The COVID Public Health Emergency Declaration Has Ended. The Emergency Isn't Going Anywhere.

In effect, the Biden administration is throwing Covid to the maw of the U.S. private insurance market, shifting both the payer and the responsibility to our predatory and extractive for-profit healthcare system. Costs will rise, the uninsured and underinsured will face tough economic choices, and pandemic-related resources will be stratified and rationed by a person’s ability to pay (like all other U.S. healthcare).

As these first 1,200 days of the pandemic come to a close, the federal government is relieving itself of responsibility for the ongoing death, disability and debility wrought by Covid at a time when continued intervention is critical. To get the next 1,200 days right, we need to understand that the story of Covid has been a story of class war.

And despite our many losses, it’s one we can still win.

In early 2020, a very different pandemic response was possible in the United States. Faced with the combined existential threats of a Trump presidency and a novel pathogen, we saw mutual aid projects and strikes over Covid protections proliferate. Prison abolitionists pressured state and local governments to ​“Free Them All for Public Health,” demanding the emptying of jails and prisons. Mutual aid networks delivered food and medicine to disabled people and elders and worked to keep people from being evicted.

That brief moment exposed the many fictions meant to excuse everyday austerity conditions in the United States. In a rush to curtail the disastrous effects of mass unemployment, the federal government added hundreds of dollars per week to the average unemployment insurance payment, in addition to making direct stimulus payments to individuals — without means testing. Under pressure from activists, the federal government also pursued eviction moratoria, even if the implementation was deeply insufficient and flawed. Student debt payments were frozen. Supplemental Nutrition Assistance Program funding and eligibility increased. Medicaid funding and eligibility also increased, with a new provision ensuring that individuals could not be kicked off Medicaid rolls until the conclusion of the public health emergency. A fund was created to pay for Covid treatment, including hospitalization, for people without health insurance.

Each of these measures was the kind of enhancement to the U.S. welfare state that we are routinely told there is simply not enough money for.

By late 2020, however, much of that early Covid response focused on welfare supports and non-pharmaceutical interventions began to fade, a process that accelerated after Biden came into office. For all its promises to ​“follow the science,” the Biden administration’s Covid doctrine has been one of personal responsibility and individuated risk, and the trajectory of the Biden pandemic response is best understood as the systematic dismantling of protections, including the few worker protections that Biden initially promised during his campaign.

Shortly before the 2020 election, Biden made it clear that his priority was protecting the capitalist economy at the expense of lives. He pledged that ideas like paying people to stay home were not going to happen, saying, ​“I’m not going to shut down the economy. I’m going to shut down the virus.” The Biden transition team was similarly quick to walk back the idea of a four-to-six-week shutdown to drive down the virus’ spread after it was mentioned by a Biden adviser in an interview with Yahoo Finance. In a round of press appearances, Biden advisers denied the incoming administration would do such a thing, with soon to be Surgeon General Vivek Murthy telling Good Morning America, ​“We’re not in a place where we’re saying shut the whole country down. We got to be more targeted.”

Once in office, Biden made his agenda even more clear. Jeff Zients, the man named as lead strategist of Biden’s pandemic response, was not a doctor or a professional in public health or health policy. Instead, he was brought in straight from the world of private equity to lead a push to reopen businesses and schools. Zients took on the pandemic response with a mantra that demonstrated his total obliviousness to symbolism: ​“Execute, execute, execute,” reportedly uttering the word so frequently that aides had it stitched into a blanket.

Under Zients, Biden’s policy pivoted even farther from collective responsibility and welfare-based interventions.

After famously promising another round of $2,000 stimulus checks, for example, the administration only sent out $1,400 checks, claiming an earlier round of $600 checks made up the difference. Other campaign trail promises never materialized at all, including a 100,000-strong national contact-tracing workforce, ​“rigorous” new Covid-specific guidelines from the Occupational Safety and Health Administration to protect workers, and federally guaranteed paid sick leave for anyone sick with Covid (or caring for someone who is).

The administration also oversaw the dismantling or premature end of pandemic-era welfare expansions, fleeing as many associations with these programs as possible. As expanded unemployment came to an end, the Biden administration didn’t fight to keep it, with unofficial White House adviser Larry Summers — whom aides reportedly nicknamed the ​“shadow director” of the National Economic Council — later erroneously pointing to the program as the main driver of inflation. After a brief expansion of testing infrastructure, the administration scuttled most federally financed testing, and by early 2022, it became almost impossible to truly know how much Covid transmission was even happening. In December 2021, the Biden administration shortened its recommended Covid isolation time from 10 days to just five. This decision wasn’t based on new information about the duration of the average Covid infection (which can often last longer than 10 days), but instead, in Anthony Fauci’s words, because there was a ​“danger that there will be so many people who are being isolated [at one time] … that you could have a major negative impact on our ability to keep society running.” The effect was to keep workers at work, even through illness, at the cost of their health and lives.

Reduced spending on testing and a shortened Covid isolation time came despite some within the Centers for Disease Control and Prevention (CDC) raising the alarm about the ongoing pandemic. An internal CDC slide presentation leaked in summer 2021 acknowledged breakthrough cases were happening; one slide included an appeal to the Biden administration to recognize that ​“the war has changed.” But when presented with real-world evidence that its actions were not controlling the pandemic and might even be exacerbating its effects, the Biden administration stayed the course, never learning from its mistakes.

