As the emergencies sputter to an end ...

[edschweppe]

Today's the day that the federal and state COVID-19 public health emergencies end. That doesn't mean the pandemic is over, as three different items (one article and two opinion pieces) in today's Boston Globe show.
First off, if you look at excess deaths, the threat is still not over:

Well into our fourth spring with COVID-19, signs abound that we have finally emerged from the pandemic. Last week, the World Health Organization declared an end to the global public health emergency. And on Thursday the United States and Massachusetts will end their emergency declarations, as well.

But despite those milestones, new data show that the threat is not completely over.

One key benchmark, so-called excess deaths, looks at the number of people who die over and above normal rates. A new analysis shows Massachusetts experienced soaring excess mortality during the first COVID wave, from March to May 2020; in the winter of 2020-2021; and during the first Omicron wave, from the fall of 2021 to February 2022. This past winter saw our lowest excess deaths of any pandemic winter, followed by a spring of "deficit mortality,” when fewer people have died than during a normal spring.

Dr. Jeremy Faust, an emergency medicine physician and public health expert at Brigham and Women's Hospital, said that, while overall deaths this spring are slightly lower than expected, they would be lower still if not for the continued presence of the coronavirus.

"By now, I was hoping we would actually have a lot of deficit mortality,” said Faust, who analyzed Massachusetts mortality numbers for The Boston Globe. Deficit mortality occurs when surges of illness, like last winter's COVID uptick, cause people to die sooner than expected, leading to a compensating period of fewer-than-usual deaths.

"That hasn't happened,” he said. "And the reason for that is because this virus is still causing enough morbidity and mortality to overcome that.”

[ ... ]

The CDC, based on combined forecasts from leading scientific groups, predicts that the number of daily COVID-19 hospital admissions will decrease nationally through May 29. In Massachusetts, the ensemble forecasts predict that the numbers of hospitalizations are likely to remain stable through the end of the month.

With the pandemic in remission for now, many experts agreed that it was a good time to let the public health emergencies expire.

"But that doesn't mean that the virus is going away or is going to stop causing death and severe illness and profoundly affect the way society operates,” said Dr. Jacob Lemieux, an infectious disease physician at Massachusetts General Hospital.

Meanwhile, the Globe's Editorial Board likes the state lifting its health care mask mandate, assuming that hospitals know best:

Medical professionals are experts at keeping patients safe from infection. That is why Governor Maura Healey's administration is making the right decision by rescinding the state mask mandate in health care settings with Thursday's end of the federal and state COVID-19 state of emergency. This will let hospitals make their own policies going forward. While opponents have real fears about hospital-based virus transmission, health care providers are well-equipped to decide when and where to impose mask requirements.

When COVID-19 was spreading virulently without vaccines or treatments, mask mandates were necessary to keep patients and caregivers safe. But while COVID still poses a serious health threat and people are still dying, society has more tools to handle it now. There are effective tests, vaccines, and treatments, and many people have natural immunity. Mortality rates have declined. Rates of COVID transmission in Massachusetts are low. Many people have returned to schools, offices, and daily activities without masks. Massachusetts is the last state with a universal health care mask mandate.

[ ... ]

Experts from Mass General Brigham, Beth Israel Lahey Health, Tufts Medicine, and the VA Healthcare System in Boston wrote in an April 2023 commentary in the Annals of Internal Medicine that in the pandemic's current stage, universal masking in health care marginally reduces the risk of virus transmission but at a high cost. It impedes communication, particularly for those whose primary language is not English or who are hard of hearing, and requires more cognitive effort by patients and providers. "Masks obscure facial expression; contribute to feelings of isolation; and negatively impact human connection, trust, and perception of empathy,” the physicians wrote.

Importantly, the end of the state mask mandate does not mean the end of masks. Any individual choosing to mask should be supported, and there is evidence that one-way masking with a high-quality, well-fitting mask is highly protective against illness.

And health care facilities have a responsibility to keep patients safe. The Department of Public Health, in May 5 guidance, said health care facilities must maintain evidence-based infection prevention and control policies. This includes improving ventilation, holding vaccine clinics, and imposing mask requirements in specific units or facilitywide, particularly during times of high virus transmission. The department directed health care facilities to make masks available to staff, patients, and visitors. DPH still recommends masking for patients with respiratory illness and for health care providers caring for COVID patients.

[ ... ]

Yet for years before the pandemic, doctors managed contagious respiratory illnesses without universal masking. The World Health Organization and the federal government have said the state of emergency is over and COVID-19 should be treated like other respiratory illnesses. In that milieu, infection control decisions are best left to medical professionals.

The Globe editorial doesn't address the danger of persons who are asymptomatic but infections.

Nor does that editorial address the danger of long COVID. Kimberly Atkins Stohr, a Globe columnist who herself has long COVID, reminds readers that the nation shouldn't leave the long haulers behind:

Before we even began winding down from one pandemic, another had already begun. We weren't ready. We still aren't.

COVID-19 is no longer a global health emergency, according to the World Health Organization. But for millions of Americans, myself included, who continue to live with the sometimes debilitating effects of long COVID — symptoms that last for weeks, months, or even years after a COVID infection — the end is nowhere in sight.

And to put it bluntly, the government has failed to do enough, especially for those unable to access necessary care on their own.

[ ... ]

But a crucial thing that the legislation addresses is the fact that getting treatment for long COVID is, in itself, an ordeal. Even for someone like me — a long COVID sufferer lucky enough to have great health care coverage, strong support from my employers, and proximity to some of the world's best medical facilities — finding care was hard.

I reached out to long COVID clinics to find that some had closed, while others had monthslong wait-lists to get an appointment.

My care had to come a la carte, and I know I am among a tiny fraction of Americans privileged enough to get it that way. I saw a headache specialist for my debilitating pain and inability to concentrate. My dermatologist helped relieve the stinging itch of the full-body rash COVID left behind. And I'm still waiting to see a gastroenterologist to treat my lingering digestive issues. As for the ongoing fatigue, I'm hoping time will continue to be a healer.

Having dedicated, multidisciplinary health facilities that meet all COVID long haulers where they are, and not simply those who live near the overloaded existing long COVID clinics that are clustered in and around major urban areas, is essential not only as a public health priority but also to bolster the economy, which has taken at least a $3.7 trillion hit from long COVID.

To sum up: declaring the emergencies to be over doesn't mean people aren't dying, or that survivors aren't running into serious problems obtaining long-term care. It just means most folks (including the Globe editorial board, apparently) can now stop pretending to give a damn. Until they are individually affected, I guess.

Feh.