On Monday, April 10, President Joe Biden signed a bipartisan congressional legislation that officially ended the COVID-19 national emergency. 
 
However, the public health emergency is still in place but is set to expire on May 11th. With the public health emergency still ongoing, the U.S. government has been able to provide an enhanced social safety net of benefits that has been helping Americans cope with the impact of the pandemic along with free COVID-19 tests, treatments, and vaccines.  
 
Because of this move, the White House plans to expedite its efforts “to wind down and provide as much notice as possible to potentially impacted individuals,” states a WH official in a report from CNN.
 
Over the past few months, the Biden administration has been working with agencies on preparations to soften the impact of this earlier-than-scheduled declaration. Both emergency declarations were originally scheduled to terminate on May 11.
 
“To be clear, ending the National Emergency will not impact the planned wind-down of the Public Health Emergency,” assured the WH official. 
 

Impact on Myeloma Patients

The Big Picture


The full impact is yet unclear, but the lack of free COVID-19 care will, undoubtedly, have a negative impact especially to the most vulnerable. 
 
In addition, the whole vaccine development process that spurred during the height of the pandemic by Operation Warp Speed is now falling into limbo. 
 
The Washington Post recently reported on the $5 billion “Project Next Gen”program which would succeed “Operation Warp Speed” in developing new vaccines and therapies.  
 
The program aims “to accelerate development of new coronavirus vaccines and treatments, seeking to better protect against a still-mutating virus as well as other coronaviruses that might threaten us in the future.”
 
“Project Next Gen would take a similar approach to partnering with private-sector companies to expedite development of vaccines and therapies. Scientists, public health experts and politicians have called for the initiative, warning that existing therapies have steadily lost their effectiveness and that new ones are needed,” The Washington Post further stated.
 
According to The Washington Post, White House Coronavirus Coordinator Dr. Ashish Jha said that “the new effort will focus on three goals: 

1. creating long-lasting monoclonal antibodies, after an evolving virus rendered many current treatments ineffective;
2. accelerating development of vaccines that produce mucosal immunity, which is thought to reduce transmission and infection risks;
3. speeding efforts to develop pan-coronavirus vaccines to guard against new SARS-CoV-2 variants, as well as other coronaviruses.”

Department of Health and Human Services Assistant Secretary for Preparedness and Response  Dawn O’ Connell said that “some of the lab work is underway and the government has begun efforts to find potential private-sector partners.”
 
However, Dr. Jha has not set any timetables for when the products may arrive, stating that this would be dependent on production plans by drugmakers, U.S. Food and Drug Administration (FDA) reviews, as well as other factors, The Washington Post further reported.
 
Currently, forward strategies remain uncertain, including practical approaches to further vaccination.



Day-to-Day Changes

Vaccine mandates 


In general, vaccine mandates are ending although they are still being retained in heterogenous fashion in healthcare settings, nursing homes and other high-risk situations. 
 
As reported by L.A. Times, Los Angeles County recently ended its COVID-19 employee vaccination requirement, allowing the hiring of workers (including sheriff’s deputies and firefighters) without requiring vaccination.  

Obviously, vaccination (including the updated booster) is still strongly recommended for all myeloma patients. However, the removal of vaccination mandates would impact myeloma patients, as encountering the unvaccinated brings increased risks, especially when community levels of infection are high.
 
The good news is community infection levels have continued to drop and are currently very low across the U.S. and in many parts of the world.



Mask mandates


In a similar fashion, mask mandates have also mostly ended except in some healthcare and high-risk settings. 
 
According to a recent report from L.A. Times, “the easing of government-issued masking orders for patients and visitors in healthcare settings took effect on April 3 in Los Angeles County,” and “masking orders for doctors and nurses” in other California counties have also expired.

However, myeloma patients shouldn’t throw away their masks just yet! Masks are very valuable and should be used when community levels of COVID-19 range from intermediate to high, to avoid being exposed to potentially unvaccinated individuals  or those who are actively infected with COVID-19.
 
Currently, mask-wearing is only highly recommended (as opposed to mandated) for individuals who are infected with COVID-19, even within the first 5–10-day period of documented infection although tighter rules apply when returning to work. 
 
Workplaces are required to notify health authorities about new COVID-19 cases. If exposure to COVID-19 occurs (or is thought to have occurred), testing is strongly recommended as well as wearing masks for 5-10 days around others.
 
Overall, masks are still strongly recommended for myeloma patients and the vulnerable, especially when community infection levels are high and particularly in indoor settings, where long exposure to those with unknown COVID-19 status may potentially occur. 
 
Outbreaks are still happening, but mostly in skilled nursing facilities. Additionally, COVID-19 data reporting has become more sporadic, including wastewater levels (but fortunately, this has been at the low range, as of late.)
 

Moving Forward: The Status of the Pandemic

Is Herd Immunity a Myth?

Have we achieved herd immunity in the U.S. with the occurrence of COVID-19 infections combined with vaccinations? Are so many people immune to the virus now that any new COVID-19 infection will no longer spread? These seem to be common questions in mind lately.
 
It’s really hard to say, but certainly the pandemic appears to have burned out for the time being, with few new infections being reported in general.
 
Difficulties in assessing the status of immunity include measuring the combination of antibodies (what we mostly focus on) as well as cellular immunity or the immune system’s preparedness to fight off new infection. 
 
T cells, which we hear about in fighting myeloma, are also very important as part of immunity against COVID -19, but they are very hard to measure.
 
As succinctly written by L.A. Times Staff Writer Melissa Healy, “the trouble is no one has a clear fix on the extent of Americans’ immunity to the virus that causes COVID-19. And beneath that lies a more fundamental problem: Scientists and public officials still have not settled on what it means to be immune or adopted a common yardstick for measuring it.”
 
Dr. Hayley Gans, an infectious disease doctor at Stanford who advises the FDA on vaccine policy, said in a recent public meeting that “we’re always at the point of having to make decisions without that data.”
 
This means that COVID-19 immunity status is still unclear across the U.S. Therefore, herd immunity remains a myth for now.
 

The Longer Term


Beyond the COVID-19 pandemic emergency, important questions remain. Long-term COVID with troubling ongoing symptoms does happen and myeloma patients are more susceptible. How do we identify, treat, and support patients then? This is part of ongoing research.



What about next-generation boosters? There is really no clear word yet, although it is assumed that enhanced boosters will be recommended this Fall, especially for myeloma patients.
 I would recommend planning on a follow-up booster soon.



The Bottom Line


The current status of COVID-19 is finally giving myeloma patients some room to breathe. The risk of new infections is currently low, with knowledge and tools available if community infections increase. 
 
We hope and trust that public health authorities will always be sufficiently on alert to provide early warning if any new COVID-19 variants (or so-called variants of concern) emerge. 
 
Wastewater screening is active and ongoing to help indicate any change from the status quo. In the meantime, we can enjoy more relaxed restrictions and freedoms to pursue life in a more normal fashion. 
 
Let’s all celebrate this turning point.