The US Wasn't Prepared for Covid-19: Dr. Sanjay Gupta's coronavirus podcast for June 22

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US President Donald Trump: When you do testing to that extent, you're gonna find more people, you're gonna find more cases, so I said to my people slow the testing down, please.

Dr. Sanjay Gupta: Over the weekend, President Trump held a campaign rally in Tulsa, Oklahoma — against the advice of many public health officials, including his own.

Now, turnout for the event was smaller than expected. But the Bank of Oklahoma Center was still pretty crowded on Saturday — especially considering we are still in the middle of a pandemic.

Temperatures were taken at the door, and masks and hand sanitizer were handed out. But as we saw, very few people were wearing masks as they stood shoulder to shoulder in the audience. Definitely not physical distancing.

This event also happened at the end of a week where multiple states — including Oklahoma — saw their highest average of new daily Covid-19 cases. The highest since this pandemic began.

It's worrisome to a lot of people. Including Dr. Zeke Emanuel. I've known Zeke for a long time. I describe him as a man who wears many hats. He's a doctor, an oncologist. But also a bioethicist. He's the vice provost of global initiatives for the University of Pennsylvania and also a former White House health policy advisor under former President Barack Obama. Now he's a health advisor on former Vice President Joe Biden's campaign team.

Dr. Emanuel has been very vocal and critical of President Trump for holding a rally this weekend, saying it's just another example of the White House ignoring the advice of public health experts.

So in this episode, I've decided to sit down with Zeke to look back on the past few months of this pandemic. Really understand what the government's obligations were. What they got right, and what they got wrong. I think most importantly, we wanted to talk about where do we go from here? How do we turn things around?

I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is "Coronavirus: Fact vs. Fiction."

I want to ask about masks. I find this really interesting. I was talking to Governor [of New York state Andrew] Cuomo yesterday and I said, "What is it about masks? Why is it so contentious?" And he said, "Look, everything's contentious. Closing down, you know, businesses and closing down the economy was contentious. Closing down schools is contentious. Asking people to wear masks is contentious."

And I was thinking to myself, Zeke, that, yeah, closing down school's a big deal and closing down business is a big deal. Asking someone to go like this and put a mask on over their face. Why is this so contentious?

Dr. Zeke Emanuel, vice provost of global initiatives and co-director of the Healthcare Transformation Institute at the University of Pennsylvania: Sanjay, I totally agree with you. I don't think it needs to be contentious. The second thing I would say is what's the downside? What exactly is the problem with wearing a mask? What's the cost? Whereas closing down businesses, it's clear what the cost is. Wearing a mask. There's no cost.

And I think we got it wrong. I think the CDC [US Centers for Disease Control and Prevention] got it wrong. Those of us who listen to the CDC got it wrong. Yes, it's true. A cloth mask is not as good as a surgical mask, not as good as an N95 mask, but it's still good. And by the way, if you wear a nylon stocking around it, it's really good. But we didn't communicate to the public that very helpful information.

And I think it's become just another one of these political divides. I think, you know, the President doesn't want to wear a mask himself, doesn't want people to wear it because it suggests that we are really dealing with this virus. It's really serious and we have to change our behavior to it. And I think he would prefer to deny it. And if you're a person in the public looking at that, you're like, well, that's how the, our leaders behave. That must be OK. And the social norming here is very important. And we have totally failed on the social norming around face masks.

Gupta: Yeah, it's, it's pretty remarkable. It doesn't seem like people are just being ignorant. It seems like they're purposely sending out a message that you don't need to wear masks. This is OK. We're, we're in close proximity, but it's OK. Dr. Emanuel, as you've heard, we are now predicting that there may be some 200,000 people who will have died from this coronavirus by October. Is, is that inevitable now in in your mind?

Emanuel: Well, I've been saying 250,000 by the end of the calendar year. And I, I will say that one thing that has surprised me is that doctors and hospitals have gotten better at managing these patients. I think we've learned a lot over the last three or four months. So I think that the mortality rate is going down, but we're getting more cases. And so I do think there's something inevitable about getting to 200 or past 200,000 before the end of the year.

