April 28, 2020

The president of Americans for Prosperity joins Christiane Amanpour to answer the question on everyone’s mind: How can the American economy be opened up safely? Then, journalist Michael Specter discusses Anthony Fauci’s career and leadership during the COVID-19 pandemic. Finally, Dr. Richard Levitan joins Hari Sreenivasan to explain why COVID-19 patients should be going to hospitals sooner.

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CHRISTIANE AMANPOUR: Hello, everyone, and welcome to “Amanpour and Company.” Here`s what`s coming up.

Health and the economy. One follows the other. We take the pulse with Tim Phillips, head of America`s most powerful conservative political group.

Then —




AMANPOUR: Superstar doctor, how Anthony Fauci become the trusted face of public health and what we can learn from his journey there.

Plus —


DR. RICHARD LEVITAN, EMERGENCY PHYSICIAN, LITTLETON REGIONAL HEALTHCARE: If we change the public education, we change the messaging and if we can

detect this silently occurring low oxygen level that we can do so much better for these patients.


AMANPOUR: Straight from the front lines, Dr. Richard Levitan tells our Hari Sreenivasan that COVID-19 patients should be going to hospitals


And finally, creativity and the arts rising under lockdown.

Welcome to the program, everyone. I`m Christian Amanpour working from home in London.

The coronavirus will almost certainly come back, that is the verdict of the U.S. chief medical adviser, Dr. Anthony Fauci. It`s a stark warning for a

nation and a world eager to get back to business and reopen their economies.

Despite people`s very real financial pain, most, though, don`t want to open up unless coronavirus is under control. And Ipsos MORI poll finds that here

in the U.K. and in Canada, 70 percent of people say they are against such a move. While in the United States, 59 percent say they oppose opening up too

early. But at the same time, a whopping majority of Americans of all political stripes fear an economic collapse according to an Ipsos-Axios


So, since public health and the global economy go hand in hand, what is the best and the safest way out of this unprecedented crisis with no vaccine or

treatment available yet?

Joining me now from Easley, South Carolina is Tim Phillips who heads the powerful Koch family`s conservative advocacy group called Americans for


Mr. Phillips, welcome back to the program.

And let me just begin by asking you, you have seen these polls that are really quite — you know, quite firm in what they`re saying and you have

also living through this dilemma of how do you open up. So, what do you make? I know that you have been talking to public health officials and

other policy and political types. What is your vision, sort of the conservative, Americans for Prosperity vision, of opening up safe and

sound, so to speak?

TIM PHILLIPS, PRESIDENT, AMERICANS FOR PROSPERITY: We have got to move as a country beyond the false choice of either shutting everything down

indefinitely into the future or opening everything immediately. That`s a false choice and this decision is best made on a state by state basis. So,

we`re working with governors and legislators and business leaders and workers on a state by state basis because it`s different, what`s happening

in New York is different than what`s happening in Texas and everywhere else in this country.

We are seeing some positive progress. Governor Greg Abbott in Texas, I believe, is offering one of the better examples of bringing people

together, trying to find a reasonable phased-in approach that minimizes risk while still getting this economy going again, which we have to do

because people are hurting out there and there`s a public health cost to the economic inactivity that is important to understand as well. But we can

reopen this economy in a responsible way. It is best done on a state by state basis.

AMANPOUR: But do — I mean, how? I understand exactly what you are saying and it is a big dilemma for everybody. Obviously, here in Europe we have

seen countries like Germany, which were very, very forward-leaning and early in the testing, the contact tracing and all the rest of it. And you

know that Chancellor Angela Merkel has done kind of what you`ve said, sort of like a gradual tailor-made turning of a dial.

But today, we hear news that, you know, it is not such great news that they have had a fractional increase in the number of infections. So, it`s a

really difficult thing. When you hear that, and we when you see the dilemma in your own country —

PHILLIPS: Yes. It is important to note that we`ve seen short two or three- day increases in infection or fatality rates even in states with tight lockdown. So, it is important to note that. I can tell you the approach we

are talking about like in Texas that I mentioned earlier is to look as a roadmap at the essential services that have been allowed to remain open,

think about the Walmarts, the grocery stores, places like that, to take an approach which seems to be working over the last several weeks and actually

over the last month that has kept people safe while still providing basic core needs and services and to slowly expand at that.

And so, that`s what we are doing. We have a roadmap from these essential services. But now it is time to carefully expand that. I think about

restaurants looking at them at 25 percent capacity rather than 50 percent or 75 percent so having tight restrictions just to still protect health but

that still allows an easing of this economic shutdown because what Congress has done is pass almost $3 trillion in aid and there is talk now of another

massive multi-trillion dollar effort.

But the gross domestic product of our nation over $14 trillion a year. There`s no amount of money on earth that can fund that for month on end as

some people are suggesting. So, this phased-in approach, it is responsible. We have a roadmap from the essential services in states that have been

allowed to remain open. We need to pursue it. It`s good that the Trump administration has not taken a one-size-fits-all federal approach as some

have urged him to do.

That would be a disaster in a country the size of the United States to make California be exactly like Florida or Nebraska or like New Jersey. Instead,

we have this opportunity at the state level. We are using it. It`s not going to be perfect. Mind you, we know that. But when you look at the cost

of simply shutting everything down indefinitely, there`s an enormous cost there as well.

