David Rosner, who studies public health and social history at Columbia University, spent 10 days in a hospital in November because he contracted respiratory syncytial virus (RSV), which worsened due to his asthma, and he developed pneumonia.
"It's all over now, but there were a few moments where it was kind of touchy, and I wish people were more aware generally that this can happen," said Rosner, 76, who has not had Covid-19.
Now he worries that US residents could become even less mindful of the continued threat posed by Covid because of the Biden administration's announcement earlier this week that it would let the coronavirus public health emergency expire in May.
While other public health experts remain concerned about Covid, some support the administration's decision because they don't see the emergency status as an effective way to solve larger problems with the healthcare system's ability to respond to viruses.
"There are much more systemic issues that we have to fix that a public health emergency is not well poised to fix," said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.
Despite disagreements over whether the public health emergency should continue beyond May, Nuzzo, Rosner and others agree that a Republican push to end the emergency now is irresponsible and that Biden's lifting of the emergency order in May could create additional problems.
"Looking three and a half, four months ahead as to what the circumstances of Covid will be, is both optimistic and courageous," said William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine. Lifting the declaration "will once again introduce disparities, both in treatment and prevention".
When the federal government declared a public health emergency about three years ago, it meant certain requirements for government programs were waived and millions more people enrolled in Medicaid. The government did not let states remove those people from Medicaid once they enrolled. The move also allowed most Americans to receive Covid tests, vaccines and some treatments for the virus free of charge.
Once the order is lifted, most Americans will still be able to get vaccines at no cost. But people enrolled in Medicare or private insurance will have to start paying for laboratory and at-home over-the-counter Covid tests, according to Reuters. Medicaid or Children's Health Insurance Program (Chip) beneficiaries will have to pay some of the testing costs beginning in 2024.
Most people will also start having to pay some of the costs for treatments such as the anti-viral Paxlovid.
People who do not have insurance will have to pay full price for vaccines, and vaccine makers Prizer and Moderna plan to raise the cost of the shots from $30 to $120.
While people continue to be hospitalized and die from Covid, those numbers have steadily decreased; most people have stopped wearing masks; and Joe Biden declared the pandemic over in September 2022.
Dr Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, said her biggest worry is about the cost of vaccines.
"What will happen every winter is that we will wrangle with insurance," said Gandhi, whose patients all use public health insurance. "We will say, really this patient is more at risk. He's older. He has HIV. He is immunosuppressed. You really need to purchase the [vaccine booster], and they are going to say, 'It's too expensive.'"
To charge so much more for vaccines is also unethical, Gandhi said, especially in Moderna's case, which received $10bn in government funding to develop the vaccine.
"I really think it's greedy," she said. "They got so much public funding."
Biden declaring that the pandemic is over and lifting the public health emergency also makes it more difficult for people to ask friends to take precautions such as wearing a mask or testing before a gathering, Rosner said.
"We still don't know it's over, and we see new variants coming out every week, and we have large portions of the American population that are still not vaccinated fully," he said.
Meanwhile, Republicans have called for the Biden administration to end the declaration immediately rather than wait until May.
That would be "disastrous", Nuzzo said.
"There will be some transitions that need to happen, including making sure people continue to have access to medicines and making sure hospitals can shift administratively," she said.
While Nuzzo also worries about uninsured people's access to medicines, vaccines and testing, she doesn't think the public health emergency is well suited to address larger problems such as the closure of children's hospitals or shortages in staffing or issues with people getting access to the flu vaccine.
The government should focus on funding public health departments, she said. Such state and local agencies work to prevent the spread of disease and ensure people have access to healthcare services such as immunizations, among other responsibilities. Between 2010 and 2020, funding for state public health departments dropped by 16% per capita, and spending for local health departments fell by 18%, according to a Kaiser Health News and Associated Press analysis.
"Unfortunately, Congress hasn't appropriated additional resources" to fund health departments, Nuzzo said. "The work of responding to Covid and all the other pathogens that are swirling in our mix continues, but we just lack the resources to do it. Unfortunately, I don't see the public health emergency declaration or rescission as making or breaking that. This was a problem before that happened."
As to the concern about public attitudes towards Covid changing because the end of the public health emergency, Nuzzo said, "We have had many of those headlines throughout the pandemic."
One month after Biden declared the pandemic over on 60 Minutes, there was an 11% increase in the number of people who also thought it was over, according to a Gallup poll. Fewer people also planned to get a new booster shot than a year earlier, according to a Monmouth University poll after the Biden interview.
Diminished concern about the virus "is always a risk, but we have had multiple opportunities" to get boosters, Nuzzo said. "So those communication challenges remain and this certainly adds to it, but it's not the sole the sole instigator."
But Rosner said the order should remain in place until "the public health community really feels it has a handle on" the virus.
"I think we are hoping that the new strains are not more resistant to the vaccines, and that's not clear," he said. "You're going to need a sense that the public is responsible, or the public understands its responsibilities and can act rationally. That's the moment."