Is the Public Health Emergency Over?

The public health emergency could be more than just about COVID-19.

I am afraid I am going to have to dissent. This pandemic is not Joe Biden’s; it is not political and never should have been framed that way. This pandemic is medical, and politicians can’t end it with a vote or an ill-advised declaration on some televised interview. They can’t wish it away or sweep it under the rug. Even if we look away or close our eyes, people are still falling sick and dying. Science prevails.

The United States no longer keeps pristine records of case rates or deaths. There is hardly a mention of COVID-19 in the media anymore, except for the pediatric tripledemic of influenza, respiratory syncytial virus (RSV), and COVID-19 which is stretching our institutions far beyond their capacity. However, if you go to https://www.worldometers.info/coronavirus/, you can see that the number of daily new cases equals multiple nadirs after earlier surges in 2021.

What is very different is the number of daily deaths, but a review of the data reveals that, in the last seven days, according to the Centers for Disease Control and Prevention (CDC) as of Nov. 23, 2,644 people died in the US from COVID-19. That is significantly lower from the earlier part of the pandemic where weekly deaths were in the tens of thousands, because thank goodness, vaccination, previous infection, and boosters do reduce deaths. But it is not a trivial number of people. And if it is your mother, grandmother, husband, or friend, it is not trivial at all.

The CDC is projecting an increase in COVID-19 hospitalizations in December by over 50 percent. They are having issues reliably forecasting deaths, although the numbers they are putting out are somewhere between 1,000 and 4,400 deaths per week. In researching for this article, I discovered that over one million people have died from COVID-19 in the US. I am appalled to realize that I lost track, and don’t remember when we reached that milestone.

We are at approximately 1.1 million deaths as of Nov. 23, 2022 (different sites quote slightly different numbers, ranging from 1.08 to 1.2 million). This is a shocking statistic. India, with a population exceeding one billion people has only recorded 531,000 deaths. This was not something we wanted to be number one at!

I was wrong about a lot of things when the pandemic started. I thought emergency departments were going to be overrun in the early days, but I hadn’t calculated on people staying home to “ride out” their non-COVID illnesses or injuries at home rather than coming to the ED. It never occurred to me that healthcare workers would be furloughed and discharged.

In my wildest dreams, it never crossed my mind that people would refuse to get vaccinated when a safe, reliable, free vaccine became widely available (as of Nov. 24, 2022, only 12.1 percent of the population eligible and 31.3 percent of people ≥ 65 years old have received their bivalent booster).

I was right about one thing, though. I knew that being inundated with patients, especially ones who could have prevented their serious disease if they had only gotten vaccinated, was going to cause severe provider burn-out and a mass exodus from healthcare. It also resulting in the death of over 1,700 health care workers (https://www.fiercehealthcare.com/practices/report-how-many-u-s-healthcare-workers-have-died-from-covid-19-contracted-job). I predicted that this would just exacerbate the problem with fewer healthcare workers being forced to do even more with less support.

This is not over yet.

I also didn’t imagine that everyone was going to just get fatigued of the pandemic and pretend it didn’t exist anymore.

Right again when I complained that we have no idea how many cases there really are because widespread home testing is not being registered anywhere. There have been times when the case rate has probably been 10 times that being presented, but the current published accounting of cumulative cases for the United States is 100,465,087. The National Institute of Biomedical Imaging and Bioengineering, a National Institutes of Health branch, has set up a new website called Make My Test Count (https://makemytestcount.org/) where people can help public health officials by documenting the results of their at-home test. They are not asking for name, birthdate, or address to protect privacy.

Eighty five percent of healthcare facilities are experiencing personnel shortages requiring financial incentives and the hiring of new green professionals to fill their staffing gaps. Seems to me like this might be a public health emergency.

I’m going to wait until the medical community declares the PHE over; seems like it isn’t only about COVID-19.

Programming note: Listen to Dr. Remer each Tuesday when she cohosts Talk Ten Tuesdays with Chuck Buck at 10 a.m. Eastern.

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Erica Remer, MD, FACEP, CCDS, ACPA-C

Erica Remer, MD, FACEP, CCDS, ACPA-C has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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