Dr. Ezekiel Emanuel, a Former White House Health Policy Advisor as well as a UPenn Vice Provost of Global Initiatives, joins The Final Round to discuss his thoughts on the coronavirus, how leadership has handled the situation, and what the United States could be doing better to help bring down the numbers without having any more lockdowns.
MYLES UDLAND: So let's turn our attention now to everything going on with the pandemic. And for more on that, we're joined by Dr. Zeke Emanuel. He's vice provost of global initiatives and professor of medical ethics and health policy at UPenn, also a former White House health policy advisor. We're also joined by Yahoo Finance's Anjalee Khemlani.
So Dr. Emanuel, thank you so much for joining the program. Let's start with your op ed today in "The New York Times," talking about what you see as a disappointing amount of innovation, really, from the American, I guess, medical community-- is that a fair way to say it?-- during this pandemic. What has surprised you in a negative way so far? What would you like to see happen over the months ahead?
EZEKIEL EMANUEL: Well, if you look at research into therapeutics-- that's treatments for COVID-- you have to say the United States has not been a leader here. We have one major study. That's the study around remdesivir, which didn't show that it improved mortality. It showed that it got people out of the hospital faster. In fact, it wasn't even big enough to show an improvement in mortality.
By contrast, in Britain, they rapidly in March began big, simple trials that enrolled 12,000 people. They showed that hydroxychloroquine for hospitalized patients was not useful. An HIV drug compound was not useful, but that dexamethasone, a very simple, very cheap, commonly used steroid actually reduced mortality by 33%.
What have they done well that we've done poorly? Well, they've done large, simple, rapid trials that the whole country use, especially in a background where we don't have a treatment. We don't know what works. So they said every patient ought to be enrolled in the trial. And we should try it for patients, things, and record them and get data from everyone.
Instead, we've been more or less haphazard. And it's taken us seven months to actually get serious trials up and running. I have to say, it's really too slow, too late. We've not been the leader that we should be.
ANJALEE KHEMLANI: Dr. Emanuel, Anjalee Khemlani here. Good to talk to you again. I wanted to just discuss something that actually happened today. We had Admiral Brett Giroir discuss testing, which I know is just a little shift in topic, but on that point of sort of the way that the federal response has gone and the way that things have developed.
Testing has been one of those things that, as we're looking to reopen schools and workplaces, continues to be a struggle in some parts of the country. And we had Giroir say it's a utopian idea to have everyone be able to be tested every single day. I'd like to know your thoughts on that.
EZEKIEL EMANUEL: Well, I don't think it's necessary to test everyone every single day to reopen. And by setting that as the parameter, of course, we're not going to reach that. But we've stalled out at about 800,000 tests per day in the United States for 330 million people. Almost every expert thinks we need to be at 5 million and then progressing up to 20 million tests per day. We're nowhere near that.
And he ought to be very embarrassed by how badly he has done. We've not had further progress to more testing. We've actually been going down in the last few weeks in terms of the number of tests we can do.
Plus, the number of tests is only part of it. Remember, getting a test and then having days and days and days, sometimes more than a week before you get results, that's also an embarrassment. That makes the test not very useful for anyone.
So I don't think he should be talking about testing everyone every day. We're not talking about 300 million tests a day. We're talking about 5 million tests a day. And he should be embarrassed by the fact that the number of tests are actually going down, not up.
SEANA SMITH: Well, Dr. Emanuel, let me just jump in here and just in terms of the fact that we've been talking about how the US has been lagging behind in testing and what we need to do to address it. And you mentioned those numbers that we need to get to. But when we talk about the flaws and why we're so far behind seven months into this pandemic, what are a couple of steps that we could do over the next couple of weeks to get us on that right track that you're talking about?
EZEKIEL EMANUEL: How about national leadership? Let's start with that. You have to go through why are we having the problem? One of the problems is supply chain issues. Well, why isn't that solved seven months into this problem?
Another issue is getting more labs in file. Why isn't that solved? Another issue is having more rapid shift from a nasopharyngeal swabbing to anterior nares swabbing-- that's just in the opening part of the nose-- or rapid test, where, you can actually, like a pregnancy test, put a drop in there and see if someone's infected. That's been available in other countries for a long-- for many months now.
