With around 20,000 people dying of covid in the United States since the start of October, and tens of thousands more abroad, the covid pandemic clearly isn’t over. However, the crisis response is, since the World Health Organization and the Biden administration ended their declared health emergencies last year.

Let’s not confuse the terms “pandemic” and “emergency.” As Abraar Karan, an infectious disease physician and researcher at Stanford University, said, “The pandemic is over until you are scrunched in bed, feeling terrible.”

Pandemics are defined by neither time nor severity, but rather by large numbers of ongoing infections worldwide. Emergencies are acute and declared to trigger an urgent response. Ending the official emergency shifted the responsibility for curbing covid from leaders to the public. In the United States, it meant, for example, that the government largely stopped covering the cost of covid tests and vaccines.

But the virus is still infecting people; indeed, it is surging right now.

With changes in the nature of the pandemic and the response, KFF Health News spoke with doctors and researchers about how to best handle covid, influenza, and other respiratory ailments spreading this season.

A holiday wave of sickness has ensued as expected. Covid infections have escalated nationwide in the past few weeks, with analyses of virus traces in wastewater suggesting infection rates as high as last year’s. More than 73,000 people died of covid in the U.S. in 2023, meaning the virus remains deadlier than car accidents and influenza. Still, compared with last year’s seasonal surge, this winter’s wave of covid hospitalizations has been lower and death rates less than half.

“We’re seeing outbreaks in homeless shelters and in nursing homes, but hospitals aren’t overwhelmed like they have been in the past,” said Salvador Sandoval, a doctor and health officer at the Merced County public health department in California. He attributes that welcome fact to vaccination, covid treatments like Paxlovid, and a degree of immunity from prior infections.

While a new coronavirus variant, JN.1, has spread around the world, the current vaccines and covid tests remain effective.

Other seasonal illnesses are surging, too, but rates are consistent with those of previous years. Between 9,400 and 28,000 people died from influenza from Oct. 1 to Jan. 6, estimates the Centers for Disease Control and Prevention, and millions felt so ill from the flu that they sought medical care. Cases of pneumonia — a serious condition marked by inflamed lungs that can be triggered by the flu, covid, or other infections — also predictably rose as winter set in. Researchers are now less concerned about flare-ups of pneumonia in China, Denmark, and France in November and December, because they fit cyclical patterns of the pneumonia-causing bacteria Mycoplasma pneumoniae rather than outbreaks of a dangerous new bug.

Public health researchers recommend following the CDC guidance on getting the latest covid and influenza vaccines to ward off hospitalization and death from the diseases and reduce chances of getting sick. A recent review of studies that included 614,000 people found that those who received two covid vaccines were also less likely to develop long covid; often involving fatigue, cognitive dysfunction, and joint pain, the condition is marked by the development or continuation of symptoms a few months after an infection and has been debilitating for millions of people. Another analysis found that people who had three doses of covid vaccines were much less likely to have long covid than those who were unvaccinated. (A caveat, however, is that those with three doses might have taken additional measures to avoid infections than those who chose to go without.)

It’s not too late for an influenza vaccine, either, said Helen Chu, a doctor and epidemiologist at the University of Washington in Seattle. Influenza continues to rise into the new year, especially in Southern states and California. Last season’s shot appeared to reduce adults’ risk of visits to the emergency room and urgent care by almost half and hospitalization by more than a third. Meanwhile, another seasonal illness with a fresh set of vaccines released last year, respiratory syncytial virus, appears to be waning this month.

Another powerful way to prevent covid, influenza, common colds, and other airborne infections is by wearing an N95 mask. Many researchers say they’ve returned to socializing without one but opt for the masks in crowded, indoor places when wearing one would not be particularly burdensome. Karan, for example, wears his favorite N95 masks on airplanes. And don’t forget good, old-fashioned hand-washing, which helps prevent infections as well.

