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Coronavirus cases TRANSCRIPT: 3/19/20, The Rachel Maddow Show

Guests: Beth Cameron, Marc Lipsitch, David Ho


CHRIS HAYES, MSNBC HOST, "ALL IN": This is not a small logistical feat  ahead of us. 

ROBERT REICH, FORMER LABOR SECRETARY: It`s not a small feat. But, look,  Chris, we are in a kind of, if you want to call it a New Deal or a war  mobilization or a depression, I mean, this is a time for big thinking and  big action. 

Now, it`s true we don`t have necessarily the most competent people in the  administration, but to say -- 

HAYES: Big action nonetheless.

REICH: But we have no choice. We`ve got to do it -- 

HAYES: Robert Reich, thank you very much. That is "ALL IN" for this  evening.

THE RACHEL MADDOW SHOW starts right now. 

Good evening, Rachel. 

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

Thanks to you at home for joining us this hour as well. Again, I ask for  your forbearance tonight if things look or sound a little different than  you are used to. We are still trying out new options and new technology in  new ways of working that are designed to keep this broadcast as resilient  as it can be even as almost everybody who works on it is dispersed with the  four winds. 

Tonight, I can tell you we`re going to be talking with one of the world`s  leading epidemiologists who runs the Center for Communicable Disease  Dynamics at Harvard School of Public Health. We are going to be speaking  with one of the world`s most accomplished scientists when it comes to  understanding viral dynamics and developing life-saving antiviral  treatment. 

The first results are the results of the first major study of a potential  drug treatment for coronavirus, was published today, the results of that  study were not good. But I want to hear from someone who knows these things  about treatment possibilities and also about possible technological  innovation that might get us some way forward on testing in this country. 

We`re also going to be speaking tonight with a PhD biologist who was the  White House official in charge of global health security and emerging  infectious disease threats under President Obama and under President Trump  for a while. I should tell you that she no longer has that job, and no one  has that job now because President Trump inexplicably eliminated that job  within the federal government for reasons that remain still unclear. But  she is going to be joining us here tonight.

All of those guests are going to be joining us over the course of this  hour. And that`s kind of a high-powered group of guests. I`m not saying  that to brag. I`m telling you that -- it tells you something about the  seriousness of this moment that we`re in, that people like that, people who  do work that important are all at the same time recognizing that they need  to stop their own work for a hot second because it`s very important that  they communicate with the public about what they know. 

Experts who are working at the highest levels on this crisis taking time to  tell the public what`s going on right now is a public service we should all  appreciate it. It`s humbling for me as somebody who owns this little piece  of public discourse to be able to bring them on. 

But, you know, people, particularly people who have special expertise are  really stepping up wherever they can and however they can. Here`s one small  example. Mayor of New York City made a public call for recently retired  doctors and nurses to please sign up for the city`s medical reserve corps.  So those recently retired doctors and nurses could be called on to report  for duty as we head into this emergency. 

More than 1,000 doctors and nurses responded within 24 hours of that call  and signed themselves up. New York City has gone from nearly 2,000  confirmed cases of coronavirus as of yesterday to nearly 4,000 confirmed  cases today. The number of cases in New York City more than doubled in one  day. The rise in cases in New York City is undoubtedly due to an increase  in testing, and specifically an increase in the processing of tests in New  York, but still, I mean, the numbers are what they are. 

New York City has again almost 4,000 cases. They`ve got more than 500  people hospitalized right now for coronavirus. Remember the rule of thumb  is that the demand for hospitalization including intensive care  hospitalization, it lags behind new infections by about three weeks. Three  weeks is about how long it takes, roughly, for people to go from getting  infected to potentially needing intensive hospital care. 

Keeping in mind that lag time is a really important single metric to keep  in mind when you think about the public health threat and why the reaction  to these rising cases in our country is as extreme as it is and probably  needs to be significantly more extreme. I mean, our ability to test as a  country is still so terrible. It`s still so bad compared to the rest of the  industrialized world that we really don`t have a grasp of how quickly  people are being newly infected in this country. 

But, you know, again, we`ve got some raw numbers. More than 500 people  hospitalized in New York City alone. Already 169 people in intensive care  units in New York City, while the number of confirmed cases just in that  one city is doubling per day. I mean, this is vertigo. This is standing on  the edge of the abyss in terms of understanding our capacity to continue to  treat sick people as the numbers rise. 

