According to a document from the Department of Health and Human Services, a total of 108 doses of Regeneron’s monoclonal antibody cocktail have been allocated to Washington, which had 265 new coronavirus cases on Wednesday alone. Somehow Rudy Giuliani, Donald Trump’s lawyer, got one of those doses. In an interview with a New York radio station on Tuesday, Giuliani did us all the favor of explaining why he qualified for privileged treatment.
“I had very mild symptoms,” he told the radio station, WABC. “I think if it wasn’t me, I wouldn’t have been put in the hospital. 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.” He said on another show on the same station that the president’s physician was involved in his care.
Giuliani, of course, is not the only presidential crony to get access to highly rationed experimental therapies. Trump himself was among the very first people to get the Regeneron treatment outside of a clinical trial, before it received an emergency use authorization from the FDA on Nov. 21.
In October, Chris Christie, the former New Jersey governor and an informal adviser to the president, got a different monoclonal antibody treatment, one produced by Eli Lilly. Housing Secretary Ben Carson wrote on Facebook that Trump “cleared” him to receive monoclonal antibody therapy when he was hospitalized with COVID-19 last month.
Some of these men received their treatments before they were available to the public. Giuliani may have got his instead of a member of the public. His case sheds light on two kinds of corruption. There’s the corruption of an administration that appears to be using government power to procure potentially lifesaving favors for the president’s friends. And there’s the corruption of a for-profit medical system in which VIP patients can receive extraordinary levels of care, sometimes at the expense of the less connected.
Both the Regeneron and Eli Lilly therapies are meant for people who are at risk of getting sick enough with COVID to be hospitalized, not those who are hospitalized already. The emergency use authorization for the Regeneron treatment specifically says that it is “not authorized” for “adults or pediatric patients who are hospitalized due to Covid-19.”
A physician with experience administering the new monoclonal antibodies, who didn’t want to use his name because he’s not authorized by his hospital to speak publicly, said giving them to Giuliani “appears to be an inappropriate use outside the guidelines of the EUA for a very scarce resource.” Very scarce indeed: According to the Department of Health and Human Services, as of Wednesday the entire country had about 77,000 total doses of the Regeneron cocktail and almost 260,000 doses of Eli Lilly’s monoclonal antibody treatment. That’s less than you’d need to treat everyone who’d tested positive in just the previous two days.
Right now, the criteria for distributing these drugs can be murky. Robert Klitzman, co-founder of the Center for Bioethics at Columbia, said that the federal government allocates doses to states, states allocate them to hospitals and hospitals then decide which patients among those most at risk will get treated. Some states have developed guidelines for monoclonal antibody treatment, “but my understanding is that most states have not yet done that,” Klitzman said.
Hospitals try to come up with ethical triage frameworks, but Klitzman told me there are often workaround for VIPs. He said it helps to know someone on the hospital’s board, bodies that typically include wealthy philanthropists. Often, he said, when these millionaires and billionaires ask hospital administrators for special treatment for a friend, “hospitals do it.”
Why? “Hospitals have huge financial problems, especially at the moment with COVID,” he said. They’ve had to shut down profitable elective surgeries and treat many people without insurance. More than ever, he said, they “need money that is given philanthropically from potential donors.”
In other words, Giuliani was right: Celebrities have access to better care than ordinary people. “When someone is in the public eye, or if someone is a potential donor, or has already been a donor to a hospital, then there’s folks in the hospital hierarchy, in the administration, who are keenly aware if they’re coming in, if they’re present, if they need something,” said Shoa Clarke, a cardiologist and professor at Stanford University School of Medicine. COVID, which is leading to rationing of medical resources, only magnifies this long-standing inequality.
But like so many in Trump’s orbit, Giuliani combines unusual candor with unusual deceptiveness. He’s honest about trading on his fame, but uses his ultra-elite experience to play down the dangers of COVID for everyone. “If you get early treatment nothing’s going to happen to you,” he said on WABC, adding, “You totally eliminate the chance of dying.”
This is wildly untrue. Even if monoclonal antibody therapies were a foolproof cure — and there’s no evidence they are — most people who listen to Giuliani won’t have access to them. They might not learn that until it’s too late.
“This message that’s been delivered, that maybe we don’t need to be so worried about COVID, that has been a deadly message, and it’s part of a bigger package of misinformation that’s been spread across our country, and it’s why we’re in the position we’re in right now,” said Clarke.
When I spoke to him on Wednesday, he’d just learned that one of the hospitals in his area had reached capacity. “We’re expecting the others to follow suit in the next few weeks, to the point where we don’t have ICU beds available anymore,” he said.
But don’t worry. If friends of Trump need one, they’ll surely find a way.
Michelle Goldberg is an Op-Ed columnist for The New York Times.