic may be seen as ‘over’ by some. However, many individuals are still in an economic and health crisis due to the effects of the pandemic.”

Rural communities were hit particularly hard by COVID-19 and were already in a vulnerable situation due to limited access to local health care options. According to research by the UNC Cecil Sheps Center, 136 rural hospitals closed between 2010 and 2021, with 19 of these closures happening in 2020 – the most of any year in the past decade.

The public health emergency supplied funding to hospitals to help cover losses in revenue from decreased delivery of patient care as well as the increased costs of buying personal protective equipment (PPE). Saleema Karim, Ph.D., associate professor of health administration in the VCU College of Health Professions, says facilities in rural regions will greatly feel the absence of these funds.

“Rural hospitals also used these funds to help them continue operations,” said Karim, who researches hospital financial sustainability and geographic disparities. “The end of these funds will have a larger negative impact for rural facilities since these facilities are already in a precarious position when it comes to remaining financially viable.”

As communities begin to learn how to live with COVID-19 in their daily lives, there are lessons in preparedness that should stay.

Teams responding to pandemics will look different from those in the past. In a piece published by the Richmond Times-Dispatch, Bearman along with Richard P. Wenzel, M.D., professor emeritus of medicine at VCU, wrote that not only public health professionals are now part of these teams, but experts in anthropology, transportation, communications, mathematics and finance, among other fields.

Having pandemic response teams and emergency managers regularly meet and practice response simulations is key to staying up to date on best practices to help the community in a crisis situation.

That’s something Haupt knows all too well. Her emergency management-related research focuses on community resiliency, cultural competency and crisis communications. While there is always another crisis a community will face, Haupt cautions “against the idea that the pandemic has ended.”

“The height of the crisis is over, but the pandemic is still affecting many individuals and communities,” she said. “As any emergency manager will tell you, long-term recovery is prevalent for a number of crises and is a struggle as many individuals shift their focus to the newest crisis... Our attention may shift to those newer crises, but we must not forget about the ongoing ones. This is why resilience is a goal for emergency managers. The more resilient our communities then the less they will be impacted negatively.”

And how can one build resiliency in their own community? VCU and VCU Health experts note that this can’t be accomplished in an individualistic way – it takes a communal effort. That could mean having compassion for those still dealing with the social and economic struggles of the pandemic or getting vaccinated to continue to stop the spread as new variants come and go.

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