ANNOUNCER: The coronavirus, there`s a good chance by now you know someone
who has it, suspects they have it or even died from it. Since the first reported case three months ago, COVID-19 has taken over everything, our health care.
UNIDENTIFIED FEMALE: People are dying, we don`t have the tools that we need in the emergency department.
ANNOUNCER: Our financial future.
UNIDENTIFIED FEMALE: What`s going to happen with paying rent, vendors and taxes we need to pay?
ANNOUNCER: Our very way of life.
GOV. ANDREW CUOMO (D), NEW YORK: Banning nonessential workers, social distancing, just flatten the curve, slow the infection rate.
ANNOUNCER: Tonight, Lawrence O`Donnell and Dr. Ezekiel Emanuel examine how the virus affects the body, how hospitals are coping and asks when will it be safe to get back out in the open.
This is a special edition of THE LAST WORD: Life in the Time of Coronavirus.
(END VIDEOTAPE)
LAWRENCE O`DONNELL, MSNBC HOST: After a weekend of stunning new estimates of Americans who might die from coronavirus, an estimates that now runs into the hundreds of thousands, we`re going to spend the full hour tonight on what how the front line troops in the battle, health care professionals are fight the fight, risking their lives every day, and will give you what you have to consider even if you don`t get sick, how long you might have to go without a paycheck.
And, of course, there`s big question of how much government can do on the medical front to help save lives and on the economic front to help save jobs. New York Governor Andrew Cuomo will be our first guest tonight. We will be joined by experts throughout the hour to get best their latest advice on how we should be living now.
Should we be wearing face masks every time we go out to buy food? How safe is it to go to the grocery store? What precautions do we need to take outside of our homes? Do we have to keep social distancing from people who we live with? How far away should we be sitting from each other when we watch a movie at home on the sofa?
Everything you need to know about how to live your life in this time of the coronavirus pandemic and everything you need to know about the people who are trying to save your life in this time of the coronavirus pandemic. That`s what we will be covering for this hour.
And with me throughout the hour tonight, as our guide through the science and the medicine is Dr. Zeke Emanuel. Dr. Emanuel is a medical doctor and has a PhD in political philosophy. He served in the Clinton administration, in the Obama administration. He is now the vice provost for Global Initiatives at the University of Pennsylvania. Dr. Emanuel is now an NBC News and MSNBC medical contributor.
Zeke, what are you hoping viewers will be able to take away from this hour?
ZEKE EMANUEL, MSNBC MEDICAL CONTRIBUTOR: Well, I think we do want to get to the facts about what it`s like to care for patients in the hospital, also how to think about this, you know, struggle between the economics and the public health. How bad is the economic situation going to be and can we actually get the country started before we really tackle the virus?
And then there`s just practical advice for people. You know, they need to understand should they be wearing masks? How often should they go shopping?
I think it`s really important to get people to look at the facts. And, of course, we`ll be interviewing Andrew Cuomo, who I think really stepped up and been one of the real leaders in this country in this fight and really take, shown how to handle a major crisis with poise and really supporting everyone in the state.
O`DONNELL: That`s right. We`re going to begin with Andrew Cuomo tonight with his state now suffering more than 40 percent of the cases of coronavirus reported in the United States.
The country now has, this country, the United States now has the most coronavirus cases reported in the world. As of today, there are 161,829 reported cases of coronavirus in the United States with as of tonight, 2,983 reported deaths from coronavirus. Last week, President Trump envisioning what he called packed churches all over America on Easter Sunday, which is April 12th, and now, the president has been convinced to change his mind about that by the medical professionals advising him and the Trump administration is now officially extending their guidelines for social distancing until the end of April.
This morning, a member of the White House coronavirus task force, Dr. Deborah Birx offered an estimate of how many people will die in this country, if we do everything perfectly.
(BEGIN VIDEO CLIP)
DR. DEBORAH BIRX, WHITE HOUSE CORONAVIRUS TASK FORCE: If we do things together well, almost perfectly, we could get in the range of 100,000 to 200,000 fatalities. We don`t even want to see that.
(END VIDEO CLIP)
O`DONNELL: So, a possible 200,000 deaths if we do everything perfectly, and doing everything perfectly would mean all 50 states doing what the Trump administration is recommending, but not all 50 states are doing that. Twenty states have not issued orders shutting down non-essential businesses, 31 states have issued those orders now.
Today, Maryland and Virginia became the latest states to close down non- essential businesses so that social distancing can be strengthened in those states. As of tonight, New York City remains the epicenter of the coronavirus in the United States. New York City accounts for most of New York state`s reported cases of coronavirus which totals 66,497 statewide. New York state has already suffered now 1,218 deaths from coronavirus.
