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Vast disparity TRANSCRIPT: 3/24/20, The Rachel Maddow Show

Guests: Inder Singh, Rebekah Gee

CHRIS HAYES, MSNBC HOST:  That is "ALL IN" for this evening. Good evening  Rachel. 

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

And thanks to you at home for joining us this hour. 

In Spain today, the main convention center in the city of Madrid has been  converted into a hospital. Spain has the second worst outbreak in Europe  right now after Italy. Hundreds of patients are already at this field  hospital that they have set up at the Madrid Convention Center. They expect  it`ll be 1,300 by the end of this week. They then expect to scale up that  facility to 5,500 patients as soon as they can at which point the  convention center in Madrid, Spain, will be one of the largest hospitals in  the entire world. 

Here`s "The New York Times" international chart of where countries are at  in their epidemics right now. This shows the death rates, the deaths  overtime in various countries. 

Country -- China, of course, is the country that has had this crisis the  longest. That`s their long navy blue line there. They obviously had a ton  of deaths that scaled up rapidly, but they have since flattened out their  death rate dramatically. 

You see Italy up there at the top in Europe with the worst epidemic now and  the worst one by far in Europe. 

And then you see Spain, close on Italy`s heels. And if you look at the  curve for Spain, it`s just on an incredibly steep curve. The total deaths  in Spain are doubling every three days. 

And you know what? Our curve is exactly the same shape as Spain`s right  now. We here in the United States have a curve that is worse than Italy`s  and that is exactly parallel with Spain. 

Our death rate is rising just as steeply as theirs is. Here in the United  States, our death rate is doubling every three days as well now. 

In Madrid, that worst-hit part of Spain, they have not only turned the  convention center into what will be one of the world`s largest hospitals,  they`ve turned the city`s ice rink into a huge morgue because normal  morgues cannot handle this kind of volume, not all at once, not like this. 

In our closest overseas ally in Great Britain, there was a slow start in  terms of government efforts to try to contain the virus. They unusually set  off on a sort of iconoclastic course where they weren`t going to try too  hard to stop it. They now have recognized that was a bad idea and they are  making up for lost time. In Britain, they are converted a big expo center  in East London from something that was called the ExCel Center to now what  will be a 4,000-bed mega hospital that instead will be called the NHS  Nightingale Hospital. 

The U.K. has asked former staff who used to work at the National Health  Service to please come back, please come back and work at the NHS again  because they are needed. 12,000 doctors and nurses and other health workers  in the U.K. have answered that call and said they will come back. 

In the U.K., they`re also moving final year med students and nursing  students out of schools and into service as front line health workers. The  British government has also asked for 250,000 British citizens to come  forward as volunteers, just people from the general population. They want a  quarter million British seasons to come forward to volunteer to support  their NHS, support the National Health Service there to keep it from  collapsing. 

And in the U.K., they are finally asking the public -- they`re now telling  the public that this is real and the time is now. Again, they had a very  slow start in Britain. Boris Johnson`s government had weird ideas about it  from the outset. But now, they have changed course and they are not messing  around. 

As of today, all non-essential public facilities are closed in Great  Britain, including things like churches, and libraries, and outdoor  playgrounds. Weddings are all cancelled. Baptisms are all cancelled. And  finally, in Britain, finally now, there is a national stay at home order. 

And the delay in Britain will prove to be costly. It`s probably this kind  of government action that we`re now seeing in Britain is probably too late  to have stopped a huge epidemic in the U.K. They had more than 80 deaths  announced in the past 24 hours. 

But taking these steps today is better than taking them tomorrow. Yesterday  would have been better than today. Last week would have been better than  yesterday. Last month would have been better than last week. But we do what  we can with the leadership that we have and the information that we have. 

In Baltimore, Maryland, today, Maryland`s governor toured the new field  hospital that`s been set up at the Baltimore Convention Center in a nearby  hotel. It`s been built with the help of the National Guard and the Army  Corps of Engineers. That`s going to be 900 beds, 1,400 more in the next  month. 

In Florida, where the response has been slow, there is not a statewide  stay-at-home order. They kept the beaches open for spring break partiers.  They closed them in sequence when they finally started to close them.  There`s a huge elderly population in Florida that may soon be encouraged by  the state`s government to maybe start staying home. 

