Dr Sanjay Gupta: The Covid-19 emergency is ending. It’s time for the patient to leave the hospital

(CNN) After more than three very long years, it is finally happening: the Covid-19 pandemic is coming to an end, at least in the formal sense, both in this country and abroad. This moment is not marked by parades or big parties but rather by the flourishes of two administrative enclosures. On Friday, the World Health Organization announced that Covid-19 no longer constitutes a public health emergency of international concern, and this Thursday the United States is expected to end its own declaration of a public health emergency.

So what does this mean? Throughout the pandemic, I have written several essays about the United States as if it were my own patient. I think of the end of the public health emergency as my patient is finally discharged from the hospital after a long illness. The hospitalization has been full of setbacks and improvements, trips to intensive care and then back to the general care floor, vital signs bordering on catastrophic but also triumphs of modern medicine and ingenuity. human.

And while that’s a very good sign that the patient is being discharged, it doesn’t mean that America (or the world) is completely out of the woods. There will always be testing, close monitoring and follow-up appointments – all hopefully to prevent readmission.

Why now, WHO?

Last week, the WHO’s International Health Regulations Emergency Committee met and decided that the public health emergency of international concern (USPPI) must end due to declining hospitalizations and deaths. linked to Covid-19 and high levels of immunity in the population.

The committee “indicated that it was time to move on to long-term management of the COVID-19 pandemic”, and WHO Director-General Tedros Adhanom Ghebreyesus agreed.

But like me, WHO plans to keep a close eye on the patient. The agency said that although the level of concern is lower, Covid-19 remains a global threat as the virus continues to evolve and spread.

“While we are not in crisis mode, we cannot let our guard down,” said Dr Maria Van Kerkhove, WHO’s Covid-19 technical officer and head of its emerging diseases programme. She added that the disease and the coronavirus that causes it are “here to stay”.

The PHE declaration draws its last breath

Long before the WHO announcement, the United States had designated May 11 as the day its public health emergency ended. It may seem like an arbitrary day, but it’s not as random as it seems.

When Covid-19 was declared a public health emergency in the United States on January 31, 2020, the country was trying to prevent the spread of the SARS-CoV-2 virus.

The declaration – which has been renewed 13 times, usually in 90-day increments – essentially gave the government great flexibility in tackling the biggest public health crisis in a century. It allowed the government to temporarily implement certain policies and actions.

For example, at the societal level, it has enabled a broader social safety net, the expansion of Medicaid in some states, and the ability to prescribe controlled substances via telemedicine. On an individual level, he gave Americans free access to Covid vaccines, tests and treatments. It has also allowed the government to keep its finger on the pulse of the pandemic by requiring states and other entities to report data such as test positivity rates, death rates and vaccination figures.

On February 9, the US Department of Health and Human Services announced it was extending the PHE one last time and said it would then allow it to expire on May 11. This means the immediate end of certain programs and actions; others will end more slowly and some will remain in place.

Another change: The US Centers for Disease Control and Prevention will lose access to some of the data it used to measure the severity of the pandemic and guide its public health recommendations.

“This is the case at the end of the public health emergency, we will have less (of a) window on the data,” CDC Director Dr. Rochelle Walensky said last week during a Senate committee hearing. “We’ll lose our percentage positivity. We won’t get lab reports. We won’t get case reports. So we’ll lose some of that.”

But Walensky, who is stepping down in late June, reiterated that the CDC “is not changing the steam we’re working on to resolve this public health emergency.”

The agency, she said, will closely monitor this virus across the country, using more novel approaches like genomic sequencing and sewage testing.

We must remain vigilant. No one wants to see the patient readmitted to the hospital.

Absolute numbers vs trends

If you only look at the absolute numbers, the decision to end PHE might have you scratching your head. After all, there were nearly 9,900 new Covid-related hospital admissions in the United States for the week ending May 1, and there were about 1,050 deaths per week at the end of April. Comparatively, when the first PHE declaration was signed in late January 2020, no deaths were reported in the United States (the first American death would not be counted until February 29). In fact, it wasn’t until February 10 that deaths worldwide exceeded 1000.

