Ezekiel Emanuel on the state of COVID-19 in the US and the ‘major issue’ of healthcare burnout
It’s been over two years since the coronavirus pandemic emerged in the U.S.
Now, in the latter half of 2022, federal agencies have slowly been relaxing their COVID-19 pandemic restrictions. In mid-August, the Centers for Disease Control and Prevention loosened its coronavirus guidelines as U.S. case counts fluctuated between over 121,000 to around 85,000 daily cases during August.
Healthcare Dive caught up with Ezekiel “Zeke” Emanuel — oncologist, bioethicist and a former White House health adviser — to talk about the state of COVID-19, the federal government’s policies on it, healthcare burnout and long COVID-19.
Emanuel is the vice provost for Global Initiatives at the University of Pennsylvania and co-director of the Healthcare Transformation Institute. He served as a special adviser for health policy during the Obama administration and, in 2020, was named to President Joe Biden’s Transition COVID-19 Advisory Board. He’s the author of several books including “Reinventing American Health Care.”
Healthcare Dive: You’ve written several op-eds recently about COVID-19, and the CDC announced in August that it would restructure amid criticism about its COVID-19 response. From your point of view, how are we doing with respect to federal regulations and COVID-19 this year?
ZEKE EMANUEL: Well, I think we can safely say this is how COVID-19 ends, not that COVID-19 is going away, but the American public has decided enough, and they’re not doing more.
You know, I walk around Washington, D.C. It’s the rare person who wears a mask. People are dining indoors. We’re over it, and we’re not going back.
Some people like me, that’s not actually the way I live my life. But I think for the vast majority of society, that’s the way it is. We have changed our risk tolerance radically, and I think this has been under-appreciated.
A really bad flu season has 50,000 deaths. I think yesterday, I have the New York Times here, just yesterday there were 491 COVID-19 deaths. Okay, that’s 500 deaths times 365. That’s three times the number of deaths in a bad flu season. We’re fine with that. That makes COVID-19 the number four leading cause of death in the United States.
We’re willing to accept additional deaths to lead a normal life, where normal means no restrictions on where we dine and social activities and no need to routinely wear face masks. That’s where the country is.
And I’ll make a prediction here shortly, probably not before the midterm elections, but shortly after the midterm elections, that the White House effort on COVID-19 will be shut down and it will be moved to HHS. And that will be a recognition that we’re over it. And it’s not going to be super special.
And at some point, maybe in the early new year, The New York Times and The Washington Post will take their COVID-19 pandemic trackers or maps and it won’t be on the front of the website. So I think that’s where we’re headed.
I don’t agree with that, I’m giving you a description, not a preference. I will be lecturing this fall at Wharton. I have four HEPA filters going in my classroom for 140 students. We bought N-95 face masks. You have to wear it in class twice a week. I present on day-one to my students on why we’re requiring this. I present them the data about how well N-95s protect, how much better they are than surgical masks.
I haven’t gotten COVID-19. I’ve gotten over 80 tests. And I am determined not to get COVID-19. I think the one thing the country is not taking about is long COVID-19. It’s a serious, serious problem, which is why I don’t want to get COVID-19. We don’t know anything about it.
I mean, we know a little bit, and what we know is not good.
Will those with long COVID-19 be left behind? Is it up to providers to figure this out on their own?
EMANUEL: I do think over time, we’re gonna get answers to this, there is a substantial investment. I don’t think we’re going to get them as fast as we need them. That’s one of the things that really upsets me is that we don’t have the urgency we should be having on this, because it really is a major problem.
You see people who have fatigue, shortness of breath, insomnia, and their life is just ruined, nothing short of ruined. And it’s millions of people in this country. A recent estimate from the Brookings Institute is that between 2 and 4 million people are out of the workforce because of long COVID-19. That’s a serious, serious national emergency. And we are not behaving as if it’s a national emergency, and I think that’s terrible.
Nonetheless, lots of super smart people are focused on this. And I do think we’re going to be dissecting the immunological breakdown or trying out a variety of interventions. We’re just going to try things and see, but I do think eventually we’re gonna find something.
You served as an adviser in the White House during the Obama administration. Did it give you any insight into how federal response shapes these big public health crises, like COVID-19?
EMANUEL: Oh, of course. Yes, absolutely. In March, we released a strategic roadmap for the country on COVID-19. I organized a group of about 25 of the country’s leading experts on this and one of the things our strategic roadmap focused on is what I call long-term infrastructure changes that will impact, on a permanent basis, the country’s ability regarding public health.
So let me give you a concrete example. One of the easiest things we can do to really reduce COVID-19’s impact is to improve indoor air quality by HEPA filters, not by upgrading our HVAC systems. And we haven’t done enough on that, in my humble opinion. If I were mayor of a large city, I would require upgrades. And where you can upgrade, put in HEPA filters. Every classroom should have a HEPA filter that’s suitable for the classroom, those kinds of changes.
Indoor air quality is one place I’ve been working, subsequently on burnout among healthcare workers. That’s another major, major issue. People are really, really upset. And we just haven’t done enough on that.
Then, what do you think the U.S. can do regarding burnout? We write a lot about it on Healthcare Dive.
EMANUEL: I think one of the most important things we can do is, first of all, recognize that this isn’t really just about individual docs, and stop with the solutions that are targeted to doctors. I think it’s part of a larger problem.
I think there are three things [driving burnout] and I think these things are not well appreciated. One is a kind of autonomy, there’s been this sort of attack on physicians and professionalism. Physicians feel like their professional judgment isn’t appreciated. Second, I think there’s been a loss of social detachment by doctors. I clearly remember my father, for example, would go to the doctor’s lounge. We’d go to medical grand rounds, he’d see all his buddies, and they would talk, usually chatting about the hospital, but it bonded them.
And I know that when I was training 30 plus years ago, when we were on call at the hospital, everyone came together and had a midnight meal. We could talk about how our day was going and conundrums and other issues. That social bonding has gone way down. And I think that’s really important to restore.
Third is sort of clinical meaning, the fulfillment that docs get, instead of patients being widgets, “I gotta get through 30 today.” We need a little more appreciation of what makes medicine meaningful.
I think when we’re challenged about how to address burnout, we have to give back autonomy to the doctors.