Trump and Friends Got Coronavirus Care Many
Others Couldn’t
Rudolph W. Giuliani became the latest in President
Trump’s inner circle to boast about the treatment he received for Covid-19, as
hospitals across the country ration care.
Rudolph W. Giuliani is the latest member of President
Trump’s inner circle to come down with Covid-19. He said he received at least
two of the same drugs as the president.
Sheryl Gay
Stolberg
By Sheryl
Gay Stolberg
Dec. 9,
2020
Updated
9:36 p.m. ET
WASHINGTON
— Ben Carson, Chris Christie and Donald J. Trump are not the sturdiest
candidates to conquer the coronavirus: older, in some cases overweight, male
and not particularly fit. Yet all seem to have gotten through Covid-19, and all
have gotten an antibody treatment in such short supply that some hospitals and
states are doling it out by lottery.
Now Rudolph
W. Giuliani, the latest member of President Trump’s inner circle to contract
Covid-19, has acknowledged that he received at least two of the same drugs the
president received. He even conceded that his “celebrity” status had given him
access to care that others did not have.
“If it
wasn’t me, I wouldn’t have been put in a hospital frankly,” Mr. Giuliani, the
president’s personal lawyer, told WABC radio in New York. “Sometimes when
you’re a celebrity, they’re worried if something happens to you they’re going
to examine it more carefully, and do everything right.”
Mr.
Giuliani’s candid admission once again exposes that Covid-19 has become a
disease of the haves and the have-nots. The treatment given to Mr. Trump’s
allies is raising alarms among medical ethicists as state officials and health
system administrators grapple with gut-wrenching decisions about which patients
get antibodies in a system that can only be described as rationing.
“We should
not have Chris Christie and Ben Carson — and in the case of Carson with
intervention by the president — get access,” said Arthur Caplan, a medical
ethicist who works with drug companies on how to ration scarce medicines,
referring to the secretary of housing and urban development’s admission that
the president “cleared” him for the therapy. “That is not the way to secure
public support for difficult rationing systems.”
The
treatments — a monoclonal antibody developed by Eli Lilly and a cocktail of two
monoclonal antibodies developed by Regeneron — won emergency use authorization,
or an E.U.A., from the Food and Drug Administration last month for outpatients
with “mild to moderate” disease who are at high risk for progressing to severe
disease or for being hospitalized.
.
With cases
soaring, the pool of potential patients is vast.
“One of the
challenges is the E.U.A. criteria really are so broad, it could be half of the
people with Covid could qualify, but there is clearly not enough,” said Erin
Fox, the senior pharmacy director for University of Utah Health, who has helped
her state draft criteria to determine who is eligible for the drugs.
“Unfortunately, that leaves each hospital or each state to develop their own
rationing criteria.”
Even some
top officials at the F.D.A. — both career employees and political appointees —
have privately expressed concern in recent months that people with connections
to the White House appeared to be getting access to the antibody treatments,
according to three senior administration officials.
Mr.
Giuliani, 76, appeared unaware of the scarcity issues, telling interviewers
that politicians have taken masks and business closures too far now that
Covid-19 is “a treatable disease.”
In fact,
the antibody treatments are so scarce that officials in Utah have developed a
ranking system to determine who is most likely to benefit from the drugs, while
Colorado is using a lottery system. Dr. Matthew Wynia, director of the Center
of Bioethics and Humanities at the University of Colorado, said that giving the
powerful access was patently unfair.
“That’s one
of the reasons why we decided that we would allocate this only through the
state and only through this random allocation process,” he said, “so that no
one could get a leg up by virtue of their special connections.”
And there
are other complicating factors keeping many people from getting the therapies
as well. The infusions must be administered in outpatient settings, but
infusion centers, which also care for immune-suppressed cancer patients, are
loath to treat people who have an infectious disease. And many emergency rooms
are so overrun that they do not have the space.
