ARI MELBER, MSNBC HOST: You can also e-mail me if you want to call that the old fashioned way at Ari@MSNBC.com. That does it for us. You can find me again tomorrow at 6:00 p.m. Eastern on "THE BEAT" or guest-hosting here again tomorrow at 7:00 p.m. Eastern. Now, "ALL IN" with Chris Hayes is up next.
CHRIS HAYES, MSNBC HOST: Good evening from New York. I`m Chris Hayes. Here`s the facts. Right now, there is not a single outbreak of the coronavirus in the United States, and there certainly is no single coordinated federal response. These are the dual challenges the U.S. faces as it continues to outpace any other nation in its rate of growth of new cases. At this rate, we are due to pass Italy and China in total cases in just the next few days.
Now, primarily, this is because we were single-handedly alone amongst other nations of our sort, the worst in the world and testing. We are just catching up now. But we have a situation today where the data is spotty and incomplete access to tests wholly unequal (AUDIO GAP) and where different places in the U.S. have different levels of intensity with different parts of the curve.
New York City, the situation is brutal. As of today, there are over 17,000 confirmed cases in the city. We are hearing about shortages of ICU beds and ventilators and protective equipment for doctors and nurses. The New York Times in a stunning article reports that 13 people died from the coronavirus at just one Queen`s Hospital in just a 24-hour window.
Yesterday, over the course of several hours, one doctor performed chest compressions on a woman in her 80s, a man in his 60s, and a 38-year-old who reminded the doctor of her fiance. All had tested positive for the coronavirus and had gone to cardiac arrest. All eventually died.
Today, New York Governor Andrew Cuomo warned that the number of cases is still three weeks away from reaching its peak. Washington State and California also have a lot of cases although California, we should note, is testing at a level much less than New York, so it is hard to know for sure.
We are already getting worrying signs from other places in the country, Atlanta, from Detroit, and now Louisiana, which has seen its numbers absolutely spike, approaching 1,800 total cases. Over 400 of those, 400 just identified today. In each of those different areas of the country, these disparate regions of our nation are being left to fend in many fundamental ways, to fend for themselves.
Now, when other countries have had regional outbreaks, Wuhan, Hubei province in China, the north of Lombardy in Italy, they`ve responded with national action because their governments recognized the virus was not going to remain in one place.
We here in the U.S. have a certain amount of federalism which makes sense. It allows governors to make decisions for their own states, but the fundamental bedrock of the response, the need for a surgeon hospital capacity, in testing capacity, and an interstate coordination of resources have not been there.
In fact, time and time again, the Trump administration, the White House, the federal government has told these states basically, you`re on your own. The Washington Post reports about what that looks like for a practical standpoint. Basically, it`s not a stretch to imagine the states right now, like shoppers at grocery store, competing to get the last bags of rice and toilet paper.
In refusing to actively coordinate a national plan and coordinate resources, the federal government is creating the conditions for competition and for hoarding that will cost lives. And then on top of that, there is, of course, the persistent fear grounded in reality that the president who notoriously plays favorites, who has used California and New York and the city of Baltimore as scapegoats to beat up on in the past, who`s used the federal government to outright threatened states represented by Democrats is playing favorite in a time of crisis.
The Daily Beast reports Democratic governors, including New York`s Andrew Cuomo, are worried that if they criticize the president, they risk losing support for the things their citizens need to keep them alive and fight the virus. Speaking on Trump T.V. yesterday, the President himself said, he would help Democratic governors but, and I quote him here, "It`s a two-way street. They have to treat us well, also."
And that comes days after ProPublica reported that as states requested supplies from the federal government, only Florida, a state with a Republican governor has himself repeatedly said the virus is not a statewide problem, got everything I`d asked for. Meanwhile, the hardest-hit states like New York and New Jersey got only a fraction of what they requested.
Earlier this week, Illinois governor J.B. Pritzker tweeted a chart showing the small fraction of the state`s requests that have been fulfilled to this point. Past outbreaks in the U.S. have been followed by natural responses and natural coordination. In fact, there is the infrastructure in place right now throughout the federal government for that kind of coordination. But this time, we just do not have that and things are getting worse.
Joining me now, one of the governor who`s been in the frontlines of this, who said this of the President`s plan to reopen the country by Easter, "We don`t think we are going to be in any way ready to be out of this in five or six days or so or whenever this 15 days is up from the time they started this imaginary clock," Republican Maryland Governor, Larry Hogan.
Governor, thank you for joining me. I guess I want to start with what you need as a governor in Maryland. What are the needs that you have right now? What are the most pressing needs?
