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Interview With Therapist Esther Perel; The Science of COVID-19. Aired 2-3p ET

Aired December 29, 2020 - 14:00   ET



This holiday season, we're bringing you some of our favorite interviews from this year.

And here's what's coming up.

The virus that came to define our lives. Tonight, science journalist Ed Yong joins me to discuss the work towards vaccines.

Therapist Esther Perel tells me about life and love under quarantine.

And Dr. Richard Levitan speaks to our Hari Sreenivasan about the plight of health care workers in this pandemic.


Welcome to this special edition of the program, everyone. I'm Christiane Amanpour in London.

If 2020 were a word, it would be coronavirus. This pandemic has transformed the way we work, love and live, overwhelming hospitals, national lockdown,

record levels of unemployment, and countless hearts left broken by loved ones gone too soon.

And around the world, the quest for a vaccine sparked a global race against time to stop the spread of COVID-19 and to save lives.

By the end of the year came breakthroughs in early trials from different pharmaceutical companies. It was a light at the end of a long tunnel. And a

question for policy-makers: Why were we caught so off-guard?

Science journalist Ed Yong is a staff writer at "The Atlantic." In 2018, he wrote a prescient article, warning the next plague was coming, and the

world was underprepared.

And he shared more insights with me when we talked earlier this year.


AMANPOUR: Ed Yong, welcome to the program.

So, just let me start by asking you the news of the day and the latest promise of the day from the White House that they are at Warp Speed going

to aim to have something ready by the end of the year.

And, in fact, the new head of this, former GlaxoSmithKline CEO, did say that he believed, from what he saw, there could be several millions of

doses available by the end of this year. Give us your take.

ED YONG, "THE ATLANTIC": I think that this particular administration has a track record of making exaggerated claims about how well the pandemic is

being controlled and what the possibilities are for the future. So, I'm not sure we should take that at face value.

I do -- I agree that we would all love to see a vaccine sooner, rather than later, but optimism isn't going to deliver one. Research will, and research

takes a lot of time. The experts that I have spoken to, much like Rick Bright, have said to this time frame of 12 to 18 months -- and that was a

couple of months ago, so, we're a bit further along -- but it does take time, not only to make a vaccine, but to ensure that it is safe and


And it is very difficult to shortcut that process, as much as we all want to get on with our regular lives.

AMANPOUR: Ed, let me just play for you, but also for the viewers, just to show them exactly what the experts are saying.

So, we start with a sort of a mash-up, but Dr. Fauci starts this little mash-up.


DR. ANTHONY FAUCI, NIAID DIRECTOR: The answer to containing is public health measures. We can't rely on a vaccine over the next several months to

a year.


schedule. And I think it's going to take longer than that to do so.

DENNIS CARROLL, FORMER DIRECTOR, USAID PANDEMIC, INFLUENZA AND EMERGING THREATS UNIT: Let me also offer a cautionary note. We have never developed

a vaccine against this family of viruses before.

JEREMY FARRAR, DIRECTOR, WELLCOME TRUST: Yes, it will take weeks and months. It may not happen until into 2021.


AMANPOUR: So, that is a much longer time frame that all the experts are talking about. And on the evidence, there is nothing to suggest that it can

be shortcut.

But, again, tell me what we should know about the science of rushing a vaccine out. And is any of the red tape and the regulations that have been

cut right now going to help make that happen?

YONG: So, the starting point of making a vaccine, actually identifying a candidate, a molecule that might work, that can progress quite quickly, and

it has.

But all the tests needed to show that it will work, that it will be safe to work out what doses are required. All of that takes a lot of clinical work,

and large clinical trials that need to be done rigorously and efficiently.

And while there can be certain efficiencies, while you can shorten the process a little bit, you can't really just crush it down into a matter of

months, which is why experts are talking about this process taking up until 2021, which is why everyone I have spoken to has repeatedly said that this

is not going to be a crisis that abates in a matter of months, that we're not going to go back into a normal summer, or at least that we shouldn't


We need to steel ourselves medically and psychologically for what is going to be a very long and protracted fight with several rounds, and that will

last until the next year, most likely.