And so —

AMANPOUR: Clearly.

PHILLIPS: — we`re working at the state level. Florida is taking some steps. We have a roadmap. Let`s follow it.

AMANPOUR: You mentioned President Trump and not a one size fits all. Obviously, you realize he`s come to that because he did actually say, I`m

in charge, I`m the only authority and the country will do what I say. And now, the governors, as you say, whether Democratic or Republican have said,

well, actually, we need to make it fit our current conditions. So, I understand that you are kind of agreeing with that.

But do you agree, you mentioned the bills to — I mean, it is disaster relief. I don`t know how you put it any other way. Do you agree that it is

absolutely necessary? I know your small government people at Americans for Prosperity. That`s the sort of philosophy of a conservatism. But are you OK

in terms of philosophically with that amount of money, you know, there to help people going under from going under?

PHILLIPS: Yes. We did say when this CARES Act was being debated that Congress and the federal government needed to act. These are times of which

we have not seen in our nation certainly in generations. And so, they did need to act. The Paycheck Protection Program that provides liquidity

especially for small and mid-sized businesses, that`s actually doing some good. It`s being implemented now and there are some problems here and

there, but by and large as I talk to small business owners across the country like here in South Carolina, that effort is working.

So yes, we did see an absolute role for government in this pandemic and the resulting economic crisis that we`re seeing. The question, though, is, what

next? And after having spent right at $3 trillion, and still having rough edges and parts of that legislation that are not being properly

implemented, it`s time to make sure the government is doing that, implementing what is already passed rather than passing trillions more.

And I`ll tell you, when folks think of a bailout that now is being considered for cities and states across this country, that`s a terrible

idea. What it`s going to go toward is funding unfunded pensions for government employee unions that have been underfunded for years. And we

want to make sure that this crisis is not used as an opportunity for politicians of all stripes, frankly, to just start fulfilling their

ideological or tgheir cronyism wish list that they have always had in place.

And so, we think we`d be very —

AMANPOUR: As you know —

PHILLIPS: — very careful before considering additional money.

AMANPOUR: As you know, many of the governors have said, hang on a second. We are net givers to the federal purse and, you know, this is not cronyism,

this is police, it`s teachers, it`s firemen, it is all those kinds of things.

I just wonder, as a conservative, because the economist has written about this and it`s not a, you know, liberal pinko rag as you know. It has said

that this pandemic shows the need, even in conservative thought, to sort of bolster up the federal government`s role for the duration of the crisis and

then get back to, you know, if they want conservative thought on spending.

Do you agree that this has changed perhaps the idea of constantly, you know, reining in the purse strings and constantly sort of keeping a tight


PHILLIPS: That`s somewhat ironic given the fact that the government runs a $1 trillion deficit this fiscal year before the crisis ever hit.

AMANPOUR: Well, it is, I know. Yes.

PHILLIPS: It`s spending over $4 trillion a year. So, the idea that government has been somehow starved is laughable. Government has been fed

and fed and fed. Spending is through the roof. And by the way, under both political parties, Republicans and Democrats alike, have driven deficits.

We have a debt now over $23 trillion.


PHILLIPS: So, the idea that government has somehow been starved is nonsense. The — but to your point, there was an absolute —

AMANPOUR: I don`t mean government has been starved. I just mean to people.

PHILLIPS: Yes. Well, there`s a difference between funding government —


PHILLIPS: — employee unions and actually providing crucial services.


PHILLIPS: And we have supported the services. And by the way, the last round of funding provided an additional $75 billion for hospitals and we

did not oppose that. That was an idea that was a reasonable one because these hospitals are the front lines in the fight against this, the nurses

and the doctors are braving, you know, risking their lives and we wanted to see funding to help them. So, we felt that was a very reasonable sum, $75

billion, that went directly toward hospitals in this last legislative effort.


PHILLIPS: So, we do know that so many Americans are sacrificing right now to take care of their fellow Americans and we are thankful to God for what

they`re doing and we are supporting them. We also want to make sure, though, that the tens of millions of Americans suffering right now because

they can`t work and they can`t pay their bills, we want to make sure that in a responsible, safe way they are allowed to get back to the livelihoods

and their hopes and their dreams —


PHILLIPS: — because that is what`s on hold right now. We know this isn`t easy. We know that. That`s why we calling for an end to the false choice of

saying either, oh, open up everything tomorrow or shut everything down until Christmas. We are saying there`s a better way. Let`s find it. Let`s

work together across business, labor, political leaders. Let`s find it because the rhetoric —


PHILLIPS: — of trying to get beyond that and actually take care of our country at a time when we`re hurting.

AMANPOUR: Yes. So, I mean, look. We are not engaged in those false choices. We know that these go hand in hand and that it is not a one size

fits all.

So, I just wanted to ask you because, you know, you seem to have a pretty, you know, clear idea of this. You know that what`s taken up quite a lot of

oxygen recently are some of the protests in some states. You know, we`ve had people — and it`s been, you know, being coordinated by people like

FreedomWorks, which was initially founded by the Koch Brothers. Also, the Michigan element is tied to the Devos family. That`s obviously the family

of the secretary of education. And also, the conservative activist, Stephen Moore, who sits on the presidential commission of reopening the economy.

And yet, your group, Americans for Prosperity, do not support these protests. Explain what`s going on here.

