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What does ending the emergency status of the COVID-19 pandemic in the US mean in practice? 4 questions answered

The emergency status allowed the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficientl…



COVID-19 hasn't vanished, but at this point it's doing less damage. Klaus Vedfelt/DigitalVision via Getty Images

The COVID-19 pandemic’s public health emergency status in the U.S. expires on May 11, 2023. And on May 5, the World Health Organization declared an end to the COVID-19 public health emergency of international concern, or PHEIC, designation that had been in place since Jan. 30, 2020.

Still, both the WHO and the White House have made clear that while the emergency phase of the pandemic has ended, the virus is here to stay and could continue to wreak havoc.

WHO Director General Tedros Adhanom Ghebreyesus noted that, over that time, the virus has taken the lives of more than 1 million people in the U.S. and about 7 million people globally based on reported cases, though he said the true toll is likely closer to 20 million people worldwide. While the global emergency status has ended, COVID-19 is still an “established and ongoing health issue,” he said.

The Conversation asked public health experts Marian Moser Jones and Amy Lauren Fairchild to put these changes into context and to explain their ramifications for the next stage of the pandemic.

1. What does ending the national emergency phase of the pandemic mean?

Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders.

In practical terms, it means that two declarations – the federal Public Health Emergency, first declared on Jan. 31, 2020, and the COVID-19 national emergency that former President Donald Trump announced on March 13, 2020, are expiring.

Declaring those emergencies enabled the federal government to cut through mountains of red tape to respond to the pandemic more efficiently. For instance, the declarations allowed funds to be made available so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made funding and other resources available to launch investigations into the “cause, treatment or prevention” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency.

The emergency status also allowed the federal government to make health care more widely available by suspending many requirements for accessing Medicare, Medicaid and the Children’s Health Program, or CHIP. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and enabled Medicaid and Medicare to more easily cover telehealth services.

Finally, the Trump administration used the national emergency to invoke Title 42, a section of the Public Health Service Act that allows the federal government to stop people at the nation’s borders to prevent introduction of communicable diseases. Asylum seekers and others who normally undergo processing when they enter the U.S. have been turned away under this rule.

2. What domestic policies are changing?

An estimated 15 million people are likely to lose Medicaid or CHIP coverage, according to the federal government. Another analysis projected that as many as 24 million people will be kicked off the Medicaid rolls.

Before the pandemic, states required people to prove every year that they met income and other eligibility requirements. This resulted in “churning” – a process whereby people who did not complete renewal paperwork were being periodically disenrolled from state Medicaid programs before they could reapply and prove eligibility.

In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. From February 2020 to March 31, 2023, enrollment in Medicaid and CHIP grew by nearly 23.5% to a total of more than 93 million. In a December 2022 appropriations bill, Congress passed a provision that ended continuous enrollment on March 31, 2023.

The Biden administration defended this time frame as sufficient to ensure that patients did not “lose access to care unpredictably” and that state Medicaid budgets – which received emergency funds beginning in 2020 – didn’t “face a radical cliff.”

But many people who have Medicaid or who enrolled their children in CHIP during this period may be unaware of these changes until they actually lose their benefits over the next several months.

At least five states already began disenrolling Medicaid members in April. Other states are sending out termination letters and renewal notices and will disenroll members starting in May, June and July.

Only Oregon has set up a comprehensive program to minimize disenrollments. That state is running a five-year federal demonstration program that allows it to temporarily let people stay on Medicaid if their income is up to 200% of the federal poverty level and lets eligible children stay on Medicaid through age 6. Many other states are trying more limited strategies to improve the renewal process and decrease churning.

The array of telehealth services that Medicare began covering during the pandemic will continue to be covered through December 2024. Medicare is also making coverage for behavioral and mental telehealth services a permanent benefit.

