The Rachel Maddow Show, Transcript 10/02/14

Guests:
Anthony Fauci, Carol Leonnig
Transcript:

RACHEL MADDOW, MSNBC HOST: Good evening, Chris.

We do have continuing breaking news on that, including – we`re going to be
speaking live with Dr. Nancy from Liberia in just a moment.

The breaking news as Chris just said tonight is news that involves this
network. Late tonight, within this last hour, NBC News reported both to
our staff here in the building, at our headquarters here at 30 Rock and New
York City, now publicly to everyone, NBC News has reported that an American
cameraman who has been working as a freelancer for NBC News in Liberia, he
has just tested positive for Ebola virus. The cameraman had been working
on the ground in Monrovia, in the capital of Liberia, with NBC News chief
medical editor and correspondent, Dr. Nancy Snyderman. Dr. Nancy, as I
said, is going to be joining us live from Monrovia in just a moment.

This cameraman was hired by NBC News this week. He was just hired on
Tuesday. But he`s an experienced journalist. He`d been working on the
ground in Liberia for three years prior to that. Again, he is an American.
He`s reported to have come down with symptoms of Ebola yesterday, on
Wednesday, at which point NBC News says he immediately quarantined himself
and sought medical attention.

Earlier this morning, he was given a blood test, to test for the presence
of the Ebola virus. Within less than 12 hours, that blood test came back
positive.

Now, NBC News is not disclosing the name of this freelance photojournalist
at the request of his family. We know that he`s 33 years old. He`s an
American. He had been working on the ground in Liberia for several years,
most recently covering the Ebola outbreak. But his diagnosis today makes
him the fourth American known to have contracted Ebola who will be flown to
the U.S. for treatment.

Now, all of the others that we know of contracted it, also, while in
Liberia. And like the three previous cases involving Americans, two
doctors and aid worker, this cameraman will be brought back to the United
States for treatment.

NBC News President Deborah Turness has put out a statement tonight saying
this, “We are dong everything we can to get him the best care possible. He
will be flown back to the United States for treatment at a medical center
that is equipped to handle Ebola patients.”

As I mentioned, this freelance cameraman had been working on the ground in
Liberia with our own Dr. Nancy Snyderman.

NBC News is further reporting tonight that Dr. Nancy and the rest of her
NBC crew in Liberia is also going to be flown back to the United States and
they are also going to be placed under quarantine here, in the United
States, for at least 21 days, which s described as the sort of conservative
end of the spectrum in terms of isolating patients after potential
exposure.

We`re told this is being done out of an abundance of caution. So far, none
of the NBC staff, aside of this young American cameraman have shown any of
the symptoms that can be warning signs of exposure to the Ebola virus.

But, again, the breaking news at this hour is that a 33-year-old American
freelance cameraman working on the ground for NBC News in Liberia has now
tested positive for Ebola. That makes him the fourth American to test
positive for Ebola up to this point.

Joining us now from Monrovia is Dr. Nancy Snyderman. She`s NBC`s chief
medical editor and correspondent. She`s been covering the Ebola outbreak
in that country. Her crew there includes this young freelance cameraman
who`s now tested positive.

Dr. Nancy, thank you so much for being with us tonight. I`m sure this is a
very, very difficult time.

DR. NANCY SNYDERMAN, NBC NEWS CHIEF MEDICAL EDITOR (via telephone): Hi,
Rachel.

It`s been a bumpy day, to say the least.

MADDOW: Yes.

SNYDERMAN: But you got things right. This is a very experienced
photojournalist who we hired to augment our team on the field in Monrovia.

And yesterday, he – we were at a border crossing, had our temperature,
taken, which is required by law now in most parts of Liberia, when you`re
traveling from one area to another. His temperature was normal. My
temperature was normal.

As the day went on, he started to feel just tired, a little achy. And, as
you know, a lot of times when you`re in the field, you work long days and
don`t take very good care of yourself. We just thought perhaps he needed
some rest. He signed off early, went home and called me that later than
evening with an elevated temperature.

At that point, I suggested and requested that he self-quarantine himself
and monitor his temperature by the hour, which he did, and checked in with
me.

And this morning, he went to the clinic run Doctors Without Borders, and
was check for malaria, which is very common here, and then also tested
positive for Ebola, and he is being kept in the clinic there right now.

The rest of my team, very healthy, we have been extraordinary vigilant.
But we are obviously very respectful of this virus, which has killed so
many West Africans at this point.

MADDOW: In terms of exposure, we`re told that the range of – the time of
exposure to when you start to show symptoms, when you start to show a
fever, can be anywhere from two to 21 days. They`re saying the typical
reaction is more like eight to nine days. Do you have any inkling or does
this young man have any inkling of when his exposure or where his exposure
might have been?