Every day, the governor of New York briefs his state on the latest grim statistics and he does it with authority, sensitivity, civility and a keen awareness of what New Yorkers need to know, and what New Yorkers care about. In those briefings, Governor Cuomo has warned the rest of the country that New York is their future. That what is happening in New York tonight will be happening in other states.
(BEGIN VIDEOTAPE)
O`DONNELL: And joining us now is the governor of New York, Andrew Cuomo.
Governor, thank you very much for joining us tonight. We all know how busy your schedule is and we really appreciate your time.
I want to get right into with the way your days work day-to-day, what is the number one problem you wake up worrying about every day?
GOV. ANDREW CUOMO (D), NEW YORK: Basically, it`s the overwhelming of the health care system, Lawrence. You know, the (AUDIO GAP). Number one, the social responsibility, public responsibility -- stay home, be smart. And that`s -- that`s a constant battle.
But what this is really going to turn out to be is an overwhelming of our public health systems. It`s going to be an overwhelming of the health care system.
And that`s (AUDIO GAP) if we`re not careful and we`re not planning and we`re not getting ahead of it, the health care system collapse on us. And then people who did not need to die will die.
So, for us, it`s watching the numbers, watching the increase and being prepared for the crush at the high point of the curve on our health care system.
O`DONNELL: The president talked about masks, the big surgeon masks going to New York. And he suggests that there`s some kind of corruption at the hospital (AUDIO GAP) New York. There`s some kind of corrupt purpose going on with it. President Trump (AUDIO GAP) right now, why there has been a surge of masks in New York and what you think the numbers are in New York on masks? And is there anything troubling that you find -- any hint of any corruption you find in the flow of the masks to New York hospitals?
CUOMO: Yes. You know, Lawrence, I think the president -- I`m sure the president heard from someone that there has been an exponential increase in the use of masks, and there has been. What is happening in the hospitals now is you have COVID PPE, one set of -- one protocol for PPE for COVID people and one for non-COVID people. The COVID PPE is obviously more extensive.
But in a hospital today, you can`t tell who has the coronavirus and who doesn`t. So people -- the staff tends to be wearing the COVID PPE. They deal with one patient, they take it off, they put on new PPE, and they go to the next patient, because they don`t want to infect themselves and they don`t want to infect the other patient.
So, there has been an explosion in the use of this PPE equipment, the gowns, the masks, et cetera. That`s why it`s happened. It`s that increase then has forced states all across the nation, as well as other countries to go out and furiously try to find the supplies to buy, which you can`t even do.
I don`t think the president got that point as the reason for the exponential use. I think what the president was inferring is maybe someone was out the backdoor. Maybe someone was taking the PPE wrongfully, et cetera. If he really believes that, then he should just call for an investigation and say I think PPE equipment is being stolen.
I don`t believe that`s true at all. People are desperate for it, nurses, doctors, et cetera. But there is an exponential use in the PPE, but that`s why. It`s because of the virus and the number of people in the hospitals with the virus is now so large that the only smart course of conduct is to assume that everyone has it.
O`DONNELL: Governor, you talked to the president just about every day now. Has he picked up the phone or in any or your conversation said to you, hey, Governor, what`s happening with all those masks? Have you had this chance to have this conversation with him?
CUOMO: No. No.
But, Lawrence, we -- there are a lot bigger issues than speculating about whether or not somebody stealing PPE out of a hospital, right?
We have a tremendous struggle in this -- in the state and in other states on how to deal with this -- how to deal with the capacity on the hospital system.
And remember, people think -- well, New York, that`s New York. There`s nothing unique about New York here. There`s nothing unique about New Yorkers` immune system. There is no American who is immune from this virus.
All you`re seeing in New York is that because of the density, the intensity of the place, the virus communicates faster, it transfers faster. But you`re going to see this all across the country. This is like a fire through dry grass with a strong wind behind it. This virus communicates like nothing else that we have seen.
So, really, New York is just the test case for this. We`re the canary in the coal mine.
And I say to my colleague, governors across the country, I said, you know, watch what`s happening here because it is (AUDIO GAP) when. So, in some ways, I think we are (AUDIO GAP) to be learned.
We have a tremendous struggle. I`m asking (AUDIO GAP) from across the nation to help us because we have -- we have a medical staff that is just (AUDIO GAP) emotionally exhausted.
You know, Lawrence, we haven`t seen anything like this. I did emergency disasters in the federal government, as you know, for many years -- hurricanes, floods, earthquakes, they happened and they were over and you started rebuilding.