PHILLIPS: Yes. We believe these Americans have a constitutional right to be protesting. We want to be clear about that. They`re within their rights.

We also want to affirm that they are having enormous hardships, their jobs, their livelihoods, they`re trying to tack care of their families, and we

are deeply understanding of that.

We just believe that it`s better at this point to work together with those in elective office, with those in the business and labor world, with

private sector because that`s the way we`re really going to solve this and it`s a nuanced position. You know, what`s — what should be open, what —

whether it`s, you know, restaurant today at what capacity or whether it`s, you know, movie theaters or sporting events, there`s enormous nuance here.

And so, we certainly understand the constitutional right and the hardship being experienced.

We just think there`s probably a better way to do that. One knows, we did not in any way launch FreedomWorks. That`s a wholly independent

organization and — so, we — it`s a totally separate organization.

AMANPOUR: All right. Well, I thought you were — it was initially founded by the Koch Brothers but I will look into that after this.


AMANPOUR: Let me ask you this.

PHILLIPS: Thank you.

AMANPOUR: As we`re speaking, the Johns Hopkins, you know, tracking operation is saying that the United States has now passed the 1 million

infection mark. This is huge, obviously. The worst in the world. I want to ask you what you think of, former Republican Senate majority leader, Dr.

Bill Frist, who was on the program yesterday. And he was calling for America to take the kind of, you know, big role, like a Manhattan project

he was talking about to ramp up things like you needed in pandemic preparedness, testing, PPE, you know, vaccines, treatments, all the kinds

of things that we know are actually not there and therefore cannot help or assist the reopening of the economy.

Do you think that that is something that lacking? Is it something that in the wake of this game changing pandemic, your group would consider funding,

this kind of Manhattan project for the future?

PHILLIPS: We are already funding multimillion-dollar efforts across our broader community, from the private sector to actually help those who have

been adversely impacted by this crisis. So, we`re doing that on our own through the stand together community that is part of our broader community.

So, we are doing that already with multimillion-dollar efforts to help people in need.

We do think that it`s a time for innovation and, you know, a call to actually look at everything we`re doing and try to do it completely

different, if necessary or certainly better. We applaud the efforts we have seen at deregulation, you know, the efforts to strip away the barriers that

have kept Americans from badly needed drugs or personal protective equipment. And we have seen actions happening.

And by the way, it`s been in both parties, at the state levels and states controlled by Democrats and Republicans, at the federal level by those in

Congress and the administration. We have seen some innovations that the broadening of telemedicine is very helpful.

My mother is on Medicare, which is the program for the elderly here in the United States. And she has been helped by broadening of telemedicine during

this time. Keeping her safe rather than having to go in for tests. So, we are seeing innovations that are encouraging. We need to quicken the pace

for those and remove the barriers because we have to find a vaccine and certainly, additional drugs that can slow down or treat the symptoms once

infection has occurred.

And what`s helping us with that is a lot of the innovation that`s already occurred. We also are encouraged that private industry, whether it`s

community banks helping to get the funds out to small businesses, through the Paycheck Protection Program, it is a wonderful idea that that wasn`t a

government program which would have taken months or years to stand up. Instead, they used the private sector that was already in these local towns

and cities to dispense those badly needed funds.

Likewise, there`s been liability protection to a limited degree, we need more of it by the way, that`s helping industries to shift over for

protective equipment and ventilators and needed stuff. So, we are seeing some of that innovation. That`s a good thing.

AMANPOUR: Yes. I know you are talking a lot about private but, you know, the question`s really about whether governments step in on these big

issues, like the moon shot, you know, like the Manhattan project. But let`s just move passed that for a moment because I do need to ask you about the


As you know, some of President Trump`s most vociferous allies, let`s just take the “Wall Street Journal” editorial board and others are worried by

his performance on the White House podium, some of the more erratic things that come out of his mouth like the disinfectant and all the rest of it, I

mean, really. And they`re seeing some the poll numbers go down.

I`m wondering what you think about re-election chances, even Fox news poll says that in various important areas Joe Biden leads President Trump right

now. We`ve got Jeff Flake, the former senator, who said that he would never, on any account, vote for Trump and Trump`s re-election would be bad

for the party and bad for the country.

You have said that — back in 2019, top Koch staffers talked about building a bipartisan coalition to tackle policy programs, that you may be open to

supporting candidates from all parties in 2020, Democrats and independents as well. Is that still the case?

PHILLIPS: It is. We`re open to supporting. We want to build policy coalitions, regardless of party, to actually get things done that need to

happen in this country. Improving health care. Reining in government spending. Broader immigration reform. Absolutely.

I can tell you this, we do a lot of polling of those — the swing voter universe in these crucial states. And politicians in both parties should be

aware of one key point. The swing voter universe in this country right now, they feel profoundly impacted in a personal way by what`s happening right

now. They are withholding judgment, they`re not blaming yet and they`re not giving credit yet, to either party or any politicians. They genuinely are


And sometime this fall, they`re going to look back on what`s happened between now and September or October and they`re going to make a

determination on which political leaders actually showed leadership. Brought people together to solve this crisis. And they`re going to punish

those who don`t. So, I would urge both parties to keep that in mind.

