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How the end of the COVID-19 public health emergency is impacting people

The Day - 5/20/2023

May 20--The Groton nursing and independent living facility Fairview posted a video a week and a half ago in which nurses removed their masks in unison, threw them into the air graduation-ceremony style, and shouted, "Woooo!"

Infection preventionist Emily Malone said residents are happy to see staff members' faces again. The end of mandatory mask protocol coincided with the end of National Nurses Week, but even more timely with the end of the federal and state COVID-19 public health emergencies on May 11.

Outside Fairview's walls, some haven't been wearing masks in months or years, and some scoff at public health emergencies lasting this long. But other disabled and immunocompromised people believe they are being left behind, wondering how they can stay protected in a system growing more scattershot.

The end of the emergencies means state-supported COVID-19 test sites will close June 30, the same day the state Department of Public Health will end its mobile and homebound COVID-19 vaccination programs. Costs for tests, vaccines and treatments will shift to traditional health care coverage through insurers. After June 1, DPH will stop reporting on COVID-19 testing, hospitalizations, deaths and vaccination rates in the summer.

Another change is that people on Medicaid known in Connecticut as HUSKY now have to annually confirm their eligibility, whereas a federal pandemic policy meant people didn't get kicked off Medicaid. The policy of "continuous enrollment"ended March 31.

Malone said if Fairview had a positive COVID case, the facility would resume masking on that floor or building, as masking guidelines overall are at the discretion of individual facilities. They can't rely on broader markers: the CDC's COVID Data Tracker is no longer reporting on community transmission levels.

Kelly Gigliotti, director of nursing at Fairview, said masking will likely become mandatory again for the respiratory illness season. Malone said rapid tests are always available, and if someone has any symptoms, they will have to test and mask.

"I think we have to shift our brains to thinking of masking (for) respiratory illnesses and not just COVID," Malone said.

Impact on insurance

Medicaid plans are still required to cover the cost of over-the-counter, at-home tests -- and COVID-19 treatments -- until Sept. 30, 2024, but that's not the case for other insurers.

Anthem Blue Cross and Blue Shield stopped covering these rapid tests on May 12, spokesperson Stephanie DuBois said in an email last week. But people with a receipt from May 11 or earlier can still submit a claim for reimbursement.

DuBois said the insurer continues to cover "prescribed COVID-19 testing and testing-related services as we do other diagnostic lab tests according to each member's plan." Anthem's website says a doctor must order a COVID-19 test, and "out of pocket costs may apply based on your plan."

Both Anthem and ConnectiCare will cover COVID-19 vaccines from in-network providers but not out-of-network ones.

ConnectiCare spokesperson Lauren LaChance said in an email, "COVID-19 PCR or rapid lab tests are covered by a member's plan when an in-network health care professional orders it for medically appropriate reasons. The member will be expected to pay a copay, coinsurance and/or deductibles for the lab test and visit according to their plan's benefits."

ConnectiCare, which offers plans on and off the state's Affordable Care Act exchange, will no longer cover at-home tests in most plans.

CVS Health and Aetna spokesperson Alex Kepnes said COVID-19 testing will remain available at all MinuteClinic locations, patients should check with their insurer to determine eligibility, and uninsured patients may be eligible for no-cost testing.

According to a news release from the White House, people can order free COVID-19 tests at until the end of May. The website says a household can get four tests if its last order was before Dec. 15.

Impact on hospitals

"Are we seeing the amount of sick people we were seeing at the beginning? Absolutely not. But COVID still exists," said Sherri Dayton, a registered nurse at Plainfield Emergency Care Center and president of the Backus Federation of Nurses. "Now it's just being treated like everything else."

But Dayton still sees a lot of things up in the air, such as whether nurses and others, for that matter will have to get a COVID-19 vaccine on an annual basis.

Her biggest concern now is workforce shortages, saying she doesn't know a nurse "who isn't working on an exit plan ... because the staffing is so horrible and the ratios are getting so bad."

She said she hopes the General Assembly will pass Senate Bill 1067, which would require specific ratios of patients to registered nurses, increase transparency on ratios, and make changes to overtime policies.

Hartford HealthCare hospitals, such as Backus Hospital in Norwich, have gone mask-optional for staff and patients.

But Chief Epidemiologist Dr. Ulysses Wu said staff are practicing "mask etiquette," meaning if a patient is masking "that may be an indication you should wear a mask." He also said staff should mask if a patient is showing signs of respiratory illness or is immunocompromised, such as if they're an oncology or transplant patient.

Wu said when respiratory season comes around, or if a new coronavirus variant emerges, "we will probably return to masking policies." He said people with a respiratory illness are still tested for COVID-19, though testing is no longer mandatory upon admission or before a procedure.

"We do allow the physicians and practitioners to make that judgment; if they want to get a test they certainly can," Wu said.

For Lawrence + Memorial Hospital, Chief Medical Officer Dr. Oliver Mayorga said Yale New Haven Health stopped mandatory COVID-19 testing of admitted patients only recently, which he said is "probably a little behind" others. But he said patients are still tested if they have COVID-like symptoms, are going into a congregate setting, or are immunosuppressed.

Mayorga said effective May 11, masking is optional in public spaces such as hallways, the nurses' station and cafeteria while in enclosed patient spaces, masking is required for staff but optional for patients.

"I think Yale tends to be very conservative. However, I don't think that's a bad thing," he said. But he does understand it can be frustrating that different hospitals relaxed their policies at different times.

Filling in the gaps

"Some of the structural supports that were there under the emergency declaration are gone, but that just makes our work to serve and protect our community that much more important," said Jennifer Muggeo, deputy director of Ledge Light Health District. She said COVID-19 "remains a public health issue of concern."

Ledge Light covers East Lyme, Groton, Ledyard, Lyme, New London, North Stonington, Old Lyme, Stonington and Waterford.

Muggeo said she hopes that people who can't find or afford a rapid test will call "so we can help them figure out a solution," as the health district continues to source supplies and has kits on-hand to distribute.

Muggeo said last week she hadn't received any calls with specific questions about the end of the public health emergency but thinks "there's probably some understandable confusion among community members in terms of what exactly it means."

She said it doesn't mean that people don't have to test or don't have to isolate if they test positive; "it's just the end of the extra structures, changes, allowances, (and) benefit programs that were put in place."

Muggeo said she does feel sad that a lot of energy and conversations the pandemic started about health equity and what public health is "have kind of dissipated, and yet there remain people in our community whose lives have been dramatically impacted."

One such person is Kathy Flaherty, who contracted COVID-19 in March 2020 and developed so called "long haul COVID." Flaherty said she is feeling better "but not the way I used to be in 2019," and say she's still experiencing fatigue.

She is also executive director of the Connecticut Legal Rights Project and a disability rights advocate. And she highlighted an issue with treating COVID-19 like other pre-pandemic respiratory illnesses: many people's "needs were never addressed effectively to begin with."

"I was never in a rush to return to normal, because whatever normal is and I'm still not entirely sure that wasn't working for so many of the people I work with and already know," she said.

With a lot of other health conditions, she doesn't know if she'd survive another bout of COVID-19, and so she still wears masks to family parties and concerts. Flaherty said she doesn't care what people think or if they want to label it anxiety.

She questions whether enough is being done for ventilation and air quality. And while Flaherty thinks we're past the point of mandates, she wonders whether the government should consider more requirements in places where people have to be, commenting, "I really don't understand why we are willing to say to people: Yeah, you have to risk your health to get health care."


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