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cases shrink in China TRANSCRIPT: 3/13/20, The Rachel Maddow Show

Guests: David Ho, Jenny Durkan, Jeremy Konyndyk

RANDI WEINGARTEN, AFT PRESIDENT:  The fear has now overtaken the fact, but  all of these kind of processes need to be in place. 

CHRIS HAYES, MSNBC HOST, "ALL IN":  Randi Weingarten and Dr. Joseph Fair,  thank you both for making time. 

That is "ALL IN" for this evening. 

THE RACHEL MADDOW SHOW starts right now. 

Good evening, Rachel.

RACHEL MADDOW, MSNBC HOST:  Good evening, Chris. Thanks, my friend. Much  appreciated. 

Thanks to you at home for joining us in this hour as well. 

In the year 1996, I was 23 years old, go ahead, do the math, yes, I`m that  old. I`m like dirt. 

But in 1996, I was 23 years old and honestly kind of a mess, but I did have  a real mission in life. I was working as an AIDS activist, and I had been  for the previous like six years or so, six or seven years or so. So, when  you`re 23, that`s a pretty big chunk of your life. 

And in 1996, I went to the International AIDS conference that year. It was  in different city every year. That year was in Vancouver, and I remember it  like it was yesterday because it was a turning point in my life. It was a  landmark moment in my life, still at age 46 when I talk about like things  that happened in my life and important moments in my biography, going to  that conference was one of them. 

At that conference, I felt like the whole world started spinning in a  different direction than it had been spinning before. There was before then  and there was after then, because at that conference, which was then, you  know, ten years into the AIDS epidemic, with more than 360,000 Americans  dead from AIDS by then, with more than 6 million people worldwide dead from  AIDS by then, by 1996, a scientist gave a talk at that conference in  Vancouver in 1996 that changed the way we understood everything about that  virus and how it kills us. 

The scientist was a man named Dr. David Ho, a young scientist, even younger  looking than he was at the time. But the talk that he gave in Vancouver  changed the world because Dr. David Ho figured it out. With literally  hundreds of thousands of Americans dead and dying at the time, Dr. Ho  designed studies and led research that figured out the mystery of how HIV  replicates inside the body. Once you get infected, the virus starts to make  copies of itself in almost unimaginably large numbers, and it does it from  the instant that you get infected. 

That`s what Dr. David Ho saw around corners and got out of the box in order  to see happening when it came to HIV and AIDS, and that new understanding  about how HIV worked, about how it did its viral business to destroy our  bodies, that led to a new understanding about the whole life cycle, right?  About how HIV led to AIDS, which led to opportunistic illnesses that killed  HIV positive people. 

I mean, his research led to this crucial revelation in understanding the  virus and in understanding how to treat the virus, how to treat HIV. And  what we learned because of his research is that you need strong antiviral  drugs to stop the virus from replicating inside the body out of control, to  suppress basically the virus`s replication enough to give the immune system  some relief. So the replication of the virus doesn`t exhaust the immune  system and leave you open to the opportunistic illnesses that are ready,  willing, and able to kill you. 

Dr. David Ho is a molecular biologist. He trained at Cal Tech and MIT. He  was a resident at internal medicine at Cedar Sinai in Los Angeles in 1981  when he started seeing some of the very first cases of what would later be  called AIDS. 

But as a researcher, it was his outside of the box thinking about how to  understand the virus`s own work, how to understand the way the virus  behaved insides human body that led to these, at the time, heretical ideas  about how to treat the virus, how to treat HIV positive people well before  they got sick -- how to attack the virus early on, to undermine the work of  the virus, to give the body the best chance of holding it at bay. 

That led to these revolutions in HIV treatment that started keeping people  alive. That`s why my life changed so much because people who had previously  been dying stopped dying and started living for long enough to get them to  the next treatment and ultimately to a long-term prognosis. That revelation  about how to treat AIDS, about how the virus works, therefore how you  should treat it, that is what changed HIV and AIDS profoundly from a  disease that killed everybody to what it is today. It was that pivot point  in 1996. 

If you are old enough to remember that time in U.S. history, which granted  is a long time ago, half my lifetime ago, you might remember that the "Time  Magazine" Man of the Year in 1996 was Dr. David Ho, and I think most people  across the country were like, wait, Dr. David Who? What`s this? 

Everybody anywhere related -- in any way related to the AIDS movement at  the time was like, yes, exactly, David Ho, man of the year, the man who  made the world start spinning the other direction on its axis.