AMANPOUR: So, let me ask you about that because the obvious question is, then, is, how does one combat it?

And you have about three options. One of them, I think the most readily available under current circumstances, is what you call Whac-A-Mole. So,

describe what this means in terms of fighting this virus.

And also describe why we're seeing in the United States kind of a plateau and different spikes in different places?


YONG: Yes.

So, the options for completely containing the virus and stamping it out aren't incredibly likely right now. And the other option of just letting it

run amuck is going to be far too costly in terms of lives leaving, which leaves us with this unenviable middle ground where we're going to have to

play this Whac-A-Mole game with the virus.

It is going to spring up in different parts of the country in areas that it has not previously hit, and it's going to reemerge in areas that once had

it under control. It will continue to do that over the rest of the year.

So, we are stuck in this weird patchwork where, in some parts of America the virus is taking off and, in others, it is declining. And if you average

that out, you end up with a plateau, which is what we are seeing.

So, this mental model of something like a hurricane, a natural disaster that hits and then goes away, is completely wrong. This pandemic is going

to linger, and it is going to shift in this very weird and unsettling patchwork way.

And even this idea that we'll get a peak now, a lull in the summer and a resurgence in the fall doesn't quite capture the dynamic situation we're

facing, where things are going to change very quickly across the country and across the calendar.

AMANPOUR: So, let us just play some of these images that we've been seeing, essentially people going to bars and into close quarters in

restaurants and waiting for all sorts of other areas of activity to open up.

Given the fact that this is happening in various towns and cities across the United States, and, to be fair, also around the world -- clearly, in

Europe and certain countries, in Asia, they have got a much better grip on the virus.

But one of the things you said is that the testing fiasco is the original sin -- you call it the original sin of the American pandemic failure. Can

you explain, not just sort of in hindsight, but what it means for the process of trying to exit this and slowly, carefully open up?

YONG: Yes.

So, none of the experts I have spoken to, even those who had worried about a pandemic for a long time, imagined that the U.S. would so thoroughly fail

to roll out a widespread testing capacity to identify cases of the virus, and that is in fact what has happened.

That meant that hospitals didn't have enough time to enact to their own preparedness measures. It meant that the country was still oblivious to

spread of the virus in the early months. And the continued failure to roll out testing to a sufficient degree means that we still don't fully

understand where the virus is and to what extent it has hit the country.

Our numbers are way, way too low. And without having testing ramped up to the necessary degree, we can't really be confident about reopening the

country. You've shown images of people going out into bars and public places.

And I think it is very easy to pin the blame on individuals doing actions we think are reckless, but we have created the conditions for that

recklessness by not having a federally coordinated plan and by leaving states to do their own thing.

Some of them have reopened early and allowing -- and allowed people to reenter the world and restart these transmission chains. And while the U.S.

government has released a federal plan, it is so bereft of detail, that it's essentially leaving things up to the states.

It basically says, there should be testing, but doesn't provide any guidance of how to actually do that and doesn't take the lead in ensuring

that that is actually going to happen.

AMANPOUR: So, on top of that, where we started was the president saying one thing with all sorts of optimism about a speedy vaccine and these

experts that we have quoted and that you have talked to saying, hang on a second, it is not that quick and not that fast.

What is the consequence for people of that kind of mixed messaging?

YONG: I think it is really bad.

I think, in a crisis like this, which is already bringing with it so much fear and uncertainty and anxiety, you need calm communication. You need

trusted information from the federal government, from our leaders. And in a situation where there is constant miscommunication, where there is a lack

of respect for expertise, lack of value for expertise, then people are left in a very unenviable situation, where they don't know who to turn to for


And that's just making all of this so much worse than it needs to be. A pandemic was always going to be a communications challenge. But when the

president is saying things like, everyone can get a test who wants a test, and everyone cannot, what that means is that hospitals get overwhelmed by

the worried well.


When the president is touting unproven medications, it leads to people giving -- getting a false sense of security. And in situations where they

can reenter the world, they probably will. These -- this failure of communication is amplifying all the dynamics that are already very

difficult in a pandemic. And it's no wonder that people are confused.

