U.S. Health Care System Steps Up To Fight Coronavirus Outbreak NPR's Rachel Martin talks to Dr. Ezekiel Emanuel, head of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, about the challenges the health care system faces.
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U.S. Health Care System Steps Up To Fight Coronavirus Outbreak

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U.S. Health Care System Steps Up To Fight Coronavirus Outbreak

U.S. Health Care System Steps Up To Fight Coronavirus Outbreak

U.S. Health Care System Steps Up To Fight Coronavirus Outbreak

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  • <iframe src="https://www.npr.org/player/embed/817046949/817048730" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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NPR's Rachel Martin talks to Dr. Ezekiel Emanuel, head of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, about the challenges the health care system faces.

RACHEL MARTIN, HOST:

The White House is now recommending that all of us avoid groups of 10 or more people. We are all trying to absorb the new guidelines that are meant to control the spread. President Trump is also asking people to keep schoolchildren at home and to avoid restaurants and bars.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT DONALD TRUMP: If we do a really good job, we'll not only hold the death down to a level that is much lower than the other way had we not done a good job. But people are talking about July, August, something like that.

MARTIN: So we could be talking several more months before we really get a grip on the contagion. What does that mean for this country's health care system? Dr. Zeke Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. He advised the Obama administration and was the co-author of a New York Times op-ed about the tough decisions that doctors could be facing. He joins us on Skype. Thanks so much for being with us.

ZEKE EMANUEL: Nice to be with you, Rachel.

MARTIN: So first off, just your reaction to the latest guidance from the White House - don't gather in groups of 10 or more people; don't go to restaurants, bars; keep your kids at home. Is that sufficient?

EMANUEL: Phew is my main reaction. They finally got to this. You may know that at the end of last week, I and a few colleagues at the Center for American Progress published that mayors and governors ought to do this. I don't know whether it's sufficient, but it's definitely necessary. The socially distancing is an absolutely essential public health measure.

MARTIN: The New York Times has this report I want to ask you about. It says that it obtained a recording of a phone call President Trump held with a group of governors, and they report that the president told those governors not to wait for the federal government when it comes to trying to get respirators or ventilators or other equipment that's crucial right now. Instead, quote, "try getting it yourself." What do you make of that?

EMANUEL: Well, I guess it's an acknowledgment in abdication of leadership at the federal government level, which I think is really sad. You know, the federal government has more resources than any state governor, including the governors of the biggest states. It's got a lot of capacity for planning. But this I think acknowledges how bad the federal government has been in preparing us, the country, for this epidemic. If we don't have the resources to plan that we need more ventilators and to get them and to say, guys, you're all on your own, I mean, that's pretty shocking.

MARTIN: Is there an argument to be made that state and local officials are closer to the ground, they can leverage manufacturers in a different way?

EMANUEL: No. The federal government has much more authority and sway, much more purchasing power. If you aggregate every one, it has, I think, better planning capacity for the whole country. Of course, it has to be done in coordination with states and local officials. But to basically say you're on your own is, I think, both a recognition of the abdication of responsibility and planning for this outbreak.

MARTIN: You co-wrote an op-ed for The New York Times recently and said physicians in this country may end up rationing health care. Can you explain how you see that playing out?

EMANUEL: Yes. I mean, it all depends on how many people get sick, how many people need the hospital, how many people need intensive care, how many people need ventilators. And at least in certain areas, it's going to overload. It's pretty clear it's going to overload the system no matter what we do in the next few days. What does overload the system mean? It means you have too many people for your intensive care unit. You have too many people who need ventilators, and you don't have enough ventilators. And, again, if we're prudent, we're planning, we're thinking about this, if that unfortunate, tragic situation happens, what do we do? We call that absolute scarcity of medical resources. And you have to think about rationing - or if you prefer the term triage - who gets it, who doesn't get it. And it's better to make those decisions, you know, calmly, thinking through, thinking through the ethical principles rather than ad hoc instinctively at the moment when you're confronted by it.

And so me and a few colleagues have offered a map, as it were, of some of the key choices that might have to be made. And in this situation, I think most people's intuition is you have to save the most people, and you have to save the people with the most chance of a good prognosis, living a long time after they recover.

MARTIN: Does that mean prioritizing younger people over older, more vulnerable people?

EMANUEL: In this epidemic, pandemic, surprisingly, I think, to many people, young people seem - immune might not be the right word, but they don't seem to get the illness as severely. Many of them you don't even know. They're not dying at the same rates. But it does mean, you know, saving the most people and saving the most people with the best prognosis so that when they recover, they'll actually recover well. You know, initially, that's going to be focusing on older people and people with comorbidities because that's the sick people and the people who seem to have the most life-threatening conditions with COVID-19.

MARTIN: When could we start to get to a point where we're seeing that kind of rationing of care? Or are we already there?

EMANUEL: You know, it's hard to know because what you have now are anecdotes. In Italy, it seems that some hospitals and some regions have gotten there. In the United States, you hear certain things, but I don't think certainly as a country we're there, and we don't have a very explicit indication that it's there. But we don't have that many ICU beds in this country. There are about 70,000 for all the adults in the country, and respirators are maybe less than 100,000 full-fledged respirators. So we're going to get there in some pockets there. I am pretty sure, unfortunately, and that's a tragic situation.

MARTIN: Dr. Zeke Emanuel - chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. He also served in the Obama administration. We appreciate your time.

EMANUEL: Thank you very much, and keep healthy.

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