Dr. Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania and professor of health care management at the Wharton School, examines what the health care sector has learned from the COVID-19 pandemic and where it continues to fall short in preparing for future crises. (Read an article featuring Emanuel and several Wharton faculty looking back at the lasting changes brought by COVID-19.)
Transcript
Lessons from the COVID-19 Pandemic
Dan Loney: As we talk about the fifth anniversary of the coronavirus, it’s a pleasure to be joined by Ezekiel Emanuel, who’s vice provost for global initiatives here at the University of Pennsylvania, and also professor of health care management here at the Wharton School. Zeke, great to talk to you again. How are you, sir?
Ezekiel Emanuel: Good, good.
Loney: How do you look back at the window and the impact of the COVID-19 pandemic? But even more so, what do you think health care has learned from that period of time?
Emanuel: One of the things I think is clear — and I feel comfortable saying it — is that we’ve learned about allocating scarce resources, or rationing. We’ve learned the ethical principles we need to bring to bear, which groups get prioritization and which get further down the list. And I think that’s actually been a big contribution. Because it’s not just relevant to coronavirus, vaccines, and a pandemic; it’s relevant to lots of other things that the exact same framework is useful for, like GLP-1s, that are in shortage.
We’ve also learned a lot about targeting high-risk groups and the importance of doing that. I would say we have learned a lot about the need for data, the need for forecasting, the need to have good, resilient supply chains. That doesn’t mean we’ve actually put that knowledge into action. And that, I think, is the big disappointment, that we have, in the end, not really changed much of our systems. As a matter of fact, under the current administration, we seem to be undermining the preparation. But even under the Biden team, they wanted to put it in the back mirror. So, lots of the things that we need to do in this country — more resilient supply chains, more domestic production of generics, having a domestic production of N95 masks, and on and on — we really haven’t done those kinds of things. We had a flurry of domestic producers of N95 — very good producers, as a matter of fact — and then we just let them wither on the vine because it’s a penny cheaper, or a few cents cheaper per mask, to buy it from China. That is very short-sighted. And unfortunately, I think the short-sighted in many, many contexts, have won.
Loney: There obviously was a lot of discussion, when you talk about the vaccines and the development of the vaccines, at the speed at which those products were developed and brought to market as well. Is there an element of that which you expect we will see continue to play into our health care sector in the years ahead?
Emanuel: Again, this is a very interesting thing. We were able to gin up testing and production of the mRNA vaccines. We were not able to rapidly test lots of different interventions in — our clinical research enterprise and structure was maladapted to urgently testing things. And I think we haven’t fixed that serious problem, in my humble opinion. Frankly, I do think academic medical centers have some responsibility to bear. Each one of us wants to get attention, wants to claim credit, and the collaboration just wasn’t as effective as it should be.
Second thing I would say is it showed that the FDA can act quickly, but that requires resources. It requires lots of people working and we’re going backwards. We’re not going forwards. We’re reducing the number of people working. That’ll slow up the review times. I think it shows you that we can do these things, but these are resource-intensive endeavors. Similarly, at the CDC [Centers for Disease Control and Prevention], the monitoring systems for global infectious threats, dismantling it. The new forecasting center there, dismantling it. We’re not keeping the infrastructure that we need to rapidly respond to threats, and I think that’s the worst outcome.
Similarly, I would say that we learned — again, learned, but didn’t take into action — that we need better ventilation in our public buildings, especially our schools. We allocated a lot of money but did not mandate that money be spent on upgrades to the systems for air handling and HVAC. And I think schools could have, should have, done that. But we didn’t.
Are Hospitals Ready for the Next Pandemic?
Loney: For the hospitals, and with all of those different elements that you mentioned a moment ago, are we headed toward a kind of regeneration of the hospital system in terms of how it runs, and all the technology, and all these components that will come into play as well?
Emanuel: I think hospitals are struggling. We’ve had a […] steady decline in the number of people admitted to the hospital. The peak was 1981, actually. Obviously, there was a big bump during COVID. But the fact is that more and more care is being shifted out of hospital to the outpatient setting, where you can do surgeries now that no one ever conceived of doing 20, 30 years ago in the outpatient setting. And that actually makes the whole economic model of hospitals a little more difficult. And the preparation — you can’t have lots of hospital beds just waiting. One of the big problems at hospitals is moving patients who are ready for discharge, who don’t need the hospital-intensive treatment, out of the hospital. That system is broken also.
Loney: If we have another pandemic, at some point, we’re not nearly prepared enough, are we?
Emanuel: We’re not nearly prepared. I would say that the big problem there is going to be just the human resources. We worked our medical staffs to the bone, and there’s a lot of burnout there. There’s a lot of feeling of being overworked and not appreciated. Yes, early on, people were appreciating them. But afterwards, it wasn’t the case.
I will note one of the terrible ironies — I was trying to figure out the right word. Probably four or five decades ago, the president of the Beth Israel Hospital in Boston wrote an article about the rights of patients and the fact that health systems have to recognize rights. Now, you go into hospitals and there — you know, here’s what patients can’t do. They can’t abuse staff, blah, blah, blah. A 180-degree turnaround. And I think it reflects the sort of frustration with the health care system now, and COVID only made it worse.