And the epidemic doesn`t have the same shape over the country. Some places  will be hit harder first. Some will be hit harder later. Some places  might`ve gotten serious enough about social distancing measures fast enough  to hold their part of the curve down further and longer than the rest of us  will suffer. 

But the nationwide picture is not good. The number of confirmed coronavirus  cases in the United States as a whole, the number of confirmed cases  doubled in the past two days in our country. And there remain places in the  country that aren`t doing much at all to try to slow down the number of  people getting infected, even know we know the infection is in all 50  states. 

Last night on this show, we highlighted seven states that were doing almost  nothing in terms of statewide measures to combat the spread of the disease.  I singled out Idaho, Mississippi, Missouri, Oklahoma, Tennessee, Texas, and  Wyoming. As I reported last night, these states stood out because even as  other states started to scale up their efforts and do their part, these  states had no statewide mandates to limit gatherings of any size, no  statewide mandates on bars or restaurants or any other businesses. No  statewide mandates on schools. 

Now, I should note, while Oklahoma was on that list last night, I was wrong  to say that last night Oklahoma hadn`t closed their schools. The state  board of education actually did order schools closed in Oklahoma earlier  this week. 

But Oklahoma is the state where the governor this weekend tweeted out a  picture of himself and his family at a crowded restaurant in Oklahoma City  bragging about how packed it was. And then his spokesman put out a  supportive statement saying the governor will continue to take his family  out to the dinner and the grocery store without living in fear and  encourages Oklahomans to do the same. 

Yes, they`re climbing down from that now. Schools are now closed in  Oklahoma. I should mention there is still no statewide order from the  governor limiting the size of gatherings from that state. There is still no  statewide order related to bars and other businesses. Some local  governments are making those decisions as best they can. But the state is  still basically AWOL. 

As of tonight, I should also mention that two of the five members of  Congress from Oklahoma are in quarantine after potential exposure to the  virus. I should also mention that the state`s corrections department, the  state prisons have announced in Oklahoma that new no longer accept any new  prisoners being transferred from county jails. So it`s not like they don`t  know they had a problem. 

Since we singled out those seven states that were lagging last night, three  of those states, Mississippi, Wyoming, and Texas this afternoon changed  course and decided finally for the first time they will institute some  statewide restrictions. 

That leaves Idaho, Missouri, and Tennessee, though, still, I guess, just  hoping for the best, assuming the best? Presuming it will be fine?  Presuming other people will take care of them? Or something? 

Meanwhile, in Pennsylvania tonight, the governor there ordered the closure  of all nonlife-sustaining businesses. Governor Tom Wolf today ordering  nonlife-sustaining businesses in Pennsylvania to close their physical  locations as of 8:00 p.m. today. Enforcement actions against businesses  that do not close physical locations will begin at 12:01 a.m. Saturday. So  midnight on Friday. 

The state says in terms of enforcement actions, any business that doesn`t  comply with the order to shut down will not only forfeit their ability to  receive any disaster relief. They may also be subject to having their  license yanked, violators the state says, quote, are subject to fines or  even imprisonment. 

So, you know, your results may vary depending on where you live and how on  the ball your state government is and how much they decided to follow the  early conservative media and presidential device that this was all a hoax  designed to flummox people, and it wasn`t a real pandemic. Your results may  vary depending on where you are in the country.

But I also want to show you something positive, where actually the only  footage I`ve got of it is from local news. And it`s strange because,  honestly, this is right now only a local story but it ought to be getting  national attention. I want to show you something important that is  happening finally in one corner of the country. The numbers nationwide  suggest that this ought to be happening in a ton of places around the  country right now. 

This is what you should want to see in your region in your city, in your  state. But so far, we only know of it happening in one place, in King  County, Washington. And the reason I can show you what`s happening there is  because we`ve got this report from King 5, which is the local NBC station  in that part of the country. 


UNIDENTIFIED FEMALE TV ANCHOR: King County is also taking action,  converting a soccer field near the shoreline pool on First Avenue Northeast  into a temporary 200-bed hospital. 

King 5`s Tony Black is live at that soccer field where significant progress  has already been made. 


REPORTER: Yes. Good evening to you, Joyce. 

When we got here earlier this afternoon, there wasn`t much up here beyond  just this fence and "closed" signs. And they have already made that  significant progress right now. 

Now, the city says that they have pledged to do their part to help this  global crisis. For some of the residents that we spoke with, they say they  get that, but this is still pretty weird. 

