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COVID-19 states of emergency are ending. Here’s what’s changing.

Pfc. Paul Diaz of the National Guard administers a COVID-19 test to a driver in Elk Grove, August 12, 2020.
Andrew Nixon
/
CapRadio
Pfc. Paul Diaz of the National Guard administers a COVID-19 test to a driver in Elk Grove, August 12, 2020.

California’s state of emergency declaration, a response to the COVID-19 pandemic, ends on February 28. The federal state of emergency also ends this spring, on May 11.

Both proclamations, along with local states of emergency, allowed the government to flexibly respond to the pandemic through increased staffing, telehealth and infusing money into local efforts to keep people healthy. They also led to the mass mobilization of testing sites, vaccine distribution and food aid.

After about three years, the efforts have largely wound down, and many proclamations implemented have been phased out. Beginning last year, California Gov. Gavin Newsom announced the SMARTER Plan as a way to begin transitioning the state’s response to the virus.

However, COVID is still circulating. Systems for support for those dealing with long COVID are in their infancy and hundreds of people are still dying daily from the virus or resulting complications, leaving questions about what treatment, testing and vaccination options will still be available. The emergency declarations being lifted impact how lawmakers prioritize funding for and legislation about COVID relief and recovery.

While public health experts stress that the end of the declaration isn’t an end to the pandemic, they also acknowledge the amount learned about the virus since March 2020.

Back then, “if you were unlucky enough to contract the infection, it was a crapshoot about whether you’d die or not,” said Dr. Brad Pollock, an epidemiologist at the UC Davis School of Medicine. “And with vaccination, that risk of death and severe disease just diminished by orders of magnitude.”

He says it makes sense to phase the declaration out now since the pandemic is a “constant state of emergency”, making it distinct from an acute emergency.

But April Jean, the policy director for the California COVID Justice program, disagrees.

“We're making a blanket assumption [by] lifting this emergency declaration that the masses are okay and we're not,” Jean said.

Jean, who works at the nonprofit Public Health Advocates, said recovery is a “rolling” process, meaning more must be done to help those most impacted.

Across the country, lower-income people — a disproportionate amount of them people of color — have been more likely to be essential workers, face food insecurity and eviction and contract COVID in the first place.

“There's still a lot of ground work that needs to be laid and investments that need to happen in order to ensure that communities who have been most impacted by the pandemic have an equitable shot at recovery,” she said.

We've put together this list of resources for what’s next after the COVID-19 state of emergencies end:

How will my insurance status impact my ability to access COVID-19 care options?

Public health officials say that for the 93% of Californians who are insured, tests, vaccines, boosters, and anti-viral treatments will remain accessible, even as these services shift away from being covered by the federal government to being covered by an individual's insurance.

On Nov. 11, six months after the federal emergency ends, people will likely have to find providers that are “in-network” for their insurance, or they’ll need to pay for vaccines and treatment.

“Americans with health insurance (private, Medicare or Medicaid) will continue to pay nothing out-of-pocket for COVID-19 vaccines,” Sacramento County spokesperson Samantha Mott told CapRadio via email.

For the almost 2.75 million Californians who are uninsured, the future of free or low-cost COVID vaccines, boosters, and treatment options is still uncertain — however, not all testing sites are shutting down.

Until Nov. 2023, Californians can get reimbursed for COVID tests from their insurers due to a state bill passed in 2021.

CVS, Walgreens and Rite Aid have guides on getting up to eight at-home COVID-19 tests a month reimbursed or covered by insurance. For people without insurance, Walgreens and Rite Aid also offer no-cost at-home PCR testing through Labcorp and Quest Diagnostics, respectively.

People can still order four free at-home COVID-19 tests through the federal government by placing an order on their website or by calling 1-800-232-0233 while supplies last. They’re not likely to be restocked once the federal emergency declaration ends in May.

The White House’s COVID-19 Response Coordinator, Dr. Ashish K. Jha, says the federal government is “committed to ensuring that vaccines and treatments are accessible and not prohibitively expensive for uninsured Americans.”

The companies that manufactured the COVID-19 vaccine have suggested prices could be up to $115 per dose, compared to up to $28 per dose for an influenza vaccine.

“The state has not determined how counties will address treating and vaccinating uninsured residents,” Mott said.

What if I get sick?

Testing

Dr. Flojaune Cofer, an epidemiologist with Public Health Advocates, says that folks who are experiencing COVID symptoms (sore throat, fever or chills, cough, shortness of breath, body aches or headaches and new loss of taste or smell) should get tested as a precautionary measure to limit the spread of the disease, regardless of vaccination status.