This is gone on for weeks and it will go on for more weeks. It`s the psychological toll. It`s the fear. It`s the death -- all weighing on people.
So, I`ve asked for health care workers from across the country, come please. Help us here in New York. And we will reciprocate because this is going to happen across the country. You hear New Orleans, you hear Detroit.
And if we`re really smart as a country, we say you know what? Let`s mobilize (AUDIO GAP) as a nation the virus (AUDIO GAP) where it pops up its ugly head.
And if it happens in New Orleans, then let`s all go to New Orleans and let`s help New Orleans. And when it`s in Detroit, we all go to Detroit -- because this is going to happen on a rolling basis. You`re going to see regional or local intensities and hot spots and curves, and we should really be mobilizing nationwide helping one another.
O`DONNELL: Governor, the recommendations and the orders that you issued have been statewide. In Florida, the governor has issued one set of recommendations for what he calls Southeastern Florida and then he has looser recommendations for other parts of the state of Florida.
You represented a state that stretches from Montauk Point to Niagara Falls. You have almost unpopulated Hamilton County up there in Northern New York. You have very different population ranges across that state.
Why have you decided that the rules have to apply as strongly in Hamilton County as they have to in Manhattan?
CUOMO: Well, look, we have -- remember, when this first started to develop, Lawrence, the number one hot spot was a community in Westchester County called New Rochelle. There was no rhyme or reason for that.
It didn`t start with that kind of intensity in Manhattan. It started in a community called New Rochelle from one person, Lawrence, one person, who then attended a large gathering where there were several hundred people and then attended a second large gathering.
So, yes, you could say it`s a dense environment. It`s New York City, but that`s not how we were introduced to it, and all you need is one, right?
Look at what happened in New Orleans and there`s a theory that, you know, a couple of people went to Mardi Gras. You look at the past pandemics, the Spanish flu pandemic, et cetera, all it takes is a couple people in a group.
So, yes, you have rural parts of the county where you have the state where you have fewer people but also, one or two people there can, by percentage, decimate a population, right?
So, better safe than sorry, especially after what happened to us in New Rochelle, and we set up a statewide policy, and I`m glad that we did because I believe that we have curved the expansion even in the rural -- rural communities.
O`DONNELL: Governor, there`s a lot of concern and we`re going to talk about it a lot in this hour with other guests about the effect of this on health care workers, the dangers they face and the expectation that they will all be going at full speed all day long. It`s also a new level of demand on government officials. It`s a new level of demand on you, yourself personally basically with this 24-hour worry that isn`t going away.
How -- how are you and your team managing your own personal approach (AUDIO GAP) days and where you get your rest and how you`re able to do on a seven- day week period -- basis?
CUOMO: Look, Lawrence, there`s no answer to that question. You do what you have to do, right?
As I mentioned, I`ve -- I was in the federal government. So you respond to the crisis at the time, whether it was Hurricane Andrew in Homestead, Florida, or the Midwest floods, the Los Angeles earthquake we went through. I did the disaster relief during the Clinton administration, the rebuilding in Haiti and in the Dominican Republic.
You do what you have to do. The adrenaline kicks in, and that`s the job and that`s what you signed up for, just the way they put you on a plane and tell you, you know, you`re going to go out and cover this.
Now, this is going to be a longer period of time and I am worried about that. So I am rotating my team and we have, like, an A, B and a C team because no one can do this seven days a week at this intensity 24 hours a day for four, five, six weeks. So, we will rotate people.
But this is, you`re right, this is a government being called on to perform in a way it hasn`t probably in most people`s lifetimes, right? This is a full blown nationwide crisis where government has to work, Lawrence. This is not abstract. It`s not theoretical. We`re not talking about policies.
You have to make that government to operate and it has to operate in a way it never did. You have to take those hospitals and make them work together in a way they never have. You have to produce those supplies.
You have to find those gowns, find those masks. You have to have those ventilators. You have to be able to move patients back and forth and not on a flowchart but in a car on a road. And it has to happen.
And if government doesn`t work, people will die who didn`t need to die.
So, you see this whole shift, Lawrence, from this abstract, political, conceptual discussion, wouldn`t it be a great idea if government did this? To the exact opposite spectrum.
This is all practical. This is all real. This is all experience. This is all competence. This is all capacity.
And can you get that government machine to work? That`s what you see the federal government struggling with, right?
Can you get FDA to work with CDC? Where is FEMA? Should they have been buying supplies? How do they do it? Where does HHS fit in?
You see these government agencies trying to perform, but that is the real test for government.