This soccer field is turning into a temporary hospital where King County  will send those who are sick with the coronavirus or who have been exposed  to it or could be. This is one of several locations King County has  mentioned they are working on as sites for those with the virus.  (INAUDIBLE) also have locations, but this is one of the first being built  to serve as a hospital. 


MADDOW: They`re building a field hospital on a soccer field. This is King  County, Washington. Part of the country that saw the first case, the first  death, the first large cluster of coronavirus cases, the first large number  of Americans being hospitalized. This is also the county that bought a  local hotel to use to try to protect their hospital capacity by having  somewhere else appropriately outfitted where they could house people who  needed to be isolated but who didn`t need to be hospitalized, at least not  yet. 

That first hotel they bought has 85 beds. They have since leased a second  motel that they are getting up and running for the same purposes as well.  And that same county now in one day put up the basic framing for what will  soon be a pop-up 200-bed hospital on a local sports field. 

In that county alone, in King County, Washington alone, they believe they  need 3,000 additional beds to support their hospital capacity. Rather than  wring their hands about it though or wait for the federal government to get  it together to start providing some sort of crash facilities, rather than  even waiting for clear direction to local officials about what to do, King  County is just getting on with it. They are building now themselves.

Two hundred beds will be on that soccer field soon. They`ve got more in  those requisitioned hotels and motels. And they`re still looking to build  or find more than 2,000 other beds. 

And they`re going to do it. I mean, they`re trying to get those beds up  right now right away. Buy them, repurpose them, build them right now.  Protect your hospitals because if your hospitals get to the point where  they cannot care for sick people anymore, the lived experience of the  epidemic in your community will pretty quickly turn Stone Age. 

King County, Washington, is doing it. Why aren`t more places in the country  doing that? It`s not like we don`t know what the start of the influx looks  like and feels like. 

In Massachusetts last night, we talked about how shortages of key equipment  were leading to breakdowns even in the conduct of the minimal testing that  we`re doing in this country. "The Boston Globe" reporting last night that  Massachusetts hospitals were rationing the availability of the coronavirus  test even when they had tests to give because they had a shortage of the  long swabs they need to take the samples that ultimately go to the testing  facilities. 

Well, they also need to take care of and protect health professionals when  they are administering those tests. Tonight, the Massachusetts Medical  Society, the professional association for doctors in the state, they put  out a statement saying that they cannot safely administer the tests they  have got even if they have got swabs and even if they have got tests,  because doctors in Massachusetts right now don`t have enough protective  gear to keep themselves safe, to keep themselves from getting infected  while they are administering these tests. 

Statement from the association, quote: The shortage of personal protective  equipment is a dire situation. If we have access to testing kits, we cannot  safely administer the test without appropriate PPE. To do so without  precaution would jeopardize the health and safety of our patients and the  health care workforce. 

Again, that`s the Massachusetts Medical Society tonight saying the lack of  protective gear for doctors is so dire, it means they right now cannot even  safely administer the test to people in the state of Massachusetts. 

Tonight, the president of Mass General in Boston, one of the great  hospitals in the world, put out a plea, I kid you not, for people who have  3D printers to please start 3D printing masks for doctors and health  workers to use at the hospitals. 

In Evansville, Indiana, tonight, one hospital is asking the public to fire  up their sewing machines and please start sewing CDC-compliant cloth face  masks for use at the hospital. They made a video of a person with a sewing  machine putting one together to show people how to sew one of these masks  that they might be able to use at your local hospital. They say they`re  going to sterilize the mask before they distribute them, but they have  literally published a sewing pattern to help people learn how to sew these  themselves and donate them, because that`s what the hospitals are down to. 

The vice president today at the White House and the president, both gave a  very cheery presentation about how millions of masks are available.  Everything`s fine with the masks. Yes, millions of masks coming online.  Yes, ask at the hospitals. 

Here`s the headline in "The New York Times" tonight. Quote: It feels like a  war zone. Doctors and nurses plead for masks on social media. Quote: As  supplies have dwindled, doctors and nurses have improvised ways to make  their stock last. 

An intensive care nurse in Illinois was told to make a mask last for five  days. An emergency room doctor in California said her colleagues had  started storing dirty masks in plastic containers to use again later with  different patients. A pediatrician in Washington state trying to make her  small stock last has been spraying each mask with alcohol after use until  the masks break down. 