Well, today, in 2020, Dr. David Ho is still a pretty young scientist. He  heads up his own lab, which is still working hard to find the ultimate cure  for AIDS, but he`s also now working to find a cure for coronavirus. 

We called Dr. Ho today to ask him what he thinks people ought to know and  ought to be thinking about in terms of the prospects of beating this virus,  and one of the things he sent over to us was a short stack of three very  simple graphs. Just three of them, they`re very easy to understand. 

I`ll show you, here`s the first one. You see the headline there, daily new  confirmed cases, and in this graph, there`s two different lines, right?  One`s red and one`s green. The red line is China. The green line, which is  harder to see. It`s on the right side there. It`s lower on the screen.  That`s South Korea. 

And by daily new confirmed cases, what this means is this is the number of  newly reported cases day by day. So, it`s not a graph of the total number  of people who have the virus. It`s the number of new infections per day.  So, this is a graph that basically shows you the rate at which people are  being newly infected in those two countries or at least the rate at which  you can detect it by testing. 

In China, the red line, daily new infections goes very, very high up,  almost 4,000 new cases per day at the height of it, and then they come down  to a low level where they are now. 

South Korea, the green line, their epidemic starts a little bit later on in  time, starting towards the end of February. Their number of new cases  follows a similar shape, right? At least they seem to hit their own peak,  and then start to come down from it, not quite as clearly as China did, but  still. Broadly speaking, their number of new cases today in South Korea is  heading down towards lower and lower numbers. 

One other thing you should notice on this graph. Notice the time frame.  Look at what`s on the X-axis there. Today is March 13th, so this basically  ends yesterday or today, but it goes all the way back. It starts in January  because that`s when China started to see and document this rapid onset of  new cases in this epidemic. It goes back to January. That`s the first  graph. 

Here`s the second graph, same kind of graph measuring the same kind of  thing. This time, it`s two countries in Europe. Here, the green line is  Italy, the red line is Spain. 

And here the bad news is that the number of new infections per day is still  trending up in both of those places. It does not look like they have  peaked. It`s a very high number of new cases per day in Italy, and it is  trending up still quickly day by day. That`s the number of new cases per  day. 

Again, this is not the total number of people with the infection. This is  new cases reported per day. This is the rate at which people are getting  newly infected in these countries. 

If you put those two side by side, that`s the China and South Korea one on  the left, the Italy and Spain one on the right. Not only is the shape of  the graphs different, in Italy and Spain, it`s not yet coming down but also  the time frame is different. 

In order to see what happened in China and South Korea, you`ve got to go  back to January. The graph for Italy and Spain only goes back to late  February, because again, later onset. It`s spreading, started in China, and  it`s now moving out around the country and people`s epidemics in individual  countries are starting at a different time. 

So, the Asia graph goes back to January. The Europe graph goes back to  February. Here`s now the third graph, and this one is New York City, and  look at the timeline here first. This one only goes back to last week, and  over the course of last week and week, this is what`s happened in New York  City in terms of the rate of new infections being reported each day. 

This is a bad graph for New York City. This is a bad graph for any country  that has this as its largest city. New York City is our largest city in  this country. 

And New York is not the place that has the largest number of cases in the  United States. That continues to be Washington state, which as of today has  reported 572 confirmed cases. 

But when it comes to the numbers here in the United States, we have learned  to be shy about taking any comfort in any apparent smallness in the numbers  because of the fact that we appear to be the worst industrialized country  in the world when it comes to actually testing people to confirm cases. So  nobody quite trusts our numbers, because we know they are artificially low  because we`re not doing very much testing at all. We`re worst in the world  among major industrialized countries who are facing this epidemic. 

When I spoke with Washington state`s governor, Jay Inslee, at the beginning  of this week on Monday night`s show, at the point, they had 160 known cases  in Washington state. He said within Washington state government, they  believed at the time as of Monday, they probably had more like a thousand  cases even though only 160 cases had been officially confirmed. He said he  expected that number, even that number to rise rapidly and dramatically. 

He said that if they thought they had about a thousand cases as of Monday  night with the rate of -- the rate of -- the rate at which the infection is  spreading, the number of infections are doubling every five or six days.  The governor in Washington suggesting that they thought that by the end of  next month, they would go from a thousand cases this week to more than  60,000 cases. That`s just one state by the end of next month. 

Well, that appears to be borne out. The governor`s expectations appear to  be borne out by the math. There`s 160 known cases in Washington Monday  night, tonight, there`s 572 cases. So, they are.

