For much of the COVID-19 pandemic, New York City has offered a variety of services to support its residents who got infected. New Yorkers could get tested for free at sites across the city, even without health insurance; they could receive Paxlovid prescriptions from the same sites where they were tested; they could call a hotline for treatments or care advice; and they could even receive a free hotel room to isolate themselves from family members.
Those services have declined over the last year, however, culminating with the shutdown of many public testing sites this spring in time with the ending of federal emergency measures. In late March, NYC Health + Hospitals announced that it would end its mobile program for testing and Paxlovid prescriptions by May 11; testing will still be available at hospital sites, by appointment. For New Yorkers who are at higher risk of COVID-19, the change will make it harder to stay safe as the virus continues to spread.
Health + Hospitals provided a “vital resource and safety net” for New Yorkers throughout the last three years, said Dr. Oni Blackstock, the founder of Health Justice and a primary care doctor in the city. The public health system primarily serves Black and Latino communities, including many New Yorkers who are low-income, don’t have health insurance, and are undocumented, she said. For these groups, the city’s free COVID-19 programs provided services that they may not have been able to access anywhere else.
Steven Thrasher, a professor at Northwestern University and author of the book “The Viral Underclass,” told the Amsterdam News that the city has been “a leader in a lot of ways” during the pandemic. City institutions quickly built a COVID-19 service infrastructure that didn’t exist in other parts of the U.S., he explained.
But now, much of that infrastructure has been dismantled, both in New York City and across the country. The local closures come as healthcare organizations nationwide prepare for the federal public health emergency to end on May 11.
The combination of local and national changes is “a perfect storm,” Blackstock said. “It really feels like an abandonment of public health.”
At this point, while the federal government is taking steps to continue providing free vaccines, it will no longer require insurance companies to provide free tests, and insurance coverage of treatments and vaccines is likely to change as well.
After May 11, many New Yorkers may not know where or how to get COVID-19 care—and this will lead fewer people to seek it out, experts say. Still, one important program remains intact: people will still be able to connect with doctors for COVID-19 care through calling the Health + Hospitals hotline, 212-COVID19, or making an appointment by calling 1-844-NYC-4NYC.
In response to questions, Health + Hospitals and the city health department both referred to its March press release announcing the site closures. “As we transition out of the emergency phase of the pandemic, the Health Department and NYC Health + Hospitals will continue to provide services and support to New Yorkers and ensure access to lifesaving COVID-19 care,” Health Commissioner Dr. Ashwin Vasan said in a statement.
The federal public health emergency “bolstered” New York State’s response to COVID-19, a spokesperson for the state health department said. After it ends, “the state is prepared to continue to ensure ongoing access to vaccines, COVID-19 tests, and treatments.”
COVID-19 services remain valuable
While COVID-19 may not be spreading across NYC as much now as it was in 2020, the disease still kills hundreds of Americans every day and has led to long-term symptoms for millions. Testing remains important as a preventative measure, said Dr. Wafaa El-Sadr, a professor of epidemiology and global health at Columbia University’s Mailman School of Public Health. A positive test result can lead the patient to isolate, breaking potential chains of transmission, El-Sadr said. This may be particularly helpful for reducing outbreaks in workplaces that require in-person attendance. At the same time, the patient can seek out Paxlovid or other COVID-19 treatments.
Paxlovid, the most effective treatment against currently-circulating variants, is more effective when patients receive it quickly after becoming sick. “So the easier it is to get tested promptly, the better,” El-Sadr said. The New York health system is also still distributing Paxlovid for free through its ExpressCare hotline at 212-COVID19 (212-268-4319).
The ExpressCare program has sent about 40,000 Paxlovid prescriptions as of April 2023, according to a spokesperson at Health + Hospitals. Nearly 43% of the hotline’s patients live in communities that the city’s Taskforce on Racial Inclusion & Equity has determined most impacted by COVID-19.
