COVID-19 has become endemic

On May 11, President Joe Biden officially rescinded the executive order that declared COVID-19 a public health emergency. What does this milestone mean for the average person?

The Well asked Dr. David J. Weber about the end of the federal emergency status, the state of the disease and his recommendations for preventing the virus. Weber, associate chief medical officer and medical director of infection prevention at UNC Medical Center and the Charles Addison and Elizabeth Ann Sanders Distinguished Professor of Medicine and Pediatrics in the School of Medicine, is also a professor of epidemiology in the Gillings School of Global Public Health.

What does the end of the public health emergency mean for the average person?

Those with Medicaid and Medicare will have the cost of drugs covered, but otherwise they’d have to be covered by insurance. People who are underinsured and not insured will, in the near future, begin having to pay for drugs like Paxlovid. We still have free drugs in the pipeline, but at some point that will be exhausted. I don’t know how much it’ll cost, but it will not be inexpensive. Vaccines are still covered by all insurance companies at this time, but if you’re uninsured, you might have to pay for vaccines again if you don’t have Medicare or Medicaid.

Is COVID-19 still a pandemic?

No. A pandemic is defined as outbreaks on three or more continents simultaneously. We have passed the pandemic phase, it’s safe to say, and entered what we call an endemic phase, meaning SARS-CoV-2, the virus that causes the disease COVID-19, will stay in humans forevermore.

Dr. David J. Weber

We have had three epidemic coronaviruses — the original SARS in 2001, MERS and SAR-CoV-2. SARS (caused by SARS-CoV) was a pandemic in 2001 and we were able to eliminate it. We have MERS (caused by MERS-CoV) in the Middle East, which still exists in an endemic phase. We have SARS-CoV-2, also a pandemic, but now endemic. SARS-CoV-2 didn’t exist in humans before 2019, as far as we know. Four endemic coronaviruses have circulated in humans for hundreds to thousands of years, so this is now the fifth endemic virus. Like most respiratory viruses, I expect that we’ll see it wax and wane. It will increase in the fall, peak in early winter and then decrease in the spring. But you can get it all year round.

COVID-19 is still having a big impact. Even with dramatic decreases in cases, we’re losing more than 100 people a day to this virus in the U.S. In the most recent week for which I have data, about 850 people died. You are more likely to die of COVID today than you are from a car crash or gun violence. You can’t watch a nighttime newscast without hearing about both of those, yet more people are dying of COVID. When was the last time you heard a story about that or the number on the news?

What are the best ways to prevent the virus?

The single best prevention is being up to date with vaccines, which means receiving all the COVID-19 vaccines for which you’re eligible. I’m talking specifically about the bivalent vaccine, which, the last time I looked, only about 18% of eligible people have received. Two-thirds of individuals over 65 have received it.

The CDC and FDA allow you to receive, if you’re a healthy adult, a bivalent booster four months after your last booster or last bivalent vaccine. Children can also get the bivalent vaccine. It’s safe, effective and particularly good at reducing hospitalizations and deaths. If you get COVID-19, but you’ve had the vaccine, you are much less likely to get long COVID-19, which is a problem that we will deal with for months to years in the future.

What’s new and what’s good is we have oral therapies such as Paxlovid for people with mild-to-moderate disease. Paxlovid, no longer only under FDA emergency use authorization, is fully approved. We now have more flexibility and are allowed to prescribe it for medically appropriate treatment.

Besides vaccinations, what other precautions do you recommend?

Masks work for people who are immunocompromised, like an organ transplant patient or someone substantially older. They not only protect you from COVID-19, but all other respiratory viruses. In those cases, the recommendation is to wear a mask at your discretion when outside of your household bubble, for example at the market or on a plane.

Good hand hygiene with an alcohol waterless product is always a good thing, not only for COVID-19 prevention, but for other respiratory viruses that are spread more easily than SARS-CoV-2 by touching your nose. Eat healthy, maintain your weight at an appropriate level, exercise appropriately and get appropriate amounts of sleep. Just live healthy. It’s always a good thing to do.

What about testing?

If you develop symptoms such as a sore throat, runny nose, cough or shortness of breath, then get tested by your health care provider or do a home test for COVID-19. Home tests are not accurate for the first 48 to 72 hours. Even if your test is negative, you need to repeat the test two to three days after the start of symptoms. Paxlovid and the other antivirals work best when given within the first five days or so. Don’t wait till you get very sick. Test yourself early, and if you are older or have underlying health problems, talk to your health care provider about getting Paxlovid.