We`re going to talk live with Seattle`s mayor in just a moment for an  update on those front lines and America`s part of this pandemic. 

Just before we got on the air tonight, Washington`s governor ordered a  statewide shutdown of all K through 12 schools and a statewide ban on all  gatherings of 250 or more people. Those measures were already in place in  Seattle, in Washington`s largest city. As of tonight, as of just hours ago,  they are expanded statewide. 

But just look back at New York City for a second, because although it`s  Washington state that has the largest number of cases in the country, New  York state is absolutely hot on its heels. New York City reported that the  number of confirmed cases just in the city rose by more than 50 percent  just since yesterday, and it`s hard to know if that 50 percent rise, 50  percent rise in confirmed cases in New York City in a day. It`s hard to  know if that 50 percent rise in one day is indicative of a huge spike in  new infections in New York City or whether it just indicates that more  testing is now happening in New York City and more cases are therefore  being found. 

I will tell you from anecdotal experience from working in New York City and  knowing tons of people who live here, I don`t know anybody who actually  knows how to get a test in New York City, including a bunch of people who  are symptomatic and indications they`ve been exposed to people who have the  virus. It`s almost impossible to get a test, even now. 

The governor of New York state has been very aggressive about the need to  get more testing done in New York and the plans to get more testing done in  New York. But there`s not much sign of it other than one testing site that  opened today for residents of Westchester County only. 

But, still, I mean, put up that New York City graph side by side with that  graph of what`s going on in Italy. Notice any similarities there? I mean,  that`s the same shape. 

Even with almost no testing here our numbers don`t look like Spain, which  is the red line under Italy there. Our numbers don`t look like South Korea.  Our numbers look like Italy. Italy when they`ve got a nationwide lockdown  of 60 million people, 60 million people quarantined. 

The number of confirmed cases rising by thousands and thousands every day,  hospitals in the worst hit areas of Italy are overwhelmed. The doctors and  the nurses at those facilities are themselves infected. The health care  system is broken in the places where it is the worst in Italy, it is feared  that it will break all over that country with the thousands of new  infections they`re seeing every day, and 15 to 20 percent of everybody  infected needing to be hospitalized for serious illness. 

I mean, that`s the devil in the data. All right. This is the statistical  manifestation of what it means for us as Americans to have had a slow,  confused, poorly led response to this pandemic with this only in America  disaster at the core of our national response, which is the continuing lack  of testing here. 

But you have to work with what you have, and we`ve only got one federal  government, and that`s all we`ve got. We`re not getting another one. You`ve  got to do what you can with what you`ve got. 

And so, you know, should we be canceling events that bring people together  in large numbers in any sort of face-to-face proximity where respiratory  illness could be spread? Absolutely. All over the country we should be  canceling events of that kind. 

Should we be canceling travel? When it comes to air travel, if you`re an  older person or a person who`s got underlying health issues, for you  particularly, the answer is yes and at least that is now clear. Otherwise  the answer is probably yes -- yes, if you have the option not to travel,  don`t travel. 

Should businesses and different workplaces around the country be  instituting rules now to have people working from home instead of working  collectively in a single location alongside their colleagues? Yes. That  needs to be happening everywhere. Everywhere it can happen. 

And that`s what we can do. We don`t have testing. So, this whole idea of  being disease detectives and tracing everybody`s contacts and figuring out  sources of infections and everybody`s contact, and getting all those people  tested and locking them down, you can`t do that if you can`t test. So, we  do what we can, which is mitigation, assuming that we`re positive. 

The president today finally declared a national state of emergency, which  he had been reluctant to do for days. That declaration will free up some  federal funding, but it won`t undo the mistakes and the bungling that is  happening thus far. The emergency announcement did lead to a rally in the  stock market, which we know is very important to the president. I`m sure  that felt great to him in terms of the immediate impact of that national  emergency announcement. 

But the economic pain that is going to be inflicted by this pandemic is not  going to be helped by that rally today. The economic pain that`s going to  be inflicted as a consequence of this pandemic is going to be severe. We  should start preparing for that too. I mean, if you just want one little  business snapshot of that today, take the announcement from Delta Airlines.  Did you see this? 

Delta Airlines announced they`re going to reduce their overall flying  capacity by 40 percent. That`s the largest reduction Delta Airlines has  ever instituted including the period immediately following the attacks of  9/11. They`re cutting capacity 40 percent, effective immediately, grounding  up to 300 planes, eliminating all flights to Continental Europe, which is a  measure, of course, that the president forced on them with his announcement  of a European travel ban, which is now going into effect. 