GOV. LARRY HOGAN (R-MD): Well, my needs are the same as just about every other governor in America, Chris. I`m the chairman of the National Governors Association. We had our seventh phone call today with all of the nation`s governors as we`re talking about the same kinds of things that you were just talking about in your lead in.
Everybody is short on testing, on all of the various things like respirators and masks. And we`ve all got requests into the federal government, and all of the states are taking action to try to find these things on our own. And we`re also pushing the federal government to get more help.
Now, the good news is we are starting to get some after not getting a lot. So, you know, many of the states have not gotten a portion of their requests. So you talked about governor Pritzker getting a small portion. We got some of our requests here in Maryland, as did most other governors across the country. But most of the volume is now going to those states with the biggest problem like New York, and California, and Washington.
The bottom line is there really -- there really is a shortage nationwide. Governors are trying to do everything they can to step up and respond in their states, and we`re also pressing the federal government to provide more assistance to us and to get some of these things out here to all of us in the States on the front lines.
HAYES: Yes. I guess on this coordination question. I mean, there`s two issues here, right? There`s a supply limit. That`s the real problem. I mean, we just do not physically have enough ventilators in the country at the moment, and how you apportion there is a grim kind of triage, right, between the states because the life of someone from Maryland is as important as life of New York. But if you`re the governor of Maryland, you want it for your citizen. Like, how is that being worked out?
HOGAN: Well, so, FEMA, now, as of -- as of last Thursday or Friday, is in charge of trying to get those limited supplies out to all of the states. And while no state got their full request, or nobody was able to get the kinds of supplies that they needed, there was an apportionment out to I believe all of the states. None of it was adequate enough, and we`re all trying to supplement that with our own individual activities on the open market, both domestically and from other places around the world.
But, you know, it just does -- it`s not that helpful to point at where the thing broke down. The bottom line is right now in America, we do not have enough of these supplies and we`re trying to get -- the governors are trying to get both the federal response ramped up, but also, you know, just trying to figure out way for the federal state and local governments to all kind of get on the same page.
We`re all just trying to save people`s lives. I mean, that`s really where we are at this point. We`re -- not what did we do wrong yesterday, but what can we do today and tomorrow to try to do a better job.
HAYES: Let me -- let me ask you this coordination question, and then I want to ask you about the sort of decisions you`re making there. You talked about the National Governors Association. Is there like -- is there a daily call? Is there -- is there a call that the governors are all on every day and who is -- who is engineering that? Like, what is that? Because right now you`ve got this situation where it`s almost like a time-traveling situation, right?
Andrew Cuomo can talk to the folks back in Minnesota or Michigan and say, look, we`re two weeks ahead of you. Here`s what we need. There`s communication that can happen there.
HOGAN: No, it`s -- that`s one of the -- one of the few things that`s working really well. So I`m the chairman of the National Governors. Governor Cuomo is the vice-chairman. We`ve had ongoing discussions with all of America`s governors. Really, in some cases, more than 50 governors. We have 55, including the territories. We typically have nearly all of them on the calls.
We had another one this afternoon. We have another one tomorrow with the president and vice president leaders, and the leaders in the administration. They`re not on all of the calls. We have some with just the governors. And in addition to those formal ongoing discussions where there really is great collaboration and sharing of information and ideas between the states and quite frankly, it`s been tremendous to see the bipartisan cooperation among the governors, we`re also having lots of one on one discussions and phone calls and text back and forth.
I`ve been talking with, you know, dozens of my colleagues across the country on both sides of the aisle about here`s what`s happening in our state, how are you dealing with this? What problems are you faced with? How are we going to fix this? And so, you know, it`s a -- it`s a problem, we`re all in this together. And it`s amazing, but there`s not a whole lot of Republican-Democrat stuff going on. It`s about hey, what can we do to help one another?
HAYES: The President seems obviously anxious to sort of reopen the country. He`s reiterated that. He talked about an Easter possibility. Today he tweeted and basically said that that it was the media that was the dominant force trying to get him to close the country and close off its economy so that that it would hurt his reelection chances. And as a governor who has to make these decisions about what to open and what to close, like, is that how you`re making your decisions?
HOGAN: No, not at all. So we -- you know, look, I think that none of that messaging is helpful at all to any of the governors. Many of my colleagues on both sides of the aisle are not happy with that kind of messaging. On Monday, they were talking about, you know, we`re getting near the end of the 15 days. So that would mean next week, we`re going to start opening and then a day or two -- you know, then the next day, yesterday, they changed it to Easter, which was two weeks later. It`s not -- all of it is arbitrary.
