A FEMA Mobile Vaccination Unit in New Britain, pictured in 2021. Yehyun Kim / ctmirror.org

Two months after Connecticut quietly marked its third COVID anniversary and the virus’ death toll surpassed 12,000, the state ended its long-running public health emergency.

The move mirrored a similar one at the federal level. The national public health emergency expired in May, prompting a shift in how testing, treatments and vaccines are paid for and how data are gathered and shared.

In Connecticut, it meant changes in daily reporting on cases and hospitalizations, the conclusion of state-run testing sites that have been a hallmark of efforts to curb the virus’ spread, the rollback of vaccination programs and modifications in how testing and treatments are covered.

State leaders say they hope COVID will become a seasonal illness, though it has yet to conform to the same cycle as the flu and other fall and winter ailments.

Still, they said, when it comes to cases, hospitalizations and other indicators, Connecticut is in a different place.

“Where we are at this stage of the pandemic and our experience with this virus, and communal immunity puts us in a different stage three years in than we were in 2020, even in 2021,” said Dr. Manisha Juthani, the state’s public health commissioner.

At a recent event, Juthani said she considers the virus to now be in the endemic stage.

“We are in a place where COVID is part of our society and is part of what we are living with. That does not mean there aren’t going to be times when we have resurgence, and we have to deal with that,” she said. “But we do recognize that three years into this, the virus is not going away, [it] will need to be managed, and my hope is that it’s going to be managed on a seasonal basis.”

So how should residents be thinking about COVID and assessing risk? What options are there for uninsured people? What happens if another wave of the virus hits Connecticut?

Here are some key things to know about the end of the state and federal public health emergencies.

How can I calculate risk?

People 65 and older and those who have not received a COVID vaccination or an updated booster shot are at higher risk for serious outcomes, Juthani said.

“COVID is still worse. People ask me, ‘Is it the same as the flu?’ It is not the same,” she said.

For years, Connecticut had been posting daily COVID statistics, including the positivity rate and number of hospitalizations. But the updates ceased on June 1. Now, the state will issue information about case rates, hospitalizations and deaths only from October to late May or early June.

The next reporting period is scheduled to begin on Oct. 5. At that point, COVID data will be reported on a weekly basis, rather than daily.

With the rise of home rapid tests, a dwindling number of people have been getting PCR tests, which are reflected in the state’s positivity rate.

“We know that those numbers are an underestimate,” Juthani said. “They’re a far underestimate [due to] self-testing. [People are] not PCR testing. It’s not where we could even capture all of those numbers.”

With fewer people taking PCR tests and the state no longer posting daily updates, health officials point to wastewater tracking as a good marker of COVID spread in the community.

Yale University researchers have been collecting samples from a New Haven water treatment facility and posting regular data on incidences of the virus found in wastewater. Their charts capture surges and dips throughout the year.

The project has been running for several years, and funding from a private donor will keep it going for at least a couple more, said Jordan Peccia, a professor of environmental engineering at Yale who leads the wastewater testing there. The program also tracks influenza, norovirus, RSV and mpox, among other diseases.

Peccia sees wastewater data as a primary means of assessing COVID spread.

“We see this as a better way to do it, because everybody could see the writing on the wall, that testing was going to go away,” he said.

Wastewater tracking is “easy and it’s accurate,” Peccia said. “It’s more accurate than the testing data right now. …  [People] can look at it, and they should look at it. It is directly proportional to the risk.”

Data from the New Haven wastewater project can be found on its website.

As people think about risk, advocates are reminding public health officials to also consider people who are immunocompromised.

“For the majority of the population who enjoys good health, and is appropriately vaccinated and boosted, I think it is reasonable to return to normal,” said Marney White, a clinical psychologist and professor of public health.

But assessing risk will continue to be more complicated for those who are immune-suppressed, just as it has been since the pandemic began. Public health guidelines have mostly left immunocompromised people behind, said White, who herself is immunocompromised.

“It’s really gone away from public health and put the very difficult responsibility on the shoulders of the individual, which is the antithesis of public health,” said White. “What’s really missing for people with various degrees of immunocompromised status are the data on exactly what type of immunosuppression is a problem.”

How is coverage changing?

The cost of PCR tests will transition to traditional health coverage and may be covered fully or partially by a person’s private insurance or by public plans such as Medicaid or Medicare. At-home testing kits will also no longer be paid for with federal funding. It will now be up to individual insurers whether to cover them.

Several carriers have indicated that the cost of rapid home tests must now be paid out of pocket.

Anthem, one of the largest insurers in Connecticut, said it will discontinue coverage of at-home COVID tests but will cover PCR testing if a doctor prescribes it.

“Since the beginning of the pandemic, Anthem Blue Cross and Blue Shield has worked to ensure access to COVID-19 testing and treatment. As the emergency designation for the pandemic ends, our coverage of over-the-counter, at-home COVID-19 test kits will also conclude,” said Stephanie DuBois, a spokeswoman for the company.

ConnectiCare, which offers health plans on and off the state’s Affordable Care Act exchange, has also stopped covering at-home tests under most policies.

“Over-the-counter, at-home COVID-19 tests are not covered by most ConnectiCare plans,” the insurer noted on its website. “You will pay the full cost of your test. You may be able to use your FSA/HSA funds to pay these costs.”

PCR and rapid lab tests are covered when an in-network health provider orders it, the company said.

Officials with United Healthcare and Cigna, two other large insurers, did not return calls seeking comment.