We learned just today that schools will be closed statewide in Virginia,  West Virginia, Rhode Island, Maryland, Pennsylvania, Michigan, Washington  state, New Mexico, Louisiana, Florida, some of the biggest school districts  in the country, L.A., Boston, San Diego, Miami all announced full closures  today. 

Interestingly, New York City schools are not closing even though there`s  been a state of emergency declared in New York City, and even as we`re  seeing with the city itself is reporting in terms of numbers. 

Boston marathon was postponed today. The Louisiana Democratic presidential  primary was postponed today moved from early next month to late June  instead. Mount Everest is now closed to climbers. The Eiffel Tower is now  closed to visitors. 

Denmark is closed to everyone. Denmark has closed its borders to everyone. 

Kuwait has closed its main airport. Ireland has closed all schools, all  colleges, all child care facilities. In Iraq where there are nearly 200,000  people in displaced persons camps, which alongside prisons and jails are  the absolute nightmare scenario for pandemic spread. In northern Iraq, they  have identified their first coronavirus case in a displaced person`s camp  in Nineveh province. 

In Canada, there was a unanimous vote to suspend parliament. All members of  parliament sent home. 

Canada`s first lady, the prime minister`s wife, has tested positive for  coronavirus. She`s ill. She`s in quarantine. Her husband, the prime  minister is quarantined as well, although he is reportedly not symptomatic. 

But as we thunder into another day of this wondering if this was another  day when American hospital capacity should have noticeably increased, as we  thunder into another day of this, with Americans still being given wildly  contradictory and inconsistent advice about whether and when to self- quarantine and what it means to isolate or self-quarantine, and whether you  should seek testing and with more government happy talk about the  availability of testing when in real life by and large people still can`t  get it, even if they seek it out aggressively and even if they have reason  to. 

As we thunder through another day of this, I`m at the point where I want to  know about the replication of this virus inside our system, and where we  really are on the epidemiological curve here, and what that says about how  worried we should be about our hospital capacity, our intensive care beds.  The safety of our doctors and nurses and health care workers, our ability  to prevent them from being overwhelmed despite the way that we are seeing  these numbers grow in the United States. 

I know there`s been a lot of talk about vaccines. I think that`s in part  because the president for a long time while facing this seemed to have no  idea what a vaccine was, and so, he frequently said things that made no  sense about vaccines and that led to news coverage of vaccines. 

In reality, best case for a vaccine is that we`re talking about a year and  a half from now. Set aside what might happen with vaccines a year and a  half, what about treatment? What about potential treatment for this, for  people who have got it? Is there outside the box thinking right now that  might hold the potential for a moment like we had in 1996 in Vancouver? Is  there outside the box thinking right now that has the potential of turning  this thing in the other direction? For making us understand this and see  this in a different way, for making us see how this might conceivably veer  off the course that it seems to be on now toward the worst disaster we`re  all now capable of imagining?

Dr. David Ho, that same Dr. David Ho is now working on coronavirus, and  he`s going to join us live in studio here next. 

(COMMERCIAL BREAK)

MADDOW:  "Time Magazine" describes it as a first of its kind library of  potential coronavirus drugs. Quote, with a $2.1 million starting granted  from Chinese technology mogul, Jack Ma, Dr. David Ho will oversee four  research teams at Columbia University whose goal is to find an effective  treatment against COVID-19 and other coronaviruses. 

If you`re pursuing a project like this, Dr. David Ho might be exactly the  person you want overseeing it. His groundbreaking HIV research changed the  course of the AIDS epidemic worldwide in the 1990s. He`s been researching  and fighting viruses ever since. Dr. Ho is now scientific director and CEO  of the Aaron Diamond AIDS Research Center, and I`m very pleased to say that  he joins us now here on set. 

Dr. Ho, you are far away from me at this desk, but that`s on purpose. Thank  you for being here. 

DR. DAVID HO, DIRECTOR AND CEO, AARON DIAMOND AIDS RESEARCH CENTER:  A  pleasure. 

MADDOW:  I know that you were able to hear my introduction a minute ago,  and I don`t want you to ask you to answer for all of it, but when I was  talking about you and your research and questions about the coronavirus, I  just want to ask you if I said anything that was -- that seemed wrong or  wrong headed to you? 

HO:  No, you got it right. 

