State of Emergency for COVID: Why Officials Are Using the Declaration to Address Rising Infections

When the COVID-19 pandemic first began, officials in all 50 states issued orders declaring a "state of emergency."

More than half of those states (26, to be exact) allowed their COVID-19 emergency orders to expire earlier this year. But some have either allowed the order to stay in effect or have re-declared states of emergency. Most recently, Maryland, Delaware, and New York has each declared a state of emergency in response to the explosive surge of the highly-infectious Omicron variant, which accounts for a majority of COVID-19 cases in the US and is causing hospitalizations to rise across the country.

You're probably thinking that calling the pandemic an "emergency situation" feels all too obvious: COVID-19 has caused more than 5 million deaths across the world; triggered massive unemployment rates; closed schools and offices; and generally devastated societies, economies, and the mental health of communities across the world. But a "state of emergency" is a term that you probably most often hear shortly before or after some type of natural disaster, like a hurricane, tornado, wildfire, or snowstorm. So how come these state officials are declaring states of emergency over a health event? Here's why they're doing it, and how the declaration can help with the pandemic.

What is a state of emergency, exactly?

A state of emergency is a declaration made by government officials—usually a governor—during times of crisis that enables the state's government to access emergency response funds and resources, in addition to activating state emergency response plans, per the Association of State and Territorial Health Officials (ASTHO), an organization representing the public health agencies in the US.

So when state officials have declared states of emergency due to COVID, they're doing more than just lip service—these official proclamations are actually tools enabling state governments to temporarily "unlock" health care resources like personal protective equipment and vaccines that are not available during non-emergency times. Emergency declarations also give government organizations the go-ahead to suspend certain regulations, laws, and bureaucratic processes that might slow the response to public health threats.

Is it unusual for a health issue to prompt a state of emergency?

Whether or not a situation calls for a state of emergency depends on what each state has laid out in its laws. "Traditionally states have a general statute that permits the governor to declare a state of emergency for any type of emergency or natural disaster, which can be construed broadly to include disease epidemics and other public health emergencies," according to ASTHO.

So while states of emergency are more commonly declared for weather disasters and civil unrest, the law allows for a situation like the COVID-19 pandemic to be grounds for a state of emergency declaration.

And this pandemic is not the first time in recent history that states have declared emergency orders to mitigate a public health threat. In 2018, six states did just that in response to the opioid epidemic, wielding the power of emergency declarations to extend access to naloxone (an overdose reversal drug) to avoid overdose deaths, mandate prescription monitoring programs, enhance reporting of overdose deaths from doctors and hospitals, and assemble federal grants for treatment services and programs.

"Declaring a public health emergency allows states to take swift, flexible action to efficiently center resources where they're most needed," Andy Baker-White, senior director of state health policy at ASTHO, tells Health. "When you're in an emergency situation, the goal is to identify the 'gaps' so resources [and health care providers] can be moved around to where they're most needed."

How can declaring a state of emergency help with the pandemic?

During the COVID-19 pandemic, state of emergency declarations have primarily been used to mobilize personnel and resources to increase testing and vaccination rates. For example, after Maryland hit a record high of 3,057 COVID-19 hospitalizations, its governor declared a state of emergency on January 4.

"The number of persons hospitalized in Maryland because of COVID-19 is straining critical health care resources," Maryland Governor Larry Hogan wrote in the state's Declaration of State of Emergency. "The widespread health impacts of COVID-19 are a public health catastrophe and public emergency. COVID-19 poses an immediate danger to public safety."

In his public address, Governor Hogan explained that he was taking the emergency action "to keep our hospitals from overflowing, to keep our kids in school, and to keep Maryland open for business, and we will continue to take whatever actions are necessary in the very difficult days and weeks ahead."

The declaration came with an order to deploy the National Guard to step in at state- and locally run COVID-19 testing and vaccine sites for the help of vaccine administration and to increase testing capacity. Another order authorizes Maryland's Department of Health to establish "alternative care sites"—aka, pop-up hospitals—to relieve pressure from overwhelmed hospitals and expedite the transfer of patients between health care facilities.

When New York Governor Kathy Hochul declared a state of emergency in November 2021 in anticipation of Omicron's surge, the state's health department was granted authorization to limit hospital capacity for "nonessential and nonurgent care" until at least January 15, in hopes of keeping hospital beds open for COVID-19 patients.

State of emergency powers are further attempting to quell staffing shortages in hospitals and health care facilities by broadening the scope of who can practice medicine. Maryland's latest actions do this in a few ways, by allowing:

• interstate reciprocity for health care licenses (which means that health care providers certified to practice outside of Maryland can now legally, temporarily practice in the state)
• health care providers with expired licenses to practice without reinstating their licenses
• graduate student nurses to work at health care facilities and provide full nursing services
• practitioners to practice outside the scope of their license to care for COVID-19 patients.

Delaware—which declared its state of emergency on January 3 to "combat the winter surge of COVID-19 and hospitalizations—is taking similar action. In part, the declaration will "enable members of the Delaware National Guard to work as certified nursing assistants (CNAs) in skilled nursing facilities to care for patients currently in Delaware hospitals," according to the official announcement. And approximately 100 members of the Delaware National Guard are now being trained to become CNAs.

How long do states of emergency last?

Sometimes, states will identify specific deadlines at which point the state of emergency will "expire." In December 2021, Oregon Governor Kate Brown announced that an earlier state of emergency declaration will remain in effect until June 30, 2022, unless earlier rescinded or extended.

But truth be told, it's not yet clear how long emergency orders will last—and the introduction of Omicron has muddled the question even further.

"We may well have more governors declaring emergency orders [in response to Omicron]," Sharona Hoffman, a professor of both law and bioethics and co-director of the Case Western Reserve University's Law-Medicine Center, tells Health. "At the same time, Omicron seems to be milder, so we may have fewer people in the ICU needing things like ventilators, and very aggressive interventions… Still, we are seeing more children being hospitalized, and if it hits health care providers really hard, which it appears to be doing, you might need resources like the National Guard to step in to make up for healthcare providers who have to quarantine."