Coping With COVID-19 Crisis: Bioethicist & New Podcast Host Dr. Zeke Emanuel On The 18-Month Reality & Trump’s Malaria Drug

Editors’ NoteWith full acknowledgment of the big-picture implications of a pandemic that already has claimed thousands of lives, cratered global economies and closed international borders, Deadline’s Coping With COVID-19 Crisis series is a forum for those in the entertainment space grappling with myriad consequences of seeing a great industry screech to a halt. The hope is for an exchange of ideas and experiences, and suggestions on how businesses and individuals can best ride out a crisis that doesn’t look like it will abate any time soon. If you have a story, email [email protected]

In the midst of conflicting reports, confusing government advice and terrifying online information comes a new podcast that aims to serve up clear and useful discussion about the virus and its surrounding issues: Making the Call from Endeavor Content launches Wednesday, hosted by bioethicists Dr. Zeke Emanuel and Dr. Jonathan Moreno.

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Emanuel, an architect of the Affordable Care Act (Obamacare), oncologist, author and professor and vice provost at the University of Pennsylvania, spoke with Deadline recently to help bust some myths, offer constructive advice and address the need for truth-telling in this time of worldwide uncertainty.

DEADLINE: What struck me watching your interviews on MSNBC is that you don’t sugarcoat the truth. You say this will go on for 18 months, and you talk about how, in your experience as an oncologist, fudging the truth doesn’t serve anybody.

ZEKE EMANUEL: What’s interesting is, I think is people want that. They really want people to tell them what it’s going to be like. Everyone knows that the President knows nothing, and is just doing what he hopes, rather than what is realistic. What they want is what’s realistic. It’s, “Tell me what the plan is over that time.” That’s what I’ve been hearing from people, loud and clear, consistently. I just got an email right now, and they said, “What you’re saying about 18 months is real.” We have to understand that. It’s not pleasant to hear, but the alternative is, “I don’t know what to do with it because I know it can’t be right.” So, I think there is a hunger for the unvarnished truth. But you can’t give people the unvarnished truth without a plan for how to address it. I think that’s what’s critical.

DEADLINE: So, let’s talk about what a plan would look like for 18 months. Are we talking self-isolating for that long? What are your thoughts?

EMANUEL: There is physical distancing, and we’re going to have to keep that on for a total of eight to 10 weeks. I say eight to 10 weeks, but a lot depends upon how honestly vigorous [people are] and how much people adhere to it. But assuming we can get people to adhere to the physical distancing, wearing masks in public, washing of the hands and all of that stuff, for eight to 10 weeks. Then we can slowly ease up in phases. I think we need a large discussion of what those phases look like, because it’s not, “Oh, we’re returning to normal, let’s party,” or, that means go to the beach and spread corona. That is not what we need.

I think I have a plan. There are other people who have slightly different plans, but we have to have a concerted discussion going forward. One is, what are the things we’re going to need? We might say, alright, with restaurants opening, maybe we can have a few, in low-impact cities that have not had a big outcome, or are at the other end, where people can go to cafes, but only with a small number, maybe with temperature checks.

There are a whole series of ways of thinking about this that need to be being developed. But we don’t have that plan when the President and Vice President are obsessed with their 30-day plan, [as if] somehow that is going to take us to anywhere. That takes us nowhere. Literally nowhere. It’s taken us to the peak of cases in the country, or pretty close to it.

DEADLINE: Do you think the President is stringing us along with the 30-day plan idea because he doesn’t want to be unpopular, or is he not really aware of the dangers of reopening the country too soon?

EMANUEL: I go back and forth on this. Does he not know, or does he not want to tell people? It’s just going to become obvious that you’re going to have another 30-day plan and you’re going to add another 60-day plan and you’ll have another 15-day plan. Who’s going to believe that? There’s a way in which biology and disease tell the truth. You can’t escape. If we still are having thousands of people die a day, you will not be able to open anything that fast. You can’t talk your way out of there. It’s relentless.

DEADLINE: How much damage is Trump doing in touting the use of the malaria drug hydroxychloroquine? Is it 100% a false hope?

EMANUEL: It’s definitely a false hope. We as scientists and researchers have seen this story many, many times before, where something looks good, ought to work, and even if it is doable, won’t work. [With] hydroxychloroquine, there’s no reason it looks good or ought to work. It’s not that powerful a drug. We’re trying things that have been approved and are out there on the market, but that doesn’t mean they’re the most likely things to work, right? The most likely thing to work is a drug that’s developed for this virus, not a drug that you’re borrowing from something else. Something else might work. We’ve had those serendipitous moments, but they’re not the common serendipitous moments.