MADDOW:  OK. We asked you today about things that we might -- you might  want to convey to the American people, help people understand better about  where we`re at with this coronavirus problem, and you sent us these graphs,  fairly simple graphs, and I walked through them a little bit. 

But can you describe what`s important? We can put them up on the screen  again. What`s important about the shape that`s evident in these graphs and  what you see as a scientist looking at these? 

HO:  Well, the first graph involved what happened in China and in South  Korea, and you could see the epidemic just took off based on those daily  case numbers and peaked around February 4th with 4,000 cases a day. But  with the draconian measures implemented within central China, it got  controlled, and it was dropping every week by half, very steadily and this  past week, I think there are only a handful of cases outside the central  province of Hubei in a country of 1.2 billion. 

So that control is remarkable, and what was not on the graph is what`s  happening in various provinces and cities in China, and they were held  under pretty tight control with no city or province over 1,500 cases, and  so what was done in China is quite remarkable. 

In South Korea, there was also a rather explosive epidemic that followed a  few weeks later, and without implementing harsh measures but by social  distancing and good hygiene, they were able to bring it down, albeit with a  slope that`s not as sharp. 

MADDOW:  Very aggressive testing was also a characteristic of the South  Korean response? 

HO:  Yes, testing obviously is central. Without testing you`re blind, and  if you have no tests, you have no cases. So, the -- so the other graphs  that show what happened in Italy and Spain occur weeks later, and it`s  following the same trend. It`s an exponential growth with Italy taking off  first, but now, Spain is following and Germany and many Western European  countries are going through the same thing. 

And then in New York, what we`re seeing is just we`re lagging behind  another couple weeks, and if we think back 11 days ago, we had the first  case in New York City, and then there were a handful of cases every day for  about a week, and then three days ago, we`re seeing cases in the teens.  That`s the inflection point. 

MADDOW:  Part of the -- part of what we`re seeing here is as this moves  through time, we see different countries deal with it as it arrives and  then takes off. 

HO:  Right. 

MADDOW:  But part of what we`re seeing here is that even when the raw  numbers are different between individual -- like between us and Italy, the  raw numbers that you`re talking about here in terms of measuring on these  graphs are different. The shape of the curve being the same implies that we  are heading in the same direction? 

HO:  Right, we`re just lagging behind by a certain period of time. China  started over two months ago. Italy about six weeks ago, and we`re just  catching up. And this implies the same wave of epidemic could sweep  through, let`s say, Middle America, which is lagging behind the New York  area and the West Coast. 

MADDOW:  With the sort of scatter shot mitigation measures that are  starting to be implemented now in the United States, New York City schools,  for example, are still open. With the lack of testing that we`ve got, which  as you say leaves us blind in terms of how to target these sorts of  measures, do you think that the United States holds any hope of bending  that curve -- bending that curve down at this point, or are we looking at  explosive growth for the foreseeable future until we can do something  radically different as a country? 

HO:  What we have to remember, the cases that were found yesterday in New  York City represent what happened about a week ago. 

MADDOW:  Right. 

HO:  When transmission occurred. 

So what we`re seeing is about a week behind, and, of course, the virus  could go through several rounds of spread, and expand at least tenfold and  maybe twenty fold. So, what we see from yesterday is just the tip of the  iceberg, and that there`s a huge mass that we cannot see. 

MADDOW:  We need a treatment then. We can`t wait a year and a half for a  vaccine and pin all of our hopes on a -- on some sort of pharmaceutical  intervention on a vaccine. We need a therapy that cures people of this  virus when they`ve been infected. 

HO:  We need some intervention that works. Vaccine, if it works, great.  Drugs or antibodies, all could be utilized to treat infection as well as to  block infection. 

MADDOW:  That`s what you`re working on now? 

HO:  We are, as you mentioned, we were funded initially by Jack Ma`s  foundation to begin to search for drugs that could target this coronavirus. 

In particular, we`re looking at two targets of the coronavirus. One is  called the protease and one is called the polymerase. These are important  enzymes that the virus uses to replicate itself and to make progeny  viruses. If you block either one, you would interrupt the replication cycle  and therefore kill the virus, in essence.

And importantly, these are two areas that are well-investigated in the  context of HIV drug development and hepatitis C drug development. So,  there`s a wealth of knowledge, and there`s a -- there`s a very rich library  of chemicals that are designed already to target proteases or polymerases. 