We`re making decisions based on the facts on the ground and by listening to the scientists and doctors in our state. I`m talking to folks at Johns Hopkins, and the University of Maryland, and NIH. And look, the bottom line is, we`re all ramping up, not down. And nobody sees the end of this in two weeks. We see it as you know -- nobody knows the exact numbers and we`re -- as you pointed out earlier, the data is incomplete. But, you know, we`re going to make decisions based on saving lives.
The economy`s critically important, and we are concerned about helping people who are going to be out of work and helping those small businesses. But the decisions have to be first about saving lives, and then how are we going to help people get back on their feet economically. You can`t just arbitrarily pick a date and say everything`s going to be great.
HAYES: All right, Governor Larry Hogan of Maryland, thank you for making some time amidst all this.
HOGAN: Thank you, Chris.
HAYES: Last week, New York Governor Andrew Cuomo talked about the coming surge and coronavirus cases as a wave. A wave he was afraid would overwhelm the hospitals and the people working within them. I`m joined now by a doctor who can give us an on the ground report of what that wave looks like, Dr. Craig Spencer, Director of Global Health Emergency Medicine at Columbia University Medical Center.
And Doctor, we had you on I think exactly a week ago. You`ve been tweeting out these firsthand accounts of what it`s like in an E.R. in New York. And just first, the difference between a week ago when we spoke, what you were seeing, and what you`re seeing now. What what`s the difference?
CRAIG SPENCER, DIRECTOR OF GLOBAL HEALTH EMERGENCY MEDICINE, COLUMBIA UNIVERSITY MEDICAL CENTER: Yes, great question. So a week ago, we were looking for the one or two coronavirus patients that might be in the E.R. Everyone was a little anxious. We were trying to think about who they might be. Now, there might be one or two patients in our E.R. that are not coronavirus, even a drastic shift within the past week where it`s become the majority of what we`re seeing.
A lot of these people, all the young are really sick. They`re being intubated, put on breathing machines, despairs no one and the increase has been pretty drastic. It`s palpable to anyone that crosses a threshold and walks into the emergency room today.
HAYES: Anyone I think who`s in emergency medicine is used to a lot of activity and I think fair to say kind of adrenaline junkies as a kind, the ones that I`ve met my life. What you`re describing, though, is on a plane that is really -- not really comparable to other things. Is that -- is that fair?
SPENCER: Yes. The analogy I`ve been given is that I worked in West Africa during Ebola. That was scary, of course. I`ve worked in the middle of civil wars providing trauma care. There`s something about this that feels kind of palpably worse. One knowing that we`re kind of just at the beginning of this. You know, case numbers are increasing on a daily basis, that drastic increases.
You`re already hearing hospitals throughout New York City that are short on personal protective equipment, on ventilators. People is setting up a kind of these temporary morgues outside of hospitals. This idea that in two or three weeks we`re going to be somehow past this when we just recorded our first case here in New York City just over three weeks ago, to me is crazy, magical thinking.
HAYES: One of the things in your documenting this that struck out -- stood out and it lines up exactly with first-person accounts of healthcare workers in northern Italy and in Wuhan, which is just the relentless drumbeat of the same kinds of issues. I mean, patient after patient short of breath. Patient after patient that needs ventilators. That too feels unique from what I`ve read. Is it -- have you encountered something like that before?
SPENCER: Absolutely. You know, we find outpatients every time we change shift. And generally, what we find out is chest pain, this one has appendicitis, this one has -- needs to see the obstetrician, sign out as now patient is COVID positive, and then we`re kind of triage and who are the most severe, who needs to be put on breathing tubes, who needs to be admitted to the hospital?
You know, it`s going to be impossible to admit every person that`s COVID positive as a coronavirus patient. We just don`t have the space even if we increase by 50 or 100 percent, it`s just not possible. So we`re thinking about different protocols. How do we risks ratify? How do we find who are the sickest patients and how to focus on them?
HAYES: One thing that`s really unnerving about this virus, and again, we`re still learning about it is it seems very random in in that, you know, we know that there`s elevated risk for people immune-compromised and senior citizens. The older you get, the more that fatality rate goes up. But on 30-year-old can get it and it feels like a cold and one 30-year-old, healthy otherwise, is being intubated a few days later. Do you have a sense of why that is or does it feel random to you as well?
SPENCER: I think it feels pretty random to all of us, which is a scariest part of it, right? The majority of deaths are going to be in older patients with comorbidities, with hypertension, with diabetes, but that does not exempt anyone, whatever your age, whether you`re a teenager whether in your 30s from getting this disease and having severe complications from it.