And for me, you know, I very much believe my way is to be out there, Lawrence. I say to my National Guard on every disaster the same thing -- I`m not going to ask you to go anywhere that I don`t go. And I`m not going to ask you to do anything that I don`t do myself.
And I don`t care if it`s a flood, if it`s a snowstorm, whatever it is. If I`m going to ask someone else to go out there, personally, I need to go there. I`m just not comfortable sitting in the office and sending someone out who has a family, who could be in a position of danger unless I would put myself there.
And that`s personal. And in this situation, my health care advisor says, don`t do that, that`s a mistake. But I can`t operate any other way.
So I`m out there. I`m visiting the facilities we`re setting up. I`m working with the staff.
I want to talk to people. The best I can, I`m trying to calm people down and explain facts because everybody gets 57 different versions of the facts, different during the day. That`s how I see my role.
At night, we get the results from the hospitals and we start to study the data to see if we can find any patterns because I`m still looking for that apex of the curve. That`s where the enemy is going to join us, and I want to make sure we win at the top of that mountain so we`re still on the way up on the trajectory.
And we`re studying the data to see on the rise of cases, the rise of ICU beds, what is that challenge going to be at that high point? How over- capacity will our system be? How many ventilators will I need? How many ambulances will I need? How many hospitals will I need?
And that`s what we do as a planning exercise during the evening hours.
O`DONNELL: Governor, before you go, I just want to say something to you on behalf of every New Yorker who I`ve been talking to throughout this crisis and people all over the country who see your briefings every day -- and that is thank you, and that is thank you for your guidance, and thank you for your approach to this.
And I know everything you just said about yourself and the way you approach this, and I think you know that I already knew that about you when I was working in government for Senator Moynihan, senior senator from New York. We were, of course, working with your father every day as governor of New York. You were on your father`s staff in Albany. You then go into Bill Clinton Clinton`s cabinet.
I`ve never known a more experienced governor than the governor that America is seeing every day when you try to guide us through this. And I just want you to feel from the people who are watching you every day how much gratitude there really is out there for the kind of expert guidance that you`ve been giving, and I know that you can give it because you actually devoted your life, your full life to government service.
And there`s something about professionalism in government that cannot be faked and that`s what we`re seeing every day. So, thank you, Governor.
CUOMO: Thank you, Lawrence. Thank you very much. It means a lot to me coming from you. Thank you and God bless.
O`DONNELL: Thank you, Governor.
(END VIDEOTAPE)
O`DONNELL: And we`re back with Dr. Zeke Emanuel.
Zeke, I want to get your reaction to the way the governor sees his job and he`s envisioning that apex and trying to bring everything he can to fighting that peak that`s coming in New York.
EMANUEL: Well, first of all, let`s connect something that`s going on with that Dr. Debbie Birx said with what the governor said. She said that there could be, if we do everything perfectly, there could be 100,000 to 200,000 deaths.
First thing I want to identify is if we don`t do things perfectly, that will be a lot more deaths and that`s important for the nation to keep in mind. The second thing is, if there are 200,000 deaths from COVID-19 in this country, that means that 20 million Americans, at least, will be infected. We`re at 160,000 or 190,000 or something like that. You know, we`ve got a long distance to go, which means it will be across the country.
And that gets to the second point that Governor Cuomo raised, which is they haven`t even hit the apex. There is this real sense of crisis in the New York City hospitals and yet, as Governor Cuomo said, they aren`t at the apex. They have time to go and that means there`s a lot more demand on the health care system coming.
And the last point I think you raised in a very good question, which is you applied the same policy of, you know, shelter in place across the state, why did you do that if this was basically in New York City? And he made the correct point that you don`t know where it is. We haven`t had enough testing. It could be everywhere and if we don`t do shelter in place in other cities, people from those other cities could have COVID-19 and could come into New York and reignite it.
And so, I think he was very prudent and he gave a very good explanation for why this had to be statewide and as you pointed out, it`s still not statewide, it`s still not nationwide, and we really do have to get these kind of measures, these public health measures nationwide.
O`DONNELL: All right. Doctor, stay with us.
When we come back, we`re going to have a special last word medical staff meeting of health care professionals on the front line in this pandemic. Zeke Emanuel will chair that staff meeting. That the next.
(COMMERCIAL BREAK)
O`DONNELL: The University of Washington Medical Center has put out a study projecting the need for hospital resources in all 50 states assuming that social distancing measures are maintained. Here`s a sample of what the hospital systems around the country would expect -- can expect when you look at Louisiana, you can see that the shaded area in purple represents the range of beds that are projected to be needed, the horizontal line represents the hospital beds actually available in Louisiana.