SNYDERMAN: Well, we started working with him three days ago. So, I
believe his exposure was sometime, you know, previous to that. We all
walk, carry thermometers on that. We all also observe the custom now,
which is to not shake hands, to not embrace people, to wash hands our hands
with diluted bleach water before we enter the hotel. We dip our feet in
bleach solution.

I was in an Ebola ward the other day and was in a typical hazmat suit that
Americans are now accustomed seeing aid workers in. And after that, was
meticulously disrobed by nurses on the ground.

We have really worked hard to minimize our risk. I mean, obviously, zero
risk means never coming to Liberia. Minimal risk means crossing over into
this country.

But you are right, that it is about eight to 10 days from the time you`re
exposed to the time you might show your first symptom, which is usually
fever followed by vomiting, achiness and sometimes diarrhea.

The deaths occur because diarrhea and vomiting are so severe that patients
basically don`t have enough fluids and then they run into clotting problems
and they die for that.

The good news is this young man, our colleague, was admitted to the clinic
very, very early. I spoke with him today. He`s in good spirits. He`s
ready to get home – of course, appropriately concerned. But he will be
airlifted out soon.

And it`s an abundance of caution, we are self-quarantining ourselves, even
going beyond the CDC guidelines. So, we recognize that there is a big
story back home. And, frankly, we want to be respectful to our colleagues
and to the American public.

MADDOW: Dr. Nancy, I just have to ask you, in terms of that self-
quarantine and these plans to bring that young man back to the United
States for treatment, to bring your crew out, what are you told – what do
you expect in terms of your ability to continue to work and what does this
mean in terms of your day-to-day life and who you`re able to have contact
with and what that`s going to be like now?

SNYDERMAN: Well, because we know that this is not a casually transmitted
disease, and because none of the rest of my team has a fever, we have no
other symptoms, we really present zero to marginal risk. I mean, I don`t
want to say zero because it`s minimal.

Really, you cannot catch Ebola from someone if that person isn`t
experiencing symptoms. And symptoms really include looking sick, feeling
achy, and being exposed to bodily fluids, vomit, diarrhea, blood, urine, or
sweat. We have mitigated those chances by being very careful.

So, our returning to the United States really presents very, very, very
little chance of giving it to anyone. And would only be a risk if one of
us ends up getting sick.

So, we will be taking our temperatures twice a day, checking in with each
other, and if any one of us suddenly spikes a fever or gets symptoms, we
will report ourselves to the authorities. We are taking it seriously. But
I want people to know that we are well.

MADDOW: Dr. Nancy Snyderman, NBC`s chief medical editor and correspondent
joining us live from Monrovia, the capital of Liberia tonight – take care.
And please give our best wishes to your cameraman and your whole crew going
through this. Dr. Nancy, we`ll look forward to seeing you back safe and
sound.

Dr. Nancy joining us live tonight.

Again, the breaking news tonight, a young man, an American, 33 years old,
who`s working as a freelance cameraman for NBC News in Liberia has been
diagnosed positively with having the Ebola virus. That makes him the
fourth American citizen known to have contracted the Ebola virus.

Two of the other three were doctors. One of the other three was an aid
worker. All three of those Americans did contract the virus in Liberia,
were flown home and successfully treated – excuse me – and survived the
disease here. This young man will be flown back to the United States by
NBC News.

The Dr. Nancy Snyderman crew and Dr. Nancy herself will also be self-
quarantining to make sure, out of an abundance of caution that they are
both safe and out of harm`s way.

We`re going to be speaking with one of the nation`s foremost experts on
infectious diseases when we come back. Stay with us.

(COMMERCIAL BREAK)

MADDOW: So, we got much more ahead tonight on the breaking news on Ebola.
A fourth American now known to have contracted the disease. He`s a
freelance American cameraman working for NBC News in Liberia. He`s on his
way back to this country for treatment.

And also, of course, the first-known Ebola diagnosis in this country, that
happened in Texas. And that story is ahead.

Please stay with us.

(COMMERCIAL BREAK)

MADDOW: So, this is a map Western Africa. Marked on this map are
countries that keep showing up on the list of African nations that had been
combating Ebola recently, countries that are having biggest ever outbreak
of Ebola that the world has ever seen. This is always the list of
countries that have been affected, Liberia and Sierra Leone, and Guinea,
they`re all relatively small countries, they`re all right next to each
other, they`re all contiguous, they`re all in one part of coastal, West
Africa.

But then, also, the fourth one that gets mentioned, Nigeria, which is not
like any of those other countries. First of all, Nigeria is huge. Nigeria
is 180 million people, more people in Nigeria than any other African
country. Their capital city is one of the biggest cities on earth, 21
million people in the capital city of Abuja.

Nigeria is big. It`s cosmopolitan. It`s fairly well off compared to other
countries in the region, in part because of its oil wealth. But most
importantly, you can tell from seeing it on map, it does not touch those
other countries, right?