AMANPOUR: So, they also are confused -- and maybe a lot of us are -- about whether this virus has changed. Is there stuff that you know, given that

you have been writing about it since it first started raising its head, compared to right now? Has it mutated? Is it different? What is the biology

of this virus now? What should we know?

YONG: So, the virus, like all viruses, has mutated. Viruses just do that as they spread.

What is -- what really matters is whether those mutations make any kind of a difference to the virus. And that's the difference between just between

talking about different strains and just lineages. So, a strain is the form of the virus that differs in a meaningful way, maybe in its

transmissibility or in its ability to cause diseases.

And as far as the virologists I have spoken to know, there is still just one strain of SARS-CoV-2, one strain that we need to deal with. And that's

different to what I'm sure a lot of the viewers have heard on the news about two, three, even eight strains.

But the experts do feel that there is just one, and that there is not enough evidence that the virus has changed in meaningful ways, and that

there won't be any evidence like that for several months or so.

That is, in some ways, a small mercy. We are actually still dealing with one enemy. That should make it easier to deal with. But it's now on us, on

the government's ability to marshal that actual defense.

AMANPOUR: Do you think it's too late to marshal that defense?

And before you answer that, I want to ask you because people have -- in the United States are saying, well, look, the first lot came from China to the

West Coast of the U.S., and then the second lot came from Europe to New York and the East Coast.

Is there a difference, and did it come -- I mean, it all started in Asia, right, and it just traveled by one route or the other.

YONG: Yes.

So, no, the -- while a lot has been said about different strains hitting places like New York from different directions, as far as the virologists I

have spoken to are concerned, that's not the case. There is just one strain of virus. Different lineages may have arrived at different parts of the

country at different times. That's to be expected.

But it's not as if those viruses have radically different properties that make combating it harder. We are still dealing with one virus, one disease.

And I do think there is still time to make a difference. The U.S. can ramp up testing. It can build the public health infrastructure needed to trace

the contacts of people infected.

And it can enact social policies that will make a difference right now, before a vaccine arrives, something like fair sick pay, like fair child

care policies, universal health care. All of these things can make a huge difference to people's capacity to contract and then to suffer from the

virus. And they can reduce a lot of the health disparities that we are already seeing.

All of this can be done right now. It is a matter of political will. And that will is being exercised at the state level. A lot of governors are

doing a fantastic job. But it is not being exercised at the federal level. And that is to the detriment of the country.

It means that the responses from the states are less than the sum of their parts, when they should, in fact, be more.

AMANPOUR: So, let me ask you, because, clearly, the United States has the military Logistics Corps, which is very good at logistics. It prepares the

U.S. military for all sorts of interventions overseas.

It could have done a lot of the supply chain stuff and a lot of moving. But, also, CDC, right? CDC is the global respected leader of all of this

kind of stuff, and yet it seems to have been, A, politicized and, B, sidelined.

I just want to read what Dr. Birx has said about it. She said in a recent meeting -- now, this is according to reports -- "There's nothing from the

CDC that I can trust."

So, it's a bit of a shocking inditement of this gold standard agency.

Can you tell me the effect of the CDC being sidelined or, in this case, less than trustworthy, if that's true?


YONG: Yes, it's been hugely demoralizing for people who work in public health, who are the people we least need to be demoralized right now.

The CDC has long been held up by people in this country as being a shining example of public health, not just in America, but around the entire world.

And to have that resource, which is so crucial, be sidelined and be silenced is the exact opposite of what should happen.

Now, I'm pretty sure that what the CDC is still doing stuff behind the scenes that we are not aware of, but they are not on the front lines. And

that is very difficult to past epidemics. They are not doing press conferences.

They are not spearheading that national response in a very obvious way. And that means that a lot of other public health people are having to deal with

quite granular questions from mayors and governors. They are being reached out -- these leaders are reaching out to these experts for advice, when

they would normally reach out to the CDC.

And I think that speaks to this devaluation of what should have been this shining exemplar of public health in the country.

AMANPOUR: So, we talked in terms of looking ahead about the Whac-A-Mole, because you say there's no way it's going to be eradicated, the herd

immunity is not a possibility right now, and so it's Whac-A-Mole.