So when the expected peak arrives on April 10th, if Louisiana hits the high part of that possible range of beds needed, there could be a need for 8,700 more beds than Louisiana has. The story is very different in Vermont. That state seems to have just about enough beds to fit its peak need. The peak of the curve represents beds needed on April 9th is just not that much higher than the actual beds available, but when you take a look at New York state, you can see what Governor Cuomo is worried about.
If New Yorkers only needed what`s on the low end of the range on the peak date of April 9th, that`s still 20,000 beds short and those are projections at this point but right in the here and now, these states and others are just beginning to climb to that peak and for those on the front lines, in the climb to that peak, in those hospitals, the effect of the virus is already taking a toll unlike anything we`ve ever seen before.
Joining our discussion is Dr. Eric Bressman. He`s the chief resident in medicine at Mount Sinai and Elmhurst Hospitals in New York City.
Dr. Najy Masri is LSU`s director of hospital services and the medical center there. He is also an associate professor at LSU section of hospital medicine.
Deb Snell is with us. She`s an ICU nurse at the University of Vermont Medical Center. She is the president of the Vermont branch of the American Federation of Teaching Nurses Union.
Dr. Zeke Emanuel, of course, is still with us, and I am going to get out of the way and let Dr. Emanuel chair this meeting of the professionals.
DR. ZEKE EMANUEL, NBCNEWS.COM MEDICAL CONTRIBUTOR: I want to start with Dr. Eric Bressman. You`re working in the hardest hit area of the country, ground zero, and in some of the hardest hit hospitals in the country. Can you describe what it`s like to care for this onslaught of COVID-19 patients at your hospitals?
DR. ERIC BRESSMAN, CHIEF RESIDENT IN MEDICINE, MT. SINAI HOSPITAL: It`s been - it`s really amazing. I mean, the past few weeks have been the most traumatic, but also the most inspiring of my young career.
There`s a lot of media frenzy going on, but the reporting coming out of Elmhurst is 100 percent true. The number of deaths is really hard to fathom on a day-to-day basis. And look at the safety net hospital, mid-sized safety net hospital with (inaudible) in the country. And they`ve been hit harder and faster than anybody else, and they`ve gotten Herculean--
EMANUEL: And are you able to give - are you able to give top-quality care to these patients or is the care really being compromised because of so many patients?
BRESSMAN: I think any stress would highlight the cracks in the system, and this stress in particular has highlighted a huge fault line, which is that between the have and have-nots, migrating between Sinai and - and Elmhurst Sinai being a major academic medical center with a huge footprint in New York City, in Elmhurst Hospital, you can sort of see the ability of a major health system to mobilize an immense amount of resources and they are doing an amazing job of preparing for this, and the onslaught is coming. But Elmhurst got hit fast and hard and just doesn`t necessarily have resources to do so.
EMANUEL: Dr. Masri, you`re in what`s an emerging hotspot in New Orleans. What keeps you up at night thinking about what it could be like?
NAJY MASRI, LSU DIR. OF HOSPITALIST SERVICES, OCHSNER MEDICAL CENTER & ASSOCIATE PROFESSOR, LSU SECTION OF HOSPITAL MEDICINE: I think we`re following a similar trajectory of New York. I think - we`re over 4,000 cases now. We have 185 deaths. I think, by the end of the week, we`ll have the most deaths in the country outside of New York.
And Orleans Parish, where New Orleans is, is an epicenter. It actually has the highest death rate per capita already in the United States. It`s twice as much as any other county or parish that we see. And really here, locally, it was the perfect storm. It was the - like Dr. Cuomo (ph) kind of alluded to a couple of weeks before our first case, we had Mardi Gras.
And if you want to talk about an event that is the polar opposite of social distancing, it`s really Mardi Gras around here. But there`s a lot we know about this virus. There`s a lot we don`t know about this virus. But one thing, for sure, we know is that this virus is not discriminated. It goes after the old, the young, men, women, regardless of race, ethnicity, religion, nationality. It`s aggressive, and it`s out there, and it`s certainly in our community.
EMANUEL: Dr. Masri, do you think you`re going to have enough ventilators for the anticipated onslaught of patients with COVID-19 or are you going to be short and have to make choices?
MASRI: So, about one in every three, one in every four patients that we have that come into the hospital with COVID-19 end up on the ventilator. That`s an astounding number. And that`s a number I have not seen in any disease process that required ventilatory support.
There are some local numbers here in the state that we`re using about 60 new ventilators a day. I think that grossly underestimates the number of ventilators we`re actually using. I think that number is much higher. There`s about 200 ventilators left here in New Orleans area. We`re using a lot of them. So this is a simple numbers game.