But, hey, no rush. There`s still no statewide order to stay at home for  anybody or closing any non-essential businesses. But nevertheless, in  Miami-Dade, they know what`s coming. They did start putting up one new  field hospital in Miami-Dade. It`s at the fairgrounds where the Miami-Dade  youth fair was going to be held. That was cancelled. 

Now it`s going to be a hospital with 250 hospital beds, 250 beds. That --  that`s good. Florida may well end up needing tens of thousands of extra  hospital beds, but they`re starting with 250. Miami has at least started  putting drops in the bucket. The statewide response putters along and  Governor DeSantis in Florida says he doesn`t have to do more. 

The World Health Organization today said that the United States is  experiencing such a, quote, very large acceleration in coronavirus  infections right now that the United States could become the new epicenter  of the global pandemic. Why has that not resulted in a national level  response to try to slow it down? 

That -- I mean, historians will tell that better than we do. We all have  our suspicions. We can all tell how it looks. But there has not been a  national, unified effort to try to slow down this pandemic in this country. 

I mean, when "The Financial Times" in London posts its daily charts of how  various countries are fairing in this pandemic, they`re doing a great job  in terms of data visualization, and putting this information out there,  "The Financial Times" is posting their latest graphs with the stark little  notes about how the U.S. is doing. U.S. case count continues to set the  pace. U.S. death curve continues to steepen with no national lockdown,  right. We have no national policy on this at all. 

Even the surgeon general from the Trump administration appears to be  flummoxed that Americans don`t all have a national message, that we need to  be responding as a country, all of us, that we all now need to be subject  to the kinds of rules that will slow this thing down and ultimately in the  end save thousands, eventually tens of thousands, potentially hundreds of  thousands, potentially millions of American lives. 


DR. JEROME ADAMS, U.S. SURGEON GENERAL:  I want America to understand this  week it`s going to get bad. And we really need to come together as a  nation. I heard the story that you were just playing, young people out on  beaches. 

We see here in D.C. that the district set up a cam for people to watch  cherry blossoms. You look at the cam, you see more people walking around  than you see cherry blossoms. This is how the spread is occurring. And so,  we really, really -- 

SAVANNAH GUTHRIE, NBC NEWS ANCHOR:  You don`t think people are taking it  seriously? 

ADAMS:  I think that there are a lot of people who are doing the right  things, but I think that unfortunately we`re finding out a lot of people  think this can`t happen to them. Everyone needs to be taking the right  steps right now and that means stay at home. 


MADDOW:  Everybody needs to be taking the right steps. That means stay at  home. The surgeon general says we really, really -- he says really -- need  everyone to stay at home. Everyone, says the surgeon general of the United  States. 

But that is not the policy of the United States. Why would everybody stay  at home? 

One, if you live in Florida, for example, or Missouri or Mississippi, the  state`s governor in each of those states says he doesn`t feel like setting  that kind of rule. So why would you? 

I mean, there`s the surgeon general saying we really, really need everyone  to stay at home. Unfortunately, we`re finding out a lot of people think  this can`t happen to them. Everyone needs to be taking the right steps  right now. That means stay at home. Everyone. 

Well, you know who thinks it can`t happen to them? A lot of governors in  this country who are in control of what is happening in their states. And  they do not see it as a big enough problem to justify statewide action. 

In Missouri, for example, state medical association wrote to that state`s  governor today asking, basically begging for a statewide shelter in place  order. 

Quote: Dear Governor Parson, on behalf of the physicians and surgeons  practicing in Missouri, the Missouri State Medical Association requests the  enactment of a shelter in place requirement by executive order. 

We understand the interwoven policy issues at play during this critical  time. However, we now believe that a statewide shelter in place order is  the only way to curve the exponential spread of COVID-19 in Missouri. If  things progressed as is, COVID-19 patients will deplete the hospital beds,  and ventilators, and precious personal protective equipment. 

Any additional time without a shelter in place requirement wastes crucial  healthcare resources, including manpower. 

And listen to this, quote: As physicians, we understand our role as the  first line of defense against this virus. We accept the likelihood that a  number of physicians will contract COVID-19 while treating the citizens of  Missouri. Despite that known fact, we are prepared to carry out our  responsibilities for as long as needed. We ask for your assistance as we  begin this difficult journey. Signed, the Missouri State Medical  Association. 