If you do all that and still feel sick? Researchers say they reach for rapid covid tests. While they’ve never been perfect, they’re often quite helpful in guiding a person’s next steps.

When President Joe Biden declared the end of the public health emergency last year, many federally funded testing sites that sent samples to laboratories shut their doors. As a result, people now mainly turn to home covid tests that signal an infection within 15 minutes and cost around $6 to $8 each at many pharmacies. The trick is to use these tests correctly by taking more than one when there’s reason for concern. They miss early infections more often than tests processed in a lab, because higher levels of the coronavirus are required for detection — and the virus takes time to multiply in the body. For this reason, Karan considers other information. “If I ran into someone who turned out to be sick, and then I get symptoms a few days later,” he said, “the chance is high that I have whatever they had, even if a test is negative.”

A negative result with a rapid test might mean simply that an infection hasn’t progressed enough to be detected, that the test had expired, or that it was conducted wrong. To be sure the culprit behind symptoms like a sore throat isn’t covid, researchers suggest testing again in a day or two. It often takes about three days after symptoms start for a test to register as positive, said Karan, adding that such time estimates are based on averages and that individuals may deviate from the norm.

If a person feels healthy and wants to know their status because they were around someone with covid, Karan recommends testing two to four days after the exposure. To protect others during those uncertain days, the person can wear an N95 mask that blocks the spread of the virus. If tests remain negative five days after an exposure and the person still feels fine, Chu said, they’re unlikely to be infected — and, if they are, viral levels would be so low that they would be unlikely to pass the disease to others.

Positive tests, on the other hand, reliably flag an infection. In this case, people can ask a doctor whether they qualify for the antiviral drug Paxlovid. The pills work best when taken immediately after symptoms begin so that they slash levels of the virus before it damages the body. Some studies suggest the medicine reduces a person’s risk of long covid, too, but the evidence is mixed. Another note on tests: Don’t worry if they continue to turn out positive for longer than symptoms last; the virus may linger even if it’s no longer replicating. After roughly a week since a positive test or symptoms, studies suggest, a person is unlikely to pass the virus to others.

If covid is ruled out, Karan recommends tests for influenza because they can guide doctors on whether to prescribe an antiviral to fight it — or if instead it’s a bacterial infection, in which case antibiotics may be in order. (One new home test diagnoses covid and influenza at the same time.) Whereas antivirals and antibiotics target the source of the ailment, over-the-counter medications may soothe congestion, coughs, fevers, and other symptoms. That said, the FDA recently determined that a main ingredient in versions of Sudafed, NyQuil, and other decongestants, called phenylephrine, is ineffective.

Jobs complicate a personal approach to staying healthy. Emergency-era business closures have ended, and mandates on vaccination and wearing masks have receded across the country. Some managers take precautions to protect their staff. Chu, for example, keeps air-purifying devices around her lab, and she asks researchers to stay home when they feel sick and to test themselves for covid before returning to work after a trip.

However, occupational safety experts note that many employees face risks they cannot control because decisions on if and how to protect against outbreaks, such as through ventilation, testing, and masking, are left to employers. Notably, people with low-wage and part-time jobs — occupations disproportionately held by people of color — are often least able to control their workplace environments.

Jessica Martinez, co-executive director of the National Council for Occupational Safety and Health, said the lack of national occupational standards around airborne disease protection represents a fatal flaw in the Biden administration’s decision to relinquish its control of the pandemic.

“Every workplace needs to have a plan for reducing the threat of infectious disease,” she said. “If you only focus on the individual, you fail workers.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

President Joe Biden is counting on outrage over abortion restrictions to help drive turnout for his reelection. Former President Donald Trump is promising to take another swing at repealing Obamacare.

But around America’s kitchen tables, those are hardly the only health topics voters want to hear about in the 2024 campaigns. A new KFF tracking poll shows that health care tops the list of basic expenses Americans worry about — more than gas, food, and rent. Nearly 3 in 4 adults — and majorities of both parties — say they’re concerned about paying for unexpected medical bills and other health costs.

