The World Health Organization declared on May 5, 2023, that the COVID-19 pandemic is no longer a public health emergency. Although the virus is still causing hospitalizations and deaths, many travelers who were reluctant to go abroad because of the pandemic now feel freer to travel internationally again.

That’s going to be a whole lot easier to do this summer if you already have a valid passport. The wait times for getting one are soaring. The State Department says it can take up to 13 weeks for it to process passport applications, and up to nine weeks for expedited service that requires the payment of extra fees. It’s getting about 500,000 passport applications a week, which is at least 30% more than last year, Secretary of State Antony Blinken said in March. And delays in processing were already aggravating in 2021 and 2022.

I’m among the many Americans who have had to cancel or delay trips because of the long wait times. I was hoping to fly to London for a weeklong break between teaching economics courses. Unfortunately, renewing my passport took so long I couldn’t go.

The government says staffing issues are contributing to the delays. As an economist who researches the everyday experiences of consumers, I wondered if there was more to the story, since international travel is a big business. U.S. residents spent around US$17 billion in just the month of March 2023 going abroad.

Origin of passports

Passports have been around a long time. They became more widespread about four centuries ago during the reign of the French King Louis the XIV. The king gave people with royal connections letters asking foreign officials to let the traveler “passe port” – French for pass through – the port or border of another country safely.

You can find a similar statement in the front of every U.S. passport, which “requests all whom it may concern to permit the citizen/national of the United States named herein to pass without delay or hindrance.”

One reason for the passport bottleneck in the United States is a long-term increase in demand for those official blue booklets. Back in 1989, there were three valid passports for every 100 people in this country. Today there are more than 45 passports for every 100 Americans. More recently, many Americans who let their passports expire because they were avoiding international travel when the pandemic began are eager to travel again.

Changes after 2000

The U.S. population has increased about 1% each year over the past three decades. During that same period the number of people holding a valid passport has jumped an average of 10% each year, 10 times faster than population growth.

Part of the rising demand for passports followed a policy change in the early 2000s. Before then no passport was required for U.S. citizens to travel to Canada, Mexico or the Caribbean. A driver’s license or an official document like a birth certificate was suitable documentation to visit countries that shared a common border with the U.S. By 2009, however, a passport was needed to visit those nearby countries by air, land or sea.

But the new rules don’t fully account for the surge in passport issuance. In 2010, about 100 million people had valid U.S. passports. Today, over 150 million do.

Lost, stolen and damaged passports

Another reason for the passport boom is that the State Department is fielding more requests than before for reissued passports to replace lost or stolen documents.

One problem while traveling is keeping your passport safe. While so far no one has ever stolen my passport, I have spilled food on it while climbing mountains, gotten it soaked in a monsoon and crushed it in my luggage on the world’s longest flight.

If your passport is ever lost, destroyed or stolen, you need to file a DS-64 form with the State Department. Filing this form prevents a thief from using that passport. The data is not just kept in the U.S. but is also sent to Interpol’s Stolen/Lost Travel Document database, which prevents worldwide travel by someone posing as you when traveling with your stolen passport.

The government periodically releases the number of DS-64 forms filed. In 2005 a bit more than 100,000 were submitted. This jumped fivefold to over 500,000 people who reported losing their passports in 2021.

Who gets passports?

Where do passport applications come from?

Not surprisingly, states with more people tend to get more passports. For example, Californians got the highest number of passports, about 2.7 million, in 2022.

But some states have more wanderlust than others. After adjusting for population, over the past few years the top two sources for international travel are the high-income states of New Jersey and Massachusetts. Around 1 out every 17 residents in those places applied annually for a passport.

The states where residents are the least likely to apply for a passport are the low-income states of Mississippi and West Virginia. In those places only about 1 out every 65 residents applied on average each year.

What can be done?

One of the reasons passport processing times have gotten so long is that many people are taking trips they put off in the spring of 2020. What can be done?

I suggest two things.

First, the Caribbean is one of the most popular U.S. tourist destinations. U.S. travelers today can visit the U.S. Virgin Islands and Puerto Rico without a passport because they are U.S. territories. I believe that expanding this access to a small number of Caribbean countries, as was possible before the 2009 policy change, would boost tourism and reduce passport demand.

