As COVID-19 emergency ends, changes will be far-reaching — and nearly invisible

By: - May 11, 2023 6:00 am

“Maskphalt” (Erik Gunn | Wisconsin Examiner)

Good-bye mask requirements. Good-bye free COVID-19 tests. Good-bye free health care for COVID-19 illness or its treatment. 

With the arrival of May 11, 2023, the national COVID-19 public health emergency that has been in place for more than three years is over. On Friday, May 5, the World Health Organization declared the global health emergency over as well.

What is not over? The COVID-19 pandemic.

“Certainly fewer people are dying than were dying in the beginning of the pandemic, but we’re still losing over 200 Americans a day,” says Prof. Tiffany Green, a health economist at the University of Wisconsin-Madison. 

“I hope the average person in Wisconsin doesn’t see the ending of the emergency declaration as the ending of the pandemic,” says Prof. Ajay Sethi, a UW-Madison epidemiologist. 

The end of the emergency is simply a “technical decision” that pulls back the federal role in paying for services and public needs Sethi says. “But it’s not solely based on COVID suddenly not being a problem in our society.”

Ajay Sethi
Prof. Ajay Sethi, UW-Madison

COVID dropped to the fourth-leading cause of death in 2022, according to the CDC, after being the third-leading cause in 2021. But “it’s still there,” Sethi says. “And while the average person may not be at risk for the most severe outcomes for COVID, there are people in our society who are. So just staying on top of the latest science and public health recommendations is still a good idea.”

For people who monitor public health, assessing the current state of the pandemic has required balancing good news with continued caution.

In Wisconsin, the daily count of positive cases has continued along a slowly declining trend since Dec. 10, according to the Department of Health Services (DHS). On average over the last seven days, there have been 179 new cases reported per day.

Those reports come from health providers and public health departments. With the rise of at-home testing over the last year, however, many positive tests never make it into state and federal databases.

Dr. Ben Weston
Dr. Ben Weston, Medical College of Wisconsin

Still, other data points have also fallen. The number of people currently in the hospital with COVID-19 has reached a one-year low —171 per day on average over the last seven days, DHS reports. Deaths each day from the illness have fluctuated in the single digits since the beginning of the year. As of Tuesday, May 9, DHS reported a seven-day average of one death per day.

“We know that COVID continues to affect folks in our community, particularly our vulnerable older and immunocompromised populations,” said Dr. Ben Weston, Milwaukee County chief health policy advisor, at a briefing for reporters this week. 

“That said, we see hospitalizations declining to the lowest levels recorded during the entire duration of the pandemic. Meanwhile, we see cases, positivity and deaths all on the decline. And we see our community and our country enter a new stage of the pandemic.”

A different illness?

COVID-19 is in some ways dramatically different now from the viral illness that surfaced in early 2020 in Wisconsin, bringing with it debilitating illness and death.

Dr. Geof Swain, Wisconsin Public Health Assn.

“In March of 2020, this was a brand new virus that was very contagious and had a relatively high fatality rate,” says Dr. Geof Swain, immediate past president of the Wisconsin Public Health Association. Hospitals were overwhelmed. “It was an unmitigated disaster. We didn’t know what we were dealing with.”

And with no vaccine, everyone was susceptible to the novel coronavirus responsible for COVID-19, Swain says. “Since then, there is a lot that has changed.”

Doctors have learned more about how the virus spreads — not by large droplets or by lingering on surfaces, as was first thought, but by very small airborne particles or aerosols. Public health providers also learned that high-grade masks — KN-95 masks and respirators — “are quite effective at reducing transmission.”

Vaccines have also made a big difference, although they’ve also shown their limitations.

“The virus clearly has been becoming more infectious, and despite vaccination or past infection, people become vulnerable for reinfection,” says Sethi.

Vaccination or an infection offer limited immunity because the virus spreads so easily, Sethi says. Antibodies to the virus appear to lose their strength in six months or so. 

Even with those limitations, the vaccines have had to pass a rigorous evaluation to win FDA approval, Sethi says, and they’ve shown they were effective at reducing the severity of infection and the risk of serious illness or death. “And everybody has a different response.”

While the evolution of the virus might at some point overcome the benefit of vaccination, “being vaccinated generally does protect people, particularly the more vulnerable, from getting severe disease,” Sethi says. “And that’s what COVID-19 vaccines are also achieving.”

What changes

Sethi and Swain both acknowledge that the end of the emergency won’t look much different to the general public — at least not at first.

“Many people in Wisconsin have come to the conclusion that COVID is no longer an emergency quite some time ago,” says Swain. Just over 65% of state residents have gotten an initial vaccination, and nearly 62% have gotten the full two-shot series, according to DHS. But a much smaller number, just under 21%, have gotten boosters.

“But people that weren’t vaccinated are still not getting vaccinated,” Swain adds. The use of masks has also declined markedly. “So I don’t think that the expiration of the federal public health emergency declaration will likely make a lot of difference in the day-to-day behaviors of most people in Wisconsin.”

The emergency’s end will bring several changes in public policy, however. Among them:

CDC Community Level COVID-19 map
COVID community levels were listed as medium (yellow) in 2 counties and low (green) throughout the rest of the state. No counties showed high community levels. Community levels were updated May 4, 2023. They reflected new COVID-19 cases per 100,000 population over seven days through Wednesday, May 3; new COVID-19 hospital admissions per 100,000 population over seven days; and percentage of inpatient beds occupied by COVID-19 patients (seven-day average) through Tuesday, May 2. (Source: Centers for Disease Control and Prevention) (Click on the image to open it in a larger window.)