And certainly there`s a concern. I applaud Governor Edwards for really trying to procure a lot from the national stockpile as well as from federal sources, but based on the numbers, something is going to have to happen to stem the curve and flatten it in order to get us through this.
EMANUEL: Are you and your doctors ready for that crisis of having to make those choices?
MASRI: So - again, kind of like Dr. Bressman talked about in New York, I think this is a time of high stress, a time of high pride. I think people are all in the planning stages over here, predicting that our model is going to follow similar to New York. We recently have reallocated our convention center to house 1,200 beds to try to off-load the hospitals.
A lot of hospitals are creating separate ICUs in order to try to care for these patients as they come in with the projection that they`re going to get sick. So we can use the convention center to kind of off-load some of those hospital census (ph).
EMANUEL: Ms. Snell, you`re a nurse in a rural state hearing what`s happening in New York and Louisiana. What`s the experience in Vermont, a much more rural state without that many - not such a dense city environment?
DEB SNELL, R. N., ICU NURSE, UVM MEDICAL CENTER & VERMONT AFT UNION PRESIDENT: Yes. So, right now, we`ve only seen about 265 positive cases in Vermont. We`ve had 12 deaths, which is a very small number compared to other states. But we also have very much an ageing population in our state, which is a big concern for us overall.
Statewide, we are in good shape right now as far as the PPE we have on hand. But even today, we started taking measures to start conserving all of the equipment that we do have because we know the worst is yet to come. And it`s scary seeing what`s happening in New Orleans and New York and knowing what the healthcare workers there are going through. It`s heartbreaking.
EMANUEL: How are the nurses supporting each other and the nurses and doctors supporting each other in this sort of anticipating the wave of patients?
SNELL: Yes - no, we`re working really well together right now. I mean, we have to. We have to be ready for this when it gets here. We`re talking about ways to improve the work we`re doing in our ICU, our workflow, creating ICUs in other parts of our hospital. The National Guard has set up some stuff over at the University of Vermont to have those beds ready, about 40 or 50 beds over there. So, as a state, we`re gearing up, we`re getting ready and kind of bracing right now.
EMANUEL: Eric Bressman, how is your staff taking what has been almost a month of constant pressure from the COVID patients? And where is the decompensation happening? And you`re the Chief Resident. You have to care for all those residents. What do you do to bolster their morale?
BRESSMAN: It`s been beyond traumatic. I think back to cases from my own residency that I still reflect on where I wonder kind of what if, what could have been, what did I do wrong there. And those are isolated cases and still are sort of traumatic memories for me. And I think, to the number of cases that they`re staying on a daily basis where they reflect on that, they come to us, they call us in the morning after a shift and they say I just don`t know what I did wrong, and it`s just heartbreaking.
I think when all the dust settles from all of this, the collective toll of all this is going to be nothing short of PTSD for many of the front line healthcare workers that have been dealing with this on a day-to-day basis.
From our own perspective, we`ve done as much as we can to adjust scheduling so they have breaks on a regular basis, so they`re not working for too many days straight, so they have time to decompress from all of this. We`ve leveraged through our health system many mental health resources for them to be able to check in on a regular basis. But the toll of it is going to be immense.
EMANUEL: Dr. Masri, can you talk to the people who are viewing this about what happens when the virus actually gets into a person, attacks them, and what does the ventilator do for these patients? And why do they need to be on the ventilator?
MASRI: Yes - I mean, actually the ventilator just provides time. The crazy thing about this virus is really when it hits the lower respiratory track, once it goes through this inflammatory cascade, people quickly decompensate. And all we`re trying to do right now is really try to stem the tide as far as seeing them through that disease process as it happens. Really, the idea there is to allow science to take effect, too.
If we can flatten the curve and get things go and we can let science catch up, use some of these medicines that are out there. I know there`s a lot of media coverage of the malaria drugs and steroids and convalescent plasma and things like that. But all the ventilator is actually doing is just giving that patient time to try to recover from the virus invading the lower respiratory track.
EMANUEL: And how are you thinking about the overwhelming demands on your staff? Have you got special plans to make sure that people can recuperate and they don`t go into PTSD or get burned out?
MASRI: Yes. I agree with Dr. Bressman. I think the media has done a great job of covering the lack of PPE and its effect on hospital providers in the hospital. And by hospital provider, I`m not just talking about the doctors and nurses. I applaud the teams that we have here locally and nationally. We`re talking about the therapists and case managers, the food services, the janitorial services, transport. Everyone is out there and putting themselves at risk. And it`s the effect of the lack of PPE in the home setting that`s also important to note.