So, Sierra Leone and Guinea and Liberia, God bless them, but part of the
problem that those three countries are having in fighting Ebola is that has
been crossing borders there, easily among those three contiguous countries.
Those three contiguous very poor countries with relatively rudimentary
health systems, they`ve just had a held of a time trying to beat back this
epidemic.

Nigeria is not like any of those countries. And it does not touch any of
those countries. So how did Nigeria get Ebola?

Nigeria got Ebola from an American guy. They got it basically the same way
that Dallas Texas got Ebola.

One guy flew in from Liberia who happened to have the disease. That`s what
happened in Nigeria. That`s what happened in Dallas, Texas.

And so, in Dallas, this week, a city of 7 million people, the city in the
state of Texas, to a certain extent the country, are all scrambling now to
trace the path of this one guy who flew into Dallas, to find out everybody
he was in contact with, to see who else he might have infected, to make
sure that anybody he might infected doesn`t infect anybody else.

They did the same thing in July in the huge 2 million strong in the capital
city of Nigeria. Same problem. And again, just like Dallas, just like the
United States, they had no Ebola epidemic in that country. It was just the
one guy who flew in.

But there he was. Sick. In a city with 21 million people and they needed
to make sure it did not spread.

And in Nigeria, they won. They were successful. They had a small outbreak
in Nigeria, but they contained it. There`s no epidemic there like there is
on those other countries on the list.

And that is because Nigeria had a really excellent response to what could
have been the start of a significant outbreak. They traced everybody that
this passenger had contact with, and everybody who had contact with those
people.

An emergency epidemic command center that had been financed in part by the
Bill and Melinda Gates Foundation that opened up in 2012 to fight polio in
that country, they decided to repurpose that center and to instead make it
an anti-Ebola command center. Local health workers pan out and did 19,000
face-to-face visits with people, to make sure they were monitoring all the
right people. They took every school kids` temperature, the kids all
arrived at school, to make sure they could find and isolate any kids who
had a fever, which is almost always the first symptom.

And they did it. They nailed it. They realized they had a problem. They
identified it. They isolated it. They sprang into action.

And since August 31st, there has not been a single, new confirmed case in
Nigeria. For all intents and purpose, it is over in Nigeria. A huge scare
there, a huge potential in such a populous and crowded country, but they
nailed it.

Is Texas capable of doing the same thing?

When Texas Governor Rick Perry held his press conference yesterday to talk
about the nation`s first Ebola patient being diagnosed, he opened up his
comments with what amounted to good news, bad news and worse news.

The good news is that the Centers for Disease Control has developed a
training protocol for state health department departments for how to
prepare for and deal with potential Ebola cases. The good news is that 13
states have completed that gold standard training process with the CDC.
So, they`ve got state-of-the-art preparation and training on dealing with
the threat of Ebola, 13 states. That`s the good news.

Bad news, obviously, is that means 37 states have not gone through that
training, even though it exists.

The worst news, though, is that Texas is one of the states that has gone
through the training. And still, Texas appears to have blown this in
multiple ways.

Now, obviously, this is very much in its early days. We do not yet know
how Texas is going to handle this as a whole. But Texas`s initial
missteps, including ones we are still learning about today are unsettling.

The man who`s the first ever Ebola patient diagnosed in this country, the
first and, at this point, the only person diagnosed with that disease here,
he arrived from Liberia last Saturday, September 20th. His family members
say he reported to feel ill a week ago yesterday. So, Wednesday, the 24th.

Now, initially, it had been reported that man waited two days after he felt
ill before he sought medical treatment.

Today, though, Texas Health Presbyterian Hospital in Dallas says actually,
the man came in a day earlier than had previously been reported. He
started to feel ill on Wednesday. He actually went to the hospital a week
ago tonight. He went Thursday, the 25th.

The hospital, reportedly, had just gone through a drill about how to handle
the presentation of a possible Ebola case. Even though the whole state had
just its health department certified to deal with Ebola, and even though
that individual hospital had just a drill on how to deal with this, when
this man turned up a quick ago tonight explaining that he had just
travelled from Liberia, presenting classic early symptoms of Ebola, the
hospital, for whatever reason, did not recognize him as a possible Ebola
case and they sent him home with antibiotics, whereupon Friday and Saturday
and Sunday he got sicker and sicker and sicker at an apartment complex in
the Vickery Meadows neighborhood of northeast Dallas.

He got so ill that by the time he and his family needed to go back to the
hospital that had previously sent him home, by that time, he had to travel
by ambulance.

And that leaves the secondary area of concern. Who did he potentially
expose during those days after that Dallas hospital sent him with
antibiotics? And did he become so ill in that time period that might have
contaminated that apartment in such a way it posed a infection risk to
others, even after he had gone to the hospital on Sunday?