“Absolutely health care is something on my mind,” Rob Werner, 64, of Concord, New Hampshire, said in an interview at a local coffee shop in January. He’s a Biden supporter and said he wants to make sure the Affordable Care Act, also known as Obamacare, is retained and that there’s more of an effort to control health care costs.

The presidential election is likely to turn on the simple question of whether Americans want Trump back in the White House. (Nikki Haley, the former South Carolina governor and U.S. ambassador to the United Nations, remained in the race for the Republican nomination ahead of Super Tuesday, though she had lost the first four primary contests.) And neither major party is basing their campaigns on health care promises.

But in the KFF poll, 80% of adults said they think it’s “very important” to hear presidential candidates talk about what they’d do to address health care costs — a subject congressional and state-level candidates can also expect to address.

“People are most concerned about out-of-pocket expenses for health care, and rightly so,” said Andrea Ducas, vice president of health policy at the Center for American Progress, a Washington, D.C.-based progressive think tank.

Here’s a look at the major health care issues that could help determine who wins in November.

Abortion

Less than two years after the Supreme Court overturned the constitutional right to an abortion, it is shaping up to be the biggest health issue in this election.

That was also the case in the 2022 midterm elections, when many voters rallied behind candidates who supported abortion rights and bolstered Democrats to an unexpectedly strong showing. Since the Supreme Court’s decision, voters in six states — including Kansas, Kentucky, and Ohio, where Republicans control the legislatures — have approved state constitutional amendments protecting abortion access.

Polls show that abortion is a key issue to some voters, said Robert Blendon, a public opinion researcher and professor emeritus at the Harvard T.H. Chan School of Public Health. He said up to 30% across the board see it as a “personal” issue, rather than policy — and most of those support abortion rights.

“That’s a lot of voters, if they show up and vote,” Blendon said.

Proposals to further protect — or restrict — abortion access could drive voter turnout. Advocates are working to put abortion-related measures on the ballot in such states as Arizona, Florida, Missouri, and South Dakota this November. A push in Washington toward a nationwide abortion policy could also draw more voters to the polls, Blendon said.

A surprise ruling by the Alabama Supreme Court in February that frozen embryos are children could also shake up the election. It’s an issue that divides even the anti-abortion community, with some who believe that a fertilized egg is a unique new person deserving of full legal rights and protections, and others believing that discarding unused embryos as part of the in vitro fertilization process is a morally acceptable way for couples to have children.

Pricey Prescriptions

Drug costs regularly rank high among voters’ concerns.

In the latest tracking poll, more than half — 55% — said they were very worried about being able to afford prescription drugs.

Biden has tried to address the price of drugs, though his efforts haven’t registered with many voters. While its name doesn’t suggest landmark health policy, the Inflation Reduction Act, or IRA, which the president signed in August 2022, included a provision allowing Medicare to negotiate prices for some of the most expensive drugs. It also capped total out-of-pocket spending for prescription drugs for all Medicare patients, while capping the price of insulin for those with diabetes at $35 a month — a limit some drugmakers have extended to patients with other kinds of insurance.

Drugmakers are fighting the Medicare price negotiation provision in court. Republicans have promised to repeal the IRA, arguing that forcing drugmakers to negotiate lower prices on drugs for Medicare beneficiaries would amount to price controls and stifle innovation. The party has offered no specific alternative, with the GOP-led House focused primarily on targeting pharmacy benefit managers, the arbitrators who control most Americans’ insurance coverage for medicines.

Costs of Coverage

Health care costs continue to rise for many Americans. The cost of employer-sponsored health plans have hit new highs in the past few months, raising costs for employers and workers alike. Experts have attributed the increase to high demand and expensive prices for certain drugs and treatments, notably weight loss drugs, as well as to medical inflation.

