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The Rachel Maddow Show, Transcript 10/15/14

Guests: Adam Levine, Clay Jenkins

RACHEL MADDOW, MSNBC HOST: And thanks to you at home for joining us this hour. So, a virus gets into your body, gets into your cells. Once it gets into your cells, it convinces your cells to make more virus. Essentially uses the healthy cells of your body as a Xerox machine to make more replications of itself. Once the virus inside your cell has convinced that cell to make a ton of new virus particles, those virus particles eventually burst out, and they move on to other parts of your body to go cause more havoc. And if that virus is one of about 30 different known viruses that call something called viral hemorrhagic fever syndrome, then what that virus wants to do more than anything once it`s gotten into your body and replicated itself sufficiently that it`s ready to get to work hurting your body, what that virus most wants to do, if it`s one of the viruses that causes viral hemorrhagic fever syndrome, what it wants to do is get into your veins, into your blood system, the whole vascular network in your body that moves blood around. So, it`s the kind of virus that causes hemorrhagic fever syndrome that gets into your body, gets into your cell, replicates in the cells, bursts out of your cells, then what it does next is it does what it exists on earth to do. It generates little tiny proteins, little tiny protein that attaches itself to the inside of your blood vessels. And once that protein is in there, it basically starts destroying them. Imagine that when you`re healthy, your blood vessels are strong and elastic and durable. When something like the Ebola virus glycoprotein gets into the inside of your blood vessels, instead of those blood vessels being strong and elastic and durable, once this virus has done its work, it`s more like your blood systems, your vascular network is made of sugar, right? Cobwebs. It rots your vascular system from the inside. It weakens all of your blood vessels. Whatever the metaphor is you can make up on your own, I`m not sure a virologist and you know this specifically, but basically it makes your blood vessels weak and permeable. And so they start to leak. They leak blood. And as your body makes more and more virus and bursts out of more and more of your cells and makes more and more of these proteins that essentially melt your blood vessels -- two things happen to you. Number one, you become more of a risk to infect other people because, just as you got infected from a virus that you got from somebody else, you now have lots and lots of virus in your system. It`s been replicating, right? You`ve got lots of virus in your system, you`ve got lots of virus in your body fluids. That`s one consequence of your infection progressing to this point. You are becoming risky to other people. They may contract the virus by having contact with you. But the other thing that happens to you at this point, in the lifespan of this virus, is not only are you more and more of a risk to infect other people, you also personally get more and more ill. They say it takes the virus anywhere between two and 21 days, it`s usually more like a week, when it creates any symptoms in you at all. But once you have got symptoms in the first one to three days it basically manifests sort of as a flu. Weakness, fever, muscle pain, headache, sore throat, joint pain, chills. So, first, one to three days. In first one to three days of you having symptoms, it can be very much like a flu, which is bad, right? But not something that most of us haven`t lived through at one point in our lives. All the while, though, while you were having your first one to three days of symptoms, this virus is still replicating inside you, it`s still working inside you. So then you get to days four through seven. And at this point, many patients decline sharply. That`s when you start vomiting and having diarrhea. Your vascular system, your blood vessels network, it`s being attacked from within. Your blood vessels are weakened and may be leaking. That may also get you very low blood pressure. So, days one to three, symptoms that may be like the flu, days four to seven will generally be much worse than that. But still, all the while, while that`s happening, the virus is still inside you, still replicating, still making more of itself and still doing its work inside your body. And yes, some people fend it off. With the worst of the vomiting and the diarrhea, they say people can be losing 10 to 20 liters of fluid per day, 10 to 20 liters every day. With intensity supportive care, even a very symptomatic patient in some cases can be supported through that. They can be kept hydrated even as they`re losing 10 to 20 liters of fluid. Their vital systems can be supportive enough to keep the patient from going into shock, from starting to have their organs unable to function. Sometimes, people`s immune system is strong enough and the supportive care is effective enough and people can recover and make it through, but sometimes not. Right now worldwide more people than not do not make it through. But if you get through the first three days and that`s like a flu, then days four through seven, and it is much worse, you`re losing all these body fluids. If you get through all that and you get to days seven through ten of symptoms, that, honestly, when you`re just a layman looking