My colleagues, a lot of the people I know that work in the hospital settings are completely isolating themselves from their families for fear that due to some of the lack of the PPE, they may be exposed, and they don`t want to bring that exposure risk down to their family. So--
EMANUEL: Wow!
MASRI: We have an over - healthcare system. We have overwhelmed--
EMANUEL: Thank you--
MASRI: Yes - overwhelmed healthcare system.
EMANUEL: Thank you very much--
MASRI: We have over held (ph) of workers. And you really have a situation where they don`t have that social support because of that isolation.
EMANUEL: Yes. Really tragic. I want to thank Dr. Eric Bressman, Dr. Najy Masri, and Dr. Deb Snell for your comments here. Thank you very much.
SNELL: Thank you.
MASRI: Thank you.
EMANUEL: Lawrence?
O`DONNELL: And thanks to Zeke Emanuel for guiding that discussion.
When we come back, we`re going to try to get to some really important questions that are on people`s minds on a daily basis. What`s happening on the instructions on face mask? It seems the public recommendations on that are changing now. And how much is too much in terms of leaving the house? We`ll be back with Dr. Zeke Emanuel after this break.
(COMMERCIAL BREAK) O`DONNELL: Three out of four people in the United States are being urged by government to stay home within their states. 31 states, the District of Columbia and Puerto Rico have now issued orders, actual orders, to shelter in place. That applies to at least 261 million people in the United States, 79 percent of the country`s population.
Daily life is changing drastically, including for the people who are staying home. We have many questions about this new normal. And we want to consult with Dr. Zeke Emanuel about the advice you need to live your life.
Zeke, let`s start with masks. The general advisory seems to be changing on masks. At first, it was you don`t need one unless you are sick or treating someone who`s sick. What`s the latest guidance on masks?
EMANUEL: Well, let`s be clear. Those N95 respirator masks that everyone is talking about, those are needed for hospital workers, doctors, nurses, respiratory therapists and the other people. They filter out 95 percent of the airborne particles. Right?
The healthy public doesn`t need N95 respirators to walk around. And if they use them, we wouldn`t have enough for the healthcare workers. Having healthcare workers have those masks is most important. But that doesn`t mean we shouldn`t be wearing masks.
It has been the case that both the CDC and the WHO have said that people who aren`t either sick with COVID-19 or caring for someone sick with COVID- 19 should not be wearing them. I think that`s probably wrong, or at least overly restrictive. And here`s how I`ve been thinking about it. And I have to say to people that my mind has changed over the last five days to think about this.
There are no randomized controlled scientific trials confirming the value of these masks. But that doesn`t mean they`re not helpful. They could be helpful. And besides, there`s no real negative consequence to wearing them.
So we don`t need regular N95 masks to go out. But if you`re able to wear a facial mask, that is over the nose and mouth, you should wear one going out. What does that do for you? Well, it does three things.
It will help you limit, although won`t completely stop your spreading of the droplets out when you talk or laugh or sneeze. Second, they serve to a queue to minimize touching your face and nose and maybe getting the virus spread and the droplets spread.
Finally, most importantly, they serve a norming function. They remind everyone in the community that we are all at risk, even young and healthy people, and that you are taking personal responsibility. It de-stigmatizes this mask.
So if you do use a mask, I think you got to wash hands before you put it on and you`ve got to wash your hands after you take it off when you get back in home. But I think that we should now be recommending that people, when they go out in public, they go to the grocery store or they go to pick up some food at a restaurant and bring it home, that they actually wear the mask. And again, mainly to prevent them spewing droplets out and not to get droplets in. And so I think that`s a change.
O`DONNELL: It is. What about going to the grocery store? People I know that that`s - the only trip they`re making is to the grocery store, and they`re all worrying that they`re going too frequently.
EMANUEL: That`s probably true. So we know that restaurants around the country are shuttered and we have to go to the grocery store to get our food. But we should do it in a limited way. You shouldn`t go every day. You should bulk up and shop once - not horde, but shop in a much larger quantity, minimize the number of times you go out and the number of people you interact with.
The second thing I think is try to go at times that are less busy. And if the store is having special time for elderly patients, don`t go during that time. Remember, the primary concern here is interacting with people and minimizing that, and don`t touch the communal surfaces as much as possible.
O`DONNELL: And Zeke, quickly, social distancing at home, people who you live with, people are not sitting very far away from each other now and they`re watching movies at home, and yet, I saw a local report in Los Angeles news saying that it`s OK for people who live together to have sex, in fact. And so now I`m very confused about what are the rules for people living together?