That swing voter universe, I`m telling you, they are hurting. They have a fear level. There`s a frustration, there`s a desire to get moving again but

there`s also a concern over health and they`re looking for leadership.

AMANPOUR: Right. That`s true.

PHILLIPS: And they have not yet made a determination. So, all the polling right now is just that is preliminary polling. Get to Labor Day and our

country early September, they`re going to make a decision. And I hope these politicians in both parties are keeping that fact in mind.

AMANPOUR: Everybody`s feeling such pressure and such hurt right now. Tim Phillips, thank you very much indeed.


AMANPOUR: And as we have said, the federal government says that it is pretty much up to the states coming to testing. That is at odds with the

U.S. chief medical adviser, Dr. Anthony Fauci, who says the two need to work together to ramp up the number of tests, and this is crucial. In a

hopeful note, he is also now saying that the virus will respond well when a vaccine is produced.

Fauci has become the face of this pandemic, stepping on to the podium at the White House briefings and, of course, into the spotlight. And we`re

going to look into his journey with someone who knows him well.

Joining me now is Michael Specter, staff writer for “The New Yorker” who has been reporting on Fauci`s work and many other medical and scientific

developments for decades. And he`s also an adjunct professor of bioengineering at Stanford University. He`s joining me now from Palo Alto,


Welcome to the program.

So, you know, I just wanted to start by asking you to comment on what Dr. Fauci has said today that — and he was doing it to a webinar in

Washington, that he definitely believes that the virus will be here to stay. It will come back at some point and it depends on how we deal with

it. What do you make of what he`s saying now, what he`s telegraphing?

MICHAEL SPECTER, STAFF WRITER, THE NEW YORKER: He`s saying what he always says, which is the truth. This is sort of obvious to anyone who knows

anything about epidemiology. The virus is not going to disappear. It is going to be around. It is going to wax and wane and it will never really be

solved until we have a vaccine. So, the thing we to do until then is fight it with the tools we have. And there are not very many. There are some. But

we need to start using those tools.

AMANPOUR: And he also said that he believes — and I`m going to get to these tools in a sec. He believed that a vaccine — or this virus would

respond to a vaccine. I mean, you heard some of the discussion, probably, with Tim Phillips and the idea of trying the speed up this vaccine, you

know, hunt.

What are the tools that you`ve just, you know, sort of raised that we need to be using? One of them must be testing, vaccine, the whole lot, right?

SPECTER: Yes. Testing is a principle thing. I want to start at the end, though. The idea that we are going to speed up the hunt for a vaccine, we

are hunting as fast as we can every sophisticated medical center in the world is working only this. But we have for decades ignored the absolute

inevitably of something like this. This is not a surprise. There`s nothing surprising about this pandemic.

This virus is like SARS, it`s like MERS, it`s like Ebola. It comes from a bat. It even enters our respiratory system in ways that we understand.

People like Fauci and many, many journalists, I am just one, but there are lots of others, have been writing about the inevitability of something like

this for decades. But we have always been a sort of quarterly profit company — country and we think in terms of a few months. We think in terms

of the next problem.

And I don`t want to talk about silver linings in such a disaster, but I would like to think finally maybe we would look forward and spend some

money to prevent an attack of biology that is preventable. We don`t have to wait. We can defend ourselves.

AMANPOUR: I know. That seems to be the most extraordinary thing.

SPECTER: As to what we have now, we only have testing. We don`t have drugs. We don`t have a vaccine. Even if a vaccine is really excellent and

fast, a year would be wonderful. So, what we have is a choice. We can all stay inside for a year, and I think that is an impossibility for every

reason we know, or we can inch out. And the way to do that is to let people know if they have been infected, if they are in fact sick, there is a

possibility that if you have been infected and you`ve gotten over the illness, that there`s immunity for a while.

We don`t know any of this for sure because there`s a lot we don`t know. But in general, that would be a good bet. So, it would be nice to know if you

have been infected. It would be nice to know if you are infectious. The only way to know these things is testing and also contact tracing. We need

— if I`m infectious and I go to Walmart, we need to wonder who`s come within 10 feet of me in the last day or two. We need to let those people

know. This is a process with infectious diseases that`s very, very old and has been quite successful in the past. But it requires lots of effort.

AMANPOUR: And to be fair, lots of — well, several countries that have been — to be fair, several countries have actually implemented that, which

is why they have done better than the U.K. and the U.S. which was slower.

But, you know, we have been reporting about ramping up — the need to ramp up testing and contact tracing and it`s just like a daily, you know, scream

of frustration and it`s difficult to see why and — it is not happening. And I just wondered whether you think — how do you think Dr. Fauci is

doing? Because he is also under pressure. He`s just not just the voice, the trusted voice, but he`s really under pressure.

I mean, look. You know, you might have seen it. In “The Washington Examiner” just today or yesterday, two representatives, two Congress people

said, you know, as the epidemic decline that`s taking place so rapidly — sorry, as in the economic decline that`s taking place so rapidly, all

things come back to the dynamic duo of economic destruction, Anthony Fauci and Deborah Birx. It is simply time for them to be thanked and leave the

stage. I mean, how does one get ahead when that is put in serious newspapers?