Here`s a second story on the same freaking problem. Doctors and nurses  plead for masks and other equipment. Quote: The open cities community  health center in St. Paul, Minnesota, is considering shutting its doors  because of a dwindling supply of face masks. Doctors at Barnes Jewish  Hospital in St. Louis have been forced to perform invasive procedures with  loose-fitting surgical masks rather than the tight respirator masks  recommended by health agencies. 

At one Los Angeles emergency room, doctors examining a suspected  coronavirus patient were given a box of expired masks when they tried to  secure them to their faces the elastic bands snapped. With cases soaring,  doctors, nurses and other front-line medical workers across the U.S. are  confronting a dire shortage of masks, surgical gowns and eye gear to  protect them from the White House. 

At a White House briefing today, President Trump said millions of masks  were in production and that the federal government had made efforts to  address the shortages. But he said it was largely up to governors to deal  with the problem. Quote: The federal government isn`t supposed to be out  there buying vast amounts of items and shipping. We`re not a shipping  clerk, he said. The president said there were no immediate plans to  activate the Defense Production Act which authorizes presidents to take  extraordinary action to force American industry to ramp up production of  equipment needed for national security. The president said, quote, we hope  we are not going to need it. 

The president`s optimistic statements contrasted starkly with the situation  on the ground. 

Rebecca Bartles heads infection prevention efforts for Providence St.  Joseph hospital in Washington state. She said it was only a matter of days  before some of that system`s 51 hospitals and 800 clinics run out entirely  of personal protective equipment. She said, quote: We are on mile one of a  marathon. If we are out of protective equipment now, what does mile 25 look  like? 

I don`t know why at the White House today, they bragged about all these  millions of masks being available. I don`t know where they are counting  those millions. But the situation in the hospitals with the health care  providers who are already actually coping with patients and infection right  now, that`s the only place that the count matters. 

Again, the key thing to keep in mind here, if you`re going to keep one  metric in mind here for our country, keep this metric in mind, three weeks,  the three-week lag time between when people become newly infected and when  critical patients start turning up at the hospital highly infectious and in  need of intensive care. This is the rate of increase in new confirmed cases  in the United States right now. And that is still with us having an  absolutely ridiculously low number of tests being performed. 

But that`s the rate of increase that we`re seeing. And it`s all 50 states.  As a rule of thumb, the crush at the hospital starts three weeks after  initial infection. Look how fast those test results are rising. 

It is go time right now for heroic marshaling of resources to keep doctors  and nurses safe so they can stay on the job. It`s go time right now for  building out hospital overflow capacity. Building it, requisitioning it,  repurposing it, just doing it. Not just talking about it, doing it right  now. Now is the time this stuff needs to happen. 

Joining us now is somebody who knows what government can do in a situation  like this. Beth Cameron served as the senior director for global health  security and bio defense on the National Security Council. It`s essentially  the White House pandemic prevention office. She was there through the early  months of the Trump administration. But President Trump thereafter  shuttered that office a couple years ago, he closed it in 2018 for reasons  that remain to be explained. 

Beth Cameron is now the vice president for global biological programs and  policy at the Nuclear Threat Initiative. 

Dr. Cameron, thank you so much for taking the time to be with us. I really  appreciate it. 


MADDOW: First, let me just ask you if I said anything in those opening  remarks or in those reports that strike you as wrong or wrong-headed or  putting the wrong emphasis on anything. 

CAMERON: No. I think you`re absolutely right. I -- particularly right now I  am happy that the president invoked the Defense Production Act. But I am  really nervous about the need to actually implement that act because, as  you rightly said, we are seeing personal protective equipment shortages. We  are worried about ventilator shortages and also shortages of test kit  reagents like swabs that you mentioned as well. And this is really not just  a United States problem. It`s a global problem. 

And so, I also would like to see the United States leading, working with  partners and allies to address these shortages all over the world. 

MADDOW: One of the things that we`ve started to see requested or  recommended or asked about by some frontline health care providers who are,  you know, asking for help who are trying to raise the alarm about what`s  going on is the question of whether there ought to be or whether there  could be a federal role in essentially monitoring the personal protective  equipment needs around the country, figuring out where the need is most  acute, where the shortages are most dire and most consequential, and  coordinating some sort of federal role to make sure that the equipment that  we`ve got gets to the places where it is most needed. 

Is that the kind of thing that a federal coordinator working on something  like this could do? 