EMANUEL: First of all, there`s no evidence that COVID-19, the coronavirus, is transmitted by - sexually. It`s not like HIV, a sexually transmitted disease. And there are some considerations. You should avoid close contact with someone who you aren`t physically intimate with now.
And if you live with a romantic partner, you`re both asymptomatic, you can continue your usually sexual habits. If you had physical contact with someone who developed symptoms, you should self-isolate yourself for 14 days. But sex is kind of important, and if you`ve got a stable relationship, that should be fine, knowing that there are some risks the other partner might get COVID-19.
O`DONNELL: OK. That`s going to be the most rewound section of this hour right there. Zeke, stay with us. When we come back, we`re going to get final thoughts from Zeke Emanuel about what we`re doing in our - the life and times of the coronavirus and how we are surviving it and why we are surviving it, and who`s fighting that fight for us.
(COMMERCIAL BREAK) O`DONNELL: We`re back with Dr. Zeke Emanuel. And Zeke, today, Governor Andrew Cuomo said, "We all wonder secretly, would we have the courage to really step up at a time of this challenge?" And what he was talking about was the doctors, the nurses, the healthcare professionals who are running straight into the danger of this virus every day. And I don`t think all of us can say that we would have that same kind of courage. Has it always been this way in the medical profession? Have they always just run straight toward the danger when they need to?
EMANUEL: Lawrence, I grew up as a physician in the HIV/AIDS era. When I was a medical student in the 1980s doing my rotations in the wards of various Boston hospitals, we began seeing the first patients with a strange new immune deficiency disease that we didn`t understand. I remember it was scary. Every patient encounter seems to be an existential threat.
Eventually, HIV led to serious changes in medical practices that we now take for granted. That was like beginning of routinely donning gloves and eye protection for even drawing blood. But as the epidemic spread, healthcare workers began voicing resistance to treating these HIV patients. They worried about catching a deadly disease and bringing it home to their family.
Some physicians and dentists and others were vocal and public in refusing to treat the gay men, Haitians, and hemophiliacs, those stigmatized groups that defined the first wave of HIV infection in this country. It really was an echo of the London during the bubonic plague in 1665 when many physicians and apothecaries escaped the city rather than care for the ill.
In the 1980s, the burning question was, do physicians have an obligation to treat patients with AIDS? At that time, I wrote that medicine is a profession built on a moral ideal, that we should heal the sick. This ideal means there`s a duty to treat patients regardless of their illness and even when it poses some risk to us as doctors. That`s been the ideal since the time of Hippocrates. Of course, there are limits to the risks we expect doctors and nurses to take, but those limits were well beyond the risks of caring for HIV patients.
Now, this COVID-19 pandemic, it`s been a totally different experience. And I`ve been really moved by what I`ve witnessed. Of course, physicians on the front line that we heard from Dr. Bressman are worried. As one New York City physician told me, I take all the precautions I can, but I fully expect to be infected.
Infection even in these young physicians can lead to a ventilator and, god forbid, death. And yet there`s not the slightest hint of any hesitation in caring for these very, very ill patients. There`s no - there`s fear, of course. But there`s no translation into that fear, into not serving the patients.
We`re seeing the opposite of what we saw in the AIDS era. Even with too few masks and gowns and gloves, they are still doing whatever they can to care for patients. As one doctor in a hard-hit hospital in New York reported, radiologists, surgeons, pathologists, doctors who normally don`t care for ICU patients have been asking, what can I do to help? The fact is that there`s no debate whether to care for COVID-19 patients or not. It`s truly touching. It`s a dramatic shift from where we were 35 years ago.
It reminds me of the sense of duty that Americans felt in World War II. The Kennedys, the Bushs, the Roosevelts fought alongside Americans of all classes, races and faiths. They all felt compelled to enlist. The HIV/AIDS pandemic reminds us that we can`t take healthcare workers` sense of duty for granted. We need to both cultivate and value it.
We need to thank physicians, nurses, respiratory therapists, and all the hospital staff for personifying the ideal of service. It should prompt all of us to do our part to contribute in this time. We ought to take responsibility for others. We need to do what we can do. We should work at food banks, practice physical distancing, donate blood, bring food to isolated people. The more we can share responsibilities, the more we can ensure that no one is left behind.
Lawrence, I think emulating today`s dedicated healthcare workers will help us through this time and represents the best of what it means to be an American.
O`DONNELL: Dr. Zeke Emanuel gets tonight`s Last Word. "THE 11TH HOUR WITH BRIAN WILLIAMS" will be up next.
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