Former Obama bioethicist says Trump’s coronavirus exit plan has ‘many problems’

Growing up as the son of a feisty Israeli immigrant, and as one of three brothers to achieve success in wide-ranging fields, medical bioethicist Dr. Ezekiel Emanuel has become well-versed in asking tough questions — something that has come in handy during the current COVID-19 outbreak.

From advising the Joe Biden presidential campaign and the World Health Organization (WHO), to writing op-eds for The New York Times, former Obama Administration member Emanuel is addressing the coronavirus situation in many ways.

Emanuel isn’t purely critical of US President Donald Trump’s phased plan for reopening the United States economy, which he analyzed in a recent column. Emanuel told The Times of Israel that he agrees that any exit plan needs phases, and he appreciates this plan’s attention to older adults and long-term care facilities, along with its different recommendations for different types of businesses. Overall, though, he said, “There are a lot of problems with it.”

The biggest problem, in Emanuel’s opinion, is its reliance on testing to identify the number of cases, from which it draws numbers for reopening the country. Calling the amount of testing “not adequate,” he asked how it’s possible to know anything about the real total number of cases.

It’s one of many difficult questions Emanuel is asking these days, along with how officials can convey best practices, when to reopen the country, and how to ration scarce medical supplies.

Emanuel said that throughout the situation, “what has been obvious to everyone is the administration’s mishandling of the crisis. They did not even have the testing right.” He said that Trump has looked for “other people to blame,” including the WHO, to which the president has halted funding; Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; Microsoft co-founder Bill Gates; and Emanuel himself.

Emanuel has faulted the Trump administration for what he describes as contradictory instructions during the coronavirus response, including on facemasks. Emanuel said that the facemask issue “points to a serious problem of getting everyone on the same page, a page informed by science.”

Surgeon General Dr. Jerome Adams initially urged the public in a tweet not to wear facemasks; Emanuel said that Adams was “caught in the back-and-forth,” and that the Centers for Disease Control and Prevention “sent out the wrong information” on facemasks and that it took “a long time” to change its policy.

Silver linings

One member of the White House coronavirus response task force earned warm praise from Emanuel: infectious disease expert Fauci, whom he has known for about two decades.

“Tony is the model I use in my own personal conduct,” Emanuel said. “He sticks to the facts. If he does not know [something], he says, ‘I don’t know, we have to look into it.’ He’s a model of clear communication.”

Another such model he cites is New York Gov. Andrew Cuomo. “If you want to teach conscientious communication, you could do a lot worse than follow his case,” Emanuel said.

“I think Gov. Cuomo has been rising to the occasion,” Emanuel said. “He had a misstep or two out of the box, but he has, in his meetings, been very disciplined, very fact-based. I think he’s done a very good job listening to the experts.” Emanuel also likes hearing the governor ask pertinent questions: “He begins every day with ‘where are we,’ ‘what are we looking at’… making it clear people understand the gravity of the situation.”

Other governors whom Emanuel praised for “a really great job” include Democrats such as Gavin Newsom of California and Jay Inslee of Washington; and Republicans Mike DeWine of Ohio and Larry Hogan of Maryland. “I think there’s actually been a lot of governorship done,” he said.

Everyone knew if there was a moderate to severe pandemic, we would be short on ventilators

Meanwhile, his frustration with the federal government dates back decades. “Every pandemic plan executed, going back 15 years to 2005, everyone knew if there was a moderate to severe pandemic, we would be short on ventilators,” he said.

At that point in time, Emanuel was working for the National Institutes of Health, chairing the department of bioethics at its clinical center.

A family affair

Medicine runs in the family. According to The Chicago Sun-Times, his father, Benjamin Emanuel, who died in 2019, served as a medic during the Israeli War of Independence before immigrating to the US, marrying his wife Marsha and raising three boys and one girl in Chicago. The family’s original name was Auerbach but Benjamin Emanuel changed his last name in memory of his brother, who died in a clash between the British, Jews and Arabs in Mandatory Palestine in 1933.

Ezekiel Emanuel’s brother Rahm is perhaps more familiar to Chicagoans as their former mayor, and Ari is a renowned Hollywood agent. Rahm and Ezekiel Emanuel both worked in the Obama White House — Rahm as chief of staff, Ezekiel in the Office of Management and Budget as a special advisor for health policy; in that capacity he is widely credited as a shaper of Obamacare.

“I think it’s very important,” Emanuel said of Obamacare. “Is it everything? No. There are 28 million people who still do not have [health] insurance in this country … A lot of things are less than optimal. But it’s better than in the past. What we really need now is to make sure it’s universal in the US, like Israel. It’s one of the good things [about Israel].”

While Emanuel declined to comment on Israel’s coronavirus response, he noted that China was “not completely transparent” in late 2019 when the virus was first discovered, and that from one soccer game in the hard-hit region of Lombardy in Italy, “a few asymptomatic people spread it basically to the whole region.” This has raised his concern about sporting events and large gatherings, including in the Trump phased plan.

Emanuel sympathizes with Italian medical professionals who have had to make what he called “painful choices” about who received limited supplies related to patient care.

“Nothing is more difficult for a doctor than to make choices,” Emanuel said. “You do everything you can to avoid it.”

On March 23, Emanuel co-authored a paper in the New England Journal of Medicine, which he said offered “very deliberate guidelines” about what to do in the event of shortages in the US.

Some of the paper’s recommendations reflect the difficulty of choices that doctors are faced with. Emanuel and his co-authors write, “Because maximizing resources is paramount in a pandemic, we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable and that patients should be made aware of this possibility at admission.” They recognize that such a decision “will be extremely psychologically traumatic for clinicians — and some clinicians might refuse to do so.”

The current chair of the University of Pennsylvania’s department of medical ethics and health policy, Emanuel said that he is helping the WHO “on the ethics side” of the coronavirus response. “We’re reviewing protocols, trying to learn,” he said.

The learning process includes questioning Emanuel’s own views on ventilators based upon the situation in Europe. “Maybe we’re overusing ventilators,” he reflected. “The Germans are very cautious… We’re trying to learn what the right situation is with ventilators.”

Meanwhile, he’s advising Democratic presidential candidate Joe Biden on the virus. “I think more could be done,” he said of the campaign’s position. “I urged them to do more.”