DENVER – When the novel coronavirus hit the U.S. in early 2020, not much changed for Jessica and her three children. At the time, she was already homeschooling her kids and her groceries were being delivered right to her door. As a mother of children with disabilities who leads a special needs Girl Scout troop, adjusting to life at the beginning of the pandemic meant moving those gatherings online. But as time went on and the majority of people dropped their masks and returned to pre-pandemic life, making sure her children were safe became a juggling act. That juggling act will now become even harder when the federal government sunsets the public health emergency at the end of the day Thursday.
Not many people will notice the difference when the public health emergency comes to a close. After all, it’s only been a couple of months since mask mandates in health care settings — the last remaining place where they were mandated in Colorado came to an end — and more than a year has passed since Denver and other metro area counties dropped theirs after Gov. Jared Polis left that decision up to local municipalities in late 2021.
Come May 11, people relying on eight free monthly at-home testing kits through their insurance companies will now have to pay out-of-pocket for the costs – if they’re able to find them at pharmacies in the first place, as Marcella Schieffelin, who is immunocompromised and recovering from her first COVID-19 infection, told Denver7 earlier this week.
She credited the patience of a pharmacist with helping her navigate confusing Medicaid policies on free at-home tests. Had circumstances been different, Schieffelin said she probably would have left the store without realizing she was positive for the virus and would not have gotten antiviral treatment to treat her infection.
“I had to jump through many hoops – even to get the test when it was supposed to be easy,” Schieffelin said. “That was supposed to be an easy thing and now it's going to get harder. I can’t imagine it getting any better without (the public health emergency),” she added.
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Hundreds of free at-home COVID-19 testing kits will still be available at all Denver recreation centers and other points of distribution across the state while supplies last. Once they’re gone though, Coloradans will have to foot the bill as the state does not expect to receive any more tests from the federal government. The nationwide program that delivers up to four free at-home COVID-19 tests to people’s homes will also end Thursday.
Regardless of where you get your COVID-19 testing kit, health officials urge you to check the FDA’s website since the expiration dates for many of those tests has been extended – something employees at Denver rec. centers and other distribution points across Colorado may not be aware of.
Tests, vaccines and other COVID-19 treatments will still be covered for 15 million people in the U.S. enrolled in Medicaid (1.8 million in Colorado alone) as well as those under the Children’s Health Insurance Program and the Vaccines for Children Program through the end of September 2024. Health First Colorado, the state’s Medicaid program, and Child Health Plan Plus (CHP+) will also continue to cover COVID-19 vaccines at no charge for members, state health officials said Wednesday.
Uninsured adults will still be able to get vaccinated against COVID-19 and receive certain COVID-19 treatments at no cost through local pharmacies from the U.S. Department of Health and Human Services’ (HHS) Bridge Access Program for COVID-19 Vaccines and Treatments, CDPHE officials said in a news release. Paxlovid will remain available for free while supplies last.
Public Health Emergency Leave, which required employers across the state to provide up to 80 hours of COVID-related paid time off will end four weeks after the state and national public health emergencies end, state health officials said.
The end of the public health emergency will also likely mean that the free distribution of KN95 masks at public libraries, recreation centers and some fire departments in Colorado will come to an end as soon as inventory runs out.
“There's not another strategy to replace it”
While the pandemic is now in the rearview mirror for most, many Coloradans remain COVID-aware three years in – either to protect themselves or protect others from infection.
One of them is Laura, a 66-year-old woman in Boulder.
“I think that end of it is worrisome in a lot of ways. I'm worried about not getting wastewater monitoring any longer. There is some concern that we will have less monitoring of the disease, and that's what I use to see how high COVID is in a community,” said Laura, who as far as she knows, has not contracted COVID-19.
The Boulder woman told Denver7 she would love to see mask mandates return to health care settings as she has a lot of friends with cancer “and they are now very concerned about going into the doctor and not being safe just to go seek medical care.”
COVID-19 case data isn’t the only thing on her mind. Laura is also concerned that the end of the public health emergency will deter important research to develop better vaccines and treatments from taking place.
“There's a symbolic thing with the end of the health emergency that seems like, ‘Oh, we're kind of done,’ when this is still a threat to all the Coloradans that have Long COVID,” she said.
Laura is not wrong. Health experts still do not have a clear picture of what causes Long COVID following even a mild bout with COVID-19, nor do they know how to treat it. A report from the Office of Saving People Money on Healthcare in the Lt. Governor's Office estimates that as many as 650,000 Coloradans – or about 10% of the state population – could be suffering from sometimes devastating lingering effects after a SARS-CoV-2 encounter, according to a review of the report done by CPR's John Daley.
