States call on Biden to shift from pandemic to endemic policy

WASHINGTON — State and local elected leaders are urging the Biden administration to produce a road map for dealing with COVID-19 going forward, to transition from the emergency demands of a pandemic to coping with an ever-present virus.

The growing calls for action come as the Centers for Disease Control and Prevention prepares to release new federal guidelines for masking.

"What does the road from pandemic to endemic look like, and how do we keep score? There was broad agreement that’s the task before us," New Jersey Gov. Phil Murphy told reporters outside of the White House last month after a meeting between President Joe Biden and the National Governors Association.

All but one state — Hawaii — has announced in recent weeks plans to lift or scale back masking requirements as infection rates continue to drop following a monthslong surge propelled by the highly transmissible Omicron variant.

New York Gov. Kathy Hochul, just days after attending the Jan. 31 governors meeting at the White House, announced that effective Feb. 10 the state would suspend its indoor mask or proof vaccination mandate, but would hold off on lifting masking requirements for schools and child care centers until further assessing health data in the first week of March.

After a string of states run by Democratic governors, including New York, New Jersey, Massachusetts, Delaware and California, announced their plans to ease masking requirements earlier this month, the White House found itself facing questions about when the CDC would move to revise its federal guidance.

Asked if states and localities were moving too soon to lift requirements, Biden in an interview with NBC News last week said: "I’ve committed that I would follow the science — the science as put forward by the CDC, and the federal people, and I think it’s probably premature, but it’s, you know, it’s a tough call."

CDC Director Rochelle Walensky, in the days after New York, New Jersey and others announced their new guidelines, said "now is not the moment" to change indoor masking policies and stood by the agency’s decision to continue recommending masks in schools and other public areas.

"We have and continue to recommend masking in areas of high and substantial transmission — that is essentially everywhere in the country in public indoor settings," Walensky told Reuters in a Feb. 8 interview.

A week later, as more states continued to adjust their masking requirements, Walensky in a briefing with reporters said the CDC will "soon" issue new masking guidance based not only on infection rates but hospitalization rates.

"Things are moving in the right direction, but we want to remain vigilant to do all we can, so that this trajectory continues," Walensky said. "We want to give people a break from things like mask-wearing when these metrics are better and then have the ability to reach for them again. Should things worsen, if and when we update our guidance, we will communicate that clearly and it will be based on the data and the science."

Part of the challenge for the Biden administration in creating a road map for a "new normal" with COVID-19 is establishing the metrics for what would create the conditions for moving to an endemic phase of the virus, said Dr. J. Alexander Navarro, the assistant director for the University of Michigan’s Center for the History of Medicine in an interview with Newsday.

"The tricky thing is we don't really know what endemic COVID is going to look like," said Navarro, who has studied the responses of past pandemics. "We're all throwing this term out ‘endemic COVID,’ but there's no definition of it and we won't have a definition of it until we're there … there's no standardized metric."

A trio of Biden’s former public health advisers during his presidential transition issued an opinion piece in the Journal of the American Medical Association in January, calling on the president and his administration to establish expectations for what an endemic phase of the virus would look like.

"What constitutes appropriate thresholds for hospitalizations and death, at what cost, and with what trade-offs remains undetermined," wrote Ezekiel Emanuel, Michael Osterholm and Celine Gounder, all physicians who previously advised Biden.

Asked about the concerns raised by the advisers, and whether the administration officials believed the virus is "here to stay," White House Press Secretary Jen Psaki said "the president’s ultimate goal continues to be to defeat the virus. The president’s focus and objective now is to save as many lives as possible."

Julia Lynch, a political scientist at the University of Pennsylvania, who specializes in public health policy, said as federal and state officials continue to formulate their plans, they should take into consideration that transmission and hospital rates will continue to vary between communities, especially in marginalized communities that have been hit hardest by the virus since its onset.

"We're all tired of the pandemic, and we all want to return to some kind of normal, but in some communities that haven't really been all that hard hit by the pandemic to begin with, where there haven't been huge numbers of children whose parents have died, where there weren’t scores of people who've lost family members … it looks reasonably safe for us to declare the pandemic over and for us to try to return to some kind of normal. But huge parts of the country aren't in that circumstance," Lynch said.

Navarro said that as elected leaders look to define a new sense of normalcy after more than two years of COVID-19 circulation through society, Biden and federal health officials will probably be hesitant to declare an outright end to the pandemic given that the surprise surges caused by the delta and omicron variants demonstrated the possible emergence of more fast-spreading variants.

"I think everyone's a little leery of declaring it over," Navarro said. "Politicians don't want to declare it over, but they also want to act like it's over, because there's a lot of social political pressure to move on and move beyond."