at this stuff and not a doctor or health worker who is experiencing these things and experienced in seeing people like this, just reading a description of what it takes to care for somebody or witness somebody going through this. When you get to what`s going on in day seven through ten, honestly, that is when it sort of just feels like all hell is breaking loose. It`s hard to imagine the human endurance it takes to witness this let alone survive it. But in day seven through ten of symptoms, and this is true of all viral hemorrhagic fever, but right now we`re dealing with Ebola, what happens in days seven through ten of symptoms can be profuse internal bleeding, can also be profuse external bleeding. Your blood vessels, your whole vascular system is basically under attack. It`s dissolving. It`s under systemic attack. Blood vessels are falling apart. Externally, you can bleed from your eyes, mouth, rectum, your nose. You can bleed from the puncture sites. Right, if you have been getting supportive care while you`re going through these things that are incredibly dehydrating, that means you have had I.V. lines and catheters in you. Those puncture sites from the I.V. and the catheter, those punctures sites in your body are among the places at this stage from which you may start bleeding profusely. So, with that vascular system becoming that permeable, and that porous, that hurt, basically, people can get extremely low blood pressure. Your blood vessels are all leaking. People`s organs can be impaired to the point of failure. There can strange systems at this point in the disease, like whole body swelling, severe confusion on the part of the patient, bleeding under the skin, large amounts of fluid in between the skin and the rest of the body. And there are people who survive Ebola even after going through terribly traumatic symptoms, but otherwise at that stage what happens after you`ve gotten to that point in your body has sustained that much it`s shock and coma and death. And even still then in the immediate aftermath of death, the virus is still inside you, still replicating for as long as it can, still doing more work, still posing at that point a very acute risk to people who come in contact with your body that they could become infected with the virus that you are now shedding at such a high rate that it dwarfs what we think of as normal viral load and normal virological conditions in other common viruses, including the deadly ones like HIV. Viral hemorrhagic fever syndrome was conjured as if from fiction, right, as a terrible way to die. It is also a rapid way to die. But knowing that, understanding how it affects you, how it makes you feel, what your likelihood of surviving at any one of those stages is and what the likelihood is of you infecting someone else at each of these stages, how it progresses over the period of these few days, that may be just important to know in terms of what the world is coping with or confronting or not confronting enough right now, but understanding that stuff, understanding the way the virus progresses in humans, what it does to your body once you`re infected, that is turning out to be a really important thing in terms of understanding even just the basic news of what`s happening with this virus in our country right now. The second case of Ebola transmission in the United States of America was diagnosed and confirmed today -- 29-year-old nurse, young single woman, she`s now the second nurse to have become infected while health care workers were helping care for the first Ebola patient who was diagnosed in this country. And so, keep in mind that timeline of how the body reacts, right? This was the time period when Thomas Eric Duncan was in the hospital. He was in the hospital for 11 days. He was diagnosed at the end of September. He died on the 8th of October. That`s the time period between those two red carrots there when he was in the hospital. This nurse`s exposure happened some time during that 11-day period when she was caring for Thomas Eric Duncan. After her exposure, she would be expected to start showing symptoms some time between two and 21 days after that exposure took place. Now, this newly diagnosed nurse, we`re told she experienced her first symptoms yesterday. Think about the timeline here. That means she`s in the very first early stages of symptoms. And after announcing her initial diagnosis today the two things that happened today about that nurse is that the CDC announced that her condition could be described as ill but clinically stable. That makes sense if she just started experiencing symptoms yesterday. So they announce that she`s ill but clinically stable. She`s in that day one through three period that we`re talking about, right? Second thing that happened is they announced that they will be moving her. They have moved her tonight to one of the four specialty biocontainment facilities trained basically as a center of excellence in our country for dealing with highly infectious diseases like Ebola. They`ve moved her to Emory. She may have gotten infected like the other nurse did at work, at Texas Health Presbyterian Hospital. But she is not going to be treated there. They`ve moved her tonight. They`re not moving the first nurse who was known to have been infected at that same hospital. And so, again go back to the timeline of how this virologically functions inside of people. The first nurse, the hospital