• President Joe Biden recently claimed the "pandemic is over," but the extension of the public health emergency indicates the administration does not believe the U.S. is out of the woods yet.
• The public health emergency, first declared in January 2020 by the Trump administration, has been renewed every 90 days since the pandemic began.
• The powers activated by the emergency declaration have had a vast impact on the U.S. health-care system and social safety net.

The U.S. has extended the Covid public health emergency through Jan. 11, a clear demonstration that the Biden administration still views Covid as a crisis despite President Joe Biden's recent claim that the pandemic is over.

The public health emergency, first declared in January 2020 by the Trump administration, has been renewed every 90 days since the pandemic began. The powers activated by the emergency declaration have had a vast impact on the U.S. health-care system and social safety net, allowing hospitals to act more nimbly when infections surge and keeping millions enrolled in public health insurance.

Biden, in a September television interview, claimed the "pandemic is over" though he said Covid will continue to present a health challenge. The Centers for Disease Control and Prevention in August said high levels of immunity in the U.S., combined with the wide availability of vaccines and treatments, has significantly reduced the threat that Covid poses to the nation's health.

But hospitals and pharmacies called for the Health and Human Services Department to keep the public health emergency in place until the U.S. has a sustained period of low Covid transmission. Hospitals in particular have been slammed with patients every fall and winter since the pandemic began, at times pushing them to the breaking point.

White House chief medical advisor Dr. Anthony Fauci, in an interview earlier this month, said the president's comments were "problematic" because some people might let their guard down and not stay up to date on their vaccines.

"It's obvious that could be problematic because people would interpret it as it's completely over and we're done for good, which is not the case — no doubt about that," said Fauci, who is stepping down in December.

The emergency declaration gives federal agencies broad authority to expand certain programs without congressional approval. The Centers for Medicare and Medicaid, under HHS, dramatically expanded enrollment in Medicaid, public health insurance for low-income people, to a historic record of more than 89 million people. HHS also expanded telehealth services and gave hospitals flexibility in how they can deploy staff and beds when a surge of patients stresses capacity.

HHS Secretary Xavier Becerra told reporters in a call last week he would give 60 days' notice to states, health-care providers and other stakeholders before lifting the public health emergency. This means HHS should inform them in November if the agency plans to lift the emergency in January.

Whenever the public health emergency does finally end, it will have dramatic impact on health care in the U.S. HHS estimates that as many as 15 million people will lose their Medicaid coverage. Hospitals also risk losing the flexibility they have come to rely on during Covid. Millions of struggling families will also lose supplemental money through the federal government's nutrition program.

HHS has also vastly expanded the role of pharmacies in administering vaccines in the U.S. by temporarily overriding state laws that, in some cases, limited which vaccines pharmacists could administer to certain age groups. It's not yet clear whether the nationalization of pharmacy vaccine rules will expire when HHS decides to lift public health emergency.

The Biden administration is relying on pharmacies to administer updated boosters for people ages 5 and older that target the dominant omicron BA.5 subvariant. Federal health officials believe the new shots will provide better protection against infection and disease compared with the old ones, which are not performing as well as they once did because the virus has mutated so much.

Public health officials are worried about another major Covid surge this winter as people head indoors, where the virus spreads more easily, to escape the colder weather and as families gather during the upcoming holiday season.

Infections, hospitalizations and deaths have declined dramatically since the peak of the massive omicron surge in January, but more than 300 people are still dying every day from Covid on average and nearly 3,500 patients are hospitalized with the virus daily, according to CDC data.

Dr. Ashish Jha, head of the White House Covid task force, said last week that 70% of those dying from Covid are age 75 and older. The vast majority of those dying are either not up to date on their vaccines or are not receiving treatments such as Paxlovid when they have breakthrough infections, Jha said.

"This is unacceptable, particularly because we can now prevent almost every Covid death in the country with vaccines and treatments that we have," Jha told reporters during a call. "If you are up to date on your vaccines and you get treated when you have a breakthrough infection, your chances of dying are close to zero even in that high-risk population," he said.

Fauci said earlier this month that the U.S. is heading in the right direction, but Covid deaths are still too high. It's also possible a new variant could emerge this winter that can evade immunity even more than the omicron variants the U.S is dealing with right now, he said.

"Although we can feel good that we're going in the right direction, we can't let our guard down," Fauci said.