DEADLINE: Not that this is the flu, but with regard to a vaccine, the flu mutates, so every year the vaccine has to be changed to reflect that. Will that be the case with a COVID-19 vaccine?

EMANUEL: It does mutate but not like the flu. It’s not flu-like in that way. You have less mutations year-to-year. That doesn’t seem to be a big issue here. A bigger issue is that the body does not cling to coronaviruses in general to retain immunity as well as it does with other things. So, we know that after SARS [another type of coronavirus], a lot of people lost their antibodies and immunity over a course of years. It wasn’t durable in the same way that a measles vaccine is.

DEADLINE: That is worrying.

EMANUEL: Yes. So that is what is worrying most health experts, not the issue of a mutation out of control.

DEADLINE: Why are we seeing these outliers in younger, otherwise healthy people getting very sick? Can you offer any insight?

EMANUEL: The short answer is we don’t know. We just don’t know. There may be some differences how the immune system reacts. There may be some difference in other things, but again, if we are being honest, we don’t know.

DEADLINE: I know a surgeon who specializes in sleep apnea, and he says he suspects that that is one of the connecting issues in the groups of people that seem to do badly. He says that mouth-breathers will likely replicate virus in the throat more. Essentially, he’s saying that if you have sleep apnea or GERD, you’re at a higher risk. Do you have thoughts on that theory, or any other theories you’re personally considering?

EMANUEL: Well, they’re interesting theories. I would say that probably if I were to be honest, is these people get a big whopping dose, and getting a big whopping dose is the real problem. It’s not mouth-breathers. But maybe they reproduce in the mouth and therefore you have the effect of getting a big dose of it. It’s really the big dose that it is the problem.

DEADLINE: What are some of the topics you’ll be addressing on the podcast?

EMANUEL: The opening episode is about rationing ventilators and how we ought to think about rationing in general. Obviously, a major topic was getting the ethics of the rationing right. So, we interview one of the world’s leading experts on rationing in pandemic situations.

We’re also talking about resilience, resilience of people, resilience of the healthcare workforce, but also resilience of families. How to think about maintaining the resilience of your kids in the midst of the situation. We’re talking about the psychological difference in resilience. We’re talking about military medicine, and how this is similar to PTSD in some ways, especially for healthcare workers. Maybe it’ll be like that for everyone in society, because to some degree, we’re living through a serious trauma collectively. And what does that mean?

We’re hoping to do a podcast on transplant surgeons and people who need care that is not COVID-related. What’s happening to that care, and how is it being altered by the presence of COVID? We also have a one about the ethics of quarantining and isolating people. How to think about the law related to that. How to think about what’s the difference between quarantine and isolation? What are the powers people have? We talk about the law, with a U.S. focus. I think many of these discussions are more general, but they raise issues which are present for every country. How do we balance individual rights with the need for the community? I think if you tune in, if I might say so myself, it’s pretty compelling because it’s both a real live issue for many in many places, but it’s also very thoughtfully done. I think people will learn a lot.

DEADLINE: The UK Prime Minister Boris Johnson, who’s currently in intensive care, took the “herd immunity” stance initially, and then backtracked. Now Sweden are doing that. What are your thoughts on that approach?

EMANUEL: A lot of people, and not just old people, will experience problems. Young people as you pointed out, can die from this thing, too. We don’t know why and so it’s going to be a real issue.

DEADLINE: We keep hearing that men are more likely to do badly with the virus. Initially that was believed to be based on Chinese figures where men tend to smoke more than women. But that has proven true here, too. What are your thoughts?

EMANUEL: I have my hypotheses and I think it may be that men have more comorbidities. We’re the weaker sex when it comes to health. Men get more health problems. We’re more likely to have heart disease, and we have [these problems] earlier. We’re more likely to have lung disease. So, a lot of those may be the fact that men have comorbidities earlier. Our cardiac system or other systems may be less robust. Also, men’s immune systems may be different… [our immune systems] may have a tendency to overreact more than women do, or have what looks like an older immune system. We’re going to learn a lot.

DEADLINE: If you had absolute power, what would you do to curb the spread of this disease right now?

EMANUEL: It really is the old standbys of public health. It’s physical distancing, wearing masks, washing hands, keeping people away. You might want to begin also with early socialization of kids whose risk of death and serious problems seems very low. Not zero, but very, very, very, very low.

DEADLINE: What about the risk of those children coming home to older family members?

EMANUEL: Families have to do it voluntarily knowing that there’s going to be some risk to that.

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