COVID-19 Is Here to Stay, Says Former Biden Adviser

BIANNA GOLODRYGA: Well, next, the highly contagious Omicron variant has pushed U.S. hospitalizations toward a record high. And with the fear of new variants occurring, a group of doctors has called for the Biden administration to adopt a new normal approach that was published in three recent opinion articles. Among these experts is a former member of Biden’s transition COVID-19 Advisory Board, Dr. Ezekiel Emanuel. Here he is talking speaking with Walter Isaacson.

(BEGIN VIDEO CLIP)

WALTER ISAACSON: Thank you. And Dr. Ezekiel Emanuel, welcome to the show.

DR. EZEKIEL EMANUEL, VICE PROVOST FOR GLOBAL INITIATIVES, UNIVERSITY OF PENNSYLVANIA: Walter, it’s my great pleasure to be here with you.

ISAACSON: You’re one of six Biden transition advisers, you’ve worked with them on COVID. And the six of you published a series of article this past week saying, hey, we’ve got to change course, we’ve got to learn to live with this disease. What was the purpose of that article?

DR. EMANUEL: Well, the purpose was to alert the American public, we’re not going to defeat the coronavirus. It’s here to stay. It’s going to become like flu, respiratory syncytial virus, other viruses that are of the respiratory tract. It’s going to be around and it’s going to get to an endemic level that’s a low level, and we’re going to live with it.

ISAACSON: Well, wait. Why not try to eradicate it? That’s what Biden said he was going to do.

DR. EMANUEL: We have, in human history, eradicated one disease, smallpox. Other than that, we still live with polio, with tetanus, with rabies, with lots of other diseases. We are not getting rid of this virus. We’re not going to eradicate it. I don’t believe the president said he’s going to eradicate it either.

ISAACSON: Well, so you say we’re going to learn to live with it. Does that mean that it is becoming more like the flu and we should just put it in that bucket of respiratory illnesses that we sometimes get every winter?

DR. EMANUEL: Well, yes. We have to put it in with this collection of many, many other viruses that we get every year. We may not identify them as flu, but there are other viruses. We’re not at the level of what scientists call endemic or it’s just around and we’ll have minor surges, but we are still in an emergency. We’re, after all, having more than 1,500 Americans die every day. That’s over 500,000 in an annual period. So, we’re not there yet. At some point, we’re going to be there, hopefully by the middle of this year, but we have to get there and then, we have to sustain it.

ISAACSON: Wait, wait. So, what changes are you talking about in the administration policy? They seem to be doing a lot of what you said.

DR. EMANUEL: They are doing a lot but I don’t think yet. We’ve had a coherent policy. Look, they started out in January 2021 when they took office with an excellent strategic plan that they executed very well on for the first six months of the administration. The virus changed. We got Delta. We got Omicron. Our strategy has to change, and that was the main purpose of writing these articles.

ISAACSON: And the notion of a strategy change means that people like myself had been vaccinated, had been booster shotted. Everybody I know in New Orleans has now had the disease. We all get a little bit sniffles and flu. We should just live with it and try to protect the vulnerable?

DR. EMANUEL: Well, that’s one thing we have to do, but there are many other things we have to do. On the vaccine, we need to develop additional vaccine against specific variants but also, try to develop a pan of coronavirus vaccine. We need to develop mucosal vaccines that might better protect against this particular kind of virus.

ISAACSON: Meaning, ones that are nose spray type ones?

DR. EMANUEL: Yes. We need to develop therapeutics, not just the one from Pfizer, because viruses mutate. So, we’ll need multiple viruses. And then, we’ve got lots of other things. We have to improve our indoor air quality to get the filtration up, to have HEPA filters if we need them. We need a much better data infrastructure so we know in real-time how many people are getting coronavirus, how many people have been vaccinated, so, how many people have breakthroughs. Where in the country they’re at? We need a better surveillance system so that we can test waste water and find out where there are outbreaks before the people themselves actually understand there’s an outbreak so we can intervene more quickly. And, by the way, if we really want to be a country that can prevent the next pandemic, we actually have to do this broadly, not just focus on coronavirus but focus, as we argue in the papers, on all respiratory viral illnesses. That’s a collection of them, not just one.

ISAACSON: You know, one of the things that struck me in your article, surprised me, was just how bad our national data collection system is. We don’t have one real-time database that says, here’s somebody who got it, here’s the exact strain they had, here was their exact vaccination status, and what type of vaccine and how long it had been. Aren’t these types of things you’re going to need the you want to get this to be where you say if we can live with the disease?