Every part of the system hasn't worked well. If you were running a competent administration, you would look at the whole path and you would focus attention at each one of the barriers or choke points and solve them. And this administration has proven itself. They entrusted Jared with solving this problem-- not solved.
ANJALEE KHEMLANI: Doctor, switching gears to vaccines, I know that the distribution of them is something that has been discussed. I believe we've even talked about this before. But today, we saw that draft from the National Academy.
And I was curious to know your thoughts. It seems like there weren't very many surprises in there in terms of who is on that priority list to receive it. But I'd love to hear your thoughts.
EZEKIEL EMANUEL: Well, first of all, they've prioritized health care workers and they've prioritized people at risk. Now, a lot of people support health care workers, although we should say that the risk to health care workers with adequate PPE is probably pretty low. When you look at people who are in Tier 1, it turns out that people with co-morbidities-- that's with health problems like obesity or diabetes or emphysema-- that's 193 million Americans. That's 2/3 of all the population.
You're clearly not getting past Tier 1. And even within Tier 1, you're going to have to actually allocate within that group. And I didn't see a clear prioritization within that group.
Let me say second of all, they want to prioritize allocating to people who participate in the vaccine trials. I don't think that's ethical. I think that many people have contributed to a good response to COVID. I don't think people who participate in the vaccine trials ought to be prioritized.
For one thing, we know that a lot of those people are probably beginning at low risk. For another thing, they have not recruited adequately. The enrollment recruitments among minorities and other groups has been low. And so you're going to disproportionately take vaccine away from minority groups. That doesn't seem to me to be right or fair.
MYLES UDLAND: And then Dr. Emanuel, the question of how you administer the vaccine kind of brings you back to what you discussed in the op ed today, which is the treatment of COVID. And I've often sort of thought as a non-medical professional, the market's so obsessed with a vaccine, right? But I would imagine that six months on, that I would have thought there'd be more focus or more progress on ways to treat patients who do have COVID. Am I mistaken in thinking that there has not been a great amount of progress in that area?
EZEKIEL EMANUEL: Well, we essentially have two treatments, as I mentioned-- dexamethasone and, to a lesser degree, remdesivir, which, as I said, doesn't-- no evidence it improves mortality. It's really about getting people out of the hospital faster. That is underwhelming. And in addition, I think what we haven't also had is any proof and really large-scale trials of people who are not hospitalized or a preventative, giving something to people to prevent them from actually getting infected that isn't necessarily a vaccine. And again, I think these are areas that we really need a lot of research in.
As I early on was skeptical that we were going to get a lot of treatment, because taking stuff off the shelf typically doesn't work. And in the case of viruses, you don't need just one medication. You typically need two or three medications to work simultaneously. That does take time.
But what I think is we've been going for convalescent plasma, which is hard to administer. It's not as simple as a pill. Or monoclonal antibodies, again, hard to manufacture in large quantities. And you have to administer at a facility.
Trying out something that would be a pill would be a lot better, because it's just easier to manufacture and easier to distribute. And getting it for people who are less symptomatic and not necessarily hospitalized, but still need treatment, that's probably going to be an important target.
DAN ROBERTS: Dr. Emanuel, Dan Roberts here. Just quickly as we wrap, I cover sports business for us. And while we have you, I'm curious your take on what is OK, what isn't OK?
We have college football, which just started. A lot of people were surprised that it's moving forward. And then on September 10, the NFL is starting its season. What's your view in terms of what's acceptable, whether these leagues should be returning, and how they should be returning?
EZEKIEL EMANUEL: Well, first of all, I have said that I think we need to get back. I've been involved since March in trying to get the sports leagues back up. I do think the NBA has shown you that a bubble can work. And I recommended that early on. We wrote an op ed in "The Washington Post" about doing a bubble for the NFL.
I think the idea-- I believe it's Iowa State is going to have 25,000 fans in its stadium-- probably not a good idea. You're probably not going to have physical distancing. They're going to be together for a long period of time. They're going to be yelling and shouting. I think that's a bad idea. And I do think contact sports, where you have people out and about and not bubbled is probably not going to be a very good recipe in the longer term.
MYLES UDLAND: All right, Dr. Zeke Emanuel with the University of Pennsylvania. Doctor, thank you so much for joining the program. Really appreciate you taking the time today.
EZEKIEL EMANUEL: Pleasure to be here. Thank you.