says she first felt ill this past Friday. She realized she had a fever, drove herself to the hospital, they checked her in and started treating her, Friday. Friday -- Friday, Saturday, Sunday, Monday, Tuesday, Wednesday. Today, she is six days in to her symptoms of Ebola virus infection. And again, she is the one who they are not moving. Is that because she is now too symptomatic to move? The manifestations of this illness once you are infected, those symptoms may start slow, but you get increasingly symptomatic fast and that affects how much care you need, what kinds of care you need, how fragile you are, for lack of a better term. And honestly, it affects how infectious you are. Is that determining where America`s current Ebola patients are now being treated and how well they`re being treated? Ebola kills more than half the people who get it globally. But in terms of America`s track record of treating people in this country who have the disease, the only place where a patient has died in this country is Texas Health Presbyterian in Dallas. That is also the only known location in the United States where anybody else has contracted the virus in the first place in this country. At least two health workers got it there under hospital conditions. And God bless the people who work there and what they are coping with, but is that really a facility that should be treating new symptomatic Ebola patients as they arise now? There of all places? And is the reason that one of the infected health care workers is having to get her treatment there now is because they did not act fast enough when she first showed up, when she first showed those initial mild symptoms. They didn`t react when they saw those initial mild symptoms when she first presented. They did not move fast enough then to move her then potentially when she could have been more safely moved. Did they move too slow? And now is she stuck there as she enters into what may be the very difficult part of both her treatment and her risk for infecting others? Last night, a group called National Nurses United held a press call in which they described complaints from nurses who they said had worked on the treatment of Thomas Eric Duncan at Texas Health Presbyterian Hospital, nurses who had worked alongside these two women who got infected while providing him with care. They said that the Texas nurses were on the call. They said that they were listening in, but they also said they would not voice their own complaints on this press call because the nurses had been told not to talk to the press and they did not want to get fired. But National Nurses United relayed these nurses` observation. They told the world last night about what these nurses had been saying about the hospital which is not in keeping with the way things have been publicly described. (BEGIN VIDEO CLIP, NATIONAL NURSES UNITED CONFERENCE CALL) UNIDENTIFIED FEMALE: Nurses had to interact with Mr. Duncan with whatever protective equipment was available at the time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids. Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients even though they had not had the proper personal protective equipment while providing care for Mr. Duncan. There have been no policies or regulations regarding cleaning or bleaching the premises, without access to housekeeping services. There was no one to pick up hazardous waste as it piled to the ceiling. (END VIDEO CLIP) MADDOW: As it piled to the ceiling. The nurses also told National Nurses United, according to National Nurses United, that Thomas Eric Duncan was left for several hours after he was checked back into the hospital not in isolation. He was left out in the open for several hours in an area whether other patients were present. The 48 people who authorities say they were monitoring because they had come into contact with Thomas Eric Duncan before he became symptomatic, those 48 did not include more than 70 health workers who interacted with Thomas Eric Duncan once he was at Texas Presbyterian Hospital. If conditions described by these anonymous nurses were actually the conditions under which Thomas Eric Duncan was treated in that hospital, it seems clear that if he was at a stage where he was that symptomatic and he was left out there in the open, and there were that many people in contact with him and there were so few protocols of how to deal with him and literally dozens of people were interacting with him under those circumstances, at the most infectious time in his illness up to and including the time after he died -- if what those nurses say is true, it seems like it is now officially foolish to thing that there will not be more cases, not necessarily more cases that are grown out of the existing patients that have been identified since Eric Duncan, but there will be more cases among the people who treated him, the more than 70 people who treated him under those circumstances. And I say there will likely be more not to try to be scary. It`s about trying to be real in a crisis that is ongoing. Today, President Obama called off his planned campaign trips to New Jersey and Connecticut, and instead stayed back in Washington and convened an emergency cabinet meeting to deal with the Ebola crisis. We`re also just learning tonight that the president has canceled planned trips to Rhode Island and New York for tomorrow. Again, he will remain at the White House tomorrow