DR. EMANUEL: Walter, you must be a doctor or epidemiologist. You’re absolutely right. In the 21st century, where we have Google and Facebook and Amazon and they know what store you’re walking into, it does seem a little archaic that we are depending upon data out of Israel or the United Kingdom instead of having our own data and showing the world how this virus is evolving. We need a real-time data system. I think there’s been a lot of reasons we haven’t had it. Worry that the government can’t execute privacy advocates that worry that the government will be tracking you. You know, people who have been talking about microprocessors being given to you with the vaccine. So, we have —

ISAACSON: Those are whacky things. Why does not the CDC track exactly who’s getting it? What kind of vaccine they had in real-time?

DR. EMANUEL: Well, I think the CDC grew up in an older era where they got a few selective pieces of data and then, relied heavily on modelling and frankly, hasn’t updated to a modern data system. And, frankly, the other part is congressional. They have not had a lot of money to support them and to support this pretty big effort. But we really do need it. And more importantly, America has the best computer scientists and computer companies that really know how to do this and we should be able to have a public private partnership that really gets that kind of data infrastructure in place. There’s no excuse, again, for not having that infrastructure. We know how important it is.

ISAACSON: But I read in the “New York Times” that the Biden administration’s already doing that. And yet, I see no signs of it. Everybody I know who’s had tested positive for COVID, whether it’s us or our daughter, whatever, we’re not asked what strain do you have, we’re not asked to put in the database. Why are we saying we’re doing this and it’s not happening?

DR. EMANUEL: Well, there is a database where people voluntarily give information, for example, about side effects of the vaccine. But I totally agree with you. It cannot be passive, that people have to go find it, upload it, because we know that’s a lot of effort and most people won’t do it. You need a system where you get pinged automatically and — by a text. And then, you look at the text and you respond. That’s the kind of data system we have to have in place. And I think it has to be thought through. It’s going to take money, not a huge amount of money, we’re not talking about tens of billions of dollars, and we need to put it in place.

ISAACSON: Is testing in the United States where you would like it and what do you do about states like Florida that say, well, that whole at the testing thing is whacky, we’re not going to overt testing?

DR. EMANUEL: First of all, Florida has been irresponsible and Ron DeSantis has been a very bad leader on this. We do need a better testing infrastructure. We didn’t get testing right at the start. The CDC got it wrong. We didn’t approve at-home tests. We didn’t have a testing strategic plan ever, in my opinion. And we didn’t know how the PCR testing is going to fit in with the at-home testing. And we didn’t make it cheap and readily available. We need a better strategic plan on testing. In addition, Walter, one of the other important things we need to do is we need to have a very close linkage between a positive test and the ability to get therapeutics, right? You have to start those therapeutics within a few days. We shouldn’t leave it to the haphazard very fragmented health care system to say, oh, I’ve got a positive. I call my doctor, and my doctor will arrange it. That will mean only people who are well off, rich, connected will get those therapeutics and will have and repeat the disparities we’ve had around COVID and many other areas in these therapeutic areas. So, again, one of the things we need is a link between your positive, you get an outgoing call. You should go to this place to get some therapeutics. If you’re not eligible, we can try to enroll you in a research trial to test out other therapeutics. And by the way, here’s what we need to do to be safe. Here’s how long you should isolate yourself. Here’s what you should look for. Here’s a number to call, if, in fact, your symptoms get worse. That’s the kind of system we really do need to implement. We need a much better, what we — doctors call public health effecter arm (ph). Once we’ve got the information going out and intervening with people.

ISAACSON: You say that we have to get out of this perpetual state of emergency. I think that’s a phrase used in your article. Are we panicking too much now about COVID?

DR. EMANUEL: No, I don’t think we’re panic panicking too much. I do think we have to get a handle on the disease. When you have a million cases, over 140,000 hospitalizations, 1,500 deaths, it’s still an emergency. What we’re looking at in our articles is, we’re going to get out of this emergency sometime in the end of February, early March. We need a strategic plan for the rest of 2022 and we need a plan that’s flexible, that can confront a variety of scenarios that might arise. Do we get a more severe virus? Does it become much easier because Omicron takes over and it’s not a very serious illness for people? But at the moment, we are having — we’re still in an emergency and I think the emergency situation is important. We’re not at endemic COVID. We need to get there.

ISAACSON: You were very close in the Biden transition, all six of you were. You know Ron Klain’s e-mail address and Jeff Zients, you know, the people who are in charge of this and the administration. Why write a public article rather than just talk to him? Did you feel there was something that needed to be said publicly?

DR. EMANUEL: Well, first of all, we are academics or we’re academics who work for foundations and other things. And what we do is write articles. And by the way, it’s not only, you know, 12 people at the White House that have to have this change in attitude. It’s the country that needs to get on board. We need a collective effort for everyone to understand where we’re going, what are the steps that are needed to get us there. And I don’t think this was — I mean, let me just say, no one intended this as a hostile attack on the White House.

ISAACSON: How did they react?