As governments abandon mitigation measures, which could lead to some people becoming “unlucky” if they develop Long COVID after repeated infections – as one World Health Organization (WHO) official put it last year – health experts in the U.S. and abroad are concerned the repercussions of such policies will proliferate into other areas of society, impacting not only the workforce, education, and health care systems, but other areas of life for years to come.
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Laura isn’t the only one concerned about risk of infection in health care settings. Denver7 spoke to several people for this story – most of them parents with immunocompromised children – who asked us not to share their full names for fear they’ll be harassed online and in public.
One of those parents is Jessica, the leader of Girl Scout Troop 65659 – which, to her knowledge, is the only Girl Scout troop in the state still implementing some form of mitigation against infection from SARS-CoV-2.
Jessica, a Denver resident, told Denver7 her main concern in health care settings – which she said was shared by other parents in the disability community – was attitudes toward masking.
“I think that the reason that health clinics and hospitals have dropped masking requirements may have to do with the public health emergency ending, even though it’s not requiring them to drop mask requirements,” the mother of three said.
CDC officials last Friday said they plan to continue using specific data thresholds to inform health care settings when to recommend facility-wide masking, though officials warned they were in the early stages of developing those metrics.
Jessica said the lack of masking in these high-risk settings is now putting people who need long-term care between a rock and a hard place as they either have to choose to get the care they need for their condition or risk infection with SARS-CoV-2.
“What’s really frustrating to me is that there’s not another strategy to replace it,” she said. “Even hospitals and clinics that have dropped mask requirements don’t seem to have any written policy when you go to their websites. And when you call them and say, ‘What can you do for people who need extra precautions?’ they don’t know what to tell you.”
As the COVID-19 public health emergency wraps up, Jessica told Denver7 the disability community has a message for public health officials.
“The disability community and the people who love them need some attention from you – you need to pay attention and hear us,” she said. “I really wish that they (public health officials) would not disregard them, because I feel that the hospitals and clinics have disregarded them completely.”
COVID-19 data at the state and city level will change a bit, but not by much
Even though the HHS will no longer have the authority to require state labs to report COVID-19 information to the U.S. Centers for Disease Control and Prevention (CDC) once the public health emergency expires Thursday, the Colorado Department of Public Health and Environment (CDPHE) won’t stop reporting some of the key metrics that have been used to track the trajectory of the disease as part of the state's strategy to live with the virus.
“We’re making no changes to cases, no changes to hospitalizations – which is absolutely the primary indicator of trends in COVID-19,” said Alicia Cronquist, the COVID-19 surveillance program manager at the CDPHE. “The only parts that are changing are test data, outbreak data, variant data, the addition of Multisystem Inflammatory Syndrome in Children (MIS-C), and then some of the data downloads. Case data, hospitalization data, the various incidences and epidemic curves, the death data, vaccine breakthrough – all the rest – none of that's changing.”
Wastewater levels, which are an early indicator about community transmission of SARS-CoV-2 in any given municipality, will also continue to be displayed on the state’s COVID-19 data dashboard, Cronquist assured Denver7 in an interview Wednesday.
But while those key metrics used by Coloradans who still rely on them to assess personal risk to the virus will remain, other things will change.
Outbreak data, for example, will focus on high-risk populations and settings, including residential care facilities, correctional settings, and other congregate living settings. Data collection at the facility level will cease, the CDPHE announced Wednesday.
And because most people are now testing at home since the state's community testing sites were shut down earlier this year, the CDPHE is moving to display the percent positivity rate – the percentage of tests coming back positive – from laboratories that participate in the sentinel surveillance network, which state health officials said will still allow them to capture a representative sample of test results across Colorado.
History buffs will likely be disappointed to learn that the CDPHE will change COVID-19 variant data visualization to only include the past four months, with that data updating twice a month. There will be a static copy of the last published visualization data from December 2020 in an archived section of the state’s COVID-19 website, officials said.
Finally, another change coming to the state’s data dashboard will be the addition of case data visualization for Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition associated with COVID-19, which will be updated quarterly. So far, there have been 196 confirmed cases of MIS-C reported to the CDPHE over the course of the pandemic.
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On Wednesday, CDPHE officials said some local public health agencies would continue to offer free community testing in their area, and some pharmacies and other locations would still be providing low and no-cost COVID-19 testing through the CDC’s Increasing Community Access to Testing program. Those locations can be found on the CDPHE’s COVID-19 testing website and the CDC’s Testing Locator.
Additionally, CDPHE officials said they would continue to provide free testing to Colorado schools and residential camps through the end of the 2022-2023 school year.
