photo by: Sylas May

In many ways, the coronavirus pandemic’s outsized impact on folks’ daily lives began to wane months ago.

So much so, in fact, that data reporting has dropped in frequency — or even ceased entirely — in the case of entities like Lawrence-Douglas County Public Health. The county as of Friday had recorded 182 COVID-19 deaths in the more than three years since the start of the pandemic in March of 2020, according to the health department, and LMH Health has recorded 1,179 hospital admissions for the virus.

Another set of changes related to the pandemic took effect earlier this month and they, too, reflect its waning effect on day-to-day life. As of May 11, the federal government is no longer categorizing COVID-19 as a national public health emergency, and that means some of the policies and provisions adopted during the height of the pandemic are expiring, too.

A panel with LMH Health spoke with the Journal-World this past week about what exactly has changed now that the public health emergency has been allowed to expire, and what those changes mean for the average patient in Lawrence.

The end of rolling Medicaid coverage

Perhaps the most significant change is the end of continuous Medicaid coverage, but that benefit actually halted federally on March 31 with the passage of the $1.7 trillion omnibus spending bill funding the U.S. government for the 2023 fiscal year. Since 2020, states haven’t been required to regularly check whether people had renewed their enrollment in Medicaid and were still eligible, instead just keeping everyone on the rolls.

But that’s no longer the case, and states have up to 12 months to return to normal Medicaid eligibility and enrollment operations. Traci Hoopingarner, LMH Health’s vice president for clinical care and chief nursing officer, told the Journal-World continuous Medicaid coverage began to unwind in Kansas at the beginning of May. That means folks with Medicaid now have to go back to the usual annual renewal process or risk losing their coverage — even if they’re eligible.

“Some concerns of ours is people who might show up and think ‘Oh, wow, I still have Medicaid’ and not realize that they should have renewed,” Hoopingarner said. “… When you think about coverage and things and you come to the hospital, you might think that your care’s being paid for and it might not (be).”

She said she’d encourage folks in the community who rely on Medicaid coverage to visit the marketplace at healthcare.gov or on the federal Medicaid website. Folks with private insurance, meanwhile, should speak directly with their providers if they have questions about billing changes, Hoopingarner said.

Changes in testing and masking

LMH Health announced that wearing a face mask would be optional at most LMH Health facilities back in March, and there hasn’t been a blanket mask mandate in Douglas County in well over a year. Hoopingarner said at LMH Health, masking — and COVID testing — will now only be required for patients who come to the hospital with symptoms of the virus. Previously, LMH Health was testing every patient who was going to be admitted or undergo a surgery or another invasive procedure.

The relaxation of those requirements also extends to providers like Dr. Christopher Penn, an infectious disease physician at the hospital.

“I make it really clear to my patients that if they want me to wear a mask, unless they’re symptomatic or there’s a reason they’re in a certain type of isolation, I will certainly defer to the patient’s wishes,” Penn said. “… Here at the office, I check with each one before I go in and just kind of read the situation. Certainly, I want patients to feel comfortable with what we’re doing.”

Penn added that, in his opinion, there’s a “pretty low threshold” for testing for COVID despite how it may have been relaxed at LMH Health, given its wide variety of possible symptoms.

And Hoopingarner said staff will automatically default to wearing the proper personal protective gear when working with patients who are COVID-positive. The hospital has PPE guidelines for any infectious disease staff has to work with, she said.

Broad masking won’t necessarily go away forever; if there’s an outbreak of COVID in one of LMH Health’s nursing units in the future, Hoopingarner said patients may be asked to wear masks more broadly again.

“Just because the government announced the end of COVID, it doesn’t really mean it’s the end of COVID,” Hoopingarner said. “Things might change at the hospital, depending on the situation.”

What will be sticking around?

The federal public health emergency allowed folks on Medicare to access telehealth services regardless of their geographic location, which means folks age 65 and older have been able to receive care from their homes. Those waivers will continue through Dec. 31, 2024.

COVID vaccines will also continue to be provided free of cost as long as the federal stockpile lasts, Hoopingarner said. After that, they’ll be covered by insurance.

Though only for the short term, a program allowing folks to order free COVID test kits through the mail is here to stay through June 30, Hoopingarner said. That’s a result of a partnership between the Kansas Department of Health and Environment and The Rockefeller Foundation.

The Journal-World wasn’t able to reach anyone with KDHE to confirm that date Friday, but entering a Lawrence zip code on the website for requesting tests results in a message that tests are still available.

Other changes more clerical in nature

The federal government had waivers in place during the pandemic that allowed hospitals to approach documenting patients with less stringency, Hoopingarner said, such as in scenarios like if the hospital experienced a huge surge in patients. That also applied to being able to house patients in units they wouldn’t otherwise be able to utilize.

The amount of mandatory reporting the hospital has to do has just decreased in general as a result, she said. That’s one of a number of changes she said have been a product of gradual adjustments to life throughout the pandemic.

“I think a lot of the declaration of the end of the emergency, so much of that was clerical and data acquisition,” Penn added. “It will impact us a bit in information that we get from agencies with respect to knowing if there’s a big outbreak in our area … (so) we’re not going to get that very specific information. We still know what’s happening in the hospital; I think that’s a good cross-section, and we still look at our numbers every day.”

What to expect moving forward

Penn said vaccination guidelines have been simplified for most adults and getting a bivalent booster can be thought of as a “one and done” need for folks who haven’t gotten one already until we hear otherwise. He said folks who are 65 and older or are severely immunosuppressed might consider speaking with their health care provider about getting a second booster shot, though.

Penn said getting a second booster shouldn’t disqualify folks from getting whatever COVID booster may be recommended in the fall. Moving forward, he said he expects an annual vaccination schedule similar to getting a yearly influenza shot will be the norm.

As for Paxlovid, the brand name for the oral medication used as a treatment for COVID, Penn said he’s unsure of what will happen to its cost. The drug still doesn’t have full approval from the U.S. Food and Drug Administration, but it’s something to keep an eye on.

And as has been the message from folks working in public health since the beginning of the pandemic in 2020, the common refrains of exercising caution and using proper mitigation tactics to prevent the spread of COVID aren’t going anywhere.

“I think we’ve gained a lot of tools through the pandemic,” Kate Kuzmyak, an infection prevention manager with LMH Health, told the Journal-World. “We have hand sanitizer more widely available, there’s masks more widely available, tests now. Hopefully, as one of the lessons learned from this pandemic, we keep using all of those tools to keep ourselves and each other safe.”