Ball`s in your court, Missouri Governor Mike Parson. The doctors in your  state are basically begging you for their lives. But you do what you need  to do, sir. You -- you take your time in Missouri. 

You take your time in Mississippi where the governor is making this  brilliant argument about not taking action. Governor Tate Reeves today  Mississippi is not China. Mississippi`s never going to be China. 

Governor Reeves has an interesting view right now from his state, looking  either east or west. 

If he looks to the east, Alabama, he`s got the city of Birmingham, Alabama,  reporting as of tonight that they`ve got 45 coronavirus patients  hospitalized including 18 on ventilators just in Birmingham already.  There`s no statewide shelter in place order in Alabama yet either. 

But as of tonight, just a little while ago, at least -- at least -- even as  the state of Alabama will not act, at least the city of Birmingham will  have a stay at home order in place as of tonight because the mayor  requested it today of the city council. The city council needed to approve  it tonight for it to go into effect. And the vote tonight in Birmingham,  Alabama, was a unanimous yes. 


COUNCILOR JOHN HILLIARD (D), BIRMINGHAM, ALABAMA:  Just the other day,  Councilman Parker and several of the council people and ministers and  business people from around the city, we had a conversation with our county  health director and his words were we`re about to be hit by tsunami, a  tsunami. 

Now, I don`t know whether that ring a lot of bells to people, but he said  our hospital system will be overwhelmed. He said this will be equal to  World War II. Now, these are words I heard come out of his mouth. 

If that don`t scare you, I don`t know what will. That we have no other  choice but to put legislation such as this in place and move forward. 

You know, I love what I do. I enjoy what I do. I enjoy representing people.  But if I was just set for this time and moment and never came back again  and save one life, I would be able to sleep. 


MADDOW:  That is John Hilliard from the Birmingham, Alabama City Council. 

Birmingham City Council tonight voted to put in place a shelter in place,  stay at home order. Birmingham, Alabama, that one city already has 18  patients on ventilators already. And so, because of that city council, they  have a stay-at-home order tonight effective immediately. But statewide, eh,  don`t bother, still no order. I`m sure it`ll just stay in Birmingham. 

Next door in Mississippi, still no statewide order. The governor says we`re  not China. Why would we need some sort of statewide stay-at-home order?  Everything`s fine. 

Well, next door, further west in Louisiana, they think they`ve got the most  rapidly growing outbreak in the nation there. I`m sure it`ll stay confined  within state borders. I`m sure there`s nobody in Mississippi commuting to  work in New Orleans, right? That doesn`t happen, does it? 

Here`s the front page of "The Times-Picayune" today, New Orleans overlooked  despite high infection rates, not receiving national attention or  resources. This is a local paper in New Orleans basically screaming at the  top of their lungs about what is already starting to happen in New Orleans. 

This is put together by their data staff at "The Times-Picayune" in New  Orleans, pointing out that of the ten worst hit counties in the United  States so far, nine of those ten counties, yes, are in the New York  metropolitan area. The only one in the top ten that isn`t, the place with  the sixth highest rate of cases in the entire country is the great city of  New Orleans, Orleans Parish in Louisiana. 

The governor of Louisiana, John Bel Edwards, now saying that he expects  Louisiana hospitals to be overrun and to potentially be unable to provide  care as soon as the end of next week. 

There are already 94 people on ventilators in the state of Louisiana.  They`ve only got 381 ICU beds in the whole state. They`ve already got 94  ventilators in use. 

State of Louisiana`s now asking for a federal disaster declaration. They  believe they have the fastest growing outbreak in the country. There is a  statewide stay at home order in effect in Louisiana. They are starting to  build isolation facilities inside state parks. They are begging the White  House for federal assistance. That`s Louisiana. 

Next door in Mississippi though, you know, no worries. They`re not China.  Whatever`s happening in Birmingham, Alabama, whatever`s happening in New  Orleans, I`m sure Mississippi will be fine. They`re not China. 

In what is dramatically the worst-hit state in the state already, New  York`s governor today continued announcing what the state of New York is  doing to try to cope with the thousands of people already hospitalized and  the ICUs already filling up. We actually just got data before we got on the  air tonight, newly updated data from New York City. 

As of tonight, just before we got on the air, in New York City, there are  15,597 known cases in New York City. In New York City alone, 2,850 people  already hospitalized. In New York City alone, 660 people already in ICUs. 