Medicaid: Even before the emergency’s official end, Wisconsin and the rest of the country began the process of “unwinding” guaranteed continuous coverage for people covered by Medicaid (known as BadgerCare in Wisconsin). 

Over the course of the next year, DHS, which administers the program, will review all Medicaid enrollees to determine whether their income is greater than allowed under Wisconsin law. DHS officials have emphasized their intention to help anyone who earns more than the federal poverty guideline navigate the shift to other coverage, whether through employer-based health insurance or by purchasing insurance on the federal exchange created by the Affordable Care Act. 

Insurance and the cost of care: The emergency’s end also makes insurance coverage even more critical in the diagnosis and treatment of COVID-19. 

DHS will continue to provide COVID-19 vaccines free of charge while the current supply from the federal government lasts, and a federal program announced in April will provide free vaccines to uninsured people.

Once the federal vaccine supply runs out, however, for people with health coverage, providers will be permitted to charge patients or their insurers for COVID-19 tests, vaccines and medication. Health insurers will now be permitted to require a patient copayment. 

“With the ending of the emergency declaration, it’s just really important that people recognize that if they’re going to access treatment for COVID, it’s no longer going to be free once the federal supply ends,” Sethi says. 

Testing: A multi-state program providing free at-home tests that can be ordered online, Say Yes Covid Test, is still available, DHS spokeswoman Elizabeth Goodsit said Wednesday. The supply of those tests is now projected to last through mid- to late May.

Telehealth: A free telehealth service through DHS for people diagnosed with COVID-19 to get access to medication, including the antiviral paxlovid, has been extended through the end of 2023.

Measuring the pandemic: Another change will be how the federal government and the state measure the spread of COVID-19.

Wisconsin COVID-19 Community Transmission map
Community transmission for COVID-19 was high (red) in 5 Wisconsin counties, substantial (orange) in 14, moderate (yellow) in 46 and low in 7. The ratings combine a county’s rate of new cases over seven days through Wednesday, May 3, 2023, and the percentage of positive tests in the county over seven days through Monday, May 1, 2023. (Source: Centers for Disease Control and Prevention) (Click on the image to open it in a larger window.)

The Centers for Disease Control and Prevention has announced it will no longer track county-by-county community spread of the novel coronavirus as it has been doing. The agency will also stop calculating countywide “community levels” that combine infection rates and hospitalization rates to gauge risk levels for the illness.

Deb Standridge, Wisconsin Department of Health Services deputy secretary (DHS photo)

In a briefing April 26 for reporters, DHS Deputy Secretary Deb Standridge said the state health department would continue tracking the results of testing that come into the state hygiene laboratory. Wastewater levels of COVID-19 and hospitalization levels will also be on the DHS watch list, she said.

The state’s COVID-19 reports are likely to be updated less often than daily, however, Standridge said, and the information will be streamlined in its presentation.

With the end of the emergency, at DHS “the main message is that people need to take care of their health,” Standridge said. “They will need to be aware that COVID does exist in the United States… We have to be responsible and making sure that we are protecting our own health, those of our family and friends and the communities that we live in.”

Community or the individual

The end of the emergency underscores what has already become the dominant lens for managing the pandemic — making it a matter of individual responsibility rather than community care.

Even as many people may find COVID-19 less debilitating, “There are still people who are vulnerable to severe COVID,” Sethi says. “Hopefully they have been in touch with their health care providers and … recognized what options they have to avoid the most severe consequences of infection.”

The federal government early on spent money “to reduce people’s hurdles to access basic provisions,” he observes. “With that ending, we’re just going to return to a time pre-pandemic, when there’s a very uneven ability for people to access basic provisions in our society in general,” from health care to paid sick leave.

Prof. Tiffany Green, UW-Madison

For Tiffany Green, the UW-Madison health economist, those who get preventive care and treatment will be those who can afford it — which has “implications for health equity.”

The Medicaid changes will affect low-income people, who are disproportionately “Black and brown people,” Green says. There are reports of employers rolling back workplace flexibility that made it easier for a time for some workers who lacked sick leave benefits on the job to stay home when they were ill, she adds.

In the HIV pandemic, wearing gloves when meeting with patients became a standard for health care providers, Green says — one that has lasted decades later. “So the question for me is, why is masking not the standard in clinical care?”

For now, it falls on people to “advocate for yourself — making decisions to mask in health care facilities and other similar areas,” she says. In her view, however, “structural changes” are in order, from sticking to universal masking requirements to addressing remedies such as building ventilation to help reduce the spread of disease.

“For a time, there was an emphasis on taking a more collectivist approach to the pandemic,” says Green. “But now people have had to make this very individual calculus  for themselves.”


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Erik Gunn
Erik Gunn

Deputy Editor Erik Gunn reports and writes on work and the economy, health policy and related subjects, for the Wisconsin Examiner. He spent 24 years as a freelance writer for Milwaukee Magazine, Isthmus, The Progressive, BNA Inc., and other publications, winning awards for investigative reporting, feature writing, beat coverage, business writing, and commentary.