HAYES: What is morale like? What is -- what is the atmosphere like among your fellow healthcare workers on the frontlines of this?
SPENCER: We are all unbelievably proud to be able to show up to work every day and take care of people. We want to know that we`re prepared. We want to know that we`re protected. But the other thing is, and this is what I`ve been trying to share with my colleagues and my friends, this is something I learned in West Africa in 2014. Everyone is afraid.
Eight percent of all total infections in Italy were amongst health care workers. We know that some of our colleagues already are being infected, are being intubated, being put on breathing machines. We know that we`re all at risk. So we`re all anxious. I tell all of my colleagues to try to be vulnerable. Share their stories. Share their concerns with someone else in the emergency department, one of their friends so that they don`t feel like they`re going through this alone.
HAYES: All right, Dr. Craig Spencer, you`re doing amazing work. Your colleagues are doing amazing work and I really can`t thank you enough.
SPENCER: Thanks a lot, Chris.
HAYES: All right, next, the Senate announced a bipartisan rescue deal to address economic fallout of the coronavirus early this morning. The details of what`s in it, however, still up in the air. There`s no one better to break down what`s at stake than Congresswoman Katie Porter and she joins me next.
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HAYES: After five days of intense talks, early this morning at 1:00 a.m., Senate leaders announced that they reached a deal with the White House, a bipartisan coronavirus rescue package. Now, the actual final language of that deal of the bill is still being hammered out. One thing that seems certain is that it will be the largest economic stimulus package or rescue package in U.S. history.
Nearly $2 trillion bill, trillion dollars after we`ve spent 15 months in the campaign about how you will pay for that, to address the economic fallout of the coronavirus pandemic. The details have been shifting all day as Republicans and Democrats been fighting over their respective priorities. It remains a very fluid situation.
Just one example, the big impasse we seem to be at right now. A group of Republican senators are now threatening to delay the bill because they believe the unemployment benefits are, get this, too generous for low-wage workers.
The White House predicted a Senate vote by tonight but that vote has yet to happen. If and when the Senate passes the bill, the House will have to vote it before it goes to the President. One of the members of Congress who has been digging through the fine print of the bill all day, Democratic Congressman Katie Porter of California, she joins us now.
I will note, the Congresswoman was currently self-quarantining after experiencing possible symptoms of Coronavirus. She`s been tested and is awaiting the results. So let me begin, Congresswoman, by asking you how you feel.
REP. KATIE PORTER (D-CA): I feel tired. I`ve been sneezing. I spent a lot of the day today in the last week in bed, on conference calls, doing the best I can to stay awake, take notes, and follow what`s happening. But I`m grateful that my symptoms have been mild to moderate. And I really have a lot of concern about all the public health and everyone out there right now who`s either feeling sick or worried about getting sick.
HAYES: So you`ve been going through the legislative language, I know that there`s a lot circulating around. I wonder if you can give us like, maybe a good and bad column in terms of your read on where this is right now, what you like that`s in there, what you`re concerned about. Let`s start with what you think good that that is in this bill.
PORTER: Yes. I actually went through the summary of what we believe is going to be in this package. As you know, we haven`t seen language yet. And I actually marked it up exactly this way. Green, good, red bad. So here`s some of the green good. $100 billion for our hospitals and our health care providers. That money is critically needed right now. $45 billion for FEMA disaster grants, and lots of money for state and local government stabilization. All of that is really, really good.
Also, some really good news for our small business owners. For the first time, what`s on the table is actually grants that would not have to be repaid. So small businesses would be able to get help and not have to worry about repaying it because it`s going to be a long time for some of them until their business recovers. That`s the good.
HAYES: All right, what`s marked in red on your copy? What`s the bad?
PORTER: So there`s bad news here for patients which is really concerning to me. One of the things we`re told is, while this bill is going to provide for free testing, well, I already held the CDC sector`s feet to the fire to get free testing, free testing was in our last bill. What`s not in this bill is free treatment. That is covering costs for uninsured people who have free treatment or covering the out of pocket costs that people might face for treatment.
And those things go hand in hand. A lot of people will hesitate to go get tested, if they`re symptomatic if they`re worried about the cost of treatment. So that`s one of my concerns. It`s an area that Democrats know that we have to do better on.
My second big bucket of concern is I`m very worried about the accountability measures here. I was very involved in watching the bank bailout with TARP, the Troubled Asset Relief Program. That was $700 billion. Here we`re looking at a similarly sized fund. We`re told around $500 billion for the largest corporations.