That man started to feel symptoms more than a week ago, last Wednesday in
that apartment. As of today, the soiled sheets and dirty towels and soiled
bedding that he used in that apartment getting sicker and sicker and sicker
are still there in that apartment.

And the apartment is not empty. The family members he was staying with,
including children in that apartment had been to stay there by local health
officials, but Texas officials acknowledged this afternoon that as of this
afternoon, nobody had removed that potentially infectious material from
that apartment nor clean it up. Even as they were ordering family members,
including kids to stay in that apartment in which he had been so ill.

Ebola does not spread through the air. The only way to contract it is from
somebody else, is from somebody else is who is symptomatic and for you to
come in contact with their bodily fluids. There`s no reason to be
hysterical about broad or casual risk about contracting Ebola without any
close contact with somebody who not only has it but is sick from it,

But if somebody who is very sick with the disease has had their body fluids
on sheets and towels and bedding, then those materials need to be handled
with pretty extreme care.

Ebola is a virus like any good virus, it replicates itself. After a person
first gets the virus into their body, it takes between 2 and 21 days,
typically 8, 9 or 10 days for the virus to replicate enough inside that
person`s body that it starts to produce symptoms. It`s only when a person
has symptoms that they are thought to be at risk for passing the virus on
to other people. So, when you`re trying to control and outbreak, trying to
make sure that this thing doesn`t spread widely, that part of its virology,
right, becomes an important thing to understand, because it means that you
can`t just widely blood test everybody who might have had contact with an
infected person regardless of whether or not those people have symptoms.

If you don`t have enough virus in your blood to give you symptoms, you
probably don`t have enough virus in your blood for it to show up on a blood
test, either. Got to wait a few days. The virus has not done enough work
to either make you sick or be detectable by a blood test.

So the key thing to watch for is the development of that fever or the
development of those other symptoms of Ebola – achiness, vomiting,
fatigue, bleeding, diarrhea. The problem with that list of symptoms is
that it kind of sounds familiar, doesn`t it? It doesn`t seem all that
exotic, I mean maybe with the exception of bleeding, that`s pretty much the
list of symptoms you`re often looking for in flu season.

Hey, happy October 2nd. It`s getting to be flu season.

So you can`t strategize to stop an outbreak with any sort of magical
technological fix. There`s no vaccine at this point, right? There`s only
experimental treatment. You can do any mass blood test to figure this out,
to find out definitely who is everybody that is the relevant population,
right?

There`s no technological fix. You need old fashioned, low tech, shoe
leather public service style detective work. You need to follow the path
of the patient, figure out who they had contact with, figure out who those
people that have contact with, and then you need multiple, face-to-face
daily encounters in which that person who is now newly relevant to the
epidemiology here, that report has their temperature taken and they have a
face-to-face talk with you in which they honestly report any symptoms that
they`ve gotten.

And they submit to monitoring. They submit potentially to isolation, if it
turns they`re very high risk or they`re symptomatic. It`s low tech, but
it`s also intrusive.

So, if it`s going to work, people are going to have to trust their
government. People are going to have to trust in health officials and
their government. They have to believe it not a conspiracy. They have to
believe that the government is telling them the truth. They have to
believe that there isn`t some ulterior agenda or some punitive moment.

They have to believe that this is actually designed just to help people and
to control the spread of disease. This is not a high-tech problem. But it
is a difficult problem. And that local officials and health officials have
to be really organized, really attentive to details, really transparent
about what they are doing and they need the support and the trust of the
communities in which they are working if they are going to succeed.

How is Texas doing on that? Are we good enough at this? Have we done
anything else as a country – has Texas done anything else as a state to
prepare them for doing this as well as they need to do it?

There`s news tonight that the Center for Disease Control has flown in
basically an epidemic A-team to take point on this. It`s a 10-person team
that includes five epidemic intelligence service officers who are described
as essentially the CDC`s disease detectives. It`s five of them to do the
investigative work to find out who`s been exposed and how to contact those
folks.

Also, they`ve flown in three senior scientists who are experts in public
health investigation and infection control. They`re sending in a
specialist communication officer, a specialist public health department
advisor. They sent this ten-person CDC team that`s flying in to bolster
the capacity of Texas state officials. And that sounds good.

That said, on the ground in Dallas, school attendance was down today, as
parents start to pull their kids out of Dallas public schools out of fear
of Ebola. And when local and state officials gave their afternoon briefing
today on the subject, honestly, there were way more questions shouted out
and ignored than there were questions answered. When the briefing had
ended, basically the local press who had been summoned to get their
questions answered at that briefing, when the briefing ended not to their
liking, the local press erupted.

(BEGIN VIDEO CLIP)

REPORTER: So we know that there are other people that have come in close
contact with his bodily fluids. So we`ve been told to expected a potential
other patient. When that happens, theoretically, our local medical
authorities will know it first. Where will that patient be taken?