to work on the Ebola crisis instead of doing that domestic travel. Even Texas Governor Rick Perry, who was very happy to stay on the campaign trail in Iowa, as Texas we now know bungled the first Ebola diagnosis in this country in his home state, even Rick Perry today decided to cut short his European trip and come back to Texas to try to deal with what`s going on or at least communicate with people about it. When the news broke today that the second nurse to be infected flew yesterday on a commercial plane, on a Cleveland to Dallas flight while she already had a low grade fever, health authorities caution that that low grade fever itself was not enough of a symptom for her to pose a significant risk of transmitting the virus to any other passengers on that plane, but still, Frontier Airlines took that plane offline today for intensive cleaning. The CDC is now asking the other 132 passengers on yesterday`s Frontier Airlines Flight 1143 to please call the CDC, call a hot line set up for them about how to self-monitor for any symptoms. In case you`re wondering, in case you were on that flight, the number to call is 1 800-232-4636. As unpleasant and upsetting as it can be to hear the details about how viral hemorrhagic fever syndrome manifests in human, once we are in a situation where viral hemorrhagic fever syndromes are being transmitted among humans in this country, it is better to know than to not know. It`s better to -- it`s not too hard to understand. It can be too unpleasant to understand, but everybody can understand it. And it is better to know than to not know. The day before Thomas Eric Duncan died of Ebola in this country, there were these like happy talk headlines that ran in the national press about his condition -- positive signs is reported. And that would have been great had that been true about Thomas Eric Duncan in Dallas. The day after this headline, he died in Dallas. If what the nurses in that hospital say is true about the way that Thomas Eric Duncan`s case was handled and the waste piled up to the ceiling and him left out in the open for hours and all the rest of it while he was symptomatic, it is better to know than to not know. If understanding how this virus works and what it does to people means getting real about handling its treatment and the poor innocents who get it, and stopping it from spreading to more people, it is better to know than to not know. Joining us is Dr. Adam Levine. He`s a member of the International Medical Corps Emergency Response Team. He recently spent five weeks in Liberia setting up and running an Ebola treatment unit. He`s got direct experience in the field. Dr. Levine, thank you for being with us. I really appreciate your time. DR. ADAM LEVINE, TREATED EBOLA PATIENTS IN LIBERIA: Thank you. MADDOW: So, I obviously am a jerk on TV. I`m a layman who doesn`t have any expert knowledge about this at all. I feel like I`m trying to understand the virology here so I can get a better grasp on the news here. Can I ask you just to correct me if I explained any of that wrong in terms of the way symptoms at least typically manifest? LEVINE: No, that was actually very good for the most part. One thing I will say is that typically in the past Ebola has been known as Ebola hemorrhagic fever because it was thought that many or most cases involved hemorrhage or bleeding, and that they`ve renamed it actually Ebola virus disease, specifically because the vast majority of cases have no bleeding whatsoever. Only about 18 percent of the cases in the current epidemic have any bleeding. And so, for the most part what`s killing patients from this disease is the severe dehydration from diarrhea and vomiting and organ damage. But only a small portion of patients actually have bleeding. MADDOW: In terms of the way that patients get sick and the ways that their lives are most threatened with the dehydration, with the vomiting and the diarrhea, whether or not there`s any external or internal bleeding associated with it, is it true that essentially the way these nurses are talking about it today, that there`s such a large volume essentially of body fluids that they`re having to deal with that not having a waste management stream set up for having to deal with those things, not having training that might apply for how to deal with things just in that quantity is itself part of the danger to health care workers? LEVINE: Right. Well, this is a disease that transmits itself by body fluids. And there`s nobody who spends more time with the body fluids of sick people than health care workers. And that`s why across West Africa and across prior epidemics in sub-Saharan Africa, we`ve seen that its health care workers, nurses and cleaners and physicians who were affected preferentially by this virus and it`s really important to have everything in place to make sure that you can deal with the large amount of body fluids that are produced in a safe way, disinfecting sheets and puddles of vomit and also protecting the workers who are working in the health facility. MADDOW: In terms of the way that this has been dealt with in West Africa and in Liberia where you work where there`s been so many cases, are there lessons to be learned from albeit a different type of health system, that ought to be seen as essentially protocols to be copied or at least frameworks to apply here in our very different kind of health system especially given the fact that we`ve