Today, in addition to explaining what New York is doing to respond as the  hardest hit place in the country as one of the epicenters of the epidemic  worldwide, New York`s Governor Andrew Cuomo also continued what is  basically now becoming a significant part of his daily job which is  explaining what`s going on in plain language to the American people because  the capital of the United States for this crisis has to be in New York and  not in Washington, then that is our fate. So be it. 


GOVERNOR ANDREW CUOMO (D), NEW YORK:  We have to be smarter about the way  this is being done. The federal government has to prioritize the resources.  Look at where the problems are across this nation. California has 2,800  cases. Washington state, 2,200 cases. Florida, 1,200 cases. Massachusetts,  about 800 cases. 

New York, there`s 25,000 cases. New York has 25,000 cases. It has ten times  the problem that California has, ten times the problem that Washington  state has. You prioritize resources and your activity and your actions to  where they are needed. 

And New York, you are looking at a problem that is of a totally different  magnitude and dimension. The problem is the volume, dealing with 2,000  cases is one thing. Two thousand cases, frankly we could deal with in this  building with the capacity that we`re providing. 

We have 25,000 cases. We need the federal help, and we need the federal  help now. Also, there is a smart way to do this. Deploy the ventilators  around the country as they are needed. 

Different regions have different curves of the infection. New York is the  canary in the coal mine. New York is going first. We have the highest and  the fastest rate of infection. 

What happens to New York is going to wind up happening to California and  Washington state and Illinois. It`s just a matter of time. We`re just  getting there first. 

Deal with the issue here. Deploy the resources. Deploy the ventilators here  in New York for our apex and then after the apex passes here -- once we`re  past that critical point, deploy the ventilators to the other parts of the  country where they are needed. 

I`m not asking for 20,000 ventilators and they stay in New York and they  live in New York and change their residence. As soon as we finish with the  ventilators, then you move them to the next part of the country that has  the critical problem. And then after that region hits its apex, then you  move to the next part of the country that has its critical problems. 

I will take personal responsibility for transporting the 20,000 ventilators  anywhere in this country that they want once we are past our apex. But  don`t leave them sitting in a stockpile and say, well, we`re going to wait  to see how we allocate them across the country. That`s not how this works. 

They`re not simultaneous apexes. They are a curve that is individual to  that region. Deploy to that region, address that region, and then move on  to the next. And I`m not only talking about ventilators. 

We get past the apex, we get over that curve, that curve starts to come  down, we get to a level where we can handle it. I`ll send ventilators. I`ll  send health care workers. I`ll send our professionals who dealt with it and  who know all around the country. And that`s how this should be done. 

You know it`s going to be on a different calendar. It`s going to be a  different sequence. Let`s help each other. New York because New York is  first. And then after New York and after the curve breaks in New York,  let`s all rush to whoever is second. And then let`s all rush to whoever`s  third, and let`s learn from each other and help each other. 

If the federal government said today, I will deploy all 20,000 ventilators,  it will take us two weeks to get those ventilators into hospitals and to  create ICU beds and to locate the staff so there is no time to waste. The  time to do this is now. 

FEMA is sending us 400 ventilators. This was on the news this morning. We  are sending 400 ventilators to New York. 

Four hundred ventilators? I need 30,000 ventilators. You want a pat on the  back for sending 400 ventilators? What are we going to do with 400  ventilators when we need 30,000 ventilators? 

You`re missing the magnitude of the problem, and the problem is defined by  the magnitude. 


MADDOW:  The problem is defined by the magnitude. 

After that today from the president of the coronavirus response, Andrew  Cuomo, governor of New York, Vice President Mike Pence in Washington did  announce that the federal government will send ventilators to New York from  the national stockpile, 2,000 today, 2,000 tomorrow. Good start. 

Good start. But as the governor says, New York expects to need 30,000  ventilators. 

All right. We`ve got more ahead tonight, including something that we`ve got  for you after the break which is data I`m quite sure you have not seen  about how these stay-at-home orders may be working in real time to slow  this thing down. 

It`s new data. You`re going to want to see this next. Stay with us. 


CUOMO: What is happening in New York is not a New York phenomenon, right?  People in New York don`t have a different immune system than other  Americans. It`s not higher in New York because we are New Yorkers. 