But as we saw with tarp, the accountability mechanisms are not strong enough. It`s not good enough to have an inspector general or oversight panel on the back end. The money will be out the door and in the pockets of the largest corporations. And I`ll give you one example that just specifically really highlights where I think there`s an opportunity to still improve this bill.
In the bill, there is a 10,000 -- up to $10,000 per worker tax credit for businesses that retain employees on payroll. That`s terrific. That`s going to be a big help in keeping businesses keeping people on payroll. But if you`re a small business, you have to choose. Do you want that SBA loan, or do you want that $10,000 worker retention payroll tax credit? If you`re a large business, you don`t have to make a choice. You can get a bailout and that tax credit. We should put small businesses and large businesses on a level playing field here.
HAYES: In terms of the mechanics of this. It`s a tricky situation procedurally. A lot of members are -- some of your colleagues are actually hospitalized. Ben McAdams from Utah, I believe, who has tested positive, has had fairly severe symptoms. A lot of self-quarantining. a lot are away. How -- what is your understanding of how this actually is going to go down as a vote in the next day or so?
PORTER: So, I spent over six and a half hours today on conference calls, and I have no idea after six and a half hours how exactly the House is going to be voting on this. We were told, no to remote voting. That`s been consistent. We`ve -- I think -- I think that we`ve been told, no to proxy voting. I think they`re expecting people to try to come back. There`s still talk about whether or not we could do this with a voice vote, or unanimous consent.
But clearly, members like me who are symptomatic cannot leave their homes. It`s a public health risk. And there are a lot of members that are going to have difficulty traveling all the way from the other side of the country to make this vote fast enough.
So we`re waiting on the Senate to take action. A lot of my colleagues I know are hopping in cars and starting to drive. But those are not people in California, they`re not people in Alaska, they`re not people in Hawaii. It`s going to be easier for some folks to get there than others.
And the problem is my constituents need my voice right now. They need me to be voting in their interests. And it`s impossible for me to do that because of this public health crisis.
HAYES: Final question. It does seem to me -- I know that the idea here is to pass this somehow, and then there`s going to be a recess and I understand why recess has happened. But the rest of the entire world including me talking to United has been adapting to how you can do your job remotely if you can and how to make a work. It really does seem if this is going to go on for several months, the Congress is going to figure -- have to figure out how to do this remotely, right?
PORTER: Well, you would hope so. I mean, I think it`s wrong for Congress to act like we`re an exception. We`re asking businesses, schools, nonprofits, healthcare providers, so many different entities to step up in this moment, to meet the moment and to be flexible and to adapt. So I do think Congress is going to have to do that.
I mean, we have lots and lots of conference calls, so information sharing is happening. But the most common thing I heard on these conference calls today was, excuse me, you might have yourself on mute, you`re going to need to unmute yourself. So it`s not easy to do this with several hundred numbers.
And so I really trust Chairman McGovern, the chair of the Rules Committee. And I know that he, along with Zoe Lofgren, the chair of House Admin, are working to figure out how we can honor our duties to our constituents, but also not risk public health.
HAYES: All right, Congresswoman Katie Porter, thank you for being with me tonight.
PORTER: Thank you so much.
HAYES: Joining me now is Dave Dayen, executive editor of the progressive magazine, the American Prospect. Dave has been following the back and forth over this bill quite closely. What`s your -- what`s your sort of top-line here about what the shape of the compromise it`s coming into focus is?
DAVE DAYEN, EXECUTIVE EDITOR, AMERICAN PROSPECT: Well, I mean, I think you see temporary necessary help for individual workers, whether it`s the direct payments or the unemployment insurance boost. And you see long term transformation of American society through a largely unrestricted bailout that is actually higher than meets the eye.
And what Representative Porter was saying was about what`s in the bill, which says $500 for large -- or $500 billion for large corporations. But a portion of that, most of that, $425 billion goes, as I understand it, to the Federal Reserve, as 10 percent of a credit facility that they build, which would total $4.25 trillion that they could point as a money cannon at any large corporation they want.
And that just dwarfs any other support for small business or any other entity. And I really -- we`ll be transformative in terms of what these large corporations will be able to do with that money.
HAYES: Well, so I want to -- let me give this what I`ve read is the sort of best version of the argument for something like that is essentially, you -- we could find ourselves in a kind of domino situation in which this turns into a really gnarly credit crisis and financial crisis. If you have a lot of companies starting to go under, if you have a lot of bonds starting to tank, the credit markets have already been a little wooly and no one is really to blame here. It`s not like the banks with the, you know, who took on all this leverage and screwed themselves and then got bailed out. Everyone here just ended up with the virus running through the economy. Like what`s so bad about shooting money cannons at American business to keep it propped up?