So, it`s an area where we could move very fast to see if we could find a  hit. A hit means it may have some activity against one of those two enzymes  and then optimize that hit into a -- what we think a candidate drug. But  this, too, is a prolonged process. We could perhaps find a hit in a couple  months, but the optimization process would take several more months, and  then you then have to do all the manufacturing and safety testing.

MADDOW:  Uh-huh.

HO:  So nothing is going to come really fast, and certainly for this coming  year we`re going to have to fight the virus without any effective drug or  vaccine. 

MADDOW:  Dr. David Ho, hearing it from you makes me understand it in a way  that I didn`t before. It`s stark, but it is good to know. 

Sir, thank you for being here. Thanks. Now go back to work. 

HO:  Thank you. 

MADDOW:  We`ll be right back. Thank you very much. 

(COMMERCIAL BREAK)

MADDOW:  The first coronavirus case in the U.S. was reported January 20th.  It was a 35-year-old man who had a cough and a fever. He just returned from  Wuhan, China. 

When he got back to the U.S., he took himself to his local urgent care  clinic in Snohomish County, Washington, just north of Seattle. 

On February 29th, the first death from the coronavirus was confirmed. It  was also in Washington state.

And now, of course, corona cases are everywhere. Alaska reported their  first case yesterday. Idaho joined this afternoon. It`s everywhere. 

As of today, it is New York state that is fast closing in on Washington  state as potentially ending up with the most cases in the nation, but  Washington`s been the bull`s eye from day one, and nowhere has felt that  more acutely than the great American city of Seattle where they have been  living this crisis from the front and without a compass, without much  advice on what to do, certainly not from the federal government or from the  rest of the country. 

James Ross Gardner writes for "The New Yorker" but he lives in Seattle.  Today, he wrote that everyday life in Seattle right now is, quote, like  living in a kind of laboratory of the country`s future. I think that`s  right. 

Seattle public schools all closed as of yesterday. Today, Washington`s  governor ordered that schools all over that state join them. Officials in  Seattle pioneered the move to buy modular housing units to house people who  don`t necessarily need to be hospitalized. A motel to quarantine sick  patients. 

Gatherings of over 250 people are banned statewide. State and local  officials have been leading on this crisis from the beginning while the  federal government has dithered and offered very little guidance, but now  the rest of us all over the country have the opportunity to learn from the  experience of the states and the cities that have had to go first and have  had to deal with this hardest and without other examples of what to do from  inside this country. 

Joining us now is Jenny Durkan. She`s mayor of Seattle. She signed a  proclamation of civil emergency in her city back on March 3rd. 

Mayor Durkan, thank you so much for being with us. I appreciate you taking  the time. 

MAYOR JENNY DURKAN (D-WA):  Thank you, Rachel. Thanks for having me on. 

MADDOW:  Is it fair to say that you have been leading without a compass  here in some ways, that there haven`t been many examples from other places  in the U.S. and much leadership from the federal government in terms of how  to do -- and how to do what needed to be done in Seattle given how early  you had to face this and on such stark terms? 

DURKAN:  No question about it, Rachel. I mean, I heard your previous guest,  and when he said, you know, without testing you`re blind. That`s absolutely  was the case for us. By the time we had our first positive cases which  seems unbelievable was only 13 days ago -- 

MADDOW:  Wow. 

DURKAN:  -- we knew already there was a bigger problem, and we could not  get enough testing. 

Fortunately, we`re the home to some of the best scientists and researchers  and nonprofits, and so we put our scientist to work on it. They were able  to actually type the genome for the virus and do some genetic calculations.  From that, the governor, the county executive and I got really sobering  news. 

As of last Monday, their calculations were we had at least a thousand cases  and those cases would be doubling at least weekly, and that if we didn`t  take some big grave actions that by early April, April 7th, we`d have over  40,000 cases and 400 deaths. 

So, we have been really grounding our decisions based on the science and  what the scientists tell us to do to flatten out that curve that you just  showed all of your viewers and really making sure how do we -- it`s one of  the most complex things I`ve ever been involved in. To have to make  decisions on such a rapid pace looking at first how do you protect the  health care system? How do you protect those people most vulnerable in the  health care system, and how do you protect the people most vulnerable in  the economic system, and having to do that simultaneously with no compass  has been challenging.

But I can`t say enough about the work I`ve done with Governor Inslee and  our county executive, we`re speaking with one voice, and our front-line  health care workers have been astonishingly amazing through this whole  thing. 