The end of the emergency also means that the federal government is no longer covering the costs of COVID-19 vaccines and treatments for everyone. However, in April, the Biden administration announced a new $1.1 billion public-private “bridge access program” that will provide COVID-19 vaccines and treatments free of charge for uninsured people through state and local health departments and pharmacies. Insured individuals may have out-of-pocket costs depending on their coverage.

The end of the emergency lifts the pandemic restriction on border crossing. Large numbers of migrants have gathered at the Mexico-U.S. border and are expected to enter the country in the coming weeks, further straining already overwhelmed staff and facilities.

3. What does this mean for the status of the pandemic?

A pandemic declaration represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more U.S. states and that controlling it requires an international response. But declaring an end to the emergency doesn’t mean a return to business as usual.

New global guidelines for long-term disease management of COVID-19, released on May 3, 2023, urged countries “to maintain sufficient capacity, operational readiness and flexibility to scale up during surges of COVID-19, while maintaining other essential health services and preparing for the emergence of new variants with increased severity or capacity.”

Former White House COVID-19 response coordinator Deborah Birx recently warned that the omicron COVID-19 variant continues to mutate and may become resistant to existing treatments. She called for more federally funded research into therapeutics and durable vaccines that protect against many variants.

Birx’s warnings come as remaining states have ended their COVID-19 press briefings and shut down their exposure notification systems, and the federal government has ended its free COVID-19 at-home test program.

With the end of the emergency, the CDC is also changing the way it presents its COVID-19 data to a “sustainable national COVID-19 surveillance” model. This shift in COVID-19 monitoring and communication strategies accompanying the end of the emergency means that the virus is disappearing from the headlines, even though it has not disappeared from our lives and communities.

4. How will state and local pandemic measures be affected?

The end of the federal emergency does not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have included provisions allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth.

Most U.S. states, however, have ended their own public health emergency declarations. Six states – Delaware, Illinois, Massachusetts, New York, Rhode Island and Texas – still had emergency declarations in effect as of May 3, 2023, that will expire by the end of the month. So far, Massachusetts Gov. Maura Healey stands alone in having indicated that she will “extend key flexibilities provided by the public health emergency” related to health care staffing and emergency medical services.

While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, we believe it could be a long time before either politicians or members of the public regain an appetite for any emergency orders directly related to COVID-19.

This is an updated version of an article that was originally published on Feb. 3, 2023.

Marian Moser Jones receives funding from the National Endowment for the Humanities and The American Public Health Association. In the past she has received funding from the National Institutes of Health and the American Association for the History of Nursing, as well as the State of Maryland.

Amy Lauren Fairchild has received funding from NIH, NSF, NEH, the RWJ Foundation, and the Greenwall Foundation.

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The Sycamore Gap: four other significant tree destructions from history

The emotional response to the loss of the Sycamore Gap is part of a long history of emblematic trees, their destruction and renewal



Chris Frost/Shutterstock

The felling of a single sycamore tree prompted an outpouring of grief last week. The tree – known as the “Sycamore Gap” – had been an iconic landmark and its location, Hadrian’s Wall in Northumberland, is a protected Unesco world heritage site.

The Sycamore Gap was an inspiration to photographers and artists and a focal point for common rites of passage – proposals, family reunions, remembering the dead. Planted in the late 19th century, the roots of the Sycamore Gap tree reached deep into individual and collective memory. The legends associated with such trees connect us with the past and remind us that we live in their shadow.

The emotional response to the loss of the Sycamore Gap is part of a long history of emblematic trees, their destruction and renewal. Here are four other examples of emotional tree fellings from history.

1. The Holy Thorn of Glastonbury

According to legend, St. Joseph of Arimathea brought Christianity to England in the first century BC. After reaching Glastonbury in Somerset, he climbed Wearyall Hill, rested and thrust his staff into the ground.

By morning, a miraculous thorn had apparently taken root. This “holy thorn” bloomed not once, but twice a year. The apparent miracle lead Glastonbury to be described as “the holyest erth of Englande”.

