Hospitals strain, but states resist health emergencies

Hospitals are once again packed to capacity and public health resources and infrastructure are strained as the nation grapples with waves of Covid, influenza and respiratory syncytial virus.

But unlike the onset of the Covid pandemic almost three years ago, when states instituted emergency orders, mask mandates and school and business closures, governments are pursuing a more more targeted and traditional response to a winter of woe.

Just 11 states still have Covid-related public health emergencies in effect.

Today, public health officials are embracing a holistic approach to Covid and other respiratory viruses, as seasonal fluctuations in infections become an accepted part of life and the public becomes less likely to modify their behavior.

“Our goal is to get our state to a new normal in which we manage disruptions like Covid-19, but also one in which we which we really take seriously, and apply the lessons from the very difficult experiences we’ve shared over the past 33 months now,” Minnesota Department of Health Commissioner Jan Malcolm said in a call with reporters this week. 

Every state has a different legislative framework for emergency declarations, with some giving public health officials the authority to issue limited proclamations and a handful allowing the governor to seize broad, open-ended powers. 

Typically, such measures are meant to be temporary, giving states the resources to tend to a crisis until it has passed. During the Covid pandemic, governors in many states extended emergency orders multiple times, leading to criticism that they upset the balance of power and curbed too many personal freedoms. 

Similar orders are unlikely to be met with much support from the public now, said Jason Mercier, director of the Center for Government Reform at Washington Policy Center, which has advocated for limitations on the governor’s ability to declare emergency powers after a Covid-related state of emergency declared by Gov. Jay Inslee lasted 975 days and limited legislative authority over that period. 

“The only reason why we saw some of the initial public support for what we saw in the Covid orders was the unknown,” he said, adding that the viruses currently circulating – which at this point includes Covid – are common. 

In the States that still have Covid-related emergency declarations in place – California, Colorado, Kansas, New Mexico, Texas, Illinois, Georgia, West Virginia, Delaware, Connecticut and Rhode Island – officials have allowed indoor mask mandates to expire. The orders that remain are focused largely on economic issues, like funding for vaccination and testing centers, addressing supply chain disruptions or hospital staffing shortages.

There is also a federal public health emergency related to Covid 19 in place until at least Jan. 11. 

Since November, two states – New Mexico and Oregon – have declared new public health emergencies to address respiratory illnesses. 

Colorado expanded its Covid-19 disaster emergency to include other respiratory viruses and extended it until January. 

Those orders are crafted to help hospitals deal with overwhelming numbers of patients while they are still grappling with staffing shortages exacerbated by the pandemic. 

The New Mexico declaration requires all hospitals in the state to return to a “hub and spoke” model of resource management they used early in the pandemic to make it easier to transfer patients between hospitals depending on how sick they are. It also allows the Division of Health Improvement to submit waivers to the Centers for Medicare and Medicaid Services to approve bed capacity expansion and any other measures necessary by hospitals to treat the increase in RSV cases. 

Other states, including Oklahoma and Connecticut, have relaxed rules regarding the allocation of hospital beds but have stopped short of issuing an emergency declaration. 

Public health officials in Washington State, New York and Los Angeles are urging a return to indoor masking as infection rates climb, though elected officials have not instituted any orders requiring masks.

Malcolm, the Minnesota Department of Health commissioner, and State Epidemiologist and Medical Director Ruth Lynfield stressed the importance of staying up to date on Covid and flu vaccinations, covering coughs and staying home if you are sick. 

But Malcom said the state does not have a provision for public health officials to issue emergency declarations — something she said lawmakers might want to consider introducing. 

“The only tool is the declaration of a peacetime emergency by the governor, which is a very, very broad action to take,” she said.  

The state’s peacetime emergency declaration to address the Covid pandemic ended in July of 2021.