It`s higher in New York because it started here first, because we have  global travelers coming here first, because we have more density than most  places. But you will see this in cities all across the country. And you  will see this in suburban communities all across the country. 

We are just a test case. We are just a test case. And that`s how the nation  should look at it. 

Look at us today. Where we are today, you will be in three weeks or four  weeks or five weeks or six weeks. We are your future. And what we do here  will chart the course for what we do in your city and in your community. 

I`m not asking you to help New York just to help New York. I`m asking you  to help New York to help yourselves. Let`s learn how to do it right and  let`s learn how to do it right here. 

And let`s learn how to act as one nation and let`s learn how to act as one  nation here. And we learn the lesson here, we will save lives in your  community. I promise you that. 



MADDOW:  Even as some states continue to insist that they don`t need them,  tonight, we have new data that shows how these stay-at-home rules that are  increasingly being imposed around the country, how they may be working to  slow down the spread of this virus. It`s a very preliminary look, just  looking at a very specific health related data point. 

But look at this, watch this. This is an animation that shows the share of  the population with flu-like illnesses, meaning people who are registering  fevers, in two different counties here in the United States. The blue line  shows Santa Clara County in California. The purple line shows Miami-Dade  County in Florida. 

As you can see, Santa Clara County, there`s a little timeline insert there.  Santa Clara County started taking action against coronavirus early. By  February 10th, Santa Clara county had declared a state of emergency over  the virus. By March 5th, the county issued work from home guidance. On  March 9th, there were further restrictions. 

Shortly after that point you started to see a new downward trend in the  share of the population with flu-like illnesses, with fevers. That downward  trend became more precipitous after further measures were put in place,  after schools were closed and a shelter in place stay at home rule was put  into place. That`s the blue line. 

Look at the purple line now. Look at what happened to Miami-Dade over the  same period. In Miami-Dade County in Florida, they didn`t take any action  until March 12th when they issued their state of emergency. In that county,  cases continued to rise. Didn`t start to fall until after several days  later, until after the schools were closed, as well as restaurants and  bars. 

But once they did institute those further measures, the curve started to  bend down. Fewer people started to get fevers. Fewer people started to get  sick. 

Two different counties, two very different outcomes, right, depending on  the speed at which they handle the virus. Both showing signs that public  policy to keep people apart, public policy to keep people at home has an  impact as long as you actually go ahead and do it. 

Here`s another animation. This shows the share of the population with flu- like illnesses in New York County which means Manhattan and New York City.  It also shows the cumulative effect social distancing measures can have in  slowing down the spread of the virus. It took the declaring of state of  emergency, restricting public gatherings, finally closing schools and  restaurants. 

But ultimately because of those measures, it looks like a share of the  population with new flu-like illnesses starting to decline at least  according to this very specific data which measures peoples` temperatures  as they take them in real time. 

This data is from a company called Kinsa Health. Last week I told you about  them on the show. They make these smart thermometers that link to an app on  your phone. Turn it on. Turn on the app. You take your temperature. 

It uploads your temperature anywhere where are to the company. The company  tracks who has fevers all over the country. And their latest data appears  to show that social distancing measures make a difference, that they work  when they`re implemented and the numbers just keep rising if you don`t  implement them. 

But their data which again is very specific, it`s literally just them  mapping fevers around the country and statistically dropping out from that  data what you would expect from a normal cold and flu season. Their data,  their fever map of atypical what you wouldn`t expect for this time of year  fevers, this heat map that they`re able to project for the country, it also  ends up putting a bit of a bull`s eye on places should be more concerned  about than public policy should suggest. 

Take a look at this map regularly updated, again, by Kinsa Health. This  tracks, as a said, atypical illness which means they look at fever. They  look at temperature readings. They look at fevers all over the country from  people using these thermometers and they drop out the day that that you  would expect to see this time of year from a normal cold and flu season. 

What`s the atypical illness that`s left after you drop out the normal  expected data from this time of a year in a normal year? Well, this is  atypical illness. This is atypical fever. 

And as you can see, there`s one part of the country that`s lit up and it is  not the only place where you see atypical illness. You see that orange  around New York, for example. 

But there`s more and it`s more acute in Florida than any other place. For  the past several days, people reporting in this one data tracker in Florida  have logged a particularly high number of atypical fevers. And yes, that is  just one data point. 