In medicine, however, numbers and data are important, but trends tell an even richer and more complete story.

Imagine my patient, America, walking into the hospital when he started to feel sick. Perhaps their fever was 101 degrees, their pulse was rapid, and they felt some discomfort. I noted their vital signs – cases, hospitalizations and deaths – but what I really watched was the trend. Are these numbers getting better or worse? Had the disease reached its climax or was it just beginning? At the start of 2020, all of these numbers were heading in the wrong direction.

But right now the trends – in terms of cases, hospitalizations and deaths – are all still high, but fortunately they are heading in the right direction for my patient, our country.

This is also true globally. “For more than a year, the pandemic has been on a downward trend,” the WHO’s Tedros said on Friday, explaining why the PHEIC declaration was coming to an end. But he said he would not hesitate to declare a global health emergency again if there was a significant increase in Covid-19 cases or deaths in the future.

Clearly, we have the ability to do much better and drive the numbers even lower before we discharge our patient, but this raises a philosophical question, even more so than a medical one: what are we willing to tolerate as a society to prevent sickness and death?

Over the past three years, I have often spoken with public health experts and other experts to try to determine exactly when we would move out of the pandemic phase and into the endemic phase of this health emergency. There were few difficult answers. Instead, many told me it came down to how many Covid deaths we could sustain as a society, in exchange for ending our disrupted lives.

At the time, I wrote, “At what point do we as a society raise our arms and say, ‘We can’t get any better than this,’ so let’s call that level of disease and death ‘ endemic”, accept the numbers and move on? »

We seem to have collectively, emotionally reached this point. If the weekly death rate in the United States at the end of April remained stable for 52 weeks (or represented the average weekly death rate), we would have approximately 54,700 deaths per year. This puts Covid on par with a bad flu season. And remember, when it comes to the flu, less than half of the adult population in the United States gets vaccinated each year.

Sound medical science in the form of vaccines and effective public health strategies, such as high-quality masks and indoor ventilation, can only get us so far if there is not a collective will to use them.

Release documents

Many of us are ready for this chapter of history to be over, and truth be told, I am well aware that many people have already moved weeks or even months ago. But we must also remember that there is a large group of Americans who are still very worried about contracting Covid, especially the older and sicker ones.

As you probably know by now, the CDC estimates that the risk of hospitalization for those 75 or older is between 9 and 15 times higher than for those 18 to 29, and here in the United States, nearly 25 million people are older than 75. When it comes to our overall health, a study published in the journal Clinical Infectious Diseases found that people with asthma had a 1.4 times greater risk of hospitalization than a person in good health, hypertension increased the risk to 2.8 times higher, chronic kidney disease to four times higher and severe obesity to 4.4 times higher. Someone with three or more health conditions had a five times higher risk. Forty percent of Americans are obese, and nearly 70 percent of the country has at least one condition that significantly increases their risk.

Therein lies one of the greatest lessons of the pandemic for my patient, the United States. While we had enormous resources to fight this pandemic, our collective poor health has put us at a huge disadvantage. We must do all we can to focus on the essentials, because no amount of wealth can buy good health.

For now, however, my patient is taking crucial steps out of the hospital and back into the world. I am delighted.

On the discharge papers, I write these parting instructions: Be careful. Stay home if you are sick. Talk to your doctor about keeping a course of oral antivirals (like Paxlovid) in your medicine cabinet if you’re at higher risk of hospitalization or death. Remember what Dr Anthony Fauci said recently: “If you’re vaccinated and boosted and you have therapy available, you’re not going to die (of Covid), no matter how old you are.” That should reassure people like my parents, who are now in their early 80s.

And, yes, please use the official end of the pandemic as a fresh start for yourself personally. Invest in yourself to have the best possible health to feel better, happier and stronger now, as well as weather any medical storms in the future.

Most importantly, go enjoy all the things that a major emergency or the threat of serious illness wouldn’t allow you to do. Call if you have any problems.

I wish good luck to my patient. I wish us all good luck.

CNN’s Andrea Kane contributed to this report.

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