SPECTER: You don`t. I mean, we can thank them and let them leave the stage and many, many, many more people will die as a result. You know, this is

not a choice economic prosperity or public health. We can`t have the one without the other. And if we send people back too soon and without a plan,

everything will be great for 11 days and then people will start getting sick. And then they`ll get much sicker and our hospitals will be overrun

again and it will be even worse than it was before. And then, in the fall, when it does come back, and it certainly will, we will have to deal with

that and influenza. And we are not prepared for any of that right now.

So, even if all you care about is the economic prosperity, and I don`t minimize this. People are going through a terrible time. The way to work

ourselves out of this is through intelligent public health measures. It isn`t a one or the other thing. And the people who say that or even the

people who say, oh, private, public partnerships and, you know, your last guest said some good things but he also said, we have invested millions of

dollars. We need to invest billions and billions of dollars.

We spend $300 billion on missile defenses in this country and they don`t even work. We don`t spend a penny on the dollar on viral defenses. And if

we actually did that, then we would have the system. And I believe and I may be old-fashioned, that requires federal leadership, and we don`t have

federal leadership.

AMANPOUR: Right. And just quickly before I get more specifics to Dr. Fauci, which I`m so interested about his journey as we said. You have been

reporting on these issues for so long. Do you think that will happen, what you have just said, the actual moving of priorities to where we actually

need them?

SPECTER: Don`t ask me things like that, Christiane. I don`t want to be a pessimist.

AMANPOUR: All right.

SPECTER: If I looked back and I am a realist, I would be pessimistic. I like to think people might now realize. You know, I would like to say, this

is a terrible, terrible pandemic. But we could have an influenza pandemic that would be 10 times worse. It wouldn`t be surprising. It can happen.

And if you think this is bad, do we really want it to happen again? And we don`t know if it will happen. It could happen next year. I could happen in

70 years. Viruses don`t have meetings and decide when to attack. But we can prepare for this.


SPECTER: And I don`t know. If we`re not going to do it now, especially with the tools we have of bioengineering, synthetic biology, the ability to

sort of not wait for biology to happen to us, we can decide what kind of biological future we want. And it is really time that we think about that

if we care about living.

AMANPOUR: So, let me ask you about Anthony Fauci because you know him as well as any reporter around. You have known him for past 36 odd years. And

we read and we have heard interviews of him. We have read your profile of him, that actually medicine was not his calling from a very young age. He

really wanted to be a basketball player. Can you imagine he reports being the high school captain of the basketball team? He was the best shooter,

the best, you know, shooter at 5`7″. And that`s what he thought. And beyond that, it was about humanities and Ancient Greek. It wasn`t medicine.

What brought him — just give us — I mean, it is an extraordinary life story that`s brought him to where he is right now.

SPECTER: What I find kind of fascinating about him is that what we have in this country quite frequently are students — and I see it here a lot —

there are students who do the very minimum in terms of taking humanities courses, so that they can appease the school`s requirements, but still get

into medical school.

Fauci did the opposite. He took the science courses he needed to take to get into medical school, but then he took humanities courses. He studied

Latin. He studied Greek. He studied romance languages. He studied epistemology.

And I really believe that is why he has always been an effective medical leader. He is — I have known this guy a long time. He`s not without flaws,

but I will say this. He has never lied to me. I must have interviewed him a trillion times. He`s never lied to me.

He`s never misled me. If he can`t answer a question, he doesn`t. If he can`t participate in something, he tells me.

He tries to give data to people and to do it in ways that they will understand. And that`s a kind of simple thing, but I think it grows out of

a broader education than a lot of our medical people have now.

AMANPOUR: And he does seem also to be, you know, pretty extraordinary in his trajectory.

You know, he found a cure to a particularly difficult disease you`re going to tell me about in a second, and then he was on the front lines of this

terrible virus that started showing itself in the United States in the early 1980s, HIV/AIDS.

And he just really turned that story of the disease around. And he took a lot of incoming, especially from the gay population, the gay community, the

activists. And yet, you know, he wasn`t so arrogant and all-powerful to think that we doctors on high can dictate.

He was able to have the people and the facts lead him. It`s really important, that, isn`t it?

SPECTER: It`s very important. It`s also very rare.

I mean, people don`t do that in general. And, you know, Fauci was presented with a system in which he was a vigorous participant where doctors

basically did the researcher and then they told us what we needed to know. And we would say, yes, Doctor, and we would take our pills or we wait for

the trials to be done.

And that is the authoritarian way it has always been conducted. And then these AIDS activists came along and said, we`re dying. You have these

stupid rules about how we can`t take two drugs at once, one of which we need to stay alive, and the other one might keep us alive longer, because

you can only be in a trial if you don`t take two drugs, and we are dying. Are you crazy?

And at the very beginning, his reaction was, no, we know what`s better. But he started listening. And I think, because a lot of these guys were from

New York, and he is too, he felt a kind of connection. And he started talking to them.

Some of them are quite brilliant. And he realized that what they said was true, and that there ought to be a way to be faithful to the medical

research, so that we can get the data we need, but also give people a chance to stay alive.

And he adopted that policy. And it was a radical, revolutionary change. And it`s changed medicine in many, many ways in this country. And it was a —

really, of all the things I have written about in my life and watched, it was one of the more exciting things to see.

AMANPOUR: It is remarkable when you just see how it happened.

And Larry Kramer, who was the big face of the opposition to what the NIH was doing, called him at one point a murderer and now calls him the hero

all these years later of — because he changed his mind and he brought in the people who were the most affected.