The state of Connecticut health plan will continue covering COVID lab tests, vaccines and boosters at in-network providers at no cost to enrollees. But COVID-related provider visits will now require a co-pay.

Vaccines and boosters are also transitioning away from federal funding to private and public health plans. “It is anticipated that most private and public insurance plans will continue covering all costs of COVID vaccinations and boosters without a co-pay or cost-share,” state health officials said in a statement.

The federal government plans to distribute all remaining COVID vaccines in its inventory to health care providers and pharmacies until the inventory is depleted or expires, state officials said. Those shots will still be provided to people at no cost.

With more people having to pay out of pocket for home testing kits, officials said, fewer people will probably test for the virus.

“The impetus to test and isolate will be much less for many people,” Juthani said. “[But] even with those choices, we’ve seen a health care system that has been able to cope in our last winter wave. That gives me some confidence that moving in this direction is something as a society we will be able to manage.”

Where can I go for care?

For the most part, where people go to get vaccines, testing and treatment has not changed with the end of the public health emergency, though the cost of these services could, depending on insurance coverage.

“I think in terms of the routine things — vaccinations, testing — our society has gotten to a place where we know where we can get all of those things,” Juthani said.

People can visit their primary care providers or community health centers for testing, vaccines and treatment. Many pharmacies are providing PCR testing for people with a doctor’s order, as well as COVID vaccines and booster shots.

What if I’m uninsured?

Under the public health emergency, Connecticut provided free Medicaid coverage of testing, testing-related provider visits, vaccines and treatment for COVID to uninsured residents, both citizens and non-citizens, of any income level. That ended with the public health emergency.

Vaccines and pharmaceutical treatments, like Paxlovid, will remain free to all people, regardless of insurance coverage, until the federally purchased supply of these products runs out.

For other COVID care, people who are uninsured should now go to providers that they would visit for any other medical care, such as free clinics and federally qualified health centers, Juthani said.

“If you’ve got high blood pressure and diabetes or you’re pregnant and you need care, you’re going to go somewhere,” she said. “And it’s those same places where you can go to get COVID care as well.”

The Centers for Disease Control and Prevention keeps a list of no-cost testing centers.

What happens if there is another surge?

If demand for PCR testing increases again, Connecticut will rely on private partners and others to provide the service, Juthani said. The last four state-supported testing sites, now running in community health centers, will cease operations on June 30, and the public health department will end its mobile vaccination clinics on the same day.

“I think we’ve transitioned back to health care as we normally know it,” she said. “The Department of Public Health is not usually in the business of direct delivery of care. That is something we often contract for different things or rely on our partners in the private sector, the public sector, even other state agencies … but that is not what DPH usually does. We had to enter that for the purposes of a pandemic.”

The health department will continue to collect and analyze COVID data, even though it is not publicly posting it during the next four months.

“The role that the Department of Public Health will primarily play is alerting people to the fact that a surge is coming. Just because we’re not reporting the data on a daily basis or weekly basis doesn’t mean we don’t have our eyes on it,” Juthani said. “I’ll still be looking at it regularly, our team will be reviewing these data regularly. If something changes, we will alert people accordingly.”

During the first year of the pandemic, the Connecticut Hospital Association hosted daily calls where providers of all types could raise issues they were facing. Karen Buckley, vice president at CHA, would coordinate efforts to resolve those issues.

It was during these calls that many statewide efforts, like getting protective gear to home care providers and sourcing ventilators, came together. While CHA no longer conducts daily calls, those efforts laid the foundation for any necessary coordination in the future.

“It provided an efficient way to kind of get to answers when every second and every minute counted for us to get things done,” said Buckley. “It’s a structure that’s in place that we could pull up right away if we needed to.”

What’s the status of booster shots?

For people who have not been vaccinated against COVID, the CDC now recommends a single dose of the bivalent shot.

One bivalent vaccination is recommended for people 6 and older, regardless of whether they have already had the primary two-dose series.

People 65 and older who received their first bivalent shot at least four months ago are now eligible for a second bivalent vaccination, as are people 6 and older who are immunocompromised and received their first bivalent shot at least two months ago.

Children 6 months to 5 years old may need multiple doses of the vaccine to be up to date, including at least one dose of the bivalent shot, depending on their age and what they’ve previously received, according to the CDC.

More information can be found here.

Health officials say an additional booster for the broader population will probably be recommended later this year.

“Coming into this fall, we will definitely make a big push for people to understand that most likely everybody’s going to be recommended to get another shot,” Juthani said. “That’s what’s going to keep us as a society most protected.”

Jenna is CT Mirror’s Health Reporter, focusing on health access, affordability, quality, equity and disparities, social determinants of health, health system planning, infrastructure, processes, information systems, and other health policy. Before joining CT Mirror Jenna was a reporter at The Hartford Courant for 10 years, where she consistently won statewide and regional awards. Jenna has a Master of Science degree in Interactive Media from Quinnipiac University and a Bachelor or Arts degree in Journalism from Grand Valley State University.

Katy Golvala is a member of our three-person investigative team. Originally from New Jersey, Katy earned a bachelor’s degree in English and Mathematics from Williams College and received a master’s degree in Business and Economic Journalism from the Columbia Graduate School of Journalism in August 2021. Her work experience includes roles as a Business Analyst at A.T. Kearney, a Reporter and Researcher at Investment Wires, and a Reporter at Inframation, covering infrastructure in Latin America and the Caribbean.