DR. ZACHARY THOMPSON, DALLAS COUNTY HHAS DIRECTOR: But to give you a
specific location, I can`t do that, since we don`t have that issue at this
moment.

(CROSSTALK)

REPORTER: Wouldn`t you want to keep them all in one place?

(CROSSTALK)

THOMPSON: Again, that would have to be evaluated.

REPORTER: Wait. Why would wait until the last minute to evaluate?

REPORTER: What can you tell us about the cleaning company that`s coming
today? What is their background? What are they focused on? How many
people you had to go through before they agreed to do this?

CLAY JENKINS, DALLAS COUNTY JUDGE: As information becomes available, we
will continue to bring it to you. And I thank you all for your attention.

REPORTER: Seriously, is this transparency? If you get us all here and
then walk away after a half dozen questions?

JENKINS: After half an hour –

REPORTER: Even half an hour isn`t enough?

JENKINS: Cheri, I`ve got meeting after meeting after meeting.

REPORTER: I have a job, too. And you guys are not being forth coming.

JENKINS: Thank you.

(END VIDEO CLIP)

MADDOW: That was the end of a local Texas briefing today on the first
Ebola diagnosis from the United States and how Texas officials are handling
it.

You can hear the frustration there from the local press. The response from
this not only has to be done right on its own terms, it can only be done
right if people trust that health authorities know what they`re doing and
that that they`re doing the right thing. Are we handling this right so far
or not?

Joining us now is Dr. Anthony Fauci. He`s director of the National
Institute of Allergy and Infectious Diseases at the National Institutes of
Health. He`s had an esteemed career in this field.

Dr. Fauci, it`s an honor to have you here. Thanks for your time.

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTION
DISEASES: Good to be with you.

MADDOW: In my description of what`s going on in Texas and, in particular,
talking about the virus and blood tests and things like that, did I get
anything wrong? Did I say anything that we should correct here?

FAUCI: I think we`re going to give you an honorary MD. You were very,
very good. Very on the money, on target and very accurate.

MADDOW: Well, thank you.

Well, what`s gone right and what`s going wrong so far in your view in terms
of the way we have responded with this first case of Ebola in the U.S.?

FAUCI: Well, the fact that Thomas Duncan got on the plane without any
symptoms and was without symptoms even for four plus days after he landed
in the United States is good news, because as you said very correctly, if
he doesn`t have symptoms, and he didn`t have symptoms, he`s not going to
pass the virus on to others. And the exposure that may have occurred on
his travels is something that`s extraordinarily low risk there. So, that`s
the good news.

The other good thing is that finally, he got into care where he`s now
isolated and being cared for in a critical care session. The other good
news is that the contact tracing is being vigorously pursued. And that`s
how you prevent, as you said very accurately, how you prevent and outbreak
by casting a big net and making sure that you get people who might have
been contacts and that eliminate the ones who clearly are not contacts.

And then you`ll probably have a core group of around 20 people or so who
you have to follow in the way that you describe, namely, monitoring them on
at least a daily basis in order to determine if they develop symptoms. If
they don`t after 21 days, then they`re good to go. If they do, then you
have to isolate them and put them under the appropriate care and determine
if they`re infected. All of that is on target and doing well.

Obviously, you described a disturbing situation where there were some
missteps. The only positive thing I can take out of those missteps,
Rachel, is that this will now be a really hard lesson learned, so that
people who are seeing this unfold in the United States and in other
countries that might have an important patient with Ebola to realize the
important things you need to do. And I don`t think there`s any emergency
room doc or nurse anywhere now who when someone comes in with symptoms that
are suggestive of Ebola would not do a travel history.

And then after you do the travel history, connect the dots of making the
right decision about how to handle it. So it`s unfortunate that there were
these missteps, but hopefully it won`t happen again.

MADDOW: When we have medical crises – actually we have lots of different
crises. I think our first thing instinct in this day and age is to hope
for – to look for and hope for a technological solution of some kind. To
look for some sort of magic bullet. And when it comes to something like
this, obviously, we`re looking for treatment. We`re looking for a vaccine.
We`re looking for something to come out of some lab somewhere that`s going
to make this easy to deal with.

But it seems like this actually does have – from a public health
perspective, this has a low-tech solution. And it makes me wonder, those
sort of disease detectives are flying out from the Centers for Disease
Control, I`m sure. Texas has their own equivalent personnel. People who
are trained to follow up those contacts and find those people and do those
daily encounters with people and you have to have all that cultural
sensitivity to do it without seeming like you`re putting people in a place
they don`t want to be.

How trains those people? Are those efforts well-funded? Are we good at –
as a country doing that stuff?