DAYEN: Well, I mean, if it was a bailout because of the unfortunate situation that we`re in, that would be certainly understandable. I think the money for hospitals who are in a really strapped situation is completely understandable, for example. This actually, to me, feels more like a bailout for a decade of irresponsibility. These are corporations that had record profits for 10 years, paid very little in taxes for 10 years, created the system that created this extreme vulnerability in the United States, which does not have the manufacturing capacity, has this system where inventory is seen as a luxury good, seen as like something that`s a cost center. It`s created this system with leaking money out to investors, not investing in people, creating inequality, which puts people further on the edge in a sudden shock situation like this.
And all of that is getting papered over without any conditions to change these terms in any way, these, you know, proclivities of the large business sector. There`s no restrictions on the money. There is one very small restriction but of course, Secretary Mnuchin can override that at his will.
You know, these companies can give dividends out with this money. They can do mergers and accusations with this money. They can do virtually anything they want with this money.
And if you see the parallels between this and the small business sector, which is going to be serviced by the Small Business Administration, one of the slowest agencies in the government compared to the concierge service that the Federal Reserve is going to give these large banks and large corporations, you know, what is the landscape of America look like after this bill is over? That`s what I`m concerned about.
HAYES: You know, that final point about I am worried, Alexandria Ocasio- Cortez raised this point last night, which I thought was an interesting point, because it`s, you know, not a left-wing point, necessarily, or a liberal point, it`s just about the mechanics of this, which is can the SBA do what it`s tasked with doing here? I mean, can -- the volume that we`re talking about, the number of small businesses, the amount of aid they are going to need, I`m just worried that the facility could be stood up and get to the people that need it in time to rescue them before they go under.
DAYEN: I mean, I think the run rate that the SBA is going to be dealing with is something like 13 to 14 times their annual budget and they have to do it in weeks rather than over the course of a year and you talk to small businesses right now and that`s just not the way this works. You could extend this parallel out to the fact that individuals who don`t have direct deposit on file with the IRS might wait as much as four months for the direct payments. You can extend this to the fact that state unemployment state insurance systems in some states are collapsing. They are not well run systems. And they`re going to have to, you know, deal with the huge boost in uninsurance and get it out to people.
This is -- you know, you see the rickety parts of this system are what the small businesses and individuals have to deal with and the strongest most robust part of the system, the Federal Reserve, is who the large corporations get as their concierge.
HAYES: That -- yeah, that is very well put. Dave Dayen, thank you for being with me.
DAYEN: OK. Thank you.
HAYES: Coming up, what is it about Coronavirus that makes it so dangerous? What we`re learning about the virus itself as the crisis grows ahead.
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HAYES: Today officials in Italy announced nearly 3,500 new cases and more than 680 new deaths. Those are, of course, gruesome, awful numbers. Italy continues to be one of the countries hardest hit by the virus, but chart along with the rest of the data from the outbreak in that country, it really is starting to look like the curve is flattening, is bending in Italy.
It is a hopeful sign in a weird way and an indication that there might be some sort of light at the end of this tunnel.
The problem with what we are going through right now, all of us here in the U.S. -- the social distancing, the staying at home, the home schooling, your kids on Zoom telling other kids to mute, the shutting down of businesses, all the emotional and economic pain that comes with that, is that the numbers of cases and deaths are just continuing to tick up.
And that is because there is a lag between what we`re doing collectively as a society and when we actually get to see its effect. And that lag could be anywhere between one to three weeks, we don`t really know, but we are actually able to get a bit of interesting insight into what is happening right now, the frontier of that thanks to this company you may have seen called Kinsa that makes these smart thermometers, and they`ve started publishing the data collected off the thermometers.
Now, obviously, this is not comprehensive by any means. But it is interesting data looking when and where people are getting fevers, one of the most common symptoms of Coronavirus we might be able to start to see results from recent interventions without having to wait for that lag. So, here`s an example from Dallas.
This graph is measuring atypical fevers recorded by people using that smart thermometer in the area. And 48 hours after the mayor ordered bars and restaurants to close, you can see the number of atypical fevers went down sharply, right there, after March 17. Same graph for San Francisco where they locked down early. Last Monday, March 16 -- and again, we see a steep decline in atypical fevers starting right after that.