Most egregiously, the Biden administration spearheaded the mass abandonment (and even stigmatization) of universal masking, still one of the most important pandemic interventions we have. Shortly before entering office, Biden told Jake Tapper that, upon inauguration, he would ask the people for just 100 more days of masking — ​“Just 100 days to mask, not forever.” The Biden administration stuck to this promise despite ongoing Covid deaths and CDC evidence documenting breakthrough infections. In a rush to declare ​“independence from the virus” by Independence Day, the CDC issued a dramatic reduction in masking recommendations May 13, 2021 — 113 days into Biden’s presidency and just 473 days into the public health emergency. Prior to the CDC’s announcement, roughly half of all U.S. states had indoor mask mandates in place. Of those states, at least 20 dropped their mask mandates shortly after the CDC’s announcement, many specifically citing CDC guidance. By July 27, when the CDC reissued masking recommendations — a seeming acknowledgement that their guideline change had been premature — the damage had been done. Only a handful of statewide mask mandates remained across the country, and 15 of the 20 states that allowed mask mandates to expire in spring 2021 have never seen them return. The remaining states dropped their mask mandates by early 2022.

Now the vaccines, long the nearly exclusive focus of the federal pandemic response, are set to be passed to the private market. Once the federal supply of vaccines runs out, uninsured people (and insured people who get the vaccine from an out-of-network provider) will face out-of-pocket payments or copays to get vaccinated and boosted. While the Biden administration has pledged to maintain free vaccination for the uninsured, the details of the plan remain vague. As we come to the end of the first 1,200 days of Covid, the federal government is in such a rush to return things to ​“normal” that even vaccination is not something it can acknowledge as a universal good.

Beyond vaccination, the outlook is worse. Treatments like Paxlovid — a centerpiece of the past year of federal intervention — will be fully privatized and their cost left to insurance companies to determine. Covid testing will also be left to insurance company discretion, further hindering many from seeking treatment while obscuring an already miserably opaque picture of Covid’s ongoing spread. Medicaid expansion ends April 1, bringing with it a wave of eligibility redetermination that will see up to 15 million people lose health insurance.

And yet, as the federal response comes to an end, the pandemic remains unflinching, meaning the first 1,200 days of Covid may soon become a substantive outlier in the broader trajectory of the pandemic.

Alongside the unwinding of pandemic policies, the Biden administration has gone to significant lengths to portray the pandemic as primarily a concern for a small fraction of the population. In 2021, a common refrain for officials was ​“a pandemic of the unvaccinated,” a position Democratic Gov. Jared Polis summarized by saying, ​“If you have been fully vaccinated, the pandemic is largely over for you” in a statement announcing the end of a mask mandate in Colorado. Despite data showing that as many as 60% of Covid deaths in a given month are among the vaccinated, in October 2022 Biden stated that ​“almost everyone who will die from Covid this year will not be up to date on their shots, or they will not have taken Paxlovid when they got sick.” Similarly, in early 2022, in an interview with Good Morning America, CDC Director Rochelle Walensky said it was ​“encouraging news” that the majority of people dying of Covid now had underlying conditions and were ​“unwell to begin with,” a statement that, in addition to devaluing the lives of disabled and immunocompromised people, had no sound evidentiary basis.

The effect of these positions was to paint the ongoingness of Covid as something happening to other people. This form of cruel optimism — shared by liberals and conservatives alike — sought to solidify the idea that the only people dying of Covid were already close to death or were personally responsible for their illness.

In this way, the Biden administration’s pandemic response has placed renewed emphasis on the tenuous, imaginary line that lies between the healthy body and the medically vulnerable body.

Our collective understanding of our relationship to this new virus has been pummeled with fantasies about understanding our own individual risk and acting accordingly. The previous, more solidaristic framings of the pandemic — like the once-common refrain, ​“my mask protects you, your mask protects me” — have slowly eroded, replaced with a slurry of advice about weighing individual costs and benefits based on whether one has pre-existing conditions. This rhetoric of individuated risk has inspired many to feel assured of their own health at the expense of the health of others.

In our book, Health Communism, we show how state policies shape and emphasize these distinctions between the healthy body and the medically vulnerable body in defense of the status quo, a dynamic on full display in the Covid response.

Fantasies of one’s intrinsic health mean little to those with long Covid, including those we’ve spoken to in the past year who developed the condition despite being, in Biden’s words, ​“up to date with their shots.” Many have told us that the experience entirely upended their understanding of their bodies and that, prior to their Covid infection, they would have thought of themselves as archetypally ​“healthy” individuals, a binary they now question. Even more people have told us they now feel more alienated at work than ever, forced by supervisors to work unmasked or risk losing their jobs. When they inevitably get sick, in addition to the risks inherent to the illness itself, they lose shifts and wages, and it throws their home life into chaos as they struggle to keep their families or roommates from becoming ill. Some have described this as feeling like a constant cycle they can no longer imagine ending.

These accounts reflect a reality the Biden administration has failed to understand. There is no individuated escape from the pandemic. There is no ​“targeted intervention” that will end it for some but not all. A pandemic is an inherently relational phenomenon, and transmission is a social process. The rhetoric and policy of personal responsibility and individuated risk has been literalized on us by force. To counter it, we will need to take aim at the state.