CAMERON: Yes. I absolutely think so. And I think that it`s something that a  White House pandemics office would be doing and should be doing. Not to be  the ones to actually monitor the actual numbers but to make sure that the  departments and agencies in the United States understood where the  shortages actually are, and hopefully the federal government and the  Department of Health and Human Services is doing that right now. 

I think it would be really, really important to understand exactly where  our supply chain is for personal protective equipment. I think there is a  disconnect between the numbers that we`re hearing in the press conferences  and the reports that we`re getting on the ground. I think it`s also  important for us to understand what the supply chain for personal  protective equipment is all over the world. 

The World Health Organization, the World Bank, the World Economic Forum  which is a group that brings together companies, are monitoring the supply  chain for personal protective equipment which is a global supply chain. And  so, it`s really important for us to understand where we can go to get more  personal protective equipment, where we can buy it from, and also really to  ramp up production and really to do it now. 

MADDOW: Let me ask you about the steps I described being taken in King  County, Washington, right now. King County obviously was hard hit early on.  They were coping with this in a way that places in the United States  weren`t. 

And they`ve made some decisions at the local level, I mean, obviously, in  coordination with the state, in coordination with the federal government to  a certain extent. But they`ve made their own decisions. They`ve taken over  motels and hotels. As of today, they started setting up a tent 200-bed  hospital on a local soccer field. I mean, this is local authorities taking  the initiative. They reportedly think they need 3,000 additional beds to  supplement their hospital capacity locally right now, and they are building  them out and finding them and repurposing them, dozens or hundreds of beds  at a time. 

Should there -- in other places around the country, people aren`t taking  the same kind of initiative. Should there be federal directives to get them  to do stuff like this? Should state and local official recognize that`s  going to come from the federal government and they just start doing it on  their own say so? 

CAMERON: I think there needs to be a lot more communication about what  exactly states should be doing and at what place in the crisis they should  be doing it. 

And so, one of the things that we`re working on with other organizations is  how to get decision support to states so people who are making the  decisions, mayors, governors, people in their offices because right now the  states are doing a lot of the leading. I think it`s encouraging to see  what`s happening in Seattle and King County and around the country. 

But I do think that there`s a lot of confusion that we`re hearing about  when to start pulling triggers on things like creating new field hospitals  to improve bed capacity or when they should be looking at school closures.  We were hearing that a few weeks ago before more states started closing  schools as a larger measure. So I do think that there is a role for the  federal government in providing not only really good public health guidance  which the CDC does provide but clear guidance to decision-makers at the  state and local level. 

I don`t think that they should be on their own. But right now they are  leading. 

MADDOW: They are leading in some of the best leadership in the country is  literally at a horizontal level from localities and states to look at each  other and find out who has the best ideas. 

Beth Cameron, former senior director for Global Health Security and bio  defense at the National Security Council, a job that I wish still existed.  She is now vice president for global and biological programs and policy at  the nuclear threat initiative. Thank you for being with us tonight. I  really appreciate you being here and sharing your expertise. 

CAMERON: Thanks so much for having me. 

MADDOW: All right. We`ve got much more to get to tonight. As I mentioned,  we are going to be speaking with one of the world`s leading  epidemiologists, plus one of the most accomplished antiviral therapeutic  researchers ever. One of the things that is not getting a lot of discussion  right now is a potential cure, a potential treatment for the disease caused  by the coronavirus. We`re going to get to that. 

Stay with us. 


MADDOW: Last night, we brought you some fascinating new reporting about a  company that now sort of as a matter of happenstance has ended up tracking  the coronavirus in real time in a way that I`m not sure anybody else is  able to. 

It`s a company called Kinsa Health that makes thermometers. Their  thermometers will take you temperature. They tell you whether or not you`re  running a fever. But you also hook them up to an app. 

Through that app they transmit the data about what temperature they are  taking of all Kinsa thermometer users around the country. They transmit  that data to the company. And Kinsa Health then puts that data on a map. 

And their thermometers are in over a million households nationwide. So  that`s over a million data points nationwide every time somebody uses those  thermometers. Through their maps they have been uncannily good at tracking  who has fevers around the country and what that translates to. 

In a normal year, that translates to them being really good at tracking  which Americans have the regular flu and where. They have these interactive  maps that have accurately predicted the spread of flu about two weeks  before the CDC is able to do so. 