Meanwhile, the ACA is popular. The KFF poll found that more adults want to see the program expanded than scaled back. And a record 21.3 million people signed up for coverage in 2024, about 5 million of them new customers.

Enrollment in Republican-dominated states has grown fastest, with year-over-year increases of 80% in West Virginia, nearly 76% in Louisiana, and 62% in Ohio, according to the Centers for Medicare & Medicaid Services.

Public support for Obamacare and record enrollment in its coverage have made it politically perilous for Republicans to pursue the law’s repeal, especially without a robust alternative. That hasn’t stopped Trump from raising that prospect on the campaign trail, though it’s hard to find any other Republican candidate willing to step out on the same limb.

“The more he talks about it, the more other candidates have to start answering for it,” said Jarrett Lewis, a partner at Public Opinion Strategies, a GOP polling firm.

“Will a conversation about repeal-and-replace resonate with suburban women in Maricopa County?” he said, referring to the populous county in Arizona known for being a political bellwether. “I would steer clear of that if I was a candidate.”

Biden and his campaign have pounced on Trump’s talk of repeal. The president has said he wants to make permanent the enhanced premium subsidies he signed into law during the pandemic that are credited with helping to increase enrollment.

Republican advisers generally recommend that their candidates promote “a market-based system that has the consumer much more engaged,” said Lewis, citing short-term insurance plans as an example. “In the minds of Republicans, there is a pool of people that this would benefit. It may not be beneficial for everyone, but attractive to some.”

Biden and his allies have criticized short-term insurance plans — which Trump made more widely available — as “junk insurance” that doesn’t cover care for serious conditions or illnesses.

Entitlements Are Off-Limits

Both Medicaid and Medicare, the government health insurance programs that cover tens of millions of low-income, disabled, and older people, remain broadly popular with voters, said the Democratic pollster Celinda Lake. That makes it unlikely either party would pursue a platform that includes outright cuts to entitlements. But accusing an opponent of wanting to slash Medicare is a common, and often effective, campaign move.

Although Trump has said he wouldn’t cut Medicare spending, Democrats will likely seek to associate him with other Republicans who support constraining the program’s costs. Polls show that most voters oppose reducing any Medicare benefits, including by raising Medicare’s eligibility age from 65. However, raising taxes on people making more than $400,000 a year to shore up Medicare’s finances is one idea that won strong backing in a recent poll by The Associated Press and NORC Center for Public Affairs Research.

Brian Blase, a former Trump health adviser and the president of Paragon Health Institute, said Republicans, if they win more control of the federal government, should seek to lower spending on Medicare Advantage — through which commercial insurers provide benefits — to build on the program’s efficiencies and ensure it costs taxpayers less than the traditional program.

So far, though, Republicans, including Trump, have expressed little interest in such a plan. Some of them are clear-eyed about the perils of running on changing Medicare, which cost $829 billion in 2021 and is projected to consume nearly 18% of the federal budget by 2032.

“It’s difficult to have a frank conversation with voters about the future of the Medicare program,” said Lewis, the GOP pollster. “More often than not, it backfires. That conversation will have to happen right after a major election.”

Addiction Crisis

Many Americans have been touched by the growing opioid epidemic, which killed more than 112,000 people in the United States in 2023 — more than gun deaths and road fatalities combined. Rural residents and white adults are among the hardest hit.

Federal health officials have cited drug overdose deaths as a primary cause of the recent drop in U.S. life expectancy.

Republicans cast addiction as largely a criminal matter, associating it closely with the migration crisis at the U.S. southern border that they blame on Biden. Democrats have sought more funding for treatment and prevention of substance use disorders.

“This affects the family, the neighborhood,” said Blendon, the public opinion researcher.

Billions of dollars have begun to flow to states and local governments from legal settlements with opioid manufacturers and retailers, raising questions about how to best spend that money. But it isn’t clear that the crisis, outside the context of immigration, will emerge as a campaign issue.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.