already had two transmissions to health care workers with just our first case? LEVINE: Well, the Ebola epidemic in West Africa is the largest Ebola epidemic that the world has ever seen. Even for us as we were setting up our Ebola treatment unit in Liberia, we were learning to adapt the protocols to fit the current size and capacity of that. And there`s going to be a lot of work to adapt what we`ve learned in West Africa to the U.S. health care contacts which is obviously very different. I can tell you from, you know, my work in Liberia, that the most important things to protecting health care workers are having the right protective equipment, having the right protocols in place and then, very importantly, making sure that everyone is trained in how to properly use those protocols and how to properly use that equipment. And the first time you use it you`re not going to know exactly what you`re doing. So, it`s important that during those first few days that you`re working in the PPE, that you`re being monitored by someone who is making sure that you`re doing everything properly. MADDOW: And that just raw experience and getting comfortable with the equipment is I think why people are starting to talk about the need to maybe consolidate care in these sort of centers of excellence. At least, not because they`re better people or they`re more highly trained people, but simply because they may be more comfortable dealing with the protocols because they`ve had to do it more. Dr. Adam Levine, assistant professor of emergency management at Brown, a member of the International Medical Corps -- thank you very much for your work and thank you for talking with us about this. I appreciate your time. LEVINE: Thank you. MADDOW: All right. We`ve got much more ahead on the Ebola situation and lots of other things. We`re going to be talking live with a man overseeing Dallas` response. Plus, one of the most bizarre and amazing moments in American political debate history just happened tonight. Wasn`t anything that either of the candidates said. It was something that happened on stage. And it was really weird. Just happened. That`s next. (COMMERCIAL BREAK) MADDOW: There`s lots of debates going on tonight. Senate debate in Kansas, Senate debate in Delaware, governor`s debate in Iowa, another governor`s debate in Maine. But something just happened in the governor`s debate in Florida tonight that was really honestly very strange, strange enough that the people who were moderating the debate on stage had no idea what to do. They just kept talking about how peculiar this was. What a strange position it put them in. And they weren`t sure quite how to deal with it. It was really weird. Nobody saw it coming. It happened tonight. I`ll just show you. It kind of speaks for itself. Watch. (BEGIN VIDEO CLIP) UNIDENTIFIED MALE: Right now, we want to take a shot of the stage here at Bailey Hall in Broward County and, as you can see, the two candidates who were invited to take part in this debate right now are not stepping up on the stage. Ladies and gentlemen, we have an extremely peculiar situation right now. We have Governor Charlie Crist. (CHEERS AND APPLAUSE) UNIDENTIFIED MALE: Governor, Florida Governor Rick Scott, our incumbent governor and the Republican candidate for governor is also in the building. Governor Rick Scott? We have been told that Governor Scott will not be participating in this debate. Now, let me explain what this is all about. Governor Crist has asked to have a fan, a small fan placed underneath his podium. The rules of the debate that I was shown by the Scott campaign say that there should be no fan. Somehow there is a fan there, and for that reason, ladies and gentlemen, I am being told that Governor Scott -- will not join us for this debate. (BOOS) UNIDENTIFIED MALE: Ladies and gentlemen -- ladies and gentlemen, this is a debate. Rosemary Goudreau (ph), I don`t know, what can we say? (END VIDEO CLIP) MADDOW: This is a debate. So, former Governor Charlie Crist wants to have a fan under his podium for the debate. Current Governor Rick Scott says that`s not in the rules and he will not come out and debate as long as the other guy has a fan. Rick Scott would not take the stage. The rules said no fan, he said. No Rick Scott even though Charlie Crist said that`s not against the rules. After about two minutes of this and the moderators having no idea what to do, randomly Rick Scott just showed up. (BEGIN VIDEO CLIP) (APPLAUSE) UNIDENTIFIED MALE: Governor, thank you. Ladies and gentlemen, that has to be the most unique beginning to any debate -- UNIDENTIFIED MALE: I don`t think we`ll forget. (END VIDEO CLIP) MADDOW: Again, that just happened tonight in the Florida governor`s debate. The latest polling in that race, just so you know, shows Rick Scott and Charlie Crist tied. Both of them have 40 percent right now. Usually after debate in a close race, you talk about who won, who lost the debate and how that might affect the election. Instead of that, Florida, the effect of this debate is going to be what just happened there? Why did Rick Scott decide that the fan under the podium was the hill he was going to die on? Why did Charlie Crist want to stand on a fan during the debate? I don`t know. Florida, always amazing. That just happened. We`ll be right back. (COMMERCIAL BREAK) (BEGIN VIDEO CLIP) JUDGE CLAY JENKINS, DALLAS COUNTY, TX: At the hospital, we have a situation involving 77 