Look, I want to ask you also about how Dr. Fauci manages. This is his sixth president. He has not had an easy time, and how he manages to speak truth

to power. He did say this recently. I`m going to play what he said about what if, if the U.S. had taken this current pandemic more seriously sooner.

Let me just play a little bit of the sound bite.


DR. ANTHONY FAUCI, NIAID DIRECTOR: Obviously, if we had, right from the very beginning, shut everything down, it may have been a little bit

different, but there was a lot of pushback about shutting things down back then.


AMANPOUR: So, of course, President Trump wasn`t pleased. He then retweeted that it was time to fire Fauci, all of that.

But, be that as it may, just explain, because I think he had an amazing relationship with President George H.W. Bush, who came to him at the NIH,

wanted to know about AIDS, with w. Bush himself and PEPFAR, and also with Clinton and Obama.

SPECTER: I think the thing about Fauci is — I mean, first of all, I don`t think you last through six presidents, these six presidents, without being

politically flexible.

And he is. But I think, primarily, he has relied on his ability to tell threat truth, and the ability of the leaders of this nation to understand

that the truth about molecular biology and viruses and blood cells isn`t a Republican or a Democratic thing.

And so people have listened to him. And they have not sort of judged him as a guy who was appointed by Obama or Reagan or anyone else. They have just

listened to what he`s had to say, and his record has been quite good.

So, I think right now is a very troubling pattern. If you read my profile, it`s not a secret that he has basically told (AUDIO GAP) don`t talk to me.


SPECTER: I have known this guy for a really long time, and he`s talking to Steph Curry, and I`m glad he is. But he`s talking to lots of people, but he

isn`t supposed to talk to people if they are writing about him.

And I just feel that is insane. I mean, really, we are in a desperate crisis in this country.

AMANPOUR: Well, we just lost Michael Specter, but you got the gist, a really important look into who Dr. Anthony Fauci is, now so well-known, not

just in the United States, but all over the world.

So, now to the front lines of this crisis, from doctors and nurses, to cleaners and bus drivers and all those essential services still working so

hard for all of us.

Here in the U.K., there`s been a minute`s silence today to remember all the key workers who`ve died of coronavirus.

Our next guest, Dr. Richard Levitan, has been practicing emergency medicine for three decades. When the virus began to overwhelm New York City at the

end of March, he rushed from his home in New Hampshire to volunteer at Bellevue Hospital, where he trained in New York.

And he speaks now with our Hari Sreenivasan.


HARI SREENIVASAN: Dr. Levitan, you have been an E.R. doc for 30 years. You specialize in airways.

You decide, in this crisis, to volunteer at the hospital that you`re trained at. How do we keep people from having to be on a ventilator?

DR. RICHARD LEVITAN, EMERGENCY PHYSICIAN, LITTLETON REGIONAL HEALTHCARE: This is a respiratory virus. It gets into the lungs, and over the period of

several days, it causes collapse of the air sacs in the lungs.

And as the oxygen goes slowly down, the patients just accommodate. They accommodate by breathing a little bit faster, but they don`t realize that.

It is remarkable, throughout medicine, how we see that disease processes that come on slowly are well tolerated by patients.

So, what is amazing about this disease is the onset of this pneumonia takes days. And, as that happens, patients don`t feel short of breath. But our

public health message has been, don`t go to the hospital unless you`re short of breath.

So this disease is remarkable in two respects. Number one, a huge number of patients hit the health care system all at once. And that`s just the nature

of a pandemic. But, number two, they all presented with advanced disease.

And what I`m saying is that, as we have learned more about this, I believe we can change that presentation window from one of advanced disease to more

milder and even very mild disease, and that that is an enormous win for the patients and for the system.

SREENIVASAN: You`re saying that our messaging has been inaccurate, at least based on what we knew when we knew it, because by the time someone is

coming to the hospital short of breath, it might already be too late to help them.

LEVITAN: I don`t think the word too late is the word to use.

I think that, by the time they are coming to the hospital with subjective shortness of breath, their pneumonia is very advanced. But what we have

learned in New York just over the last month — and I say we — the credit goes to the front-line health care workers who are overwhelmed in Queens

and Brooklyn and the Bronx, who realized some very simple things could avoid ventilators, simple things like putting nasal cannula oxygen at high

flows onto people, turning them on to their abdomen, so laying on their stomach, that that would boost their oxygen, decrease the work of


And what we found over — and there`s just a recent study published about this. I was the last author. But a fellow by the name of Nick Caputo in the

Bronx was the primary author, and Reuben Strayer, who is in Brooklyn, was also on this paper.

And what we found was, two out of three patients, even with moderate to advanced pneumonia, were able to avoid a ventilator during their

hospitalization. So, I don`t want to tell people that coming to the hospital means you`re too late.

But what I am saying is that, if we move, if we change the public education, if we change the messaging, and if we can detect this silently

occurring low oxygen level, that we can do so much better for these patients, and I believe we`re going to avoid even more ventilators going


SREENIVASAN: Help explain why it`s so important to keep people off ventilators in the first place.

LEVITAN: So, in many lung diseases, if we bridge somebody who is having respiratory problems, their body will recover, and they only need it for a

few days. And we have learned how to do that in a way not to harm them.

