The COVID-19 Public Health Emergency, which has been maintained for more than three years, across two Presidential Administrations, will lapse on May 11th, bringing a symbolic and a regulatory end to a crisis that has claimed more than 1.1 million lives in the United States and disrupted nearly every aspect of American society. The expiration takes effect several weeks after President Joe Biden signed a Republican-led bill, supported by no small number of Senate Democrats, to end a separate COVID-related national emergency, which had granted the government additional crisis powers, and several months after he casually remarked at the Detroit Auto Show that the “pandemic is over.” The message is clear: it’s time to move on from the plague years.
Our understanding of COVID often suffers from a linguistic determinism. The words we use encourage a binary conception of viral threat: we are in an acute state of emergency—a pandemic—or we have entered a long-awaited, tractable endemic phase. But, of course, an endemic pathogen can be all kinds of bad. Tuberculosis has infected humans since at least the Stone Age and is the thirteenth leading cause of death in the world, killing a million and a half people a year. COVID seems to have settled into its own punishing form of endemicity. Even without a major surge this past winter, it has killed some forty thousand people in this country so far in 2023 and is on track to have taken tens of thousands more lives by the end of it. Last week, the Centers for Disease Control and Prevention announced that COVID was the fourth leading cause of death in the U.S. in 2022. This year, it will likely remain a top-ten killer. But, because the toll is concentrated among older and medically vulnerable people, it quickly recedes from the public consciousness. Last summer, when average daily COVID deaths were more than double what they are today, Americans, according to one survey, were nonetheless three times as likely to think that car crashes killed more people than the coronavirus did. (COVID was, and is, far deadlier.) In a poll conducted after the new Congress was sworn in this year, people were asked about their top priorities for lawmakers. Of twenty-one options, COVID ranked last.
The end of the Public Health Emergency also carries practical ramifications. Many people will no longer have access to free coronavirus tests; hospitals will no longer receive extra payments when they care for COVID patients; private insurers will no longer have to reimburse out-of-network vaccinations; the federal government will no longer be able to compel labs to share test results with the C.D.C. Uninsured people should, for a time, still have access to free vaccines through a new Biden Administration program that buys and distributes them to pharmacies and local health centers. (After the government’s stockpile runs out, the uninsured will largely have to pay full price—probably a hundred and thirty dollars a dose.) Some changes are overdue: the end of the emergency also means the end of Title 42, a provision used by both the Trump and the Biden Administrations to expel migrants and asylum seekers coming from countries where a serious contagion is present, which could mean anywhere and everywhere.
The early-pandemic idea that a crisis that threatens everyone could unify the nation now appears quaint. The virus proved destructive for our health and our politics: by most accounts, the U.S. suffered the highest COVID death rate among wealthy nations, and Americans are especially likely to believe that their country is more divided now than it was before the pandemic. And yet pandemic policy also contained flashes of what is possible: real achievements in making life easier for millions of people came as a result of the choices we made. A reversal of those achievements will come from choices we’re making now.
In March, 2020, as the coronavirus began to spread, Congress authorized enhanced benefits through the Supplemental Nutrition Assistance Program, which provides support to some forty million people. The following year, the share of households with kids who were food insecure fell to twelve per cent—a shockingly high number, perhaps, in the world’s richest country, but the lowest since we started keeping track, more than two decades ago. This year, states began rolling back the extra benefits, and SNAP recipients are expected to lose, on average, around a third of their monthly allotments. Similarly, between the pre-pandemic period and the emergence of Omicron, in late 2021, the child poverty rate fell by nearly half—from around ten per cent to five per cent—with especially large declines among Black and Hispanic children, owing in part to child tax credits made available through the American Rescue Plan. Nearly all low-income families used the extra money to cover basic expenses: food, clothing, rent, utilities. When the tax credits expired, at the end of 2021, families immediately reported more difficulty in paying for such necessities.
Another reversal is just beginning. During the pandemic, states received additional federal funds for their Medicaid programs, and were generally prohibited from disenrolling people once they became eligible. As a result, millions secured stable health coverage, and the country’s over-all uninsured rate fell to eight per cent. (Medicaid and the Children’s Health Insurance Program now cover ninety-three million people—more than one in four Americans.) But last month states were permitted to again start purging the rolls, launching what has been called the Great Unwinding. According to government estimates, up to fifteen million people could lose health coverage in the coming months. Moreover, in the byzantine world of America’s social safety net, some seven million people who are still eligible could lose Medicaid coverage owing to “administrative churn”: paperwork problems. Nearly three-quarters of children who lose Medicaid will do so not because they no longer qualify but, basically, because bureaucracies can’t confirm that they do, on account of a defunct phone number, a new address, a missed appointment, or a delayed or incomplete form.
We often view the pandemic’s turmoil as a failure of American governance and society. We couldn’t agree on masks, vaccines, social distancing, school closures, abstract goals, or concrete facts. These failures cost lives and livelihoods. Flip the lens, however, and another reality comes into focus: this was also a time when many people had access to food, shelter, and medical care with a consistency they’d never had before. After three years of COVID life, it’s natural to welcome a return to normal. But, for many, normal is a precarious place. ♦
