Biden administration extends Covid public health emergency as highly infectious omicron XBB.1.5 spreads

The Biden administration has extended the Covid-19 public health emergency until April as a highly transmissible omicron subvariant stokes concern that the U.S. may face another wave of hospitalizations from the disease this winter.

"The COVID-19 Public Health Emergency remains in effect, and as HHS committed to earlier, we will provide a 60-day notice to states before any possible termination or expiration," a spokesperson for the Health and Human Services Department said.

The U.S. has renewed the Covid public health emergency every 90 days since the Trump administration first issued the declaration in January 2020.

The emergency declaration has had a vast impact on the U.S. health-care system over the past three years. It has protected public health insurance coverage for millions, provided hospitals with greater flexibility to respond to patient surges and expanded telehealth.

The White House Covid task force led by Dr. Ashish Jha has repeatedly sought to reassure the public that the U.S. is in a much stronger place today due to the widespread availability of Covid vaccines and treatments that prevent severe disease and death from the virus.

In August, HHS told local and state health officials to start preparing for an end to the emergency in the near future. HHS has committed to giving state governments and health care providers 60 days notice before lifting the declaration.

President Joe Biden said the pandemic was over in September, a period when infections, hospitalizations and deaths were all declining. But HHS Secretary Xavier Becerra told reporters during a call in October what the virus does this winter would determine whether or not the emergency needs to continue.

Once U.S. officials decide to end the public health emergency, hospitals will lose flexibility in how they deploy staff, add beds and care for patients when there's a surge in admissions. Lifting the emergency could also affect the vastly expanded role pharmacies have played in administering vaccines during the pandemic, though it's not yet clear the extent of that impact.

Millions of Americans are expected to lose health insurance coverage under Medicaid in the coming months as well. Congress banned states from kicking people off the program for the duration of the public health emergency. Enrollment in Medicaid has surged 30% to more than 83 million as a consequence.

Last month, Congress severed the Medicaid protections from the public health emergency and said states could start withdrawing people from Medicaid in April if they no longer meet the eligibility requirements.

The omicron XBB.1.5 subvariant is rapidly becoming dominant in the U.S. Scientists believe it has a growth advantage because it is better at binding to human cells and is also adept at evading immunity. The World Health Organization has described it as the most transmissible subvariant yet, though there is no data, so far, indicating that it makes people sicker.

Since the arrival of omicron in the U.S. in late 2021, which caused massive waves of infection in the U.S. and around the world, Covid has splintered into an alphabet soup of subvariants that are evolving to become increasingly adept at evading immunity from vaccination and infection.

Scientists at Columbia University, in a study published in December, found that the BQ and XBB families of omicron subvariants pose the biggest threat to the Covid vaccines and could cause a surge of breakthrough infections. These subvariants are also resistant to all of the authorized antibody treatments used to protect people with weak immune systems.

In a series of Twitter posts last week, Jha said he is concerned about the rapid rise of XBB.1.5 but does not believe the subvariant represents a huge setback. He encouraged people to get an omicron booster if they haven't received one already and for the vulnerable to obtain an antiviral treatment if they have a breakthrough infection.

Only 38% of seniors ages 65 and over have received an omicron booster so far, according to data from the Centers for Disease Control and Prevention. There is concern that as XBB.1.5 spreads, it could cause a spike in hospitalizations and deaths among older Americans.

Jha has said most people who are hospitalized and dying from Covid right now are ages 70 and older who are either not up to date on their vaccines or are not getting treated when they have a breakthrough infection.