As PCR testing sites across the city close, healthcare providers have directed New Yorkers to utilize at-home, rapid tests instead. Health + Hospitals, for example, continues to distribute free at-home tests at a number of locations around the five boroughs, and will keep the program going as long as supplies last.
However, PCR tests are more accurate than the at-home tests, particularly as the coronavirus continues to mutate. Elana Levin found out that she had COVID-19 this past December through a PCR test at a mobile site in her Brooklyn neighborhood of Sunset Park. The PCR result allowed her to isolate soon after her symptoms started, she said, while an at-home test she took the same day was negative.
As valuable as tests can be themselves, experts say the city’s mobile testing sites also showed New Yorkers that they could easily access COVID-19 care if they needed it. These sites were highly visible, outdoors, and required no appointments; all of these qualities implicitly encouraged people to take advantage of the sites.
Their absence “will change the perception of access” to COVID-19 services, El-Sadr said.
Closures will worsen disparities
As the Health + Hospitals walk-in sites close and the federal health emergency ends, New Yorkers will have to work harder to get a PCR test if they need one. Health + Hospitals still offers free testing at its hospital sites, but patients now need to make an appointment for the service. They might need to make an appointment with a doctor, pay a $100 fee, or even risk COVID-19 exposure by entering a healthcare clinic to get tested, as outdoor options will no longer be available.
Many healthcare settings have also dropped their mask requirements after a statewide rule expired in February, increasing the risk that someone might get COVID-19 while seeking a test. The advocacy group Mandate Masks NY has compiled a list of organizations across the state that still require masks.
Jasmin Smith, a former contact tracer who lives in Brooklyn, worries that diminished public resources will contribute to increased COVID-19 spread and make it harder for people with existing health conditions to participate in common activities, like taking the subway or going to the grocery store.
COVID-19 safety measures “make the world more open to people like myself who are COVID-conscious and people who might be immunocompromised, disabled, chronically ill,” Smith said. “When those things go away, your world becomes smaller and smaller.”
The ending federal public health emergency has also contributed to widespread confusion and anxiety about COVID-19 services, El-Sadr said. “People have so many questions about this transition,” she said, and local leaders could do more to answer these questions for New Yorkers.
The near future of COVID-19 care in the U.S. could reflect existing health disparities for other endemic diseases, like the seasonal flu and HIV/AIDS, Thrasher said. For example, people with insurance and a primary care physician are more likely to get their annual flu shots, he said, while those without are more likely to face severe outcomes from the disease.
After May 11, COVID-19 outcomes are likely to fall along similar lines. “More people have died of AIDS after there were HIV medications,” Thrasher said. “More people have died of COVID when there were vaccines in this country than before.”
To respond, experts say that New York City institutions should maintain crucial COVID-19 services for people who need them most. This might include giving out free masks and rapid tests, requiring masks in crucial locations like healthcare settings, and improving awareness of COVID-19 and long COVID through public campaigns.
Some of the infrastructure built during COVID-19 may also be valuable in responding to other health crises. Health + Hospitals has maintained its ExpressCare hotline (631-397-2273), initially developed to provide COVID-19 services; New Yorkers can now contact this hotline 24/7 for a variety of health needs. According to the website: “For medical urgent care, self-pay patients will pay a flat $125, and insured patients will pay a copay amount based on their plan.” Health + Hospitals has a policy to not deny care to those who are uninsured and can help those who qualify sign up for coverage.
The mobile testing sites similarly provide a model for easily-accessible care in future crises. “We need to be meeting people where they are,” Blackstock said, whether organizations are providing COVID-19 tests, treatment for substance use disorder, or anything in between.For additional resources about COVID-19, visit www1.nyc.gov/site/coronavirus/index.page or call 212-COVID19. COVID-19 testing, masks, and vaccination resources can also be accessed on the AmNews COVID-19 page: www.amsterdamnews.com/covid/.