So, based on this data, those early interventions, those calls for social distancing, they do seem to be doing something, having an effect, working. And that is some promising news in the fight against this brutally nasty virus.
And we`re going to talk about some of the actual biological reasons why this thing is so bad, so hard to fight, next.
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HAYES: Epidemiologists who deploy to Wuhan, China from around the world, and others who first started looking at the Coronavirus up close and what it was doing to patients and hospitals, would talk about it almost like they had seen a ghost. Coronavirus, this Novel Coronavirus that we`ve encountered is both much more transmissible than the seasonal flu, and way more serious.
According to some published studies, the Coronavirus is, we think, about twice as transmissible as the flu, and the rate of hospitalization is nearly 15 times that of the flu.
Now, there is still a lot we do not know and are learning about this virus. People understandably have a lot of questions about why exactly it`s so bad and crucially how it`s transmitted and also, crucially, how you can protect yourself for the people you love.
Here to talk about that, Nadia Abuelezam, an epidemiologist at Boston College`s Connell School of Nursing.
Let`s start with this question of what -- why is this virus seem to be more transmissible, or more effective at moving from human to human than either the flu or earlier Coronaviruses we saw, like SARS and stuff?
NADIA ABUELEZAM, INFECTIOUS DISEASE EPIDEMIOLOGIST: Sure, I mean, I think the brief and the quick answer is that our human bodies have not been exposed to it before, so we have no prior experience with it, and we have no prior immunity to it. And so our bodies are sort of completely naive to it and are reacting for the first time, which is probably what`s leading to some of these more severe cases. And it`s also probably what`s contributing to the fact that we`re able to spread it from person to person much more easily than something like the flu.
And I think your stats that you presented were exactly right. We think that, you know, one infected person can spread the disease to between two and three other people. That number is between one and two people for the flu.
So it is much more transmissible, a much more infectious, we believe, than the flu and that`s what we`re seeing now from the data that`s coming in.
HAYES: There`s a real question I`ve seen a lot of competing ideas, you know, again, we`re learning about this how it gets transmitted. So, the sort of consensus view that everyone agrees on is some, you know, droplets, the coughs or sneezes like that that get into people. And, you know, you touch your face or something like that. But there is questions how long it lives on certain surfaces. What do we know about that part of it, whether it can be transported, airborne, how long it lives on surfaces, and the like?
ABUELEZAM: Yeah, so there was a recent study that was published in The New England Journal of Medicine, which was done in a lab environment, which I think is really important to say because that does not necessarily reflect what happens in the real world, but that experiment suggested that there was potential for droplet transmission. And there was potential for the virus to live on surfaces for a few hours, depending on the type of surface that it was. And in that particular experiment, they also showed that it can be aerosolized, so it can stay in the air.
But we do believe that in sort of normal, real life experiences the most likely ways that this virus can be transmitted is through droplet transmission, so if someone coughs or sneezes near you and that droplet finds its way into your mouth or your nose or on to your hand and then your mouth or nose, or transmitted from surfaces to individuals. So those are the primary ways we think that this virus can be transmitted, but of course, more data needs to be collected to figure that out.
HAYES: What about asymptomatic transmission? This is something, as well, that I`ve read some debate on. The degree to which asymptomatic transmission either is possible and what percentage of transmissions that makes up. What is the research that we know so far suggest about that?
ABUELEZAM: Yeah, so I think there is, as you said, some debate about this. I think most of us are assuming that there is a bit of asymptomatic transmission, meaning that you can transmit this virus while you`re not showing symptoms. The duration of that asymptomatic transmission is still unknown, but it is believed to be relatively short.
Of course, when you are showing symptoms, that`s also a time when you can be transmitting and much, much more -- transmitting much more when you`re showing severe symptoms, as well.
HAYES: All right. Nadia Abuelezam, that was really, really illuminating. So, thank you for that.
Coming up, a look at how the world was caught on the wrong foot by the Coronavirus and why the U.S. seems to have been particularly unprepared, next.
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HAYES: Last December, on New Years Eve, the World Health Organization learned that dozens of people in China were being treated for a mysterious pneumonia. Eight days later, a new type of Coronavirus was identified as the cause. And now months later it has landed here and taken most of American society along with many governments around the world by complete surprise.
Why were we caught on the wrong foot? One person who started writing very early about this virus and the ways it preyed on institutional dysfunction, particularly in China, wrote in The Atlantic that, quote, we had time to prepare for this pandemic at the state, local and household level, even if the government was terribly lagging, but we squandered it because of widespread asymptomatic thinking. The inability to think about complex systems and their dynamics.