Gupta: You know, it's, it's quite striking, obviously, to draw the comparison with some countries, which are, which are numbering their deaths in the hundreds or even teens. And, you know, without sort of trying to unfairly bash on the United States, they didn't have a medicine or a vaccine, obviously, or something that we didn't have. Is it really just that people did not make decisions that needed to be made when they needed to be made?

Emanuel: I think it's multiple factors. I do think political leadership, which didn't activate and take this seriously is one problem. And when they did activate, they didn't actually activate in a very effective manner, as you can see from our testing regime.

I think in Taiwan, you had three factors. One, big suspicion of China after the SARS episode. You had two, face masks culture that wore the face mask. Took it seriously. And three, you had this health card they have, that allows them to actually know in near real time, after a few days, why people are going to the doctor, what they're going for.

And they could merge that health data with immigration and customs data to know who was traveling to China. So they could alert the health care system. Here's someone at high risk because of travel. Here's someone at high risk because of respiratory symptoms that tested negative for influenza. And that allowed them to jump on any cases and really isolate them, test them and isolate them very, very quickly. And that made a big difference as you can see.

Gupta: If you had been advising in the White House in January, of this year, because you've done that sort of work, obviously, in the past, what would Dr. Emanuel have advised the President?

Emanuel: Well, in, in ... I think the third week of February or something, I did advise the President, and I did say to the President that you've got to do what, say Lyndon Johnson would have done, or Franklin Roosevelt would have done, which is you create a tornado of activity that. ... So you've got a task force that deals with testing. You've got a task force that deals with PPE [personal protective equipment]. You've got a task force that deals with ventilators. Got a task force that deals with contact tracing. And on and on, so that you're covering the waterfront with competent people who know how to make the bureaucracy move, can coordinate with states, can coordinate with private industry.

And they created a small task force at the White House, which was supposed to do all of that. And that just was totally inadequate. And I think it would have made a huge difference.

Gupta: There were a lot of people in the beginning saying, look, this is a coronavirus. We've heard that term before, SARS and MERS, not to mention a lot of common cold sort of viruses as well. With SARS and MERS, there was a lot of concern up front. But in the end, if you take SARS, for example, some 8,000 people roughly around the world became infected and some 800 people died. Very high fatality rate, but wasn't particularly a problem, certainly not in the United States. Was it not reasonable for people to be thinking, well, this will probably be like that. Why should we get so worried?

Emanuel: I don't think that was unreasonable to have that hypothesis. But as you know, in medicine and in public health, you plan for the, hope for the best, but plan for the worst. And this was not planning for the worst. And we quickly passed the 8,000 cases and 800 deaths, in I think, it was in the fourth week of February, the third week of February worldwide.

And so you should have hopped on this much earlier than what this administration did. And I would say that hopping on it is one thing, but using that time when you're flattening the curve to actually get in place a good testing regimen, get in place good contact tracing. We didn't do that and we still don't have it.

Gupta: I am curious again, because you're a unique person in having advised the President, even during a previous pandemic like H1N1. When public health officials make recommendations to the White House, to the President in this case, how is that information generally received? What was the atmosphere like?

Emanuel: I would say the deference to science in the Obama administration was very high. We didn't win every, you know, every one of the decisions. But I would say we won easily the vast majority, and we did not have a hard-push sort of resistance like "We don't believe you." I would say the same thing — I'm advising the Biden campaign. I would say the same thing about the Biden campaign. They come to questionn, can we open up our offices? What do we need to do to open up the offices? When we lay out, the scientists lay out what we think is necessary, you know, they're pretty OK. That's what the scientist have said. There seems to be consensus on this one among our scientists. We're going to do that. And the pushback is, you know, are you sure or tell us what the uncertainties are. Not, "We don't believe you."

Gupta: You know, it's, it seems to me that part of the reason I never wanted to get involved in electoral politics is because it seems like there would always be competing interests. And you just mentioned you're advising the Biden campaign now. You know, in some ways, it obviously is a lot easier if you're not actually the President right now. You can say, I would do this. I would give money to all small businesses that have been shuttered throughout this. It's easier to say these things when you're not actually in the job.

But again, you're in a unique position because you've been in the job and now you're advising someone who is running for the job. Do you think that the Biden campaign, they're listening to you, but would they implement these things or would political interferences arise? You know, if Vice President Biden became President?