What's the new normal going to look like?

YONG: Yes, so, I think that the country needs to heavily invest in testing and tracing. These are just normal public health pillars that have brought

a lot of epidemics to heel, and may well work here.

If they don't work, because of this patchwork effect, because the virus could potentially move from one place that doesn't have it under control to

one place that does, the country should steel itself for the prospect of further rounds of social distancing, for further restrictions to come.

It is very unlikely that places will be able to return to normal and stay that way for long periods of time, until a vaccine is ready. We should be

prepared to have to restrain our activities once again. And I think that is going to be a difficult toll on a lot of people.

It is the result of a lot of this lack of coordination, but it seems that that is going to be part of our future. And I think we need to start

thinking very hard about how we build the systems that will help us in that time, how to look after the most vulnerable populations among us, people in

nursing homes, people in prisons, in meatpacking plants, places that have been hot spots of this outbreak since the very start.

We need to be able to control that in order to keep the entire country safe. And I think that principle that none of us are safe unless all of us

is safe is something all of us need to internalize.


And the whole world is included in that, obviously, because it travels all over the place.

But I'm very interested, because you have also kind of considered a bit of the psychology. People are quite shocked that, in the United States, it's

the epicenter by far, the worst statistics, here in Britain, the worst in Europe, I mean, just by far, the two countries that are the most powerful

and that yet took way too long to get serious about it.

Describe the sort of national characteristics that you have talked about.

YONG: Yes, so, America is famed for its sense of exceptionalism, that it is the greatest country in the world.

Britain has a very different tack. It's got this Blitz spirit, this idea that it is stoic, it has stiff upper lip and all of that. I think both of

these characteristics left the countries vulnerable to a threat that would -- that started in a place as distant and foreign as China.

I think there was a sense that what happened in China would not hit other parts of the world or that, if it did, those countries would be ready. And

I think we have underestimated how vulnerable the world is because of the globalization, because of a weakening of public health, because of a

devaluation in expertise.

All of those things have meant that these countries that have -- that should have been much more prepared than they actually were have really

fumbled in their response to this pandemic.

And I think, in America, we are seeing this very strange dynamic where -- think about 9/11; 9/11 was an attack on an -- the American ideal, and it

gave the country something to rally around.

But a virus doesn't really do that to the same extent. In some ways, the response to the virus, telling people to stay at home, diminishing their

freedoms, feels more like an attack on what America is.


And I think that's contributing to some of the protests you've seen, some of the rush to go back into the world. That sense of not living in fear is

not the right attitude when you're dealing with a virus, which doesn't care about how scared you are.


AMANPOUR: And even if news of effective vaccines gives hope, scientists warn that it will take some time for them to be widely distributed, which

means patience and bearing with each other a little more.

That is the advice from my next guest. Relationship guru Esther Perel has had a busy year, talking to couples under lockdown across the planet with

her podcast "Where Should We Begin?"

I started by asking her about how the economic hardships so many people are facing right now impact their relationships at home.


ESTHER PEREL, PSYCHOTHERAPIST: I mean, these economic realities that we have just described on a macro level, they literally enter inside the home

of every family, every couple and every individual.

So, we have -- I'm hearing a breadth of experiences when it comes to relationships. What we have often known when it comes to disasters is that

they function like a relationship accelerator, basically.

So, if we just began dating, we may suddenly be living together. If we were together, we suddenly decide it is time to have a child. We are aware that

life is short, that mortality is hovering around us. And so some of us say life is short. What am I waiting for? Let's have babies. Let's be together.

Let's have marry -- let's marry.

And then, we have other people say, life is short. I have waited long enough. I'm out of here. I'm done.

And we know that there is always an increase of divorce and increase of children that come on the heels of this acute awareness that we can so

randomly be exterminated, that we have lost whatever sense of safety and security that we thought we had about the world and that we are in an acute

state of grief at this moment, not just for physical death, but for the death of the world that we have known.

AMANPOUR: It is really interesting, that, because you have also talked about how what's happening is total disruption, not just global disruption

but disruption of each individual's life.


AMANPOUR: So, given what you've just said, how are people coping? What do you tell them?