Second, citizens with a current passport should be able to use it while waiting for a renewal. Right now old passports must be submitted with renewal forms, which blocks international travel. The State Department doesn’t really need the old documents. It recently ran a trial allowing people to renew passports online without asking for their current passport books.

Once a new passport is issued, the old one becomes invalid. This could present a problem for people traveling abroad while their passport renews. There is a simple solution for this. At the beginning of the COVID-19 pandemic the State Department allowed U.S. citizens who were abroad when their passports expired to reenter the country.

Extending this policy would mean people could continue traveling no matter how long it takes to renew their passport.

Jay L. Zagorsky, Clinical Associate Professor of Markets, Public Policy and Law, Boston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Research Brief is a short take about interesting academic work.

The big idea

Concerns about unnecessary use of a common class of antimicrobial chemicals used in disinfectants reinforces recommendations to opt for soap and water or safer products, my colleagues and I determined in our recent critical review of the scientific literature.

Quaternary ammonium compounds, or QACs, are increasingly marketed and used in homes, schools and workplaces with limited evidence for their appropriateness or safety. These chemicals can be found in common disinfectant solutions, wipes, hand sanitizers, sprays and even foggers.

Laboratory animal studies have found that some QACs can have developmental and reproductive toxicity with sustained exposure, may contribute to weight gain, and can impair energy production in cells.

Surprisingly, despite these concerns, studies on people have been limited to patients with allergic contact dermatitis and workplace-induced asthma among workers in hospitals and other facilities that require a sterile environment. We were even more surprised to find a lack of comprehensive screening for health hazards in the majority of this large class of common and widely used chemicals.

One of the top reasons to use antimicrobials only when needed is that overuse leads to the rise of antimicrobial resistance, which contributes to millions of deaths per year worldwide. QACs and other antimicrobials create “superbugs” that not only can’t be killed by disinfectants but can also become resistant to lifesaving antibiotics.

Why it matters

When the COVID-19 pandemic began, recommendations circulated in the news and social media to disinfect almost everything, from doorknobs to desks to groceries. Because COVID-19 is not primarily transmitted from surfaces, many of these disinfection practices don’t substantially reduce transmission risk.

Our team became concerned that frequent disinfectant use could lead to adverse health effects from QACs. Most people probably don’t know about existing health concerns regarding QACs, or aren’t aware that QACs can remain on surfaces and in indoor air and dust long after the product has dried, exposing more people to these chemicals than just the initial user. Researchers have found that the average levels of these chemicals in people’s bodies have risen since the pandemic began.

What still isn’t known

One of the most commonly used QACs is benzalkonium chloride. Others may be identified on ingredient labels with names that end in “ammonium chloride” or similar terms.

While reading labels can help consumers identify QACs, some products may not require disclosure of these chemicals in the ingredient list. For example, pesticide labels are required to list QACs whereas paint labels are not. QACs can be used in a wide variety of consumer products where they may or may not be listed when used, including personal care products, textiles, paints, medical instruments and more.

What’s next

Reducing the harm of QACs requires their disclosure in all products, comprehensively screening them for health hazards and closely monitoring their broader effects in people and on the environment.

In the meantime, my colleagues and I recommend that individuals, schools and workplaces take a close look at their cleaning practices to see where disinfectants can be replaced with safe cleaners or safer disinfectants.

Cleaning with soap or detergent removes most types of harmful germs like COVID-19 from surfaces. While disinfection can help kill any remaining microbes, it should be limited to situations where people have been actively ill, such as vomit on a surface, and during certain disease outbreaks.

For disinfectants to work properly, they must be left on the surface long enough to kill the germs, and this required contact time may be noted on the product. When you use or handle disinfectants you should wear protective gloves and eyeglasses or safety glasses, and you should open windows and doors to ventilate indoor spaces.

Courtney Carignan, Assistant Professor of Food Science and Human Nutrition, Pharmacology and Toxicology, Michigan State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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, Associate Professor of Health Services Management, Policy and History, The Ohio State University and Amy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.