FAUCI: Yes. Well, the CDC is really superb. They are the best in the
world at this. Not only of what they do, the epidemiological officers who
went down there. The people who are doing that. The people who are either
doing their contact tracing or who are training the people to do the
contact tracing are as good as you can get. So I have an extraordinary
amount of confidence about how our Centers for Disease Control will handle
that.

They set the example. They set the protocols. Whenever we need to figure
out exactly how we`re going to handle someone, all of the protocols of how
you handle someone who is either exposed or actually has Ebola, how you
dress, the kinds of equipment you put on, are all protocols that are
developed by our CDC. So they`re good. And I have a great deal of
confidence that if people follow their protocols, as you say, it may seem
like low tech.

But that`s how you, A, take care of patients in an appropriate way and
prevent an outbreak. And the contact tracing that`s going to go on right
now, done properly, we won`t have an outbreak. Just the way you said, and
you gave good credit to Nigeria. They did a terrific job on that. Let`s
hope we do the same thing.

MADDOW: One last question for you. We`re hearing some sort of wild pitch
policy proposals from a Congress that`s on vacation right now saying things
like we ought to close off all airplane travel from West Africa. We`re
seeing a local response in Dallas county where parents are pulling their
kids out of schools, saying that they don`t want any kids in schools
because something might happen. They`re not trusting local authorities.

What`s the right response to proposals like that?

FAUCI: I think it`s understandable that people might feel that way, but
that is really counterproductive. When you start having those kinds of
restrictions, you create a good deal of fear, particularly if you block
transportation in and out of a place. It creates a situation where you can
actually make matters worse. So you have to be very careful when you try
and institute draconian measures with something that could be handled in a
much less aggressive way.

So I`m against those kinds of very severe restrictions that don`t have any
real proof that they make a good difference.

MADDOW: Dr. Anthony Fauci, director of the National Institute of Allergy
and Infectious Diseases at the National Institutes of Health.

Great American, sir. Thank you very much for being with us tonight. I
really appreciate it.

FAUCI: Good to be with you. Thank you, Rachel.

MADDOW: Thank you.

Not like I get to bestow the title great American, but Tony Fauci is really
a big deal. A big deal that he agreed to come on this show. I`ve
impressed myself by the fact that we had him.

All right. We`ve got lots more ahead tonight. Stay with us.

(COMMERCIAL BREAK)

MADDOW: This has been a crazy news day and a kind of crazy week for news.

On top of the first Ebola diagnosis in this country and a Liberian man who
traveled to Texas and was diagnosed in Dallas, we are also tonight
following the breaking news of another American being diagnosed with the
disease. He`s a 33-year-old American camera man working for NBC News with
an NBC News crew who is in Liberia to cover the Ebola outbreak there.

NBC News announced his diagnosis tonight and announced that he is now being
flown back to the United States for treatment. Dr. Nancy Snyderman and the
rest of her crew in Monrovia, the capital of Liberia, right now are in a
self-isolation condition and they`re also being brought back to the United
States.

There`s no signs that anybody else on that crew has any symptoms or that
they`ve been exposed. But NBC is bringing them home out of an abundance of
caution.

On top of those breaking news stories tonight, all week long, of course,
we`ve been following a string of blockbuster scoops about the failings of
the Secret Service. Partly because of that reporting, the director of the
Secret Service offered her resignation this week. Today there was yet more
on that story and the woman at the “Washington Post” who has been leading
much of the reporting on this scandal joins us next.

(COMMERCIAL BREAK)

MADDOW: A couple of weeks ago, President Obama went to Atlanta to speak at
the Centers of Disease Control about the U.S. response to the growing Ebola
epidemic in West Africa. Now since then, of course, the United States has
had our own first case of Ebola. But a couple of weeks ago, President
Obama was there to talk about America`s global leadership against the virus
and how the U.S. would try to help combat and contain the virus in the
countries where it was already epidemic.

On that trip to the CDC, we have since learned that Secret Service agents
who are traveling with the president allowed President Obama to board an
elevator with a man who had been hired by the CDC as a private security
contractor.

Here`s how Carol Leonnig at the “Washington Post” wrote up what happened
next.

“The contractor first aroused the agents` concerns when he acted oddly and
did not comply with their orders to stop using a cell camera to record the
president in the elevator. When the elevator opened, President Obama left
with most of his Secret Service detail. Some agents stayed behind, though,
to question the man. They used a national database check that turned up an
extensive criminal history. The man had three convictions for assaults and
battery.

When a supervisor for the security firm approached the agents and
discovered their concerns, the contractor was fired on the spot. And
here`s the really bad part. After being fired on the spot, the supervisor
then asked the contractor to please turn over his gun, quote, “surprising
the Secret Service agents who had not realized that the man was armed
during his encounter with President Obama.”