Per the state’s latest guidance on testing, if you’re exposed to someone with COVID, you should test within 3 to 5 days of exposure and wear a mask for 10 full days after the day you were exposed, as well as if you start to develop symptoms.

In Sacramento County, some state-funded testing sites are winding down, although the county doesn’t have clear ending dates at the moment. KQED created a great guide for how to access tests, which you can find here.

“The state has indicated testing sites will remain open as long as funding is available and they are being utilized,” Mott, the county spokesperson, said via email. “The county does not currently have any county funded sites open and does not intend to open any as state funded sites close.”

COVID-19 testing locations can be found through the state’s map, which will remain open after the state of emergency ends. Calling is recommended, in case a site closes and the map isn’t updated.

You may also be able to access testing through your child’s school district through at least the end of the 2022-23 school year; Sacramento City Unified is offering such services.

If you test positive for COVID, the CDC recommends that you isolate for 5 days if you had no or minor symptoms (as long as you’re fever-free for 24 hours), and for 10 days if you had moderate to severe illness (had trouble breathing or were hospitalized).

Most people will need to take regular sick days from work, or PTO, as COVID sick leave policies ended Dec. 2022.

Cofer added that people may be eligible for disability leave or Family or Medical Leave Act leave, depending on the nature and extent of their illness.

Treatment

Regardless of whether or not you have insurance, you can still access Paxlovid and other antiviral drugs through a primary care provider or at your local pharmacy. This will remain true until Nov. 2023.

For now, California is still keeping Test to Treat sites open statewide, where people can get tested for COVID-19 and be prescribed Paxlovid immediately if they test positive.

Over the course of the year, Paxlovid will transition to the private health care market, and experts agree that there are still questions about how uninsured people will be able to access free and low-cost treatment. So far, many have been able to get the drug through test-to-treat sites paid for by the government.

Paxlovid currently costs the federal government $530 per dose, and is expected to cost more when it transitions to the private market, although Pfizer, the company that makes it, has not disclosed the planned price.

There have already been equity issues with how Paxlovid is being distributed, with CDC data showing Black seniors receive the medicine much less than other groups. 

You must take these medications within 5 days of testing positive for COVID-19 for them to be effective.

A study of patients who took Paxlovid released Nov. 2022 found the antiviral drug decreases the likelihood of persistent COVID symptoms after the initial infection.

Vaccines and boosters

Much like treatment, you can still access vaccines and the bivalent booster at a local pharmacy or through your primary care provider.

Sacramento County still conducts weekly pop-up vaccine clinics, and intends to through November 2023.

While the Biden administration is considering how to continue offering free vaccines and boosters for uninsured people, there is no confirmation yet on whether it will do so.

Sacramento City Unified offers free vaccinations through at least the end of the 2023 school year for students who are under 19 and have Medi-Cal, no insurance or are Native American or Native Alaskan.

Long COVID

At least 65 million people who have had COVID have post-COVID syndrome — more colloquially known as long COVID — which the U.S. Centers for Disease Control refers to as persistent COVID symptoms weeks, months or years after the initial acute infection. More reinfections with the virus generally lead to a greater likelihood of adverse health outcomes.

If you believe you have long COVID or post-COVID syndrome, some experts advise that you seek clinical care and get labs taken, especially since COVID-19 may have just unmasked other illnesses. In the Sacramento region, that could look like getting in touch with the clinicians at the UC Davis Post-COVID-19 Clinic.

“We're still at the infancy with long COVID, but I wish I could tell you that we have the magic secret formula to who's going to get it,” Pollock, the UC Davis epidemiologist, said. “Unfortunately, we don't. There doesn't seem to be a lot of risk factors for somebody who does get a Long COVID infection other than getting a COVID infection.”

Aside from avoiding infection entirely, rest during a COVID-19 infection has been found to help reduce the likelihood of long COVID.

For those navigating long COVID symptoms, Body Politic, a group led by patients with long COVID, put together a handout for providers and patients compiling several patient-led and moderated Facebook groups. Patients also share their experiences with long COVID via #LongCOVID on Twitter.

Long COVID qualifies as a disability, per the Department of Health and Human Services, which means those with it have the legal right to have access needs met at work and may be eligible for disability benefits.

Looking forward

We asked some local health policy experts some of our most pressing questions.

