This week, the White House informed states that President Joe Biden has approved an extension of Federal Emergency Management Agency COVID-19 relief until April 1, 2022. That means all state, local, and tribal governments will continue to get 100% reimbursements for efforts to continue to combat the pandemic, like vaccination clinics and public campaigns to encourage people to get the shots. The extension includes 100% federal reimbursement for national guard troops who have been deployed to help hospitals still overwhelmed by coronavirus patients.

There are still states in that position. The entire state of Idaho has been under a crisis standard of care declaration since September 16, 2021. That provides guidelines to “help healthcare providers and systems decide how to deliver the best care possible under the extraordinary circumstances of an overwhelming disaster or public health emergency. The guidelines are used when there are not enough healthcare resources to provide the usual standard of care to people who need it.” About 20 of Alaska’s hospitals have authorization in place to activate those standards if necessary. Colorado has had to reactivate the standards, and the two largest hospitals in Albuquerque, New Mexico, had to activate the standards Thursday.

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If the public health crisis isn’t over, the economic crisis can’t end. While much of the nation is returning to some kind of normal, that just can’t happen while other big chunks of it are still in crisis. The White House does recognize that, and that’s a big part of why President Joe Biden’s Build Back Better plan exists.

At this rate, with Sen. Joe Manchin playing his delay game, that plan could be delayed for weeks and weeks, if not months. Manchin apparently believes that Congress should instead be focusing on the looming debt ceiling and government funding deadlines. He’s not concerned enough about those things to consider ending the filibuster so that Democrats can easily deal with these issues on their own, however.

So given that the pandemic is still with us, and that millions of people are still struggling, some form of pandemic assistance needs to continue to flow to people. “Nearly 20 million adults—9 percent of all adults in the country—reported that their household sometimes or often didn’t have enough to eat in the last seven days, according to Household Pulse Survey data collected September 29–October 11,” the Center on Budget and Policy Priorities reports.

“When asked why, 82 percent said they ‘couldn’t afford to buy more food,’ rather than (or in addition to) non-financial factors such as lack of transportation or safety concerns due to the pandemic.” Additionally, “12 million adults living in rental housing—16 percent of adult renters—were not caught up on rent, according to data collected September 29–October 1.”

In addition, rising heating fuel costs and the complex economic factors created by the pandemic mean rising food costs aren’t likely to resolve quickly. So with those two must-pass things coming up, debt ceiling and government funding, there needs to be something in it for people. If nothing else, the monthly Child Tax Credit extension payments need to be included. Those are set to end as monthly payments in December.

Another option would be a fourth stimulus check, a solution Democrats have been talking about for months, but thus far haven’t worked to make actually happen. The Senior Citizens League has been rallying for $1,400 checks for Social Security recipients. “Social Security benefits only raised by 1.3 percent—on average that’s $20. That really eroded the buying power people had even just 12 months ago,” Mary Johnson, the group’s Social Security and Medicare policy analyst, told Newsweek. “We thought a one-time stimulus payment would help heat homes right now.”

It would, but the population that needs it is larger. If Build Back Better—and the myriad programs included in it—isn’t going to pass, something is going to have to for millions of Americans facing a long, cold, hungry winter.