Carol Leonnig reported that Tuesday at the “Washington Post.” Now today,
she reports that the White House and the agency that oversees the Secret
Service, the Department of Homeland Security, neither of them were notified
of the gun in the elevator incident when it happened.

The guy with the gun in the elevator with the president, that happened two
weeks ago. White House officials said they first learned about it only
moments before the “Washington Post” published their story on this matter
on Tuesday of this week.

So that`s one thing that we learned today about the Secret Service. Today
we also learned that during President Obama`s re-election campaign in 2012,
at least one of the Secret Service agents assigned to keep the president
safe while he was campaigning, instead, leaked private, non-public details
of the president`s schedule to the Mitt Romney campaign.

The agent told the opposing campaign exactly where the president was going
and when he would be there days before the schedule was ever made public.
That was reported today by a Web site called Inside Sources, which is run
by a former Romney campaign staffer. He says he confirmed the report with
multiple Romney campaign sources.

I have to say if multiple people on the Romney campaign knew that a Secret
Service agent was doing that, why didn`t they tell anyone before now?

I mean, I know you`re running against the guy and that`s strategic
advantage and everything but as an American, wouldn`t that make you worried
for the president`s safety, that a Secret Service agents was doing that
kind of thing? Wouldn`t you say – any who.

We`ve also now learned about the Secret Service that this gentleman, Joseph
Clancy, will be the agency`s interim director now that the director Julie
Pierson has resigned over these recent scandals. Joseph Clancy is a Secret
Service veteran, he retired in 2011. His appointment is getting a positive
reaction from what apparently are the lots of people inside the Secret
Service who are now leaking to the press about these supposedly Secret
Service.

But we also know that Joseph Clancy was the guy in charge of White House
security in 2009 on the night that two totally random people waltzed
uninvited into the White House and managed to get into the very first state
dinner of the Obama presidency including them getting to shake hands with
the president himself.

It`s not like the Secret Service hasn`t had trouble over the years. But it
seems like in the Obama era there`s been a lot of trouble and that state
dinner breach was the first public sign of Secret Service trouble in the
Obama era and the guy who is now in charge of the Secret Service starting
Monday was the guy who was in charge of White House security that first
night.

Joining us now is Carol Leonnig, reporter for the Washington Post who`s
broken many of the details about this story as it has unfolded over the
past two weeks.

Carol, thank you for joining us tonight. I really appreciate it.

CAROL LEONNIG, THE WASHINGTON POST: Thanks, Rachel. I`m glad to be here.

MADDOW: So what can you tell us about the man who`s been named the interim
director? There has been some sort of anonymous positive response among
the Secret Service ranks to learning that he`d be taking over at least in
the short run.

LEONNIG: Yes, most of the people that I have spoken with and trust have
said Joe Clancy, you can`t find a person in the service who doesn`t like
him. Genteel. His nickname was “Father Joe” because of a brief stint he
did in seminary, grew up in Philadelphia, played football. All around good
guy. But he`s kind of anti-conflict. And that sounds like a good thing to
be if you`re going to be the temporary sort of placeholder until a
permanent, outside person comes in to do the real reforms and shake-up.

Most of people I`ve talked to said this is not the person who`s going to
lead any reform, but he will certainly be warmly received and trusted by
many of the agents, especially the ones he worked with.

MADDOW: The White House says that they`re not going to name a permanent
director until after December 15th, which is the date when an independent
panel of experts is expected to submit its reports on this White House
security breaches to the Homeland Security secretary. Is it clear from
your reporting on this – you`ve reported on them more extensively than
anybody else in the national press.

Is it clear what the areas of reform are going to be? In terms of not
necessarily the exact recommendation, but the problem areas that they are
going to need to overhaul? And Mr. Clancy, whether or not he`s going to be
there on the long run, does he have the credibility to make movements in
the short run?

LEONNIG: Well, it`s hard to make movements in that kind of short run.
But, you know, you could boost morale. You can`t, all of the sudden, host
a zillion, you know, Secret Service academies that have enough recruits to
fill all the vacant, open jobs that need to be filled to really make this
team, you know, full strength instead of stretched too thin.

MADDOW: Yes.

LEONNIG: But if this group that`s going to do the top to bottom reform and
review is serious, it will think about what these agents and officers are
saying inside. And those kind of fall down into four categories of reforms
they`d like to see. One, you know, they`re stretched too thin. They`re
doing more assignments, more security details, more special National
Security events than ever before and they have less people. And that`s
just not tenable.

And, as well, the second thing would be a certain amount of complacency.
You know, there hasn`t been a real assassination attempt on the president.
And that`s a great thing. Don`t get me wrong. A lot of agents say
wonderful, but they`re really petrified about how sort of comfortable
everybody seems to have gotten. Training has fallen by the wayside.
Modernizing of surveillance and weapons and tactical strategies and
focusing on the protective mission. So people are really worried about
that complacency. That`s second.