Being rooted in the “holyest erth” was no guarantee that the holy thorn would be immune from attack, however. In 1647, the thorn was cut down by a Civil War soldier who deemed it a monument to Roman Catholicism and superstition.

A tree stump surrounded by ribbons.
The remains of the Holy Thorn tree. Avalon Dreaming/Shutterstock

In 1951, a new thorn was planted in its place, but in December 2010 this too was reduced to a stump. In language that echoed the legend of St. Joseph of Arimathea, the perpetrators were described by the director of Glastonbury Abbey, as “mindless vandals who have hacked down this tree” and “struck at the heart of Christianity”.

On April 1 2012, a sapling grafted from a descendant of the pre-1951 thorn was consecrated and planted, but two weeks later it too was damaged beyond recovery.

In May 2019 the landowner removed what remained of the thorn. But despite its chequered history, traditions associated with the holy thorn endure. After the damage caused to the Holy Thorn in 1647, cuttings were taken from which a tree now growing in Glastonbury Abbey is believed to descend. A branch of this thorn in bud has been sent to the British monarch every Christmas since.

2. One Tree Hill

A similarly chequered history belongs to the 125-year-old Monterey Pine which sat on top One Tree Hill or Maungakiekie in Auckland, New Zealand.

Like the Sycamore Gap tree, the pine was an iconic landmark, dominating the skyline. But it was also a focus of controversy as a culturally and spiritually significant place for the Māori and Pākehā people.

One tree hill in New Zealand.
One Tree Hill, also known as Maungakiekie. 780Moments/Shutterstock

The pine had been planted on the peak to replace a native tōtara tree, chopped down by a European settler. Twice – in 1994 and 1999 – attempts were made to destroy the tree as a protest against perceived injustices perpetrated against Māori people, before it was finally removed on safety grounds in 2000.

In 2016, at a dawn ceremony, nine young tōtara and pōhutukawa trees were planted on the hilltop, grown from parent trees on the maunga (the ancestral mountains of the Māori people), establishing a line of succession and memory.

3. Newton’s apple trees

There is a proliferation of “Newton’s apple” trees supposedly descended from the tree under which physicist Isaac Newton devised his law of universal gravity.

The original tree in his Woolsthorpe estate blew down in a gale, but scions (as at Glastonbury) were taken and grafted to create clones.

As a result, “Newton’s apple trees” are now found across the world, their roots connecting to create a library of human history and discovery.

4. The Shawshank Redemption white oak

In 2016, strong winds uprooted a majestic white oak in Mansfield, Ohio in the US, made famous by the 1994 film The Shawshank Redemption. Film fans were distraught and souvenir-hunters rushed to the site, removing parts of the fallen tree.

The white oak scene from The Shawshank Redemption.

A local craftsman reached an agreement with the landowner to keep the memory of the tree alive by using its wood to make furniture and fashion mementoes into which quotations from the film were carved. The tree stump itself has vanished beneath the crops that now grow in the field, but its emotional and cultural memory survives – like the Newton Apple Tree – embedded into objects that have been sold around the globe.

Throughout our history, trees have been assigned a religious and magical meaning, a medicinal purpose, a place in film and theatre and a functional value in agriculture and construction. Their branches and roots connect the brief history of humanity and the deeper history of our planet. No wonder then, that we feel their loss acutely.

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Helen Parish does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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How we hired 2023 Nobel laureate Anne L’Huillier – and why we knew she was destined for greatness

L’Huillier was busy teaching when she her Nobel prize was awarded.



L'Huillier and her husband at the Nobel prize celebration in Lund. Sune Svanberg, CC BY-SA

Most of the atomic physics division at Lund University were assembled in a spacious room with a big screen to await the announcement of the 2023 Nobel laureates in physics from the Royal Academy of Sciences on October 3. Of course, the Nobel secrecy is perfect, but there was still some expectation in the air.

