How the midterm elections could affect the COVID response

Story at a glance

• The national public health emergency status for the COVID-19 pandemic could expire by mid-2023.

• This year, governorships and state legislators will be decided in the midterm elections.

• Without emergency status, the COVID response loses ground with funding and national data collection efforts.

The national status of public health emergency for the COVID-19 pandemic may expire, and the White House Covid team could get phased out as early as mid-2023. By then, there may be new governors in office from the midterm elections. State legislatures may also see a wave of change as seats open and get filled. All of this could have significant implications on the COVID response and surveillance of the coronavirus, experts warn, potentially putting the public at risk.

The public health emergency status gives the federal government and certain agencies the funding and authority to take action. For example, this status gives the Centers for Disease Control and Prevention the authority to require all the states and territories to report COVID-19 data. In addition, federal funding paid for the coronavirus vaccines and made the shots accessible to everyone regardless of insurance coverage. All of that could be at risk pending the results of the midterms.

Loss of funding

The emergency status can’t be kept in place forever, said physician Georges Benjamin, the executive director of the American Public Health Association, to Changing America. The biggest concern he has is that once the status expires the funding for pandemic-related programs and health insurance coverage will go away.

For example, many government-run testing facilities and mass vaccination sites have shut down or downsized. The new bivalent booster shot is still free for anyone who is eligible for the shot, but it may not be in the future, requiring people to use their insurance to cover the cost.

The Biden administration has asked for more funding, but this would require a vote in Congress. The midterm elections could change the balance in the House and Senate and throw into question whether further funding could get approval.

Fragmented data collection

Another major issue will be that the CDC will not have the authority to require reporting of coronavirus data from the states. This could lead to fragmented data collection, where nationally we do not know what the up-to-date numbers are for cases, hospitalizations and deaths. Each state could choose to continue to collect and share the data, but they may also choose to cut funding for those programs.

Benjamin would like to see mandatory reporting on hospitalizations and deaths. Although deaths are regularly recorded, the data systems are fragmented and not well coordinated.

Outside of a public health emergency, there are national requirements to report certain diseases. These diseases could pose a potential bioterrorism threat, like anthrax, or could be highly infectious, like measles. This list is called “Nationally Notifiable Diseases” or reportable diseases and includes cholera, malaria and salmonella.

The coronavirus could get added to that short list, but that would take administrative time and effort.

Downstream effects

“Even beyond the emergency question is the question of what will we leave in place that allows us to respond in an adequate way to the population health needs,” said epidemiologist Delivette Castor from Columbia University.

We’ll go from a space of knowing and having a lot of evidence by which to respond to one where there are fewer resources. One of the consequences could be that we’d be setting ourselves up for the same thing to happen again, when by the time we notice something is happening we may already have a reemergence of COVID or another infection and we’d be playing catch up.

Another concern is you can easily have an increase in a community of a new variant, Benjamin said. And even though case numbers aren’t as important as they used to be, it does give you a sense of the prevalence of a disease in a community, he continues. If there is an increase in a particular variant, that will be important to know.

A potential downstream effect of not having this surveillance data is that we won’t have a working alert system with the red, yellow and green color coding to let us know when we should start masking in public and crowded areas.

Where the midterms fit in

With the midterm elections coming up, people who are elected into the state legislatures and governor seats will determine what the response and surveillance in each state will look like once the public health emergency status expires nationally. They also have the power to enact laws around data sharing and privacy that might limit COVID reporting. There’s already been cases of state laws limiting health departments’ ability to require vaccination.

The elected officials’ “ability and knowledge around the importance of these public health metrics matter, and view around governance and the role of government,” said Benjamin.

So if there is a government official who believes the government has no or a limited role here, there is the risk of the public being blinded because of limitations in reporting.

Regarding elections, Castor is thinking about the younger voters and what issues they may be considering. The pandemic has greatly affected everyone, and we’re still learning about the potential long-term effects. Young people’s economic prospects and mental health are suffering, and in cases of long COVID their physical health has been damaged as well.

Voters of all ages are following news about inflation and gas prices closely, according to a poll from the Survey Center on American Life. And only 35 percent of young voters (ages 18 to 29) said they were absolutely certain that they would vote in this election, according to the poll. The coronavirus pandemic may not be front of mind for many voters this year.

It’s not over yet

Loss of COVID funding could worsen health inequities. And it does not look like we can stop thinking about the coronavirus jsut yet.

“A lot of the epidemiology suggests that not only is COVID not going away,” Castor said.

We still have a sizable number of infections that wax and wane, a sizable proportion of people who are hospitalized and a significant amount of deaths, Castor explained.

The long-term effects of the coronavirus pandemic will be felt after the public health emergency status expires.

“It has been a multi organ, multi system, presentation of conditions. I think it also adds a tremendous, not just burden on the health system, but also burden on the individual because it’s not a single thing,” said Castor.

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