Well, now, they are using the same technology to track the coronavirus in  real time. They are looking at what kind of fever data they`d expect to see  under normal cold and flu season conditions. And then they are comparing  that with the fever readings they are seeing now, ones that are over and  above what would be those normal conditions. 

What they find when they compare those two data sets just turned out to be  very helpful in identifying places where epidemiologists and public health  folks maybe ought to be looking, maybe where test efforts ought to be  directed, maybe preparations for people being hospitalized ought to be  geared up. 

Take a look at this map that is being regularly updated by Kinsa Health.  This is what it shows as of right now. And as you can right at the top, it  says it`s tracking atypical illness. That means it`s tracking fevers that  are higher than you would normally expect to see this time of year. 

And as you can see, Florida is kind of lit up on this map. It`s not the  only place but more than any other place. 

Florida has a particularly high amount of atypical fevers being reported  right now. And that`s just one data point, but it is striking, and it`s  worrying and it`s probably caused for public health attention. 

It`s particularly worrying to see stuff like this because we are relying on  data points like this one in the absence of real widespread testing in the  United States. It`s something that`s being radically ramped up in other  countries. 

Yesterday, for example, we talked about a town in northern Italy called Vo,  V-O. It`s the name of the town. There are only about 3,300 people in that  town but it was the site of the first coronavirus death in Italy. 

After that they decided they would do an experiment in the town and test  every single resident there. What they found was that some of the people  who came back as positive were completely asymptomatic. These are people  who would otherwise never have been tested had they kept to these rules  that say they should only test people who have symptoms. 

Had they not tested everyone they wouldn`t have found those positive but  asymptomatic people. Because they did test everyone, even the people who  were asymptomatic, they were able to isolate positive cases, all the  positive cases, with that information, the town has now gone days without  any new cases being reported there at all. 

Today, there is a sort of similar story out of the small nation of Iceland.  Iceland is now carrying out large-scale testing of its general population.  Already, they have tested a larger proportion of their citizens than any  other country on earth. The country`s chief epidemiologist says the goal  there is to try to find the actual prevalence of the virus in that  country`s population as a whole. 

Again, most countries are only testing symptomatic people or people thought  to have been exposed. In Iceland, they are trying to test everyone  including non-symptomatic people with no known exposure. Just like they did  in that little town in Italy. What they found in Iceland thus far is in  line with what they found in that little town in Italy. They are finding a  bunch of people who are testing positive who are non-symptomatic. In  Iceland, it`s about half the people who are testing positive are non- symptomatic. They would never be identified had they not been testing  everyone. 

More and more what we`re learning from the places that have tons of testing  is that asymptomatic people have it and can transmit it. The question is,  how do we in this country respond to that news, right? Could we live in  this country for a while as if we are all positive, just assuming that  we`re all positive? 

I mean, we`re not testing widely. We`re not even testing narrowly. We`re  not even testing nearly the number of people who have symptoms in this  country. If we can`t do mass surveillance testing where everybody who`s  positive is identified, should we, even those of us who are asymptomatic  assume that we`re positive and behave accordingly? 

Do we have the will as a country to do that? If we don`t, what`s the next  best thing? I have just the guy to ask. That`s next. 



GOV. GAVIN NEWSOM (D-CA): At the end of the day we`re one body. There`s a  mutuality and there`s a recognition of our interdependence that requires of  this moment that we direct a statewide order for people to stay at home.  That directive goes into force and effect this evening.

And we are confident that the people in the state of California will abide  by it. They`ll do the right thing. They`ll meet this moment, as they`ll  step up as they have over the course of the last number of weeks to protect  themselves, to protect their families and to protect the broader community  in this great state in the world that we reside in. I have confidence in  that. 


MADDOW: That`s the governor of California Gavin Newsom speaking just  moments ago announcing a remarkable order. California is a state of 40  million people. And the governor tonight has just ordered a stay-at-home  order statewide starting tonight. 

There had been an earlier order related specifically to Los Angeles, the  largest city in California. There had also been what they were calling a  shelter-in-place order in effect in the San Francisco Bay Area and multiple  counties around the San Francisco Bay Area. But now, California Governor  Gavin Newsom ordering statewide a stay-at-home order as of this evening  because of the coronavirus crisis. That`s just happened moments ago. 

Joining us now live is Dr. Marc Lipsitch. He`s the director of the Center  for Communicable Disease Dynamics at Harvard School of Public Health.

Professor Lipsitch, thank you very much for joining us tonight. I really  appreciate you making the time. 