In Utah,
Dr. Fox said her hospital had shipped much of the supply of antibodies to rural
hospitals, which had more room. Both she and Dr. Wynia in Colorado expressed
concern that the therapies might not be distributed equitably across racial and
ethnic lines, with hard-hit minority communities not getting their fair share.
The
scarcity is such a problem that the National Academies of Sciences, Engineering
and Medicine is holding a session next week to help medical professionals sort
their way through rationing questions.
“We’ve been
trying to get the word out so that as patients might get a positive test they
could get information that they might qualify for treatment, but that only
works for people with a lot of resources,” Dr. Fox said.
Politicians
are not the only ones with resources getting access.
In an
interview on Wednesday, one prominent businessman, who spoke on condition of
anonymity to avoid harming his reputation, described his aggressive efforts to
track down the Regeneron treatment — including calling friends who were
hospital executives and hospital donors — after he tested positive last week.
Eventually
he was directed to an emergency room in his city, which was expecting him. He
was given an infusion of the drug on Monday. He is feeling much better, he
said.
Both Mr.
Trump and Mr. Christie, a longtime friend of his and former New Jersey
governor, got the antibodies before they were approved by the F.D.A. Dr.
Caplan, the medical ethicist, said he had no problem with Mr. Trump, 74,
getting the therapy — he is, after all, the president, “a special person unto him-
or herself.”
But Mr.
Christie’s access appeared to be extraordinary. Mr. Christie, 58, was offered
participation in a Regeneron clinical trial but turned it down, a person
familiar with his treatment said, fearing he might receive a placebo. Instead,
he received the Eli Lilly treatment. He is overweight and has asthma, and thus
may have been a good candidate, Dr. Caplan said, though he wondered if
similarly situated patients would have gotten the drug.
Dr. Carson,
69, got the Regeneron cocktail after it was approved, then took to Facebook
last month to say he was “desperately ill” with the coronavirus until the
president intervened.
“President
Trump was following my condition and cleared me for the monoclonal antibody
therapy that he had previously received, which I am convinced saved my life,”
he wrote, adding that “we must prioritize getting comparable treatments and
care to everyone as soon as possible.”
Mr.
Giuliani’s treatment is less clear. Calling into ABC Radio from his hospital
bed on Tuesday, he said specifically that he had received two drugs —
remdesivir, which has F.D.A. approval for treatment of Covid-19, and
dexamethasone, a steroid.
But he also
said he had received the same treatment “cocktail” as the president: “Exactly
the same, his doctor sent me here; he talked me into it,” Mr. Giuliani said of
Mr. Trump’s physician, adding, “The minute I took the cocktail yesterday, I
felt 100 percent better. It works very quickly, wow.”
The
therapies are being allocated by the Department of Health and Human Services to
states and jurisdictions based, the department’s website says, on a “percentage
of the country’s total number of confirmed Covid-19 patients and the total
number of confirmed hospitalized patients during a seven-day reporting period.”
California,
for example, has been allocated 17,760 doses of the Eli Lilly therapy and 5,728
doses of the Regeneron cocktail (the Eli Lilly drug is in greater supply).
Maine, with many fewer people and Covid-19 cases, has been allocated 330 and 98
doses of those therapies.
Health
Secretary Alex M. Azar II told reporters on Wednesday that so far, 278,000
doses of the two therapies have been allocated. There were almost that many
coronavirus cases (220,225) diagnosed in the United States on Tuesday alone.
Once state
and local health agencies determine which hospitals or medical facilities
should get the drugs, they are shipped out by a third-party distributor. Then
it is up to health care providers to figure out what to do with them. Dr. Peter
L. Slavin, the president of Massachusetts General Hospital, said in an
interview Tuesday that access there would be by lottery.
“The notion
that we are going to be able to treat a significant percentage of the people
who qualify for the drug with the drug — it’s not going to happen,” he said.
Noah
Weiland and Katie Thomas contributed reporting.
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