PEREL: So, look, one of the first things that people describe is how there is a complete amalgamation of all of our roles in the one place.

I'm sitting on the same chair the whole day in the same day and then, from that place, I am a therapist, I am a mother, I am a partner, I am a friend,

I am -- you know, all the roles are bleeding into each other. All the weekend is same as the weekday.

And there is this loss of demarcation and delineation. Usually, our roles are taking place in certain locales. We change for them. We go to different

places for them. Now it is all in one spot.

And that disruption, it's more than just a disruption of our routines and our sense of continuity. It's a disruption of every ritual of our life. And

so the first thing I say to people is, find ways to create borders. Don't eat at the same table. If you can or change the table, change the look.

If you want to have dinner with your partner, and you're just the two of you and you can't -- have a date, dress up, pretend you're going out.

Children are our guides in this moment. They are able to continue to understand that freedom in confinement comes through our imagination. They

are talking to dragons. They are talking to kings. They are talking to imaginary people all the time.

We need to access our imagination, because that's the one place where we are currently not confined. We are maybe physically confined, but we can

still create environments around us. So, creating delineations is one thing that is going to go a long way, finding some kind of structure within the

chaos is suddenly being experienced, not trying to pretend that we are just working from home, as I heard you say, but we are working with home.

At the same time as we're working, the only borders that's left for some of us is the mute button. You know, behind us is a whole cast of characters

sometimes and a whole life taking place that we are trying to ignore while we try to be professional here.

We are working with home. And that means that we are working with the fears of others, and we are working with the sleepless nights of others, and

we're working with the stress levels of others. And we need to find ways to regulate all of that.

Put headphones on, if you can, on occasion. Listen to music that makes you feel good and brings joy to you. Take walks. Take walks alone on occasion.

Just move, because we are so static in this moment that our entire sense of trauma and dread is contracting in our body.

And there is this undercurrent of dread going on, which is not always named, sadness, fear, helplessness, despair, powerlessness, anger. Those

are the emotions. And it comes with gratitude and hope and courage. They are there, too.


And the more we name them, the less we react to them and the more we are able to actually articulate them and connect with the people around us.

This is the real time for mass mutual reliance.

AMANPOUR: Mass mutual reliance, that's really an interesting way to put it. I hadn't heard that put that way.

But can I just ask you, because you are also conducting your podcast, "Where Should We Begin?" "Couples Under Lockdown." And you still are

dealing with relationships.

And I just want to play a little clip. It is obviously audio, because the way you do it is you get them to agree to be published, but also,

obviously, anonymously.

So, this is a couple in Sicily.

PEREL: Oh, wow.

AMANPOUR: And they're sort of finding each other again. We'll play a little bit of a clip, and we'll talk about it.


PEREL: What's the one thing that you've been wanting to say to her?

UNIDENTIFIED MALE: One thing that I wanted to say to you? I miss you. I miss you. I miss you. I know -- I mean, I know I can't just say I miss you

and then you come back suddenly. But I miss you and I want you. I want to be with you.

You know, somewhere along the line, we were together and then, somewhere, something happened, and we weren't together anymore.


AMANPOUR: So, you can hear that, clearly, they had lost or drifted emotionally apart, although we understand that they live in a very small

pretty -- pretty small space in Sicily.

Tell us about that and what you learned from that.

PEREL: Right.

You know, so they are together for more than 15 years. He used to be the one who worked outside. She used to work outside. She is a doula. She still

goes every day to the hospital and she delivers babies. She is afraid every day that she comes home that she may infect her three children.

And he has suddenly taken over that role. And they were living de facto in what we call an invisible divorce in their own home for quite a few years.

And this sudden sense that they could lose one another, that they could no longer be that family, he realizes that he needs to find a way to reconnect

with her.

And I get a chill when I hear him say it, because he is actually able to -- this is after talking around and around. And, suddenly, he just says to

her, I just miss you.

And I realize that a lot of the priorities are shifting in this moment, and all the superfluous is being thrown overboard, and we touch to the essence.