Emanuel: I actually think that they would defer to the scientists. I mean, they'd have people you know, the economists weigh in, too, because it's very relevant. But I think there's actually a confluence here. I don't think the competition is the way the Trump administration suggests it. Because all the economists I've talked to is, look, we're not going to get the economy to 90, 95 percent of where it was pre-Covid, unless we actually get the public health measures in place and restore consumer confidence.

The public health and the economics are intimately related. You cannot solve one without solving the other. And I do think that's critical, understanding it. And I know that the Biden campaign understands that. I don't think the current administration wants to believe that.

Gupta: Yeah, I think it's really interesting. And I think that the timetable plays a role here as well. I mean, I guess even if you say, hey, look, I guess I understand how it would be better for the economy in the long run to stay shut down longer now. But you know what? November is five months away. Right?

Emanuel: Sanjay, I don't think that's the right answer. Because if you look at places like Italy, like China, if you implemented the public health measures stringently, they actually turned out overall to be for a shorter period of time. And then you were able to get the number of new cases way down, so that any new case that came up, you didn't have to shut the whole economy down. You could focus your interventions to get to the few small cases and do the contact tracing and actually contain those individual cases.

So I think part of this is they actually, the administration, by keeping focus on the economy, shot itself in the foot. Rather than being stringent, which would have been a shorter period of time, they were less stringent. And that, as I said, made the public health measures less effective. And that has prolonged the number, a high number of new cases. It's not actually allowed us to safely reopen parts of the economy.

Gupta: So a more stringent lockdown, perhaps even for a shorter period of time?

Emanuel: Correct.

Gupta: It could have led to relief both on the public health side as well as the economic side. We didn't do it.

Emanuel: I mean, absolutely. We didn't do it.

Gupta: If you're a doctor, it's kind of like saying, hey, you know what, let's just do the right treatment, even if it's more aggressive, because that will actually take care of the problem instead of sort of doing a half-baked treatment for a longer period of time.

Emanuel: Sanjay, you're talking to an oncologist, right? We all believe, you know, we're doing the four drugs. We're not doing two now and two later because we know, two now two later, it's actually not going to cure you. Four drugs now, it's gonna be much tougher. But guess what? We have a 70 percent chance of curing you, and that's what we're going for.

We didn't do that in the United States. We dribbled it out, and dribbling it out is both prolonging it and making it much less effective in terms of bringing the cases and the total number of deaths down.

And I think that was a critical mistake. You know, for an oncologist this is like, the right answer is pretty clear here.

Gupta: And the metaphors is, is pretty direct, it seems, in this case as well. You know, Dr. [Anthony] Fauci [director of the National Institute of Allergy and Infectious Diseases], he said something that didn't surprise me at all. My guess is it didn't surprise you either, which is that he's concerned about an anti-science bias in the United States. I think that's been clear, frankly, even before this pandemic. If you look at things like vaccines and you look at things like climate change.

But I guess there's a real urgency to this anti-science bias now, because if a vaccine does come to fruition — and there's still a lot of ifs around that — but if it happens and it's available by early next year, as some have suggested, some polling now suggests that 30 percent of the country, even 40 percent in one study I read, people say that they would be reluctant or hesitant to take it. That would be a problem because you're not going to get to that herd immunity that everyone's talking about.

What do you think needs to be done? Is there anything that can be done now, to try and prevent that problem later?

Emanuel: Well, first of all, I have, I'm on the record and I believe that we should make these kind of lifesaving vaccines mandatory, certainly mandatory for children. I think that's open and shut. And I think the Supreme Court says you can make them mandatory for adults. And I actually think unless you have a good religious reason, it should be mandatory. And we should not let someone endanger the rest of the community for vague beliefs that are not based upon reliable science. I do think that there's been a long period of attack on expertise and science is just one element of expertise. And I do think we have to reverse that.

You know, you and ... well, I grew up in the '60s and in the '60s, scientists were revered. Right. It's scientists and engineers who put a man on the moon. We thought that investing in science, educating kids in science was critical. And it probably suggests, among many other things, that our educational system, especially around science, really needs to be rethought. We obviously have had this big push for the last few years around STEM, but I think we've got to broaden that out.