But if I were the state of Florida, this would ring like an alarm bell,  especially since their governor isn`t even taking the steps that other  states are taking yet to try to slow this thing, even with that state`s  huge elderly population. 

What should we make of data like this? How should we understand its  limitations and what it can help us project in terms of needs and need for  attention? 

Joining us now is Inder Singh. He`s the founder and CEO of Kinsa Health,  which is the company behind this data. 

Mr. Singh, thanks very much for being here on the show tonight. 

First, let me ask you if I`ve explained anything wrong or in a wrong-headed  way in terms of what your company`s doing what this data seems to shows. 

INDER SINGH, FOUNDER AND CEO, KINSA HEALTH:  Rachel, you got it exactly  right. Thank you for explaining it so well. 

MADDOW:  In these new animations, you line up official restrictions and  shutdowns with what appears to be a decrease in fevers reported to you by  individuals in specific parts of the country. And I know you`re tracking  fevers, not tracking coronavirus cases specifically. But what can you tell  us about the correlation between these fevers that you`re able to document  and the epidemic that we`re all tracking. 

SINGH:  Yes. So, that`s right. We`re tracking febrile illness. So, it could  be flu. It could be cold. 

But I think you explained well that we`re doing subtracting out the  normally expected cold and flu to get that atypical illness. What we saw in  Florida was a massive rise in atypical illness over the course of about a  week and a half, a significant slope, way above what you would normally  expect, more than 2X in most instances what you would normally expect.

And that has me worried, right? Because Florida`s got vulnerable  populations. The demographics are such that they have a lot of vulnerable  populations. They have elderly people. And that time frame between when  they started implementing social distancing activities and when you saw the  fever start to curve off and diminish, well, that`s a significant time for  spreading illness. 

My fear is that in two week`s time, you`re going to see massive case  numbers in Florida. I can`t imagine the difficulty that governors and  mayors have in making these decisions to pick someone`s livelihood versus  saving lives. I can`t imagine how they`re making decisions with such  limited data. 

This is one tool that gives you feedback. Whether your actions are breaking  the chain of infection in communities or whether they`re not. And what  we`re clearly seeing with this data is that for locations that have  implemented aggressive social distancing, shelter in place, stay at home,  they are clearly breaking the chain of infection. They`re breaking the  chain of infection for cold and flu and they`re breaking the chain of  infection for COVID. 

And what you ultimately want to see is you want to ultimately this see go  to zero. You want to see there is no additional febrile illness in a  location and that`s a sign you`ve almost completely broken the chain of  infection. 

MADDOW:  Let me just ask you. We first talked about your company and this  interesting stream of data that you`re producing and how it relates to this  illness, relates to this epidemic a few days ago. And we started looking at  that map that you`re posting online and regularly updating. 

And it was immediately evident that Florida had something going on  according to that data. Is there any possibility that there is statistical  noise in the data, that there`s a disproportionately large or small numbers  of your thermometers in Florida, that there could be something different  about the way that state is uploading data that makes it look different  even if nothing all that different is really happening? 

SINGH:  We`ve been mapping illness for eight years. There`s a whole body of  literature out there around how w contract and predict flu. It`s possible  that the actual numbers are not perfect, of course, because we only have a  sample of the population. But what we`re clearly seeing is community spread  of illness. It`s very clear. 

When we launched this site on Thursday, we were very, very nervous and  shared with it a number of scientists and public health colleagues in  advance. We were very nervous to get it out there but we thought it was the  right thing to do. It was the moral imperative to get this day that out  there because of what we were seeing. 

Only five days before we launched it, we were on a call with three very  senior public health colleagues and, you know, they said, hey, you know,  the methods sound -- they seem sound, but what you`re showing me on this  map is, I don`t know if it`s credible. We`re seeing Florida and the  northeast light up. At that particular time there were not a lot of cases  of coronavirus in those areas. 

And they cautioned us. Lo and behold, three days later, we saw a ton of  cases in those areas start to compile, start to pile up. So, what we did  internally, our data scientists ran a couple of models so say let`s look at  the correlation between hotspots that we`re identifying and COVID cases.  And the correlation is very, very strong. 

And the intuition is obvious, right? When you see spikes and clusters of  people that are having fever, clearly there`s an outbreak of some sort. The  whole point of that happen is to say, hey, let`s put a flash light on that  particular location, send the test kits in, send the virologists in. Find  out what`s going on, and we need to be doing that in Florida, and we need  to be doing that in Florida faster. 