And I want to show up for you. I want -- I know you are going every day to the hospital. And while I'm home, I want to do right by you and I want to

find a way to raise these kids as best as I can.

He's never done it. And she been -- she's had a double shift, basically, for all those years. And they're in this tiny little apartment in Sicily.

And what you see in the "Couples Under Lockdown," I have done three episodes right now in this new series. One is this couple where suddenly

there is that kind of can we -- can this help us find each other again?

And then there is another couple who were living apart for the last year- and-a-half. They're in Germany. And they were in a lockdown with each other because each one said to the other, you abandoned me. You didn't follow me.

And, somehow, the virus decided for them. Once Italy went into red zone, they got reunited. And for the first time, they are able to trespass beyond

their criticisms and to know that, behind every criticism, there often is a wish, but it is much more vulnerable to talk about the wish than to blame

the other.

And then the third episode is a couple that has just filed divorce for the last two weeks before they went into quarantine. And so he is not in

sheltering place. He feels like he is under house arrest of some sort.

And they have to put that aside for a moment, because they also have three daughters. And that's what they need to do. It is like they need to find a

way to manage the task, because what they feel about each other in this moment is irrelevant.

And so what you see is the way this virus and this quarantine is intersecting with all the other normal developmental stages that

relationships go through, from people who are single, to people who have gone back to being with their family, to people who suddenly find

themselves living with someone that they have just met twice, to people who are separated, but suddenly reunited for this occasion.

It's this interplay between the regular stuff that happens in a couple with the added huge experience of being in this global crisis with prolonged

uncertainty, when nobody really knows where this is going.


And what that means is that, you know, a couple has to negotiate their different coping styles. You may have one person who's very much into self-

reliance and self-control and another person who is much more fatalistic and has a much better sense that things happen in life, you know. And these

two people have to negotiate their coping responses in the face of something for which nobody really has an answer. And all of that sits at

the dinner table.

So, this is what the podcast is trying to capture in this moment. And it is very, very visceral because you're literally in people's home at this

moment. They're no longer in my office. They're literally, you know, in their tiny spaces. And so, you have a level of intimacy and an entry and

that has launched a conversation with thousands of people, you know, through a miniseries I've done on social, on YouTube, that is amazing

because people talk about mental health and -- but not enough and they are busy talking constantly about physical health, this virus, have you been

exposed, you know, have you had it, have you -- are you symptomatic, asymptomatic. But in fact, mental health is a part of our physical health

and the essential part of our mental health is our relational health.

And so, it is never named like this. And this relational health is what is going to help people when they -- once they go back outside again. I mean,

these things are all interconnected. So, this is the contribution of one therapist to try to do something to bring meaning and clarity to this very

complicated experience.

AMANPOUR: Very complicated indeed. I just with to ask you, also, it's kind of related. Basically, there are some, there's some stories that suggest

that people, perhaps patients of yours, others, who have, you know, chronic depression and all sorts of other issues and are very unhappy, somehow are

managing in this -- in a different, more resilient way than might be expected. They're doing better at the moment.

PEREL: Yes, yes.

AMANPOUR: And I'm interested whether you have come across that and why.


AMANPOUR: And also, you are the child of holocaust survivors. And you know what it's like or you know from your family what it is like to have

survived terrible, unspeakable trauma and you also spent time, obviously, being a therapist after 9/11 and, you know, near where you lived in New

York, et cetera. Can you talk about all those issues? How some people manage it better and that somehow counter intuitive?

PEREL: Yes, yes. It is a great question. You see, some of -- this is true for my patients, this is true that we hear on our social channel. So, it's

actually not just a few people here. If I have grown up with neglect and if I have grown up having to rely on myself and if I've grown up with chaos,

this is a moment where for which I'm actually quite prepared, you know. And if I've grown up with those things and I'm still here, it is probably

because there is a fair amount of resilience inside of me that knows how to bounce back.

So, our resources, our inner resources, our psychological strengths, often come from some of our most painful experiences. And in this moment, it

feels like my inner world matches the outside reality. This is the world. You want to know how I feel? This is it. This is how I live all the time.