people, two of which have tested positive for Ebola. We are preparing contingencies for more, and that is a very real possibility. (END VIDEO CLIP) MADDOW: Dallas County`s top elected official, Judge Clay Jenkins, warning today that given the two infections of health care workers in Dallas already, it is reasonable to expect more from the Dallas experience of coping with Thomas Eric Duncan. Judge Jenkins today also announced that he would prepare a legal order restricting any of the health workers who treated Thomas Eric Duncan from traveling as long as they`re still being monitored for symptoms. This new order coming after the second nurse diagnosed with the virus today was reported to have traveled on a commercial airliner yesterday despite the fact that she had a low grade fever. She reportedly called the CDC, told them she had the low grade fever, she reported she was being monitored as a possible exposure to Thomas Eric Duncan. But ahead of time, ahead of that travel, the CDC apparently did not tell her she shouldn`t get on the plane. Today, the head of the CDC said, in retrospect, she should not have been on that plane. But tonight, Dallas County, at least their top elected official, says it will be illegal from hereon out for any other worker being monitored in Dallas to even try to take that sort of a commercial flight. Joining us is the man at the center of this crisis in the country, Dallas County Judge Clay Jenkins. Judge Jenkins, thank you very much for taking time to talk with us again tonight, sir. I really appreciate your time. JENKINS: Glad to do it. MADDOW: As this continues to evolve, and as Dallas has not just the case of Mr. Duncan, but the second carry case of the health care worker, and now, the tertiary case of the other health care worker, I have to ask since I`ve spoken to you a few times -- how are you doing in terms of handling -- in terms of yourself and being at the center of this and handling it? JENKINS: You know, I`m doing great. I`ve got a ton of support from my family and the community. I haven`t slept in about 48 hours. But other than that, life`s good. MADDOW: Yes. You announced today plans to enact a legal order to restrict travel for these dozens of hospital staffers who treated Thomas Eric Duncan who are being monitored as having been exposed and watching for symptoms in those cases. What does that legal order mean? How would it work? JENKINS: Well, it`s -- in their case, these are hometown health care heroes. They just need the rules of the road. It is a legal order. It is binding, but these people, given their life`s work to public health, if they`re asked not to travel, they won`t. Once I heard of the travel and talked to Dr. Frieden, who, you know, who was honest to them, that in hindsight he would have liked to have informed the hospital to not have them travel, inform the hospital we didn`t want them to travel and the hospital sent that down the chain to all the people that are being monitored and everyone stayed here, and they`ll get these orders tonight that will lay out the kind of the parameters of their monitoring period, and I have no doubt they`ll all comply with those. MADDOW: Do you know if any other of these health care workers, again, more than 70 people involved in this care, do you know if others of them have traveled just personally have taken commercial travel over the last couple weeks, while they either were being monitored or should have been monitored, do you know if this nurse who was diagnosed conclusively today, if she is the only one? JENKINS: Well, I don`t because they won`t on our monitor list. The Epi team, the epidemiologists said there was little to no risk for the health care workers since they were wearing their personal protective equipment. And we were tasked at looking at 48 people who they thought had either somewhere from low to high risk. Luckily, all those people are asymptomatic. These people we didn`t begin to look at until Nina Pham was tested positive for Ebola and we realized that there was a breach somewhere in the donning or the taking off or the wearing of the PPE gear. MADDOW: Obviously, her case proves that there was something wrong, either something wrong with the protocol or something wrong with the way that it was adhered to, this secondary case now with this other nurse obviously proves it further. Do you expect, given those two cases, that essentially our proof of concept -- do you expect that there will be additional health workers among the people who treated Mr. Duncan who are going to test positive in the days to come? It seems like you -- I ask you that not because you have a crystal ball, but because I hear in your public pronouncements that you`re essentially trying to prepare people for that eventuality. JENKINS: I`m certainly trying to prepare our first responders and our emergency operations center for that possibility, and given that we don`t know the precise breach, but we know given that there`s two, that it`s not isolated and we had at least two days where the personal protective equipment protocols were different than they were in the middle, which is different than they are now -- MADDOW: Yes. JENKINS: -- we have some real concerns of what the breach period was and how long that could have gone on and how many people might be affected by it. MADDOW: Dallas County Judge Clay Jenkins, as you continue to be managing the local response to this, I wish