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As public health emergency ends, COVID vigilance should remain, public health experts say

On Wednesday, Governor Maura Healey announced that she would end the state's public health emergency, which was enacted nearly three years ago when COVID-19′s impact was uncertain.Jessica Rinaldi/Globe Staff

Governor Maura Healey announced on Wednesday that she would end the state’s public health emergency, marking the beginning of what public health officials say is the next phase of life with COVID-19.

The move takes effect May 11, which aligns with the lifting of the federal public health emergency.

Healey said the state now has the tools to manage the virus, including vaccines, masking, testing, treatments and protocols for staying home when ill.

“We’ve reached the point where we can update our guidance to reflect where we are now,” she said in a statement.

The decision comes almost exactly three years after then-Governor Charlie Baker first declared the state of emergency on March 10, 2020. At that time, COVID-19′s impact was uncertain, there were no vaccines or treatments, and health care experts had a limited understanding of how the virus was transmitted.

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COVID-19 has by no means gone away. Over 1,800 people nationally continue to die of the virus each week, and long COVID remains a risk for those who recover. COVID still presents a threat to older individuals and those with underlying medical conditions.

But for the majority of people, their risk of severe illness and death is much lower than before. We have higher levels of population immunity, thanks to vaccinations and COVID infections. We also have a better understanding of the medical consequences of the infection. Vaccines and boosters are available to prevent serious illness and death, as are therapies for when individuals become sick.

“It makes sense to move past the public health emergency,” said Dr. Paul Biddinger, chief preparedness and continuity officer for Mass General Brigham. “We can’t be in an emergency state in perpetuity.”

At Mass General Brigham, the state’s largest health system, doctors are seeing fewer cases of COVID-19 and declining rates of hospitalization.

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Experts caution that the elimination of a state of emergency doesn’t end the need to be aware and responsive to COVID, and they encourage continued vigilance so people remain up to date with vaccinations, test when they feel ill, and get therapies earlier in the course of their illnesses.

But the response moving forward should be more sustainable than a heightened state of emergency.

“If we keep constantly calling it an emergency, for some audiences, it makes it harder to take those recommendations to heart,” Biddinger said. “If we move out of an emergency status, and move to the way we message about other illnesses — about risk factors, behaviors and prevalence — then it does make sense for us to pivot.”

Bill Hanage, associate professor of epidemiology and co-director of the Center for Communicable Disease Dynamics at Harvard T. H Chan School of Public Health, agreed that it was responsible to end the emergency. But he said messaging needs to be robust that COVID was still a public health threat that requires many of the resources the public health emergency had brought to bear.

“If we take our eye off the ball, and people stop being able to get things that help them - masks, tests, shots — because we no longer have the machinery that comes with an emergency, more people will get sick and die as a result,” Hanage said. “And we still have preventable illness and suffering. I worry the end of the emergency will make people think that’s not the case. And it is the case. We can still be better.”

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Biddinger said experts need to monitor the availability of tests and vaccines, particularly for vulnerable and under-resourced communities, and bolster it with clinics or support when necessary.

“Not having the public health emergency doesn’t change that need,” he said.

Public health officials are still working through the best ways to communicate the ongoing risks of COVID to support mitigation strategies. For example, while the public expects messaging around flu vaccines seasonally, COVID has no defined season, and so it will be harder to tell people the exact steps to take.

Healey will file legislation to extend several public health orders imposed during the pandemic, such as permanently reducing staffing requirements for ambulances that provide advanced life support. She will also rescind an order requiring executive branch state employees to be vaccinated. But the end of the public health declaration will eliminate several other standing orders imposed by the governor, including one to mask in certain health care settings, reverting to a system where masking rules will be determined by the Centers for Medicare & Medicaid Services and state regulatory processes.

Biddinger said that even after the expiration of the public health emergency, there would still be an understanding that masking would be required in public and clinical areas of hospitals and licensed health care facilities — applying to all staff and all patients regardless of symptoms or clinical setting.

Yet, as health care systems rethink the next phase of COVID response, discussions are underway with infection control experts, hospital officials and state public health officials on the rationale for continuing universal masking. In the past, hospitals tailored their use of personal protective equipment to different infectious diseases based on patient symptoms, condition, and clinical setting, which could be the baseline moving forward.

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“It may be that we should reassess the universal mandate for masking in health care settings,” Biddinger said. “It’s something we’re actively looking at and discussing with different public health leaders.”


Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.