All in all, I think the update continues to be moving in a positive direction. Notably, the rate of new hospitalizations dropped significantly last week in tandem with a decrease in the percent of hospital beds being occupied by COVID-19 patients. Wastewater surveillance data is continuing to trend downwards. The official case rate seems to be bumping around and has trended up the past two weeks. 

I overlayed the graph of the official case rate in Easthampton and the graph of wastewater surveillance data in Hampshire County to see if it provided any insight. It's interesting to look at but it doesn't shout an answer to me of what might be going on with the case rate (if something is, in fact, "going on" above and beyond normal variability in testing and reporting). Over the past six months, trends in Easthampton have matched wastewater data trends fairly well, although in there is one period around November 2022 that looks like the decline in infection may have lagged behind the rest of the county, and in another period, at the end of December and start of January, that it seems the decline in infections occurred sooner in Easthampton than in the rest of the county. I really want to stress here though that I'm musing - there is no data analysis to determine if either of those things are "true" or if there's no true pattern and just random variation.

As promised, I'm continuing to watch the Biobot and CDC variant trackers to understand what's happening in Hampshire County with XBB 1.5. I'm not sure what is different, but there's been a substantial change in the variant proportion estimates according to Biobot Analytics, such that now the CDC and Biobot estimates are in agreement that XBB 1.5 is responsible for the vast majority of infections in Hampshire County. I think this is good news - we're not "bracing" for XBB 1.5 to make its way here. 

Finally, an update on the "emergency declaration" status of COVID-19 in the US: It's complex! Last week I reported that the WHO declared that we are still in a "global health emergency". The US has an entirely different procedure related to emergency status and there is a lot of discussion right now about if emergency status will end and what that might mean. There is an excellent and thorough overview available from Dr. Jetalina (https://yourlocalepidemiologist.substack.com/.../what...) - check that out for more details.

Essentially there are five components to the COVID-19 emergency in the US and the status (and consequences) of each are separate. The five components are 1) the FDA emergency, 2) emergency status under the Stafford Act (i.e., FEMA), 3) a public health emergency, 4) a national emergency, and 5) emergency status under the PREP act.

The public health emergency and the national emergency are going to end in May. An ending date has not been determined for the other components. The real question is what does this mean? What changes when we're no longer in a public health emergency or a national emergency?

- There may be a change in access to and cost of rapid tests. Right now there is a federal stockpile and blanket insurance coverage. Insurance companies will no longer be compelled to cover the rapid test after May; Many likely will continue to do so. It's unclear what will happen for those who are uninsured, particularly after the stockpile is used.

- There may be a change in access to and cost of COVID-19 vaccines and boosters. Right now there is a federal stockpile and the vaccine is free either from the stockpile or through blanket insurance coverage. Insurance companies will no longer be compelled to cover the vaccine after May; Many likely will continue to do so. It's unclear what will happen for those who are uninsured, particularly after the stockpile is used.

- We will have less "tracking" information available related to COVID-19. The CDC will probably continue tracking variants and vaccine uptake. Labs will no longer be compelled to report test information, though, so we may lose test positivity information. Hospitalizations will continue to be reported, but hospitals will no longer be compelled to report hospitalization data as rapidly as they do now, so this data will always be "behind" real-time.

Those are the big changes coming in May related to the ending of two of the five components of the pandemic emergency in the US. There is something else to be aware of, though: Big changes are coming to Medicaid coverage. Starting in April, regular "checks" on eligibility will start occuring again after being paused during the pandemic. This change to Medicaid isn't technically related to the public health emergency or national emergency ending, but it is occurring at about the same time. The full impact is unknown, but experts estimate that 5 to 14 million people may lose Medicaid coverage. Yikes.

Stay well,

Megan W. Harvey, PhD (she/her)

Epidemiologist