You want to know what it's like to live with danger, to live in neighborhood where there is no safety, to know that you could lose somebody

every day? Welcome to my world kind of thing. And that suddenly turns into a strength for people because the reality on the outside matches the

reality on the inside. It is not for all but it is quite common, more common than we think.

When it comes to my own experience, I would say, you know, my family they - - my two parents lost everybody, everybody. So, they were the sole survivors. And they decided that there was going to be a difference between

not being dead and being alive. And I really understood that frame work for me. That what does it mean to actually experience pleasure in the midst of

crisis, connection when everything else is being destroyed, hope when you can experience despair? And that this becomes an antidote to the sense of

loss and deadness.

And -- but you live with the notion of dread. You know, this invisible current of dread that is pervading our society in this moment says, don't

ever think that, you know, when you say I'm going to do this, you are in charge of it. There is a sense that any moment you can experience

disruption. That's the legacy, if you want.

AMANPOUR: That's the legacy. But, also, I kind of hear you saying, in a different way -- and I want to know --


AMANPOUR: -- do people have permission to be joyful, to be happy, to think about something other than coronavirus?

PEREL: Oh, I'm so glad you've asked. No, no, no. I cut you off, but continue. Sorry.

AMANPOUR: No. You continue. We have got a minute left. You tell me.


PEREL: Yes. I think it's such -- because that's part of the legacy, too. Yes, my father fell in love in the concentration camp. My mother sang

songs. People wrote poems. People wrote love stories. People held each other. People created community. People dreamt together. People had all

kinds of premonitions, dreams.

I think it's extremely important to give ourselves the permission to experience pleasure in the midst of the crisis, to understand that, when

you are confined, your mind can actually go infinite and that your imagination is what is going to give you that sense of hope, and that it's

not just that it's a permission. It is a must. It is something that keeps us alive and keeps us resilient. And it is in every story of resilience

that we will learn from our families and from our culture, is that ray of light that shines through the crack.

AMANPOUR: Well, you give it in spades. What a great conversation. Thank you so much, Esther Perel.

PEREL: It's a pleasure. Thank you.

AMANPOUR: The podcast, the newsletter, I hope everybody takes a chance to get your wisdom. Thank you.

An important reminder about cherishing loved ones and finding hope during these trying times.

Well, as the pandemic raged on, we did all pause and remember our essential workers, the doctors, the nurses, bus drivers, teachers, cleaners,

shopkeepers, all putting their lives at risk to keep society running. Our next guest, Dr. Richard Levitan, has been practicing emergency medicine for

three decades. And when the first corona virus first overwhelmed New York City at the end of March, he rushed from his home in New Hampshire to

volunteer at Bellevue Hospital where he had trained. And he spoke with our Hari Sreenivasan about his experience on the frontline.


HARI SREENIVASAN, CNN INTERNATIONAL CORRESPONDENT: 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 it.

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 breathing.

And what we found over -- you know, 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, you

know, just consumer-grade pulse oximeter. 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, you know, people say, well, you know, that's going to cause a rush on these, and you're going to -- you know, it's going to cause a shortage.

Well, in the hospital, we use a different one. You know, in the hospital, what we're using the hospital-grade. But I don't control the supply of

these devices. You know, 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



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, you know, 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, you know, this -- how do we track -- you know, 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, you know, 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, you know, demanding from our health care system is influenza times 24 or

times 50.

You know, 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, you know.

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. You know, 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, you know, complications of this disease. But, you know, the overwhelming number of

people who die of this disease die of pneumonia. But when you look at this disease, you know, 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 that.

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. You know, 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, you know, we're going to come up with a single

pill that is going to, you know, 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, you know, 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, you know, 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 its 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.

You know, 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



AMANPOUR: An important reminder of the selfless dedication of our healthcare workers.

And, finally, we brought you a lot of music to provide comfort during a year of lockdowns and stress. And so, we leave you now with the legendary

cellist, Yo-Yo Ma. I spoke with him about 100 Offerings of Peace, it's a project that he took part in, which asked artists what music means to them.

Thanks for watching this special edition of Amanpour. Catch us online, on our podcast and across social media.

And here is Yo-Yo Ma playing his offering for peace, the Shaker tune, "Simple Gifts."