COVID public health emergency ends Thursday, what it means for Michigan

• Pro tip: Stock up on COVID tests now. They’ll be tougher to find for free after the U.S. health emergency ends Thursday
• Its end leaves an enduring legacy, from telehealth expansion to greater investment in mental health services

On Thursday, the COVID-19 public health emergency officially ends in the United States after 13 renewals over three years. Its expiration means, among other changes, the end of free COVID testing for some people.

But other COVID realities and culture shifts will remain. 

Some Americans continue to suffer from long COVID, which researchers are still trying to fully understand. Masks, long discarded by most Michiganders, remain an ever-present necessity for those who are immunocompromised, have chronic conditions, or still worry about the coronavirus.

Related:

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• Medicaid review could drop 400,000 Michigan residents from coverage

New COVID cases, hospitalizations and deaths continue to decline across the state, but they are far from gone.  

“We’re likely to call this a pandemic that doesn't truly peter out,” said Howard Markel, a medical historian at the University of Michigan who has written several books on the social and cultural history of epidemics.

“We’re in a whole new era, where we have this almost science fiction-like virus that changes its coat of arms, every four to six months,” he said. “It figures out that's how to evade the vaccine ... We're always several steps behind even in a remarkable age of science and technology.”

In the meantime, here are some rules and practices that will change Thursday: 

Free OTC rapid tests

Private insurers no longer will be required to reimburse consumers for at-home rapid COVID tests. They won’t be required to cover the entire cost for a doctor-ordered test, either. That includes Medicare plans.

Medicaid will be required to cover those costs until Sept. 30.

But what the consumer will soon pay is unclear.

Costs vary among insurers, the type of test and, when applicable, the health care organization doing the testing, according to an analysis Monday by the San Francisco-based healthcare research nonprofit, KFF.

And costs for polymerase chain reaction, or PCR, testing — considered the gold standard for detecting COVID — run from $44 to $145 in Michigan, with the median about $91. And that’s just the cost for the test, the results of which generally aren’t immediate and take a lab to interpret. A doctor’s visits or other administrative fees could add to that expense.

Even consumers with insurance coverage now face copays and deductibles, especially if they head to the chain pharmacy down the street that is more convenient but out of their coverage network.

“Our plans will still cover testing, but they will have to be done in-network,” said Brian Mills, spokesperson for the Michigan Association of Health Plans.

And those bins of free tests at the local pharmacy? They’re likely to disappear as well. Since January 2022, private insurers were also required to reimburse for up to eight at-home rapid tests for each person they covered. That rule ends Thursday.

At least for a time, there will still be some places with free tests, but Michiganders might have to do a bit more work to find them.

The Michigan Department of Health and Human Services will continue distributing free over-the-counter tests to all residents, regardless of income or address, via Project Act which runs through June this year. Additionally, federal funding is available through July 2024 to support continued free tests through the state’s partnership with Michigan libraries program, neighborhood and community testing sites and some federally-supported locations, said MDHHS spokesperson Lynn Sutfin.

For children, COVID-19 vaccines, Sutfin said, will continue to be available and will be unaffected by the end of the Public Health Emergency because of federal policies, including the Vaccines For Children program. Other federal programs will offer the vaccines to uninsured Michiganders through www.vaccine.gov, she said. And Medicare plans will continue to cover COVID vaccines and boosters.

Insurers likely will continue to cover vaccines as well, even if they aren’t required to do so, said Dominick Pallone, executive director of the Michigan Association of Health Plans, the insurers’ association.

“It’s a preventative medicine decision,” he said.

Data dwindling

Detailed COVID data — including the number of reported new cases in the state, the percentage of people who test positive, the availability of hospital beds and supplies — will no longer be required to be tracked as closely. 

As a result, the U.S. Centers for Disease Control and Prevention will stop tracking community spread levels across the nation.

Certainly, there’s a need for close surveillance during an acute disease outbreak, but at other times these requirements create a “burden of data collection,” said Sam Watson, senior vice president of field engagement at the Michigan Health & Hospital Association, an industry group.

Releasing health providers and others from the constant demands of data collection will allow them more time to react to new, emerging diseases, he said. And, he added, the pandemic has prompted hospitals to collaborate more closely to track disease spread and supply shortages — practices he doesn’t expect to change any time soon.

Some data, including hospitalizations, deaths and other metrics that build The Bridge Michigan COVID dashboard, will remain but may be tracked less often.

The U.S. public health emergency, first issued by President Donald Trump in March, 2020, and renewed more than a dozen times since, released emergency funds and allowed federal agencies and departments to relax some rules and enact others that allowed health providers to react more quickly and safely to an evolving virus, for example, by letting patients fill prescriptions without person-to-person contact, or allowing the expansion of telemedicine for routine exams or therapy sessions. 

Some rules were enacted behind the scenes for most Michiganders, while others have already expired. The feds discontinued extra food assistance during COVID in March. And after allowing everyone who had Medicaid to stay on their coverage without question for three years, a year-long process of reevaluating coverage eligibility is now underway. 

The legacy of a national emergency 

At its core, the years-long public health emergency allowed the federal government to provide average Americans free access to tests, treatment and vaccines against a deadly virus. 

The emergency’s termination on Thursday does not mean the end of COVID, or its lethal legacy. 

As of last week, more than 38,000 Michigan deaths were linked to COVID over three years. Labs confirmed more than 2.6 million cases of COVID; at the height of omicron in 2022, more than 17,000 new cases were being detected each day. On a single day in January, 2022, 5,009 people in Michigan hospitals were being treated for COVID.

Stiles Simmons, superintendent of the Westwood Community School District in Dearborn Heights, said he sees that fallout — a sort of low hum of uncertainty — every day in the faces of students. 

A child’s development, he said, depends on a stable framework on which to climb: the certainty of a parent’s income and a safe place to sleep at night, loving support, and a predictable schedule and expectations.

“But these kids saw their parents lose jobs and their families break apart,” Simmons said. “They saw loved ones pass away. They are less certain about their future.”

Many students still wear masks — not out of fear of infection, Simmons said, but because the fear and isolation that arose during the pandemic caused them to lose confidence in their ability to do schoolwork, manage their time, or prioritize tasks. They struggle to emerge from virtual Zooms and socialize one-on-one with classmates.

“I don’t know if there’s a formal diagnosis or what you would call it,” he said. “There are kids who are now more confident in masks and hoodies or even both… They don’t feel confident in the skin they’re in.”

The mental health challenges exacerbated by the pandemic have prompted more funding for school mental health programs, counselors and other staff to try to meet some of the demand.

The health emergency also fundamentally changed local public health and how employees there saw their jobs. 

Jane Nickert, nursing director at the Washtenaw County Health Department, helped people get medications and groceries and, most of all, medical care they needed. But she also heard the phone go dead when she called people in the community to trace the virus’s spread.

She felt like a hero when she began administering the COVID vaccine; then many in her own family refused it.

She said she would never forget talking with the sick on her cell phone in the isolated, most terrifying early days of the pandemic, hoping they could continue breathing at least for a few more minutes as an ambulance raced to their home.

In her Ypsilanti office, two thick wads of surgical masks hang from her cupboard at the ready. There are three N-95 masks and goggles on the other side of the room, too.

COVID testing and data tracking may go away, she said, but masks will forever be in reach for many Michiganders — disposable, but permanent reminders of a world that has changed forever for her. 

“There are things that some of us will never forget,” she said. “Some things may go back to the way they were, but there are ways the world has changed forever. We don’t even know all of those ways yet.”