What would it take to enact another state of emergency?

Pollock from UC Davis says since the number of people vaccinated is very high, it’s possible — but not probable — that the state and federal government would enact another state of emergency.

“To reach the threshold of getting to an emergency again, again, we'd have to have a very high level of infection in the community, maybe very high levels [of COVID in the] wastewater,” he said.

California residents can monitor wastewater levels in their area here.

What might future COVID policy look like?

Jean, the California COVID Justice policy director, said there’s an opportunity for the state to revise its emergency framework overall and figure out how to provide resources to community-based organizations.

Public Health Advocates put forward AB 2360 last year, which made it far in the legislature before stalling in committee. The bill would have created a working group to develop a plan to reduce racial disparities following state and local emergencies.

Jean said the organization is still undertaking those conversations and hope to produce a report laying out an equitable funding framework for emergency response in the state.

“What communities are really being challenged by an emergency declaration, a pandemic, a fire, a climate disaster?” she said. “These zip codes are being impacted the most. So our efforts and our resources need to go there.”

Another of Public Health Advocates’ biggest policy priorities includes advocating for a more robust public health ecosystem in Sacramento County. That includes more support for community-based organizations.

“They become the vessels for communities to have equitable access to testing, vaccines, resources, to understand how to keep themselves safe during the pandemic,” she said. “Many of these organizations had to translate that material [about public health declarations] so that their communities understood what was happening during the pandemic. So we can't just let that go away.”

What gaps are created by the emergency declarations ending?

Aside from stratifying access to COVID-19 testing, vaccinations and treatment based on insurance status, Jean says there’s a lack of long-term support and investment in helping people recover from ongoing impacts of the pandemic.

“Recovery is rolling, right? It’s not something that happens in a vacuum,” she said. “There are long-term consequences that we still do not understand quite yet. And so to make a blanket statement to lift our declarations is really, in some senses, a bit irresponsible.”

She points to the end of eviction moratoriums last year as one example of withdrawn support for people whose impact and livelihoods have been affected by the virus.

With state funding for testing shrinking, Jean said the responsibility shifts to local governments for COVID-19 response.

“I'm not quite sure if our local government is prepared to sustain those sorts of recovery efforts, specifically at the county and city level,” she said about Sacramento County.

And she added that she had questions about how COVID-19 care moving back to managed health care will impact not only low-income people, but people who are non-English speakers or come from communities of color.

“I am middle class and a policy director who still has challenges navigating my managed health care plan,” she said. “You layer on that issues of marginalization, issues of cultural, linguistic needs. What does that mean for our community to continue to maintain safety and to continue to understand how COVID can still potentially impact them?”

What have we learned from COVID-19 response so far?

Dr. Brad Pollock, the UC Davis epidemiologist, said the world of how we build spaces, how we monitor diseases and how we teach health seem forever altered.

As a public health professional, he said he’s got his eyes on the possibilities of the sewers.

“The public surveillance [for COVID] has sort of now come down to wastewater monitoring, which is a very big deal,” he said. “The state is investing in that. The federal government is also putting money into this.”

Pollock also said the way public health is integrated into medical schools has changed, with students learning from county public health officials, and those officials gaining access to academic institutions’ technology. He said he believes more work needs to be done earlier, too, to combat health misinformation.

“The level of health literacy we have in our country is so low,” he said. “I think we need to start improving that literacy starting in young ages in school, so that people understand what is this idea of a virus that can infect three people and those three people can infect three or more people, having this exponential increase in the number of cases.”

Pandemic response has shown the crucial role community-based organizations play in connecting communities to resources, Jean said, since they’ve built trust in places the government has often failed to.

“I know there are people that look like me [at those organizations],” she said. “There are people who speak my language. There are people who understand my cultural needs. I can walk in there and ask them specific questions about vaccinations or even historical consequences that racism has propagated.”

But another lesson she’s taking from the emergency declarations ending: A desire to move back to “the status quo.”

“What that signals to the rest of our populations is that we maintain support for the comfortable but not for the oppressed,” Jean said.

The Sacramento County board of supervisors will vote on whether to end the local emergency declaration on Feb. 28.

The Central Valley is something that is incredibly personal to me. Having grown up, studied and worked in the valley, I’ve learned that there are stories in every corner of every city here: stories about intergenerational organizing, environmental (in)justice and the labor that feeds much of California, among others.
I’m interested in how health care policy impacts Sacramento and California, who gets access to care and the issues facing health care providers.
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