States close mass testing and vaccine sites, but uptick in virus could be looming

CHICAGO — As Americans throw away their masks and return to offices and restaurants, local and state officials are scaling back the most visible public health efforts to combat the coronavirus pandemic.

States like Illinois are closing free Covid-19 testing sites after nearly two years of operation. Arizona, Nevada, Hawaii and Ohio have stopped releasing daily data on virus-related hospitalizations, infections and deaths. And, perhaps most notably, some places are scaling back their resident vaccination campaigns even as federal officials announced Tuesday that people 50 and older could receive a second booster.

The slowdown in state and local efforts comes as the virus in the United States appears, at least for now, to be receding, with cases declining rapidly in recent weeks.

But the reductions also come at a time when a more transmissible version of the Omicron variant of the coronavirus, known as BA.2, is spreading across Europe, Asia and is now the dominant version of new cases of virus in the United States. New coronavirus infections are on the rise again in several states, including New York.

And Americans still lag behind many other countries when it comes to vaccinations. Only about 65% of Americans have had initial injections and less than a third of Americans have had a first booster injection.

If another outbreak of the pandemic is coming, public health officials said, it could be difficult to quickly scale up vaccination and testing sites and other measures that are currently closed.

“We have to be careful how we move forward,” said Dr. Ben Weston, chief health policy adviser for Milwaukee County, Wisconsin, where he has kept vaccination clinics open. “Imagine that we are a boat at sea and have just come out of the biggest tidal wave we have ever encountered. It would be a strange time to throw away the life jackets.

Some health officials said they were only shifting efforts in the face of falling demand for Covid tests and vaccines, with fewer than 225,000 injections being given across the country each day.

Chicago’s top health official Dr. Allison Arwady said two popular vaccination initiatives — a $50 gift card incentive and a program to vaccinate Chicagoans in their homes any day of the week. week – would be reduced in April.

“Now is definitely the time to pull back some resources,” Dr. Arwady said. Demand for vaccines has declined, she explained, and she is trying to save money as she anticipates federal funding cuts due to a standoff in Washington over Covid spending.

In San Antonio, with a majority of residents already immunized and a low number of cases, demand for vaccines at the mass site outside the city’s Alamodome has plummeted, said Miguel Cervantes, the administrator of public health in the city. The site closed Friday after 15 months of continuous operation and more than 200,000 doses of the Covid-19 vaccine. At its peak, it administered about 3,500 vaccinations a day. Last week it averaged under 50.

“We haven’t seen the numbers to support a need for a site,” Cervantes said.

The high price of maintaining site staff and equipment is a less cost-effective use of those resources than smaller community events, he added. And with the 64,000-seat Alamodome stadium now hosting a full slate of sports and concerts, the parking lot has returned to its pre-pandemic use.

“If people don’t come through the door, it burns a lot of money to have a fully staffed testing center,” said Andrew Noymer, a professor of public health at the University of California, Irvine. “So I can understand why states and localities are closing them. We’re going to have to find a way to be flexible.

Federal dollars for the Covid pandemic have dwindled in recent days as a fund intended to reimburse testing and treatment for uninsured people is no longer accepting claims. State and local officials, alarmed by debates in Washington over the future of Covid funding, have predicted they will face tighter budgets in the near future if federal funds are cut.

Targeted, community-based events are more effective at reaching those still unvaccinated, said Dr. Desmar Walkes, medical director for the city of Austin, which has closed all but one of its mass vaccination sites.

“We’re at this point where one-on-one conversations and the ability to have community partners to educate about vaccine safety and answer questions gives us greater acceptance,” Dr. Walkes said. Her department is seeing a higher turnout at mobile clinics in long-term care facilities, schools, workplaces and even football games than at mass vaccination sites, she said. .

If demand for vaccines, tests and treatments spikes amid an impending wave of the BA.2 subvariant, health officials say, they can easily restart those programs. It would only take a few days to do it in Austin, Dr. Walkes said.

But some experts have expressed doubts that the resumption of operations at test and treatment sites can occur as quickly as necessary in the event of a surge.

Adriane Casalotti, head of government and public affairs for the National Association of County and City Health Officials, said that during lulls when cases are low, health departments could take the time to plan and prepare for the sequel. Shutting down larger-scale efforts like test sites follows a certain logic – but leaves a community vulnerable.

“In a situation where you don’t have long test lines, people think, we can get rid of that test site,” she said. “It could work for this week and next week, but putting something like that back together – if the situation changes on the pitch – is really difficult.”

Public health experts worry that Americans may have emerged from the pandemic before it is over and that the United States is unprepared for another wave. The virus still kills more than 700 Americans every day.

“We are in this phase of the pandemic where we are in transition,” said Aubree Gordon, an infectious disease epidemiologist at the University of Michigan. “It’s always very important that the tests are readily available – you can’t know what’s going on if you don’t watch it.”

As immunization and screening efforts increasingly fall to community health centers and local clinics, these providers are seeing their funding disappear. For months, Kintegra Health, which operates health centers in central North Carolina, has relied on money from the Health Resources & Services Administration. A federal program, it provides reimbursements for testing, treatment and administration of Covid-19 vaccines for uninsured patients, facilitating thousands of tests and vaccinations a day, mostly at mobile clinics.

But that program stopped accepting applications this week due to a lack of funding, forcing the health center to stop its mobile clinics.

“I’m worried about what’s next, because when I close and all these people find other jobs and the next variation comes along, will I be ready?” said Robert Spencer, chief executive of Kintegra Health.

In many states, services administered by local and state governments are shifting to traditional health care providers.

By mid-April, pharmacies and health care providers will deliver all vaccines in Vermont as the state government shuts down its vaccination sites. Demand for vaccines from state-run sites has dropped 77% in the past 30 days. The only providers that reported a slight increase in vaccinations were primary care offices.

“Reintegrating immunization back into the healthcare system is really the way to go,” said Dr. Mark Levine, commissioner of the state Department of Health. “People don’t go to these other sites; they show the stall. And they go to the health care system, where they belong and where vaccination has always taken place.

In Vermont, the state has also moved its state-run testing sites primarily to distribution centers for rapid home testing, rather than PCR testing. That means the state has a fuzzier picture of the number of Covid cases in the state, but Dr. Levine said state health officials have already moved away from focusing on the number of cases, instead relying on sewage monitoring and genome sequencing to track the virus.

The state still publishes a report of daily new Covid cases five days a week on its website, but plans to soon follow the lead of many other states by publishing a weekly report instead.

Many states have moved to weekly notification of daily reports of new cases on public dashboards. Officials say updating the data publicly each day is time-consuming and the daily variation in the data makes it less meaningful than weekly reports. Instead, some post it to public dashboards only once a week, in line with reports of other illnesses, such as the flu.

In Chicago, Dr. Arwady said the city is still trying to vaccinate all Chicagoans — keeping its at-home vaccination option open four days a week instead of seven, phoning eligible residents for boosters and researching contacts in high-risk settings such as prisons and nursing homes.

Even at a time when Covid infections are low, she worries that federal funding cuts will be damaging in the long run and threaten the country’s ability to deal with future surges of the pandemic.

“I’m concerned about this idea that ‘Covid is over, we can stop funding public health,'” she said. “It will take us back to where we were.”