MADDOW:  Interesting. Founder and CEO of Kinsa Health, publishers of, which is that map that we`ve been showing in real time  here on the screen. Thanks very much for your time this evening.

I hope you`ll keep us apprised as things changed. It`s fascinating as a  source of data and I hope more public officials start looking at it. Thank  you, sir. 

SINGH:  Thank you. 

MADDOW:  And I will say, just for us as civilians who are not the ones who  are making these decisions on public health grounds, seeing not just places  to worry about in that heat map, but also seeing those changes overtime,  seeing the re restrictions that we`re all; living under, seeing -- well, a  lot of us are living under, seeing that get put into place, and seeing that  bend the curve down in terms of new illnesses in places that are subject to  new stay-at-home orders, new school closure orders, new state of emergency,  anything else that`s keeping things apart from each other and socially  distanced, seeing it make a difference in terms of people getting newly  infected to me is motivating. It`s not an abstract thing. It`s not  something that I need to imagine in terms of the people I can see around me  and what I imagine in term of my own potential role as a vector. 

Seeing those numbers drop when those policies go into effect is motivating.  It at least is for me and I really hope that it is too for public officials  who have authority in cases like this and who have decided thus far that  they don`t care enough to act. 

Stay with us. 


MADDOW:  This is the headline in "The Detroit News" tonight. Beaumont nears  capacity, 635 hospitalized for COVID-19 with limited ventilators. 

Beaumont is the great state of Michigan`s largest health care system. And  tonight, Beaumont is announcing that already, its eight hospitals are,  quote, near capacity for staffing, protective equipment, and ventilators. 

As a result, Beaumont, that Michigan hospital system, says it has started  transferring patients between hospitals to try to find space and they`re  beginning to convert some operating rooms into intensive care units.  Beaumont says while it currently does have enough ventilators to treat its  seriously ill patients, quote, that could change as more people become  infected. 

Again, that`s Michigan`s largest health care system. As of this evening,  Michigan has 1,791 confirmed cases. That`s fifth most in the country behind  New York, New Jersey, California, and then Washington. 

Also tonight, we are hearing alarm bells from the great state of Georgia  where they are closing in on their first thousand cases. Excuse me, their  first 1,100 cases. The head of the hospital in Albany, Georgia which is  southwest Georgia says tonight that after this three of their intensive  care units filled up, they improvised a fourth unit for non-COVID patients,  a fourth unit with ten additional beds but that one has already hit  capacity. 

And so, Phoebe Putney Hospital in southwest Georgia says they have had to  start discharging patients to make room for sicker ones who are coming in.  That`s just a snapshot tonight. 

Michigan, Georgia, just a couple of the many states where hospitals are  already closing in fast on their maximum capacity, where they`re already  asking for help. 

But then there`s one southern state where the number of new cases, they  believe, is rising faster than anywhere else in the world. And it may be  traceable to a specific celebration, a specific event late last month. That  story`s next. 


MADDOW:  Two weeks ago, the great state of Louisiana had zero confirmed  cases of COVID-19. Now, according to a new study by the University of  Louisiana, the number of cases in that state has risen faster than anywhere  else known in the world. 

Louisiana has gone from zero cases to 1,388 cases in two weeks. The New  Orleans Metropolitan area now has more cases than Los Angeles County, which  has a population 26 times as large as New Orleans.

Bel Edwards is asking for a federal disaster declaration, warning now that  per state projections in New Orleans, the current projections of  hospitalization significantly exceed capacity beginning on April 4th, which  means New Orleans won`t be able to continue to provide hospital care at the  end of next week. 

Some Louisiana officials say that Mardi Gras celebrations last month may  have been sort of a virological accelerant in Louisiana when 1.4 million  people flooded into the city to party and parade through the streets at a  time we now know coronavirus was spreading in the United States. 

Among doctors worried that Mardi Gras in New Orleans this year may have  been that kind of a problem is Dr. Rebekah Gee. She until recently was head  of the state`s health department. She`s now the CEO of the LSU health  services. 

Dr. Gee joins us now from Louisiana. 

Doctor, I appreciate you making time tonight. Thank you. 


MADDOW:  What do you make of the governor`s stark projection that in New  Orleans at least hospital capacity may be over-topped by the end of next  week?