When the screen with the laureates appeared, and with our colleague Anne L'Huillier´s face included, the roar almost lifted the roof – the big lasers in the basement must have been brought out of alignment!

L'Huillier, however, was nowhere to be seen – she had been giving a lecture to students.

New laser facility

About 30 years ago, the atomic physics group in Lund was considering a new research orientation. We ultimately selected the field of high-power laser-matter interaction. For this purpose, we managed to acquire a quite unique laser in 1992 (called a terawatt laser), firing 10 ultrashort pulses per second.

This was possible thanks to good academic contacts with leading laser groups in the US and Europe, as well as with industrial partners. The generous support by the Wallenberg Foundation (a key player in Swedish research financing) secured the realisation of arguably the most attractive system at the time for performing advanced research in a novel field of atomic physics.

At this point, L'Huillier was an up and coming researcher in France. Only years earlier, in 1987, had she discovered that many different overtones of light arise when you transmit infrared laser light through a noble gas – as a result of the gas and laser interacting.

With our new facility, we were able to attract L´Huillier to come to Lund with her own dedicated experimental set-up. This came quite naturally since we had, as project preparation, also visited the CEA Saclay Center where she was employed. I also invited her to be one of the key speakers at the inauguration of our new facility in Lund.

When on site for the experiments, it immediately became clear to us that L'Huillier was an extremely talented physicist, both regarding experiments and theory, with great promise for the future. We published our first joint paper in 1993.

L'Huillier felt good about Lund and, for many different reasons, decided to stay on. At first, she was employed on a lectureship and later on a dedicated professorship, which we got funded. This was a strike of luck for Lund – L'Huillier could easily have obtained prestigious positions elsewhere.

L'Huillier. Sune Svanberg, CC BY-SA

She was also very dedicated to learning Swedish. That says a lot. In a small country like Sweden, the natural language in an international endeavour like science is English, but L'Huillier became absolutely fluent in our “exotic” language.

At an early stage, I transferred the leadership of the high-power Laser laboratory to L´Huillier and Claes-Göran Wahlström. With the help of many talented collaborators, the field has developed tremendously in Lund, making it one of the leading hubs in this fascinating research field.

L´Huillier energetically pursued her work with high harmonics and the associated formation of attosecond laser pulses. These were the areas for which she ultimately won the Nobel prize – work that has helped scientists gain a window into the high-speed world of electrons.

In particular, she could show that processes earlier considered to occur instantaneously in fact come about with an extremely short delay.

Modest and rigorous

L´Huillier is absolutely brilliant. Despite that, she has always had quite a low-key personality. She cares a lot for her collaborators and students. It is perhaps her modesty and lack of interest in fame and glamour that makes her such a great physicist. She doesn’t cut corners and has a deep, genuine interest in science.

She has been, and is, a true role model for young scientists – female and male alike – showing how excellent research can be combined with enthusiastic teaching.

L´Huillier eventually talked to the Royal Academy in Stockholm during a scheduled break in her class. She later joined our celebration party, beaming and extremely happy. Clearly this was the ultimate achievement, the diamond among the many other distinctions she had already received.

The celebrations went on all afternoon, together with university leadership and students alike. L´Huillier was in an endless row of interviews. Receiving the highest scientific award will certainly change her life, but I am sure that she will always remain the same generous and modest person that we all came to know her as.

Our warmest congratulations to our “own” Nobel laureate!

Sune Svanberg is an emeritus professor at Lund University, who received the initial funding for the build up of the Lund High Power Laser Facility.

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Guerilla gardening: how you can make your local area greener without getting into trouble

Many people are gardening on land that is not theirs – here are some things to consider to avoid getting into trouble.



What are your rights if you want to become a guerrilla gardener? Goami/Shutterstock

When Richard Reynolds first started gardening around London’s streets, he was so worried he might be arrested that he worked under the cover of darkness. Reynolds was one of the UK’s first modern guerrilla gardeners, a movement that encourages people to nurture and revive land they do not have the legal rights to cultivate.