But in this disease, it seems that putting people on ventilators triggers a cascade of other problems. Like I said, we can fix the lung stuff, at least

by numbers, right away, but the subsequent problems of blood clot, of renal failure, of other issues, and the fact that they require to be on a vent

for so long is really just overwhelming the system from a resource perspective.

So, just to explain, you get a breathing tube, you also get a tube in your stomach, you get a tube in your bladder, you get a central line, a venous

line, you get an arterial line. You then need a team of people to move you twice a day. And you need sedatives, a lot of sedatives.

Most of these patients require two and three sedatives, and then another medicine for their blood pressure. So, most of these patients are on four

I.V. pumps, all of these tubes, all of these lines, they`re not moving, and — because they`re so sedated. Otherwise, they would buck the vent.

And they have to be flipped twice a day. You compare that to a patient who has one I.V. line, monitoring, getting oxygen, who`s awake, who`s turning

themselves in different positions, so they open up areas of their lung, proning, and these patient-positioning maneuvers, the resource utilization

there is a fraction of the resource utilization that is happening in the ventilated ICU patients.

SREENIVASAN: What are the CDC guidelines on when you should go to the hospital? And you`re proposing a different view.

LEVITAN: I am proposing a radically different view.

And where I live in rural New England, I drive about 15 miles to a convenience store. And on the front door of my 7/Eleven is the sign. And it

says, you`re not going to feel well with COVID. You may have fevers. You may have muscle aches. You may have stomach aches. You`re not going to feel

well, but don`t go to the emergency department.

What they`re telling people is, go to the emergency department if your fingers or your lips turn blue. And what I`m saying is, I think, if we move

this window of presentation, if we educate patients to come in earlier, if we can do point-of-care testing in the E.R., and know, OK, you have COVID,

and then we monitor their oxygen, we can make a dramatic difference.

SREENIVASAN: Doctor, one of the things, though, people are concerned about is, if they weren`t sick already, that going to the E.R., they`re

definitely going to be sick, because that`s where all the sick people are, right?

There`s still this hesitation about having to go to a place full of sick people to be tested, diagnosed or treated.

LEVITAN: So, late last night, I got an e-mail from an emergency physician in Northern Italy. And he explained to me, we are seeing earlier cases of

illness, and we`re doing much better.

And so I immediately asked him, so, why is that? He says, well, the patients are no longer scared to come in. And so they diagnosed 250

patients with COVID in the emergency department. They sent every one of them home with a tiny little device, a portable, just consumer-grade pulse


So they sent people home with this tiny little device. One out 20, 5 percent, came back as their oxygen levels started to go down, and they were

hospitalized and treated. None of those 250 patients died.

If we move this whole management of this disease to earlier identification of who has it, better pulse oximetry monitoring in COVID-positive patients,

as well as those at greatest risk for serious illness, I think we can dramatically influence how this country faces this problem, how we deal

with it economically, how we deal with it just societally and globally.

SREENIVASAN: You`re advocating for the use of a pulse oximeter almost like a thermometer that we have at home.

LEVITAN: Yes, I think we would do much better as a country if, in the medicine cabinet of every American was a pulse oximeter and a thermometer.

And, ideally, a phone call away is the physician who you can talk to about how you`re feeling and, hey, these are my numbers. If you are

extraordinarily wealthy, and you have a concierge physician, this is not a radical concept. This is being done. This has been done with all of these


And people say, well, that`s going to cause a rush on these, and you`re going to — it`s going to cause a shortage. Well, in the hospital, we use a

different one. In the hospital, what we`re using the hospital-grade.

But I don`t control the supply of these devices. People on Twitter have said to me, oh, the people who need them aren`t going to get them. Well, I

don`t control the world supply.

But if I did, what I would say is, overnight, tomorrow, let`s make sure that every assisted living community, every nursing home is checking the

elderly with pulse oximetry early and continuously.

If we did that, we would identify the elderly, who can`t communicate with us often as well with what`s going on with them. So, if we first did all of

the elderly, and then we did every COVID-positive patient with pulse oximetry, I think we would have a dramatic impact on this disease.

SREENIVASAN: What do we know about the pneumonia that`s presenting here vs. what the influenza does to a body?

LEVITAN: Well, so, influenza obviously can cause pneumonia, and it can cause death.

The reason why this virus is honestly so scary to many is because a lot of the advance — the pneumonia silently advances. So, the human body does not

have a lot of responses to low oxygen. It basically has one response initially, which is, you breathe faster.

And we know that, among pilots, if the oxygen levels drop quickly, pilots pass out. But we have also learned, with climbers, that if you slowly go up

to altitude, and the oxygen is diminishing rapidly as you climb, as you get to 15,000 to 20,000 feet on the summit of Everest, the oxygen level is one-

third that it is on sea level.

But the human body can adapt. So what we`re seeing with this disease is, oxygen levels and blood gases that I have measured in patients that rival

the summit of Everest, and yet the patient is sitting there on their cell phone.

And there are other reasons why this is so different than every pneumonia. Most pneumonias cause a problem with both oxygen and carbon dioxide. And

when you acutely drop oxygen, you pass out. So, choking, drowning other acute problems that hit the lungs, if you don`t get enough oxygen to your

brain, you pass out or you seize.