MADDOW: Part of the reason that I wanted to talk with you is because you  issued some of the first public estimates that made -- sort of took my  breath away in terms of the amount of the existing population that could  ultimately become infected with this virus, also because recently you have  been saying very bluntly. There are two options for COVID-19 at the moment,  long-term social distancing or overwhelmed health care systems. 

I`m worried at this point that we are going to have both. 

LIPSITCH: Well, I think that is a real risk. And the statements you  described earlier about efforts to mobilize the country are both  encouraging where there is some progress and really discouraging that the  progress is not uniform and that the federal leadership does not seem to be  taking seriously the idea that we have to prepare not only for getting --  rapidly getting supplies of personal protective equipment and testing kits  and all of that but also for dealing with the disruption that this will  cause to people`s lives, the economy, their social well-being and other  things. So -- and education. 

So, there`s a lot to be done, and it feels as though individual places are  very hopeful like King County that you described earlier and other -- but  the general picture is really uneven. 

MADDOW: Let me ask you about this new announcement from California`s  governor. Obviously, California the most populous state in the country.  It`s also a massive place. We had seen local efforts, six counties around  San Francisco put in place a strict stay at home order. We then saw Palm  Springs do a similar order. 

Now we are seeing it announced by the governor tonight statewide. In New  York there`s been discussion about whether or not that should happen in New  York City, which has its numbers of cases absolutely skyrocketing and  already 500 people in the hospital heading toward 200 people in intensive  care already. The governor has said that he doesn`t want to do something  like that for New York state or for New York City. 

Do you think that those measures are warranted even though it may be hard  to sustain them in the long term? 

LIPSITCH: I think we need to pretty much pull out all the stops right now  in order to slow things down, in order to give us time to build up supplies  of all these things that we need to respond, and also in order to make an  informed decision about how we are going to manage this over the long term. 

This is a very long-term problem. If we do manage to slow the spread of the  infection, that means that we are in this position where we are waiting for  slowly to -- for cases slowly to occur so that we begin to build up  immunity in the population. But the more effective we are at slowing the  spread which we have to do to protect the health care system, the slower  that buildup of immunity will be. 

So we need to sort of slam on the brakes now in order to preclude an  overwhelming of intensive care as you described earlier. And then we need  to figure out ways to mitigate the problem, both the disease itself and the  consequences of the social distancing. 

MADDOW: One of the things that you`ve talked about is using the time that  we can earn ourselves, the time before health systems are overwhelmed. Use  that hopefully to try to innovate, to try to develop new ways that we don`t  know now of how to cope with it and how to try to lessen the impact. I  wonder if, in your thinking about this, you`re factoring into that the  possibility of an effective treatment, if not a cure, something that  lessens the severity of illness, something that might be able to keep  people out of the intensive care units. 

Is that something that you think we should reasonably hope for in terms of  our arsenal? 

LIPSITCH: Absolutely. I know there are a number of efforts to test existing  chemical entities, drugs, that have been approved as safe and effective for  other things. There are screening efforts of other chemical compounds  underway, and we don`t know what`s going to work and what`s not. 

I am cautiously hopeful that we will find something, that the research will  find something. But we have to slow things down enough so that has time to  occur. We also could do things like what Seattle is doing and expand our  hospital capacity and make a large effort to get a greater supply of  ventilators and other intensive care equipment. 

That would not only cushion the blow in the health care system, but our  models suggest it would also help to speed up the process of building up  immunity because we can afford to have more cases if we have greater health  care capacity. 

So, there are -- those are two of the issues. We also need to redouble our  efforts to get to a vaccine and think about new and innovative ways to test  those vaccines that may be faster. All of these are uncertain and each one  may not be -- may not pan out. But if we don`t try all these different  efforts, then we will be sorry that we haven`t. 

MADDOW: Marc Lipsitch, epidemiologist, the director of the Center of  Communicable Disease Dynamics at the Harvard School of Public Health --  thank you very much for your time tonight, sir. Thank you for work and for  taking time to talk to the public about it. I really appreciate it.

LIPSITCH: Thank you.

MADDOW: All right. Up next, one of the most -- one of the foremost doctors  in infectious disease, and particularly in antiviral medication joins us  live next. 

Stay with us. 


MADDOW: There is no vaccine. There is no treatment. 