Gupta: It's been a challenge at times to celebrate the rapid progress that's being made on the vaccine. I have conversations with NIH [National Institutes of Health] scientists almost every day, and they are legitimately excited, Zeke. They'll say, "Hey, look, we've been able to create evidence of neutralizing antibody effect very early. It's, it's early evidence, but we hadn't been able to do what we've done here with HIV in 20, 30 years of research on an HIV vaccine." So there is some, some legitimate celebrations.

And yet at the same time, it seems to raise suspicion. You guys are rushing this vaccine. Look what happened in 1976. You rushed a vaccine back then and people got this Guillain-Barre syndrome, this ascending paralysis. You know, if you're rushing it, it's bound to have problems. And that raises more suspicion. So how do you help craft that message then, to give people the confidence that, yay, we can celebrate the rapid pace of things and also have some comfort that it's gonna be a safe vaccine?

Emanuel: Well, I do think we probably have more brain power worldwide working on this vaccine. You know, the equivalent is either the Human Genome Project or the Manhattan Project. And that is one reason we're making so much rapid progress.

I do think you have to convince people that the effectiveness trials that we're going to do with 30,000 people in the study — 10,000 getting a placebo, 20,000 getting a vaccine — are going to look very seriously at every side effect. And going to look at it for a period of months and not, you know, just a few weeks. And we're going to be sure that when we approve the vaccine, it really does protect people from getting infected. I think those criteria are essential.

And unless we can very reliably, based upon the data say that, I do think people have a legitimate reason to say, "You rushed the result. And it's not really ready for prime time." And that would be a disaster that would fuel the anti-vax movement. And that would be, I think, very, very harmful in the long term.

Gupta: Let me, let me just finish today by asking you about your new book. I don't know where you find the time, first of all. The book is called "Which Country Has the World's Best Health Care?"

If you wanted to live in a country, you, Zeke, that had the world's best health care. For you. Where would you live? Would you stay here in the United States or would you move somewhere else?

Emanuel: Well, it really does depend upon what you value most. And partially, it does depend upon the kind of illnesses you're anticipating and not. Norway, Germany, the Netherlands and Taiwan. Very low cost at the point of care. Good primary care. Good choice of doctor. Low cost. There are lots of advantages. But I would say that, you know, we should appreciate what we have in the 21st century. In 1900, the average life expectancy was in the low 40s. Now we're in the high 70s.

Yes, there are problems with the system. The main problems are really exorbitant costs that are affecting every country, the United States the worst. We have a very complex and inefficient system. There's a lot we can do to improve it over time. And the main purpose of this book was to find out what are other countries doing well, that we can actually adapt to our country.

Gupta: I'm really glad you wrote it. I mean, I think sometimes we have a tendency to get provincial in the United States. But it doesn't mean that we can't continue to learn from places all over the world. But I really appreciate your time.

Emanuel: Thanks, Sanjay. This has been a great interview. Really appreciate it.

Gupta: Dr. Emanuel's new book "Which Country Has the World's Best Health Care?" is out now.

I've got to tell you, experts like Zeke have been clear about what needs to be done to end this pandemic. I think you've heard this over and over again by now. And keep in mind, as I said, all these countries that have done so well, they don't have a medicine or a vaccine or something that we don't have. We're all dealing with the same resources. We need to do more testing. We need to do more contact tracing. We need to be more diligent about physical distancing and wearing masks.

But the concern is that four and a half months into this, we still don't have the public health systems in place to implement those basic steps. As a result, more people will die. People who didn't need to die.

There is hope. If you look around the world. Places like Taiwan and New Zealand, they show us that defeating the virus is possible. And we also have the world's top scientists working at record pace to develop a vaccine.

But we can't wait until then. Our government and all of us need to listen to the experts. We need to look at the data and we need to correct the mistakes that have already been made. It's not too late to save some lives.

Lately, I have heard a lot of people say, I don't need to wear a mask, I'm not worried about getting it. I think we need to change that conversation. If you don't wear a mask because you're not afraid of getting it, then you should wear a mask because you're afraid of giving it.

We all need to take care of each other. Be kind. Remember, we're all in this together.

We'll be back tomorrow. Thanks for listening.