Dee Dee Gilliam, the endemic COVID-19 manager at the Denver Department of Public Health and Environment (DDPHE) said even though the public health emergency is ending, the work of the DDPHE to monitor disease transmission will continue for the time being with free testing and vaccines at homeless shelters, migrant shelters as well as senior support services.
“The whole idea is that we're rolling (COVID-19 monitoring) into our regular operations,” said Gilliam. “COVID-19 is going to be part of that operation, so we will continue to monitor the levels in the city and county through that reporting.”
In an email, a DDPHE official told Denver7 COVID-19 data would still be available through the city’s COVID-19 website for people trying to understand trends in viral transmission, with wastewater, incidence rate, hospitalizations, and outbreak data being considered as the main variables city health officials will be looking at moving forward.
The end of the public health emergency will also bring about the end of a somewhat controversial tool used by the state to curb transmission of SARS-CoV-2 a few months after the pandemic was well underway.
On Thursday, both Apple and Google will be “decommissioning” the state’s Exposure Notifications app, which was made available to Coloradans in late October of 2020. The app, which brought public health contact-tracing efforts to the 21st Century, used Bluetooth technology to send anonymous “tokens” to other users and would let them know if they had been exposed to someone who had recently tested positive for the virus.
John Ingold at the Colorado Sun reported that while more than 4 million devices in the state enabled Exposure Notifications, the app’s effectiveness in limiting spread of COVID-19 was so far inconclusive. On Thursday, a message will appear on phones that have the app alerting them that the system is no longer operational and will prompt users to delete their data.
Health officials still recommend people inform others they may have been in contact with if they test positive for the virus. Current guidance states contact tracing should occur if you had close contact with anyone in the two days before you took a test or two days before your symptoms started (whichever happened first). Those people should begin taking precautions around others, according to the guidance.
Though exposure notifications will be gone, Coloradans are highly encouraged to report their test results at MakeMyTestCount, which works in partnership with the National Institutes of Health (NIH) to help fill some of the gap in data left to track community spread of COVID-19 after community testing sites shut down and at-home testing kits became the norm, largely obscuring the true spread of the virus in the country.
But Coloradans will not be left completely in the dark, as Meg Wingerter over at The Denver Post reported earlier this week. The CDC still plans to continue collecting and publishing certain information:
- It will still track COVID-19 hospitalizations, though only weekly instead of daily
- The CDC will still gather information about mortality based on preliminary death certificate data
- About 6,300 hospitals will continue to report what percentage of their emergency room visits are related to COVID-19
- A network about 450 labs will submit data about the percentage of tests coming back positive for genomic sequencing, though it will no longer be possible to track that information on the state or county level
The end of the public health emergency does not mean the end of the pandemic
On Friday, the WHO declared COVID-19 was no longer a public health emergency of international concern, a designation that acts as a sort of SOS signal for member states to respond to diseases that could have worldwide implications for public health.
“However, that does not mean COVID-19 is over as a global health threat,” WHO Director-General Tedros Adhanom Ghebreyesus warned during a news conference in Geneva. “The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that COVID-19 is nothing to worry about."
The number of hospitalizations for COVID-19 in Colorado was in the 100s as of Wednesday and trending downward, but still higher than numbers reported around the same time last year, according to CDPHE data. Forty-two out of Colorado’s 68 wastewater facilities were reporting steady decreases in viral samples. Nearly 100 facilities – mostly nursing homes – were reporting active COVID-19 outbreaks.
The CDPHE continues to urge people who have cold-like symptoms to get tested for COVID-19 at least two times, 48 hours apart if using an at-home antigen test, and to contact their health care provider if they test positive for the virus to see if they're eligible to receive antiviral treatment. People who test positive with an at-home test should also get a PCR test, as having documented proof of a positive result could make it easier to get properly diagnosed or treated if you were to develop Long COVID.
Other ways people can limit their risk of infection with SARS-CoV-2 is by wearing high-quality masks in poorly ventilated indoor settings, moving gatherings outside, ventilating indoor settings if gathering inside, practicing proper hand hygiene, and following CDC quarantine guidance if you've been exposed or test positive for the virus.
Though the U.S. is now in a different place than at the start of the pandemic three years ago, Meagan Fitzpatrick, an assistant professor of medicine at the University of Maryland School of Medicine, said it’s important to understand that hospitalizations and deaths for COVID-19 are not negligible.
“I think it’s important to recognize that, even though we are certainly at a low point right now with cases and hospitalizations and deaths, that COVID is certainly not done with us yet,” she recently told SciLine, a nonprofit that connects journalists and researchers. “Our three-year history with this virus does tell us that we should expect more variants to emerge and another surge to come our way. And we should be ready for that.”