Gardening, in general, offers physical and mental health benefits. But as many as one in eight British households have no access to a garden or outdoor space of their own.

This issue is particularly pronounced among city dwellers, ethnic minorities and young people. A 2021 survey conducted in England revealed that those aged 16-24 were more than twice as likely to lack access to a garden or allotment compared to those aged over 65.

Quarter life, a series by The Conversation

This article is part of Quarter Life, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.

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Guerrilla gardening is a particularly good option for these groups of people. It can involve planting herbs or vegetables for a whole community to enjoy, spreading seeds or plants, tidying weeds, or even something as simple as picking up litter.

But if you’re considering becoming a guerilla gardener, it’s important to understand your rights. Could you be arrested for it? And should you wait until after dark?

Can you be prosecuted?

It’s important to remember that much of the unused or abandoned land that is potentially suitable for guerilla gardening in towns and cities throughout the UK is owned by local councils. Common examples of such locations include broken pavements with missing slabs, wasteland and the central areas of roundabouts.

Although much of this land is already open for the public to walk over, actively gardening on it would become an act of trespass.

The law of trespass sounds scary. However, gardening on this land would be a breach of civil law rather than a crime. This means that most guerrilla gardeners are unlikely to receive a fine or a criminal record.

Landowners do have the legal right to use “reasonable force” to remove trespassers from their land. But, fortunately, it seems most councils have ignored guerrilla gardeners, having neither the time, money or inclination to bring legal action against them.

Colchester Council, for example, were unable to track down the identity of the “human shrub”, a mysterious eco-activist who restored the flowers in the city’s abandoned plant containers in 2009. The shrub returned again in 2015 and sent a gift of seeds to a local councillor.

In other areas of the UK, the work of guerilla gardeners has been cautiously welcomed by local councils. In Salford, a city in Greater Manchester, there is a formal requirement to submit an application and obtain permission to grow on vacant spots in the city. But the local authority tends not to interfere with illegal grow sites.

There seems to be an unwritten acceptance that people can garden wherever they want, given the abundance of available space and the lack of active maintenance. This also offers the additional advantage of saving both time and money for the local council.

You should still be careful about where you trespass though. In some areas, guerrilla gardening can lead to unwelcome attention. During the May Day riots of 2000, for example, guerrilla gardeners were accused of planting cannabis seeds in central London’s Parliament Square.

Gardening at night may draw the wrong attention too, particularly if you are carrying gardening tools that might be misunderstood by the police as threatening weapons.

How can you start?

There are many different types of guerrilla gardening that you could get involved in, from planting native plant species that benefit pollinators and other wildlife to tidying derelict land to create safer places for the local community.

One of the simplest forms of guerilla gardening is planting seeds. Some environmental projects circulate “seed bombs” and others use biodegradable “seed balloons” that are filled with helium and deflate after a day, distributing seeds by air.

Whatever you try, as a guerrilla gardener you shouldn’t harm the environment or spoil other people’s enjoyment of the space around you. Remember that weeds and wilderness have an environmental value too. And think carefully about the species you are going to plant so that you can protect local plants and wildlife.

A man dropping a seed bomb on the ground in front of a grey building.
Some projects circulate seed bombs. Miriam Doerr Martin Frommherz/Shutterstock

The most attractive species to humans might not provide the best home or food for wildlife. Some can even outcompete native plants and drive them towards extinction. Planting certain harmful, invasive or poisonous species like ragwort, knotweed or Himalayan balsam is even prohibited by law.

That said, some guerrilla gardeners have used social media to organise “balsam bashing” events, where people come together to pull up this harmful invasive plant.

Guerrilla gardening takes many forms and can bring great benefits for people and the environment. You’re unlikely to be arrested for planting and growing trees and other greenery in public spaces. But remember that these spaces should be shared with everyone, including your local wildlife.

Ben Mayfield does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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