MADDOW: How do you protect the health care system? If that modeling that  you just described is correct, if by less than a month from now, you`re  going to have 40,000 cases and we know that 15 to 20 percent of people get  seriously ill and need potentially hospitalization, how do you protect the  health care system to avoid over topping the number of ICU beds and  actually hospital beds that you need? How do you protect the capacity and  the people who provide the care within the system? 

DURKAN:  So I think you have to do a range of things. First, we had to take  those really significant interventions to really reduce the amount of  public gatherings because all the scientists say you want to change that  point of inflection to flatten that curve because if it grows so steeply,  that`s what really overwhelming the system. That`s what`s happening in  Italy. 

So the governor and us taking those interventions to have people work from  home, to cancel public gatherings, to really tell people what they need to  do to keep themselves safe. But the other thing we have to do -- and this  is where we still need help from the federal government, and I`m hoping the  federal emergency today helps us, is they need to have the basic equipment  that they need to do their jobs. And, for example, right now our hospital  workers and our first responders like our firefighters and our police are  running out of the protective equipment like goggles and masks and gowns  that they need to deliver the care safely. 

So each one of those things can become a fail point, and you`re really  trying to work to avoid those fail points in any one of your systems  because then you get the cascading events. So you work on the health care  side, and you also have to work on the economic side to make sure that  those people who are going to suffer most from the huge economic impacts  we`re going to see from this as a region and as a country that you build in  as much resiliency as you can. 

I will say this, Rachel -- we will get through this, Seattle will get  through it. Washington state and our country, will be a lot of pain and a  lot of suffering, but if we all act together and do the best we can, our  goal needs to be to come out together and to be strong and resilient at the  end of this, but there`s a lot of tough suffering that`s going to happen.  Between now and then, tough decisions that other people have to make. 

Today, I was on a call with over 100 mayors giving them some of the lessons  we`ve learned, and I think that that`s how we really move forward, and it`s  been hard not having that clear voice from the top so that all of America  knew but the seriousness of the threat that we face and what we can do to  protect ourselves. 

MADDOW:  Major Jenny Durkan of Seattle, you are in a unique place in this  country and a lot of people are going to be learning from your example and  watching how things unfold there. Thank you for taking time to help us  understand it. Thank you. 

DURKAN:  Thank you very much. 

MADDOW:  All right. We`ve got much more ahead tonight. Stay with us. 

(COMMERCIAL BREAK)

MADDOW:  This is Wuhan, China, on January 23rd of this year. 

You see an empty plot of land. It became a 24/7 around the clock  construction site, live streamed by the Chinese government as that site was  transformed into a fully functional 1,000 bed hospital that began accepting  patients ten days after they broke ground on building it, ten days, a whole  hospital up and running. 

Here in the U.S., we looked on with amazement at this incredible feat that  just seems completely unimaginable maybe anywhere other than China, but now  we`re belatedly starting to realize why the Chinese government might have  taken measures that extreme. 

In Washington state, as I just mentioned, King County recently bought an  84-bed motel to help combat what`s expected to be an impending hospital bed  shortage in Washington state. It will be a place to house people who need  to be isolated but not yet hospitalized. 

The state also set up RVs as a temporary set of quarantine sites. Again,  trying to preserve critical hospital beds for the expected crush. 

Yesterday, the governor of California issued an executive order that allows  the state to take over hotels and medical facilities. The state now has the  power to commandeer those places if need be if it wants to use them for  California`s response to the pandemic. 

Now, as the U.S. braces for the inevitable surge of new patients into our  already rather full hospitals, we`re also confronting the fact that we  probably should have made plans for this a long time ago, and that right  now is probably the golden hour at which we ought to be doing our last  minute shoring up of these kinds of facilities. 

One of the people who`s been warning about this fast-approach reality is  Jeremy Konyndyk who led the Obama`s administration response to national  disasters and was a key role -- played a key role in the response to the  Ebola epidemic during the Obama administration. He`s now a senior fellow at  the Center for Global Development.

Mr. Konyndyk, thank you very much for being here tonight. 

I first have to ask you -- you have a lot of Ys in your name, and I`ve been  practicing all day saying Konyndyk, but is that right? 

JEREMY KONYNDYK, CENTER FOR GLOBAL DEVELOPMENT SENIOR POLICY FELLOW:  You  nailed it. 

MADDOW:  First thing I`ve definitely nailed all week, thank you very much.  You just kept me alive for another three years. 

The president today announced a national emergency in response to the  coronavirus outbreak, a lot of people said that was overdue. A lot of  people were happy to hear him announce it. 

Do you think that was the right move to make here? What do you think of its  timing and its scope? 