And yet, the president inexplicably announced today in -- a malaria  medicine had been approved by the FDA as a treatment for coronavirus. It`s  not true, at all. That is not true. Not true. Not true, and it is insane  that the president of the United States would say something that false and  that irresponsible in the middle of a crisis this serious.

But let`s be clear, there is no approved treatment. There is no vaccine. 

"The New England Journal of Medicine" published results today of one study  of a potential treatment for seriously ill patients with coronavirus. This  is one of the first major studies so far. Unfortunately, it was not a  success. This was about the combination of two anti viral drugs used to  treat HIV. It turned out it has no efficacy against coronavirus.

The pandemic has evolved so rapidly that doctors and scientists are trying  a range of existing drugs, including antiviral drugs to see if they might  work. But so far, it hasn`t made a difference in mortality. 

The good news is this is only the beginning. This was just the first study.  It`s also good news some of the best scientists in the world are racing to  find effective treatments for coronaviruses. Scientists like Dr. David Ho.

Dr. Ho`s groundbreaking HIV research changed the course of the AIDS  epidemic in the 1990s. Now he`s leading a team of researchers at Colombia  University trying to find a cure for this coronavirus that has turned our  world upside down. 

Joining us is Dr. David Ho, scientific director and CEO of the Aaron  Diamond AIDS Research Center. 

Dr. Ho, welcome back to the program. It`s good to see you again. I`m sorry  we have to do this by Skype. 


MADDOW: Let me put a couple clear questions to you and you can tell me  whether they are the right questions to be asking. 

The first is, what the prospects are, into your mind, for developing  therapeutics -- treatment for this virus? Obviously, this first test today  published in the New England Journal of Medicine was a failure. But how do  you feel about the prospects of developing something that could save lives? 

HO: Well, in the long term I feel the prospects are good but,  unfortunately, we`re in the midst of an explosive outbreak and we need to  have solutions for patients now. So the idea of repurposing approved drugs  to apply to the most severely ill patients is the appropriate thing. But  this study you just cited is repurposing an HIV drug called lopinavir for  treating COVID-19. 

And as you read, it`s unsuccessful. It`s not all that surprising because we  knew the activity was rather low. 

And I think the president was referring to chloroquine which is a drug that  we take for malaria, particularly if one is traveling to regions that  endemic for that parasite. And it`s been reported to have low level  activity and there`s some flat-out statements made by Chinese scientists  and doctors that it was helpful, but it was helpful in maybe shortening the  course of the infection or course of the disease by a little bit, but there  is no evidence that it made a huge difference in terms of mortality or  survival. 

MADDOW: One of the reasons I wanted to come back to you on this looking at  that study today, is that you had talked about the kind of time frame that  we should have in mind if a new drug is found or if a drug is found that  was effective against coronavirus. If it turns out that a drug is found  that is repurposed for another purpose, something that has been tested and  proven effective in human patients for other conditions and it also works  against coronavirus, would that significantly shorten the amount of time it  would take to get something like that distributed if, in fact, that was the  path to a cure or an effective treatment? 

HO: Yes, for a licensed drug, then we could immediately apply it. But some  of the drugs that are not yet licensed but have gone through human testing,  for example, there is another drug called remdesivir which is being tested.  The rationale behind that usage is, in fact, higher and that remdesivir has  been shown to have activity against the SARS coronavirus, which is highly  related to COVID-19 and also against another coronavirus called MERS, and  there is two large clinical trials on going in mainland China and we should  have readout in the near future.

And if that should work, that drug could be scaled up reasonably quickly,  but repurposing a drug to be an effective agent against COVID-19, we would  have to be very, very lucky. I think the most effective drugs will be newly  discovered and that`s s going to take time. As we previously discussed,  that`s likely to take a year, 18 months or even two years. 

MADDOW: Dr. David Ho, scientific director and CEO of the Aaron Diamond AIDS  Research Center, a legend in the field of antiviral research -- sir, thank  you very much for your time tonight. I hope to talk to you whenever we can.  Thank you. 

HO: Thank you, Rachel. 

MADDOW: All right. We`ll be right back. Stay with us. 


MADDOW: Here is an advanced look at the front page of "The New York Times"  tomorrow. I think we got that that we can show you. Just a stark look how - - in terms of what the news is and what we`re facing.

In just a mom, seconds away from now, Lester Holt from NBC will be hosting  a special report on the coronavirus that will feature a number of important  guests including Anthony Fauci. You`re going to want to watch this. 

Stay with us. 

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