you very, very good luck. We`re all pulling for you. And I also hope you get some sleep toward that end, sir. Thanks for talking to us tonight. JENKINS: Thank you, Rachel. MADDOW: Thank you. All right. Wow. How much are you happy that you don`t have his job right now in terms of what`s just happened, not just since the initial case but these two cases since? Just incredible. All right. We`ve got a surprise for you tonight about the elections. It is a surprise that`s been hiding in plain sight but it should probably change how people are thinking about this year`s elections or whether they are thinking about them at all. A surprise finding. That`s ahead. Stay with us. (COMMERCIAL BREAK) MADDOW: And now, in the middle of an uncomfortable national freak out about viral hemorrhagic fever syndromes -- behold a river otter pup. His name is Mo. He`s a North American river otter. He was born last year. His mother was a rescue otter who was found as an orphan and rescued by the Oregon Zoo. When Mo the otter got a little bit older, his mom taught him how to swim. Her name`s Tilly. And as river otter mothers go, she is a good one. Here`s how you swim, big guy. Doesn`t that kind of make you feel better? That makes me feel better. On a day like this, I just like looking at Mo the otter, as he is, ready for the world. So, Mo, the otter is the most amazing otter I almost know. And I do just like looking at him. He is nowhere in the news today, except here. But the second most amazing otter I know is in the news today legitimately. And that otter and the very surprising political news about him, that story is straight ahead. Can we just finish that -- he`s getting weighed. See that? They put him in the bucket. Come on, look at him. (COMMERCIAL BREAK) MADDOW: So far, the country doesn`t much care about the midterm elections this year. And maybe that is unavoidable. Maybe that`s just inherent to midterm elections that people don`t care very much. But if the thing that ought to make people care is drama, uncertainty about what`s going to happen, a really close race -- well, here`s the news: right now, it`s a really close race. Seriously. There`s a lot else going on in the news right now, so we`ve not been doing like daily on the air tracking on all the polls and all the races this year, but because the election is in less than three weeks now, we did today sort of casually try to take a snapshot of what`s going on in all the top tier races in the country right now and the results is amaze-balls. The results is almost every legitimately contested, legitimately interesting race in the country is tied right now, with less than three weeks to go, with 21 states already early voting. This is not the way people are talking about it, but when you look at the numbers, it`s uncanny. These are the states where there was a contested Senate race of some kind. There are some races that were going to be a lost cause for one party of the other. So, I know it hurts, but if you take the lost causes out, a little brutal, but just drop them out. That takes out these states and that leaves the supposed battleground on which we`re going to decide who controls the United States Senate this year. These are the states that are left. And among them, these are the states in which the races are tied right now. We looked at all the major polling currently in these races and there`s been at least one major poll in the last two weeks that have shown the candidates to be either literally tied or at least within the margin of error of the poll. In every single one of those Senate races all over the country, it`s a tie. And yes, there`s new polls out every someday that show somebody up by two and somebody else down by half a point, these things are definitely still in motion. Campaigns matter, the different methodologies of the pollsters matter, but big picture, it`s a tie in Colorado, in Georgia, in Iowa, in Kansas, in North Carolina and in New Hampshire. In at least one major recent poll, it`s either a literal tie or the candidates are within the margin of error. If you factor in the lost cause states that we show before, Republicans need to win six seats that Democrats now control in order to take the Senate. Almost all the forecasters say Republicans are favored to do that overall, but their path to that supposed likely result is through a surprisingly large number of states in which the outcome right now is too close to call, statistically speaking. It`s weird. I think maybe it`s because people aren`t paying much attention to the elections this year, so this is the political god surprise attack. The political gods are like oh, you don`t care about this year`s elections? Then we`ll make them the most exciting elections ever. Mwah ha ha ha. And it`s not just the Senate about which this is true. The other top tier races that are happening this year, of course, are the governor`s races. These are all the states that have governor`s races this year. And again, I don`t mean to be harsh, anything can happen. But there are a number of states you can sort of drop out because they`re basically a lost cause for one party or the other. If you take out the states where the result of the governor`s race is all but preordained, this is what`s left. And look at how many of these states are a tie. Look. A major poll within the last couple of weeks has shown the candidates running for governor in these states to be literally