KONYNDYK:  Yes, it was the right move to make several weeks ago, and a  number of the other things that they announced today would have been the  right move to make several weeks ago. You know, they`re finally announcing  measures to help shore up hospitals, taking the reins off the federal  government processes, saying it`s no longer time for business as usual. The  full measure of the federal government will be thrown at this problem.  That`s great. 

You know, we saw what happened in Wuhan in mid-January, the lockdown of  Wuhan started on January 23. We`ve had ample warning, and it`s amazing to  me that it`s only now they`re really beginning to act. 

MADDOW:  When the president gave his sort of ill-fated Oval Office address,  you said at the time that if you were making such an address, one of the  things that you would announce is that you had assigned the Army Corps of  Engineers to literally get out there and start building additional housing  capacity -- excuse me, additional hospital capacity in places where we  expect to have the first crush. 

Was that hyperbolic or do you really think that the U.S. should be  physically building new facilities or commandeering existing facilities to  try to save the hospitals?

KONYNDYK:  I think we need outside the box ideas. You know, China built  this 1,000-bed hospital, as you talked about. I don`t think we have the  ability to do that but ways to be creative. It could be the Army Corps  building or expanding facilities, setting up triage tents outside  hospitals. 

It could be reactivating old hospitals. We have a lot of shuttered  hospitals now in this country. There`s one just down the street from me  outside Washington D.C. We need that creative thinking.

And what`s so shocking and saddening is that we really have had two months  to be thinking about this and planning for this and now instead, we`re  scrambling. 

MADDOW:  You, as I mentioned, helped oversee the Obama administration`s  response to the Ebola outbreak in 2014. You`re the head of the USAID Office  of Foreign Disaster Assistance at the time. There`s been a lot of  lamentation over the fact that the president just did away with so much of  the pandemic preparedness that existed in the federal government, that was  created in part in response to the Ebola epidemic so we wouldn`t start from  zero when the next one came. 

KONYNDYK:  Yes.

MADDOW:  What can you tell us specifically about what the federal  government did in dealing with Ebola? What the federal government did right  that is missing from this administration`s response? 

KONYNDYK:  You know, there`s a lot we did right. There are things we did  wrong but I think what was fundamentally different was a check your math  mentally. You know, we were -- we were looking for the weak points in our  plan, the things that could derail us and undermine us and building back up  to that so that we weren`t vulnerable if something went wrong.

And that I think is what is so problematic about the testing issue, is that  it`s a little bit like the military going to war and through one satellite.  If that satellite goes down, you`re toast. 

Is that the fault of the satellite or is that the fault of you putting all  your eggs in that basket? That`s what happened with the testing. 

MADDOW:  Jeremy Konyndyk, senior policy fellow at the Center for Global  Development now, former head of foreign disaster assistance at USAID --  thanks for -- I mean, I want to thank you for what you`ve been doing as  just as a public intellectual and a public expert in terms of putting out  critical questions at this time but thanks also for making time to be here  tonight. Appreciate it. 

KONYNDYK:  I appreciate it.

MADDOW:  All right. We`ll be right back.

(COMMERCIAL BREAK)

MADDOW:  So heads up. One more thing to watch out for tonight, we`re  expecting a late night vote tonight in the House of Representatives. We got  word late night tonight lawmakers struck a deal with the White House,  maybe, for a coronavirus relief package. Among other things, it would  provide free of charge testing for the virus. As well as emergency leave  for all Americans, which my God, that`s the least they can do, right? 

The House is expected to vote on this bill sometime tonight, again, it is  supposedly been worked out with the White House. The bill after it gets  voted on is supposed to get zipped to the Senate. There, a vote is expected  as early as Monday. Yes, the Senate got sent home so they won`t get around  to it until Monday.

Keep in mind, the number of new infections scientists believe is doubling  every five or six days now. So time is of the essence and taking three days  off doesn`t make sense. But I guess time isn`t of the essence in the United  States Senate.

Watch this space. We do expect that House vote tonight. Here`s a thing you  should know, you should stick around for, though. Up next here live, our  colleagues at "THE LAST WORD" are going to offer a special edition of their  show on coronavirus where a team of doctors and others experts will be  answering your live questions. Tweet your questions to #MSNBCanswers or  email them to talk@MSNBC.com. 

So, that`s going to do it for me. But you should definitely stick around  for that live special.

Have an excellent weekend. Get some rest, stay strong, do what you love.  We`ll get through this. 

I`ll see you Monday. 

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