Is This the Last Word on COVID-19? Probably Not.

by Debra Powell, MD, MS, FIDSA Interim Chair, Department of Medicine Chief, Division of Infectious Diseases Reading Hospital/Tower Health

State of the Pandemic

We have been extremely fortunate that the number of COVID-19 reported cases, deaths and hospitalizations are decreasing. The evolving COVID-19 variants have been less severe, although they have been more infectious. Over 96% of the US adult population has detectable antibodies as of September 2022, providing at least partial protection.1 Our current predominant variant in the US is Omicron variant XBB.1.5. This variant has been predominant for over 4 months and is now being displaced by Omicron variants XBB.1.16 and XBB.1.9.1 which are increasing.2 These newer variants have similar severity to other Omicron variants, with similar-to-increased transmissibility.

End of the Public Health Emergency

Due to declining hospitalizations and deaths from COVID-19, the Federal Public Health Emergency (PHE) ended as of May 11, 2023.3 Over the past 3 years as part of this federal initiative, the US has administered vaccinations to over 270 million people, over 15 million courses of lifesaving treatments, and provided more than 750 million free COVID-19 tests.4 Due to widely available treatments, vaccines and testing, access is being turned back over to the traditional health care systems. These are the changes:

• Vaccinations that are recommended by the Advisory Committee on Immunization and Practices (ACIP) will be fully covered without a co-pay for those with private insurance. For those with Medicare Part B, vaccinations will continue to be covered without cost sharing. For those patients with Medicaid, vaccinations will be covered without cost sharing and co-pay until September 30, 2024.

• For treatments such as Paxlovid (nirmalrelvir ritonavir) and Lagevrio (molnupiravir), these will be covered by private insurance similar to costs of other medications. Medicaid patients would continue to receive COVID-19 medications without cost sharing through September 20, 2024.

• The FDA Emergency Use Authorizations for medications, tests, and treatments will not be affected.

• Major telehealth flexibilities will not be affected. The Consolidated Appropriations Act 2023 extended many Medicare telehealth flexibilities through December 31, 2024.

• HHS will no longer require the reporting of all COVID-19 test results. During the PHE, HHS collected both negative and positive test results to determine test positivity results. This will no longer continue. Hospitals will continue to report as required by CMS conditions of participation through April 30, 2024, but this requirement is now reduced from daily reporting to weekly reporting.

• HHS began the process to end the COVID-19 vaccine requirement for employees of CMS-certified healthcare facilities. The new recommendations will now align with other infectious disease vaccinations, such as influenza. It is expected that CMS will encourage ongoing COVID-19 vaccinations through its quality reporting and value-based incentive programs. The proposal for fiscal year 2024 would report number of personnel who are up to date with the current recommendations on COVID-19 vaccination.5

Vaccination recommendations

It is now recommended that everyone aged 6 years and older obtain the COVID-19 bivalent booster to be up to date. The FDA is recommending that vaccine manufacturers target the current COVID-19 dominant variant, XBB, for fall doses. Vaccine boosters are highly recommended for those at higher risk for adverse outcomes including immunocompromised patients, those with diabetes or chronic kidney, lung, heart or neurologic conditions, and older individuals. Although 70% of the US population has received the 2-dose initiation primary series, only about 20% of adults in the US have received the bivalent booster shot. This percentage is higher for those over 65 years of age with 43% receiving the bivalent booster.6

We cannot forget the over 1.1 million deaths that have occurred in the US attributed to COVID-19. We should encourage those patients at highest risk, and those who interact with them, to continue to obtain the COVID-19 boosters to be up to date to decrease their risk of severe disease.