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Biden administration extends the COVID public health emergency as the highly transmissible Kraken variant drives U.S. cases upward

January 11, 2023, 7:50 PM UTC
President Joe Biden (right) renewed the COVID public health emergency on Wednesday for an additional 90 days.
Yuri Gripas—Abaca/Bloomberg/Getty Images

The Biden administration on Wednesday extended the COVID-19 public health emergency until April as “Kraken” XBB.1.5, the most transmissible Omicron variant seen yet, drives cases upward.

The public health emergency has been extended every 90 days since it was first declared by the Trump administration in January 2020. 

Some public health experts predict that Wednesday’s extension will be the last. The U.S. Department of Health and Human Services has committed to providing states with a 60-day warning if federal officials intend to end the state of emergency, Bloomberg reported Wednesday. That means a warning could go out to states as early as February. HHS officials warned states in August that an end to the public health emergency could come in the near future.

Both the White House and the HHS declined to comment on when the declaration might end, Bloomberg reported Wednesday.

‘If everything’s an emergency, nothing is’

“From a functional perspective,” federal officials “can’t keep the emergency state forever,” Dr. Georges Benjamin, executive director of the American Public Health Association, told Fortune on Tuesday, prior to Wednesday’s announcement. 

“It’s got to go away at some point. And I think we’re quickly approaching that point.”

In addition to allowing expanded access to public health care for millions, the emergency declaration has given hospitals flexibility in managing patient surges, and expanded access to telehealth. But keeping the U.S. in such a state desensitizes Americans to the pandemic and public health emergencies in general, Benjamin said.

“The policymakers don’t want to fund it anymore; people don’t want to pay attention to it anymore,” he said. “It’s a human behavior thing. If everything is an emergency, nothing is.”

But declaring an end to the emergency doesn’t mean the pandemic’s over, Benjamin cautioned. “It doesn’t mean anything,” he said. Case in point: “We’re not in a public health emergency and we still have an HIV/AIDS pandemic.”

Terminating the national public health emergency would allow for one to be declared again if evolving COVID variants become severe enough to warrant such a move, Benjamin added.

WHO committee could declare global health emergency over

A World Health Organization committee will convene on Jan. 27 to determine if COVID still constitutes a global public health emergency, Reuters reported Tuesday. WHO Director-General Dr. Tedros Adhanom Ghebreyesus recently expressed hope that the emergency status could draw to a close this year. 

But some experts warn that now is too soon—especially given unprecedented levels of infection in China following the recent relaxation of its “zero COVID” restrictions. Chinese officials are underreporting levels of disease spread, hospital capacity, and deaths in the country, WHO officials reiterated Wednesday, so the extent of the situation there isn’t known. But ultrahigh levels of viral circulation in China place the world at a statistically higher risk of a dangerous new variant developing, experts warn.

“The world cannot close its eyes and hope the virus will go away. It won’t,” Ghebreyesus said at a Wednesday news conference. “You may not die with this disease. But you could give it to someone else who does.”

Kraken on U.S. warpath

The extension of the U.S. public health emergency comes as the ultra-transmissible XBB.1.5 variant continues on a path to become the most dominant variant in the U.S. 

A combination of two Omicron BA.2 strains, XBB.1.5 was behind 18% of COVID cases nationally last week, the Centers for Disease Control and Prevention (CDC) said Friday. It’s projected to fuel 28% of cases this week, making it the second most common variant in the U.S.—and putting it on track to become the most dominant in the States, according to a Jan. 5 memo from the European Centre for Disease Prevention and Control (ECDC).

Kraken is estimated to double the number of people it sickens every nine days, according to the ECDC’s report.

It’s unknown whether the variant is contributing to a rise in hospitalizations in the northeast U.S., where it’s thriving, WHO officials said last week. But experts told Fortune this week that Kraken is likely playing at least a part in the regional rise in hospitalizations—and that the rise could spread, as case levels of the new variant rise in more Western states.

“The rise in hospitalizations being seen in the Northeast may eventually be seen throughout the U.S., if the XBB.1.5 subvariant is helping fuel this rise and this subvariant continues to spread throughout the rest of the country,” Dr. Bruce Y. Lee, professor of health policy and management at the City University of New York School of Public Health, told Fortune.

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