Third, probably, is the whole idea that – and this is the number one
complaint I hear from agents and officers, that it`s not a meritocracy.
That you don`t rise based on amazing performance. You rise based on being
favored, being a get along, go along guy. And that`s really got to change.
And then – and then, finally, I think the morale problems that everyone`s
been really struggling with and suffering from will probably fall in line
if you fix those three.

MADDOW: Absolutely. The meritocracy one is absolutely corrosive in any
agency but in one that needs to be as good as these guys need to be, it`s a
chilling diagnosis.

Carol Leonnig, reporter for “The Washington Post,” thank you so much
tonight. I really appreciate. Thanks.

LEONNIG: Thank you.

MADDOW: All right. It`s been a very, very busy news day. We`ve actually
got some more breaking news out of Texas. Just ahead. Stay with us.

(COMMERCIAL BREAK)

MADDOW: Believe it or not, we have more breaking news tonight out of Texas
as well but this is not about Ebola. This evening, we got a major federal
appeals court ruling that will force at least a dozen abortion clinics in
Texas to close immediately. As in they are closing tonight.

After a year-long legal struggle, the court has decided to uphold for now
the most draconian part of the sweeping anti-abortion legislation that
Texas Republicans passed last year. This is the same law the Democratic
state Senator Wendy Davis, who is now a candidate for governor, this is the
law that she attempted to block with a marathon filibuster.

Since the first part of that legislation took effect last fall, half the
abortion clinics in Texas have already closed. Another part of the law
that would have closed even more clinics in Texas had had until now been
blocked by the courts. But tonight, an appeals court sitting in New
Orleans has ruled that Texas can go ahead and implement that further part
of the law. And that means that at least a dozen clinics, “The New York
Times” is reporting 13 clinics will be forced to close their doors tonight
in Texas.

That includes the clinic we visited a few months ago in McAllen, in the Rio
Grande Valley, which had been able to reopened, if briefly, while this was
blocked by the courts. That clinic`s owner is Amy Hagstrom Miller. She
gave us this statement tonight when court`s ruling came down. She said,
quote, “We`ve been open for a whole month now in McAllen and this ruling
will force us to stop offering abortions immediately. We`ll also have to
cease care – abortion care in our Fort Worth clinic as well where we have
been the only provider open since the law went into effect last November.”

But again, tonight`s decision takes immediate effect. As of tomorrow,
Texas will have only eight clinics providing abortion services for the
whole state with 5.4 million women of reproductive age. There will be no
abortion services available in west Texas whatsoever as of tonight.

More news coming in. Stay with us.

(COMMERCIAL BREAK)

MADDOW: Welcome back. I want to recap our top story this hour which has
been an NBC News freelance cameraman who was working on the ground in
Liberia for NBC News, he`s now tested positive for the Ebola virus. He`s a
33-year-old American photojournalist. He was working in Liberia with our
own Dr. Nancy Snyderman.

The young man woke up feeling fine yesterday but then later in the day he
began feeling symptoms. He started to run a fever, which he quarantined
himself. Earlier today, blood test results confirmed that this young man
has, in fact, contracted the Ebola virus.

He`s a 33-year-old cameraman. He`s working for NBC News just for the last
few days on a freelance basis. He`s an experienced photojournalist. He`s
now the fifth American known to have contracted the Ebola virus. He`s the
fourth American to be flown back to the U.S. for treatment. The three
previous Ebola patients who flew home were all successfully treated and
released here.

We can also report tonight that Dr. Nancy Snyderman herself and her NBC
News crew, they are also going to be flown back to the United States and
they will be quarantined for at least 21 days out of an abundance of
caution. Nobody else but other than this cameraman is showing symptoms.

We spoke to Dr. Nancy about this earlier this hour live from Liberia.

(BEGIN VIDEO CLIP)

DR. NANCY SNYDERMAN, NBC NEWS MEDICAL EDITOR: Our returning to the United
States really prevents very, very little chance of giving it to anyone. It
would only be a risk if one of us ends up getting sick. So, we will be
taking our temperatures twice a day, checking in with each other, and if
any one of us suddenly spikes a fever or gets symptoms, we will report
ourselves to the authorities. We are taking it seriously. But I want
people to know that we are well.

(END VIDEO CLIP)

MADDOW,: Dr. Nancy Snyderman speaking with us live from Monrovia, Liberia,
earlier this hour.

But, again, the breaking news is that an NBC News freelance cameraman has
contracted the Ebola virus and will be the fourth American patient flown
from Liberia back to the United States for treatment tonight.

That does it for us tonight. We`ll see you again tomorrow.

Now, it`s time for “THE LAST WORD WITH LAWRENCE O`DONNELL.”

Thanks for being with us.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY
BE UPDATED.
END

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