Recently, there has been a spate of media articles and opinion pieces about the need for additional funding to get ready for the next pandemic. An editorial in the New York Times stresses the need to prepare for the next pandemic. Another opinion piece, also in the New York Times, warned that time is running out before the next pandemic. I also added my voice to the chorus on this website.

The underlying assumption is that the current COVID-19 pandemic is over in the United States, almost three years after the first reported infection. The current epidemiology seems to suggest that the country has entered the endemic phase of the pandemic, with incidence, hospitalization and mortality data leveling off and only slightly higher than the previous low point in late spring 2021. But is that the case?

Lately I’ve been asking myself several related questions. Why is there still a declared national public health emergency (PHE) for COVID-19? Should this continue? And with the upswing in respiratory syncytial virus (RSV) and influenza infections and hospitalizations, does it make sense to be thinking of a single-disease PHE versus, more broadly, a respiratory-diseases PHE. The answers to these questions are informed by the facts.

Pushing the PHE

The federal government, without much fanfare, recently extended the declaration of a PHE for the 11th time (the initial declaration was on Jan. 31, 2020) through mid-January due to the COVID-19 pandemic. Depending on what happens over the next few months with infection rates, this may be the last extension. Have you noticed that COVID-19 vaccine manufacturers are now running ads for their vaccines or sponsoring athletic events, a sure sign that we are shifting to a non-emergency environment.

In contrast, all but a handful of states have ended their state-based declarations. Pennsylvania’s ended in June, 2021, New Jersey’s in March 2022 and New York’s in September, 2022. The ending of most of the state-based PHE declarations presages the eventual end of the federal declaration.

The declaration of a federal PHE, together with other federal emergency declarations, allowed for an expansion of governmental powers to provide a wide variety of services and permit actions to address and limit the impact of the emergency. Typically, a PHE declaration targets one event or disease, for example COVID-19; the most recent declaration targets monkeypox.

In the case of COVID-19, services included broad coverage, cost and payment for related tests, vaccines and treatments; expansion of Medicare, Medicaid and private insurance coverage; telehealth across state lines; emergency use authorizations for new vaccines and treatments; and expansion of health providers’ state-regulated scope of practice — for example, pharmacists’ ability to vaccinate children at younger ages.

A recent Kaiser Family Foundation analysis summarized in great detail the implications for ending these federal declarations for COVID-19. The ending of the state-based declarations has additional impacts.

The pandemic is over … Right?

The general attitude is that the COVID-19 pandemic is over in the United States. The majority of the public and our elected officials have demonstrated through their actions that the risk of COVID-19 infection is no longer high on their list of concerns. Virtually all restrictions both in the private and public sectors have been lifted; people have returned to work in office settings; masks are no longer being worn; and people are traveling and gathering everywhere. Certainly, vaccination levels together with the fluctuating incidence of infection since the start of the pandemic have contributed to this laissez-faire attitude.

As a result of this COVID-19 malaise, we remain vulnerable to infection, due to either unvaccinated or under-vaccinated people, waning immunity after vaccination and the potential rise of variants that can escape existing immunity provided by the vaccines, previous infection or both.

Moreover, the country has experienced an early rise in other respiratory infections such as annual influenza and RSV, potentially enhancing our vulnerability.

The good news is that there is ample supply of a range of influenza vaccines that so far appear to contain the strains that match the circulating strains causing infection this season.

As for RSV infection, the bad news is that there is no vaccine available (yet). But there are new vaccines on the horizon, both for infants and adults. Hopefully, they will be available in time for the respiratory season next fall.

All this brings me back to the issue of the current COVID-19 PHE declaration. Given the implications of what has been called a “tripledemic” (the confluence of COVID-19, flu and RSV this fall and winter) the PHE declaration should continue through at least late next spring, with the understanding that it is needed to help minimize the expected burden of respiratory disease on the public and the public health care system over the next six months.

Continuing the declaration will send a message to the public that the risk of several preventable respiratory diseases in the aggregate is rising, not falling, and there is much that individuals can do to decrease their chances of getting and suffering from these deadly infections. The federal government should publicly acknowledge that the continued COVID-19 PHE declaration is informed by the potential tripledemic.

We must continue to encourage everyone who is eligible to get the new, bivalent COVID-19 booster and their annual flu shot (and their initial COVID-19 vaccine if they have never been vaccinated), especially those at high risk such as pregnant women, seniors, individuals with chronic diseases and those with immunocompromised conditions. Everyone needs to get their shots as soon as possible to maximize their protection as the holiday season approaches.

And we need to diligently practice the basics of respiratory hygiene. This includes covering your nose and mouth when you cough or sneeze; washing your hands with soap or using a hand sanitizer after touching your mouth or nose; not touching potentially contaminated surfaces such as in public restrooms; avoiding contact with people when you are ill; and, dare I say, wearing a mask if you have symptoms and decide to go out in the public.

These commonsense measures may save your life and the lives of others.