Joining me now, the author of that piece, Zeynep Tufekci, an associate professor at the University of North Carolina.
Professor, you have been writing about this a lot from the very beginning. You wrote a great piece about China and you sort of made parallels to Chernobyl. What was it that sort of captured your interest about the virus from the beginning?
ZEYNEP TUFEKCI, ASSOCIATE PROFESSOR UNIVERSITY OF NORTH CAROLINA: Well, it was SARS mostly. In 2003, we had a similar outbreak, which started in China, and China covered it up for a while, and it got out of hand, and it almost became a pandemic, right. We came this close to having a global crisis. So, when we heard again that the first week of January there was now this viral pneumonia linked to a seafood market, a wet market, which means probably a zoonotic virus jumping species, it was a five alarm fire right there. And it was identified very early. And later, on January 20th, when China itself shut down Wuhan and Hubei, which are these 50 million person provinces, that was also a very strong signal, if they`re doing this, they`re facing something very significant, because they is switched from cover-up to, you know, all hands on deck.
And then at the end of January, we started getting papers from top notch, you know, scientific journals, like New England Journal of Medicine, The Lancet, that told us that some of the patients were asymptomatic or had atypical clinical presentation, they didn`t necessarily have fever, they were shedding the virus before they were sick, which in SARS in 2003, the fever and the infection came together, which is how we caught it, right, we could put a temperature gun in airports and check the people.
So, at the end of January, if you look at it honestly and if you were following the epidemiologists and the people who kind of follow this stuff, they were telling us that this was going to be a pandemic. This was really likely there.
The thing that got me very worried were the early reports on how much ventilators and ICU care this was requiring from the patients, because if it was just a pandemic, let`s say of a flu-like illness, that would be terrible enough, because flu is terrible enough, and if we have a flu plus a flu-like illness, that is going to overwhelm our hospital system right there, even if it is just like the flu.
But worse in this particular case, we weren`t getting reports of a flu, which -- what happens with flu, is that it makes you weak and you get sick and there are infections, perhaps, like bacterial opportunities for infections, and this one was putting patients in pneumonia directly.
So, the way I explain it in my article is that flu is like the person who unlocks your door for the robber, and this COVID-19 is the thing that just comes in and robs you, hits you over the head. So, that`s the big difference, so that method, I see the ventilator capacity was going to be overrun. Well, I say all over this, because by the end of January and early February, all of this is was known.
So as you note that a lot of us that were either close to studying pandemics or following the epidemiologists, were really frustrated because in February, we should have been getting ready. We should have been ramping up the masks and personal protection. We should have stopped travel. We should have started screening. We should have gotten the tests ready. So it is really tragic that this kind of failure of listening to the right expert, and failure of imagination.
People kept saying, it doesn`t kill more or less than the flu. But that`s not the question, because if you have a flu, and then you have one more illness, and you have no room in your hospitals, right now, I`m hearing of NICUs being emptied to make room, right, so you`ve got babies who not catching the disease, but their health care is threatened. We he have reports that people can`t give birth with anyone else in the room, because there are no masks around to give to a single person.
So the kind of complexity that goes to something like this is a known expertise, but unfortunately it doesn`t really fit into either the media narratives, and also of course, the government failed, our government failed, the European governments failed, the Chinese government failed in another way, so that`s all -- and here we are, I`m doing an interview from my house, trying, hoping not to become (inaudible) with something unexpected happening.
HAYES: What do you account for the countries that did sort of figure it out quickly? Do you think it was just the experience with SARS. There`s some reporting to indicate in the case of South Korea, that was definitely the case.
TUFEKCI: So Hong Kong, which I actually did a lot of research on Hong Kong, because I studied the protests, the moment the news of this viral pneumonia came out of China, because they are part of the greater China, if you want to call it that, right, Mainland China, two countries -- two systems, one country, they went into lockdown, the people went into lockdown, which is important to example, because their government did not want to contradict Beijing, did not want to close the border, they were kind of downplaying it, but the people that lived through SARS, right, so they were -- started universal mask wearing, started social distancing early January.
Taiwan, which had also gone through this, tried -- heard from Mainland China, that there was human-to-human transmission and they did the same thing -- ramped up production, locked down. Those are the countries that have it under control.
We should have been one of them.
HAYES: Zeynep Tufekci, who is one of my favorite writers on a variety of topics, thank you so much for your time tonight.
TUFEKCI: Thank you, Chris.
HAYES: That is ALL IN for this evening. "THE RACHEL MADDOW SHOW" starts right now. Good evening, Rachel.
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