DR. EMANUEL: Look, they reacted positively that this was a very useful suggestion. Let me just say, Walter, I’ve been in the White House during an emergency in 2009 and 2010. You are working from 6:00 a.m. to midnight trying to solve problems. It’s not — you don’t have the time to step back and say, all right. Let’s lay out the strategic plan in detail. Who’s going to be responsible for what? That’s why we’re helpful there, and we thought that trying to develop — indicating we needed the strategic plan, indicating where the country was going and what the initial steps were, this is really a down payment on a strategic plan, was necessary. And by the way, I think they recognize it and they think it’s a positive contribution, not someone stepping on their toes, being angry at them and critiquing them. That wasn’t the intention at all.

ISAACSON: When I read the three articles, the ones with your name on it, and those of other people, I was shocked by the time I got there of what a total mess of this, a total mess on data collection, of knowing exactly how the vaccines work, which ones are working and which timing of how we do vaccination mandates, of how we don’t have a strategic plan. Is there somebody in charge now who’s supposed to be doing this?

DR. EMANUEL: Well, again, I think, you know, they are in charge. They’re working extremely hard. I’ve been in those trenches. It is a very hard job to do. And, Walter, it’s not just this moment. Look, you know, the problems we have with the CDC came out right from the start in February 2020 where we got the testing wrong, their advice on masking was wrong, and those things do not just happen with COVID. We have really some great institutions, but we also have some practices and cultures that are not optimal, and we really do need —

ISAACSON: Like what?

DR. EMANUEL: Well, look, I’ve been, frankly, a little disappointed in the NIH and the research the NIH has done. You know, we spent a lot of money on convalescent plasma. We never did a full randomized trial because we couldn’t organize people to do a trial. We beet heavily from the NIH on monoclonal antibodies, even though every virologist will tell you, well, the virus is going to mutate and it’s going to mutate away from these. We did not heavily invest in oral therapeutics like the new Pfizer and Merck drugs, even though that is obvious where we needed to go, and we had a history of knowing it was obvious through HIV where you needed a multidrug cocktail. We’re going to need a multidrug therapeutic cocktail with COVID too. And yet, we didn’t investigate — spend — focus our research on that for a variety of reasons. I think we — when we get out of this, we do need some really important rethinking of those biomedical institutions. I will say one really positive thing that I do think has been shown by COVID, and that is the FDA can review and assess trials much more quickly than it has in the past. The problem is personnel. To do that requires a lot more people than it has. And I think that is one of the things we ought to learn. We can work at much faster speed in terms of the regulatory process or drugs and devices and other things and we need to institutionalize that.

ISAACSON: One of the things you all call for is vaccine mandates. Now, I’ve known you for a long time, Zek. You’ve got more political savvy in your fingertips than anybody I know. Vaccine mandates clearly are not working. They’re gone up to the Supreme Court. The Biden administration wants them, but, you know, the courts are stopping it. People when faced with a mandate go ballistic. You can’t even get the U.S. Postal Service which works for the government to do it. So, why just call for vaccine mandates when that seems impractical?

DR. EMANUEL: Walter, I have been calling for vaccine mandates since April and we are going to need vaccine mandates for COVID. It may go against our strain, but there’s no other way. You can voluntarily, as we’ve shown, get 60 percent of Americans to get vaccinated. And we have not really been able to get much above 60 percent. We’ve plateaued. We need to get closer to 85 percent or 90 percent and the only way to get there is through requirements. I would very much disagree with your view. When companies impose mandates, people respond. The Mayo Clinic just really announced that 99 percent of their people agreed, 700 people out of a workforce of 70,000 decided they would rather lose their job than get a vaccine. That seems to me, a success. Not a failure at all. We’ve had successes with many other companies. You’ve got Starbucks recently instituting its own requirements. I think the Supreme Court would be dead wrong to say that OSHA overstepped its bounds in issuing a mandate for vaccination at companies. We are in the midst of a crisis, an emergency. This has, you know, been analogized to wartime and the Supreme Court would be wrong to take away one of our most important tools. I actually do think, this is one of those health measures where what I do affects you, affects the whole community and we know that in that circumstance, we should be able to require people to take precautions. In the case of COVID, the precautions, they need to include getting vaccinated to reduce the spread, and if the spread is bad, to reduce the imposition on the hospital and healthcare system so that everyone who has an illness, whether it’s pregnancy or if — that’s not an illness, but whether it’s a pregnancy or a heart attack or stroke or cancer can get the appropriate care. When the system is straining because of COVID, it’s hard for people to get the best care available, and that imposes burdens on many other people.

ISAACSON: Dr. Ezekiel Emanuel, always, great to see and thanks for being with us

DR. EMANUEL: Thank you, Walter. It’s a great honor to be here.