When your lungs don`t work and they get stiff, carbon dioxide builds up, and that has a narcotic effect. So, patients become somnolent. So,

clinicians worldwide are looking at patients who have X-rays that look as bad as anything they have ever seen, with oxygen levels that are basically

seemingly incompatible with life, and yet these people are on their cell phones.

And what happened early in this pandemic is the belief that, well, they`re about to die, let`s put them on a ventilator. And what we realized, and in

hindsight is now better understood, they got there slowly. We can correct their oxygenation. And if we keep careful monitoring on them, and decrease

the work of breathing, improve their oxygen and keep them off the vent, it`s actually better.

SREENIVASAN: In the midst of this, there are still — there are doctors in California who say, you know what, this is similar to influenza. We have to

start the economy back. We have to get people going.

Are they wrong?

LEVITAN: So, clearly, we cannot stay hunkered down in our homes for the next three years. I`m not saying that.

And I leave to the public health and epidemiology people this — how do we track — and this whole complicated and political question, frankly, about

reopening way above my pay grade.

But this disease is deadly. It is way more deadly than influenza. And just by the numbers, you look at the excessive death rates all around the world,

this is not influenza. And the resources that this disease is demanding from our health care system is influenza times 24 or times 50.

The average length of stay of these COVID pneumonia patients who get intubated, they`re staying in the hospital, on average, 30 days. They are

requiring to be ventilated for approximately 20 days. That is just incredible, like, from a resource perspective.

So, to compare this to influenza is not correct in terms of what it is doing ,in terms of demand, what it is doing to — crushing the health care

system. My little hospital up here in Northern New Hampshire is used — is losing $4 million a month because we`re not doing all the elective stuff

because of all the outpatient stuff.

Every tiny hospital across this country, of which there are 1,500 of them, are basically facing financial ruin. The cost of this disease is being

measured in the hundreds of billions of dollars. Each one of these ventilated patients, I believe, is probably costing more than $1 million.

So, to say that this is like influenza, I think, is not appropriate.

SREENIVASAN: We have also seen, in the last few days, more research going into blood clotting, something that`s happening in younger patients.

I mean, are we discovering this partly because some of those patients are able to get into the system faster?

LEVITAN: Yes, so this disease is complicated. And as we are encountering hundreds of thousands of patients, we`re finding things that this virus

does to them.

So there are cases of brain infection, encephalitis, this terrible story of this young girl who died. There are cases of the virus affecting the heart,

causing myocarditis. We are seeing neurologic complications of this disease.

But the overwhelming number of people who die of this disease die of pneumonia. But when you look at this disease, 35 percent, roughly one in

three patients who are on a ventilator develop blood clots. The number of people who are not on ventilators and develop blood clots is one-tenth of


So, what we are learning about this disease is that we can actually address the lungs early on. Whether you get on a ventilator or you don`t, we can

fix oxygen, we can fix the lungs.

But what happens on the ventilator over time is multi-organ failure. One out of six patients on ventilators will require dialysis. One out of three

develop blood clots.

So this is an awful disease. And at the end of it, there are many, many complications that spread throughout the entire body.

SREENIVASAN: Do you think that we, as a society, as a health care system, have the potential, so that if or when there is a second wave this fall,

that we can deal with this better?

LEVITAN: I don`t think we have a choice. I don`t think we have a choice.

I don`t believe this war is going to be won through some magic bullet of a vaccine that somehow we`re going to get to a billion people on the planet.

I don`t think we`re going to come up with a single pill that is going to prevent this from infecting everybody on the planet. It would be great if

we did. That would be wonderful. I would be happy as heck.

But I think that what we need to prepare for is a long, slow battle over 12 to 24 months, but that, through incremental gains, we are actually having a

tremendous effect.

And what the public needs to know is that we`re learning how to do better with this, simple maneuvers, turning people on their stomach, improving

oxygenation, and avoidance of ventilators in two out of three patients is the savings of — I mean, it`s incalculable. It`s billions and billions of

dollars, and it`s tens of thousands of lives that will be saved.

You know, so, yes, I think the public needs to know that this isn`t an option. Like, for the foreseeable future, until a magic bullet comes along,

we need to continue doing these slow, incremental gains.

But the public, I think, has not heard this message that we`re getting better. In the ICU, the ICU doctors are learning how to better ventilate

these patients, so they`re getting more people off of ventilators who they put on them.

So there are lots of wins happening. But the public has this perception it`s all doom and gloom. And I want to tell them that it`s not, that

clinicians on the front lines, both in New York and Italy, are reaching out to me and telling me that we`re doing better. And that`s a message of hope.

SREENIVASAN: Dr. Richard Levitan, thanks so much for joining us.

LEVITAN: Thank you very much for having me.

Again, I went to New York for 10 days. The heroes in this story are the front-line workers in New York City.


AMANPOUR: But it`s still great to hear that message of hope.

And, finally, the power of creative thinking in these uncertain times. One nursery in the Netherlands has transformed a field of famous tulips into a

work of art. This picture, which was taken by drone over the weekend, shows that, by cutting the heads of three million of those tulips, they were able

to carve out a message of solidarity: “Stay strong.”

From Asia to Europe to the U.S., artists are spreading powerful messages of hope and resilience.

And we`re going to leave you with some of these images from around the world.

Thanks for watching “Amanpour and Company” on PBS, and do join us again next time.