Coronavirus scenario that has Dr. Zeke Emanuel really worried

Dr. Ezekiel Emanuel, Former White House Health Policy Advisor for the Obama Administration and Vice Provost of Global Initiatives at the University of Pennsylvania, joins Yahoo Finance’s Seana Smith to discuss the coronavirus outbreak, as the U.S. death toll surpasses 10,000.

Video Transcript

EZEKIEL EMANUEL: Well, I think mortality is lagging. It lags about 15 days, 21 days after you get infected. And so people are expecting, if we're seeing a peak maybe on hospitalizations, ICU visits, that mortality will come behind that. And so that we'll see a big rise in mortality until we get to the peak. I think that's what all that laying of black crepe is about.

But remember, we're also likely to see other cities besides Detroit and New Orleans begin to see some kinds of peaks, because they were late in terms of sheltering in place orders and physical distancing orders. And they will begin coming up with a larger number of infections, and really enter that exponential phase.

So I think it's kind of part of the process of preparing the country that the numbers-- number of infections, number of hospitalizations, number of deaths-- is likely to go up much higher than we've anticipated.

SEANA SMITH: Dr. Emanuel, how encouraging is the latest data out of Europe, just in terms of the number of cases and the number of deaths starting to level off?

EZEKIEL EMANUEL: It's all preliminary, but it is somewhat encouraging that physical distancing and really strong sheltering in place policies can make a difference. I think one of the things that's a problem here is that we're all focused on the day. So how good is the data from Italy? And should we feel optimistic because of it?

I think you have to remember that that means that you're going to have to have another three or four weeks at least of this strong sheltering in place. And even then, you can't ease it up with the flip of a light switch. It's not like we're going to go out suddenly and restaurants and bars are all going to reopen, we're going to have more sporting events and things.

This physical distancing is here for a very long time. And I think the markets haven't sort of fully taken on-- you know, the president tells us a 15-day plan, a 30-day plan. It is not going to be done in 30 days.

And we are going to have a prolonged period until we get an effective treatment, an effective prophylactic, or a vaccine. That's many months away. And I think this is where there's a disconnect between the public health community and the market and finance people.

SEANA SMITH: Yeah. Dr. Emanuel, I wanted to ask you about the treatment, or even possibly a vaccine at some point, because we had Bill Gates coming out over the weekend, and he was talking about how he's spending billions of dollars on seven possible vaccines for the coronavirus in hopes of possibly finding a way to end the pandemic at this point. Is a vaccine, is that what is needed to eventually beat this virus, from your perspective?

EZEKIEL EMANUEL: Almost assuredly. Maybe we can get a prophylactic, like there is PREP for HIV, that you can take and you substantially reduce your chance of infection. I think that's less likely than getting an effective vaccine. So I think an effective vaccine is likely.

If you talk to the companies that are doing the work, just lay out the timeline to really assess a vaccine for its potential effectiveness, you might get tens of millions of doses a year from now. And for the general public, you might get a lot of doses available in Q3, Q4 2021. That's the timeline. And that's what people have to get into their head.

And I think for obvious reasons, politicians are resistant to that. And I think the public hasn't heard it loud and clear, despite it being said by public health experts over and over again.

And then I would just mention, if you look at other countries-- you know, you've said, let's look at Europe. But what about looking at Asia, places like Hong Kong, South Korea? They have seen a resurgence when they've eased up. And that resurgence is what we're likely to see unless we have widescale immunity. And I think that's what people have to understand. We're not going to get rid of this or be past it or return to full normalcy until that vaccine is available.

- Doc, that's kind of what I wanted to ask you about, is we see these kinds of orders, and then people constantly asking, when will the orders be lifted? When can we all go back to life as normal, can we go to restaurants? But it seems that would invite a new wave of infections.

At what point do we get to a place where we don't run that risk? Is it really, we have to wait till the vaccine is available before we can go back to life as normal?

EZEKIEL EMANUEL: If you mean normal as in December 2019, the answer to that is yes. If you mean, can we begin to open up various parts of the economy before that, the answer is also probably yes. But not full normalcy that we knew in 2019 until we have that effective vaccine.

And I really worry that what we're doing is having people who really, for obvious and good, well-intentioned reasons, want the economy to open up rapidly, don't want businesses to fail, don't want what we're having-- tens of millions of people unemployed.

But we need to be realistic about what is likely and possible given the nature of this virus, and the fact that no people in December 2019 had any immunity to this thing, and this thing is deadly. This is a class of viruses that leads to a very strong immune disregulation and very, very strong body shut down when it happens.

And yes, it has a predilection for old people. But that doesn't mean young people are immune. And we don't understand a lot about it because it's so brand new. But we've got plenty of reports of healthy, strapping people in their 30s dying from this virus. So I think that's what we have to keep in mind.

SEANA SMITH: Dr. Emanuel, I want to ask you just about the treatment advice that has come out of the White House, or conflicting reports, I guess I should say. So we had President Trump doubling down over the weekend on this push for the use of the anti-malarial drug hydroxychloroquine and that--

EZEKIEL EMANUEL: Chloroquine, yeah.

SEANA SMITH: --it prevents the virus. But how do the risks of that drug compare to the potential benefits that have yet to be proven at this point?

EZEKIEL EMANUEL: First of all, there are no proven benefits. We have to be very clear about that. The president can have all the feelings he wants. But proven benefits, we don't have any. And that requires data. It requires randomized controlled trials. Those are going on now.

I think many of us in the health community are suspicious because you use the drug with patients who are doing well. We call that patient selection. And that's probably what we're seeing in most of the positive reports. Those patients might have done well anyway, even without the drug.

The second thing is I think that a lot of virologists and scientists look at the way chloroquine likely works on this virus and say, you know, that is not a very strong way of preventing the virus from invading the body. It's unlikely to be a very powerful therapeutic, even if it's got some slight benefit, because what it does is it changes the environment around the binding of the virus to the cell. And changing the environment is not a strong blockage of that binding.

And so it's just not likely to be a silver bullet, whatever politicians want. I mean, we all want a silver bullet. But it's not going to-- it's unlikely. And I think, again, rather than being overly optimistic and talk about the good feelings that we have, we need to really rely on data, because if we just go with our feelings, we're likely to be severely disappointed. And that could be a problem.

Let me say a word about the side effects. There are two side effects. One is the people who really need the drug for diseases like lupus not being able to get it because it's not available in any pharmacy. And then there are, the drug is relatively safe. And we should always use the word relatively. Any drug you use a lot is going to have side effects. And when you use it for lots of people, those side effects pop up when you don't expect it.

No one should take this drug if they don't have coronavirus. The idea that you're going to take it as a prophylactic when it's totally unproven, bad idea. Some of the side effects is you can have rare effects on your heart, rare effects on your blood that gives you stop producing blood cells. Yeah. Those are rare effects. And if you have a serious illness like lupus, it's worth taking those risks.

But if you're taking it just because you want to prevent COVID, that is not a good idea. And when a lot of people, thousands of people begin taking it in that manner, those side effects become a real risk. Because they're rare does not mean they're nonexistent. And I think we often confuse those two words.

SEANA SMITH: Dr. Zeke Emanuel, very, very important stuff. Thanks so much for taking the time to join us this afternoon. I also want to mention that you're cohosting a four-part special edition of MSNBC's "Last Word-- Life in the Time of Coronavirus," Lawrence O'Donnell's show. That's Monday nights through October 20. Dr. Emanuel, thanks again.

EZEKIEL EMANUEL: It's tonight. Thank you.

SEANA SMITH: Thank you.