GEE:  Yes, Rachel, as you just mentioned, Mardi Gras was the perfect storm  for spread of this virus. We now know that this virus is incredibly  infectious. You can get it not just from coughing or sneezing on someone  but breathing or standing next to them. Not only did we have people in  floats but people in parties, people from all over the world came here, and  we now know that people who came here and left from here have now spread  the virus to other parts, so we have documentation that the virus was here  at that time. 

Unfortunately people were throwing beads, sharing drinks. They weren`t only  throwing beads, but likely throwing COVID-19 and people were catching that  as they came here for the celebration. So because of that we have the worst  problem in terms of the number of cases moving fast at 68 percent nearly  increase in two weeks, which is higher than L.A., and higher than Italy. 

So the projections are real projections based on the experience of other  places, and need to be taken seriously. 

MADDOW:  What is -- how would you assess the hospital capacity in  Louisiana? Louisiana`s not a wealthy state. You head up one of the flagship  -- the flagship university health system in the state. You`re a former  secretary of Louisiana health department. 

What should we understand around the country if Louisiana does have a  rapidly, rapidly increasing epidemic that`s already of considerable size,  how much capacity is there in the state to continue to care for people  while the number of patients rise? 

GEE:  Right now, our hospitals are about 50 percent capacity. And we  estimate that we have about 380 additional ICU beds. Systems like Ochsner  and LCMC are trying to build capacity. 

And certainly bed capacity and then availability of ventilators is a  problem, but we`re also really worried about staff. We only have a certain  number of pulmonologists, critical care nurses, and so on in the state of  Louisiana, and we don`t have enough of those to meet the need that we`re  going to have when this surges, which will be in approximately two weeks or  when the governor said in early April when we`re going to run out of bed  capacity. 

And so, that`s why the major declaration of disaster is so important. That  California and New York and Washington have received, so that we can start  to get federal assets deployed here. We simply don`t have enough here. 

Now, Louisiana does have a lot of health care assets. They`re mostly in  southern Louisiana which is bad when you have a hurricane season and you  have a storm coming to hit you, but good in this case because they are  located near where the people who are getting sick are, which is in the  Greater New Orleans area. Of course, elsewhere in Louisiana people are  sick, but the majority here, again, because of Mardi Gras. 

MADDOW:  In terms of staffing, we reached out to a number of nurses today  in Louisiana, trying to get our heads around what`s happening, what the  ground truth is in New Orleans hospital. We started hearing anecdotally  about reports already, about there not being enough protective equipment,  about nurses not having access to enough masks, about nurses being worried  not being able to protect themselves and potentially bringing this home to  their families. 

Do you feel like the state has a handle on how to get after some of those  problems that are already manifesting in emergency rooms and wards around  the state? 

GEE:  Well, this is a big problem and it really is a supply chain issue.  And I spoke with Senator Cassidy about this, this evening. You know, the  fact that normally you have supply chains from China that allows hospitals  to get what they need, but now is disrupted because you have individuals  who are price gouging, buying up hundreds of thousands or a million masks  in one case last week, much of which I spent sourcing masks, and that  disrupts the ability of normal supply chain. 

That being said, people are resorting in New Orleans now to making masks in  a furniture store. Goodwin Furniture using 3D printers to print face  screens. And right now, things are okay but the estimates are we`re about  four or five days in some systems from being out of personal protective  equipment, and today, people are reusing their personal protective  equipment, PPE, or masks, being instructed to in some settings put them in  a paper bag at the end of the day and reuse it the next day. That would  never happen in normal conditions. 

MADDOW:  Dr. Rebekah Gee, CEO of LSU Healthcare Services, until recently  secretary of Louisiana Health Department -- thank you for joining us. Keep  us apprised, Doctor. Thank you. 

GEE:  Thank you. 

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


MADDOW:  Just a quick heads up. On tomorrow night`s show, we`re going to be  reporting on a pilot project that is starting up in one American county  that aims to test every single person in that county for coronavirus. This  is along the lines of what they`ve been doing in Iceland already where  they`ve had fascinating results. 

One U.S. County is going to try that same kind of project starting  tomorrow, a universal testing pilot project that starts tomorrow. We`re  going to have a report for you on that tomorrow night. I will see you then. 


Good evening, Lawrence.

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