tied or at least within the margin of error in the poll. And in that big picture snapshot, it`s a tie in Alaska, Connecticut, Colorado, Florida, Georgia, Kansas, Maine, Massachusetts and Wisconsin. Here`s how crazy things are right now. Even Idaho, bright red Idaho, a brand-new poll out today shows a statistical tie in the governor`s race in Idaho. Republican Governor Butch Otter -- awww -- he leads, but his lead is within the margin of error, even in Idaho. So, let`s put up those two maps side by side. The tied races right now in terms of the Senate, and the tied races right now in terms of the governor. Can we put them both up at once? OK, the list of who`s tied. (AUDIO GAP) about mid-term elections inherently, no matter what you do. And maybe, even the fact that so many races are so close won`t change that. But what this means in the last three weeks with early voting already under way in 21 states, what this means is that governance in the United States, both around the country and in Washington is going to be determined by nuts and bolts stuff about voter turnout, right? The very basic issue about whether or not parties and candidates can get their voters to the polls. And in addition to that, when races are this close, when there are this many tied races, it becomes newly important to pay attention to issues like voter suppression. So, in the state of Georgia right now, both their Senate race and their governor`s race are literally both tied. Not even just within the margin of error. They`re both tied. And so, there, it suddenly really matters that the secretary of state`s office in Georgia appears to have misplaced 40,000 registration voter forms from would-be new Georgia voters, from people who only will be new voters if they actually turn up on the voter rolls. In North Carolina, if it was a year in North Carolina when nothing was going to be close, maybe it wouldn`t matter the Koch brothers-funded Americans for Prosperity group sent out hundreds of mailers, giving people confusing, conflicting wrong information about how they should register to vote, right? "A.P." later apologized for the multiple errors. But in Georgia and in North Carolina, and around the country, when this many races, this many top of the ticket races are this close, number one, you think that might get people interested in the elections this year, but whether or not that happens, this many races being this close makes it all the more tempting and frankly, all the more possible for elections to be effectively stolen, either by flat-out blocking people from being able to vote, or by bamboozling and confusing them to make them think they shouldn`t even try to vote. With these many top of the ticket races tied, turnout will be everything. So, now is the part where we watch for the ways that people will try to stop voters from turning out or from having their votes counted by hook or by crook. Whether or not you have been following the twists and turns of any individual race, right now, three weeks out, this is a tie game. Close enough to be fascinating, but also close enough to be stolen. Watch this space. Watch this very, very contested space. (COMMERCIAL BREAK) MADDOW: So, we have a programming note for you. I`m going to be a guest on "Late Night with Seth Meyers" tomorrow night on NBC, which is very exciting. It`s always very flattering to be asked. I have to wear pants, because when you do shows like that, you can see my legs, which you guys never get to. You have no idea if I`m wearing pants. I`m going to spend the next 24 hours pants hunting, because they`re going to see them. They warned me about that today. So, that`s the thing. But now, here`s another thing. This is actually a thing we do on the show called "Now Here`s a Thing". So, now, here`s a thing. (BEGIN VIDEO CLIP) SUBTITLE: This is Charlie Baker. He`s the Republican candidate for Massachusetts governor. CHARLIE BAKER (R), MASSACHUSETTS GUBERNATORIAL CANDIDATE: We have a detailed plan to make Massachusetts a leader again. A leader in jobs. UNIDENTIFIED FEMALE: It`s about jobs. UNIDENTIFIED MALE: Good jobs. UNIDENTIFIED MALE: Better jobs. ANNOUNCER: Charlie Baker for governor. SUBTITLE: That`s how Charlie Baker is running for Massachusetts governor. Today, this happened to Charlie Baker. It`s from Charlie Baker`s CEO past. He`s winning an award. The award is called "Outsourcing Excellence Award". It`s from something called the Outsourcing Center. Massachusetts Democrats have been pretty feckless in recent elections. And have lost some of winnable races. Bu today, less than three weeks before the election, they turned up this photo, of Charlie Baker`s "Award for Excellence" in turning U.S. jobs into jobs into other countries. In a tuxedo. And that is a thing that happened. (END VIDEO CLIP) MADDOW: And that is a thing that happened. Honestly, I live in Massachusetts and I`m a liberal so I`m used to watching the Massachusetts Democratic Party spend every election just going like this. But the fact that they turned up that picture today, whatever it is, 19 days before the election and he`s wearing a tuxedo and it`s the "Outsourcing Excellence Award". I finally feel like Democrats are doing something right. All right. That does it for us tonight. We will see you again tomorrow. Now, it`s time for "THE LAST WORD WITH LAWRENCE O`DONNELL". Good evening, Lawrence. THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED. END