COVID-19-stricken TRANSCRIPT: 3/31/20, The Rachel Maddow Show

Guests: Christopher Murray, Nick Vyas, Ray Mabus

CHRIS HAYES, MSNBC HOST:  All right. Judy Sheridan-Gonzalez, thank you so much both for coming on tonight and the work that you and all your colleagues are doing. I really appreciate it.

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.

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

The United States now has over 186,000 cases of coronavirus. More than 3,800 Americans are dead. That means that the United States has now surpassed the number of deaths that China reports that it suffered from the coronavirus.

Today, at the White House, the president and Dr. Tony Fauci and Dr. Deborah Birx, from the coronavirus task force showed off this graphic which projects 1.5 million to 2.2 million Americans could die from the virus. But the hope is with policy intervention to keep Americans at home, policy intervention to slow the spread of the virus, the hope is that the number of American deaths, if we`re lucky, could be more in the range of 100,000 to 240,000. That is essentially the goal, as described today by the Trump administration. If all goes well, somewhere between 100,000 and 240,000 Americans will die here. And that is if the United States somehow gets more serious about preventing people from getting it, preventing people from passing it on.

Right now, here`s the national projection graph showing the U.S. trajectory of new cases versus other countries in the world. This is from "The Financial Times". At the "FT", their data visualization team aggregates this data from all over the world. They put out new graphs every day.

And you can see the U.S. here is in pink, right at the top. Our trajectory is the worst in the world by a considerable amount in terms of the rapid increase of new cases. Interesting though, look at Italy on this same graph.

We -- Italy`s the sort of gray line there. We reported over the last week and a half that Italy was starting to see a slowdown, what appeared to be a slowdown in the rate of growth of their new cases every day. Italy finally last week dropped from double digit daily growth new cases into single digits. Then for a few days we noted they sustained only single digit growth in their new cases.

Well, now Italy is finally reporting that their numbers of new cases are dropping each day from the day before which means finally that Italy is rounding the curve. God bless them.

We here in the United States are not rounding the curve. And there`s a lot to talk about. There`s a lot going on. There`s a lot of crises that are coming to a head.

We`re going to be talking tonight about the U.S. aircraft carrier that has more than 100 U.S. sailors on board who have tested positive. The captain of that nuclear-powered aircraft carrier is now calling for help and looking for a place to onshore his 4,000-sailor crew.

We`re going to be talking tonight about Walmart, the gigantic low-wage retailer that is going to start temperature screening their employees when they arrive at work every day, something that is a remarkable step at this point frankly only because it`s Walmart that`s starting to do it when the rest of the country still can`t get it together to take steps like that. We`re going to be talking tonight about the ongoing and very bad situation in New York where just in the past 24 hours and just in New York City, 182 people died of coronavirus over a 24-hour period. That means in our nation`s largest city, one American is dying from coronavirus about every eight minutes, a little faster than every eight minutes.

A field hospital opened up on the East Meadow in New York`s Central Park today. The Javits Convention Center is open as a field hospital now too. The navy hospital ship Comfort has docked in New York harbor.

Today, they also said that the huge stadium complex at the U.S. open tennis facility, the place they play the U.S. open every year, is also going to be set up as a temporary hospital with hundreds of beds. Even so, New York says with all the building out and all the finagling they have done of all these temporary hospital facilities, New York has only been able to up its hospital capacity from 53,000 beds before this all started to about 75,000 beds.

And while that is a gigantic increase, the state`s governor today says that their models show that even with that increase, the state`s already -- it`s still looking to be about 50 percent short of where they need to be, the projection showing that New York is going to need the capacity to hospitalize 140,000 people all at once, 140,000 hospital beds in simultaneous occupancy. So, going from 53,000 to 75,000 is great, but you`ve still got a ways to go.

The TFC center, which is the huge convention center in Detroit, Michigan, that`s being built out now as a 1,000-bed hospital. The New Orleans convention center will have a thousand hospital beds up and running by Sunday and then another thousand beds on top of that by three weeks from today. In Illinois, Chicago`s McCormick place, which is the largest convention center in North America, they are converting McCormick place into a huge medical facility, one that may ultimately hold 3,000 beds.

And, you know, who`s going to staff those 3,000 beds? Who`s going to staff it? An army of American health care workers, a proverbial army of doctors and nurses and health workers that is going to need to be bigger than what we can likely field as a nation.

Residents of the great state of Illinois got this emergency alert on their cell phones today, complete with the big, loud buzz of everybody`s phone going off at the same time and this banner popping up on the lock screen. State needs licensed health care workers to sign up at illinoishelps.net to fight COVID-19.

Have you ever been on a plane when the flight attendant or the captain gets on the P.A. and says, is there a doctor onboard? If there is a doctor onboard, please come to the front of the cabin. If you`ve ever been in that situation, I`ve been in that situation once. If you`ve been there, you know everybody`s heart just leaps into their throat, and everybody on board that plane who isn`t a doctor wishes in that moment that you were a doctor so you could help, right?

That moment is something that we only experience in this sort of suspended animation, the literal suspended animation of an in-flight emergency. But that is the moment that we are living through now for the whole country as licensed health care workers of all kinds are being summoned to please help, because if the number we are aiming for as a country, if the goal for the Trump White House, as they put it today, if their goal is to get to a range of 100,000 to 240,000 Americans dying, if that`s what we`re aiming at, if that`s the number of Americans who are going to die, think about the number of severely ill Americans who are going to need to be cared for in hospitals and hospital-like settings if that`s going to be the death toll. I mean, it is going to be a nationally transformative thing.

And yet we are not nationally transforming. And yet, even as of today, in all of these U.S. states there is no statewide order to stay at home, in Nevada, in North Dakota, South Dakota, Nebraska, Iowa, Arkansas, and all of these states, there`s some places in the state where you`re ordered to stay home, local, right? But nothing statewide. What`s the rush?

Utah, Texas, Oklahoma, Missouri, which has had a huge rise in cases. Mississippi where the governor put a stay-at-home order for one county, one. Alabama, where they`ve got a serious issue in Birmingham already and increasingly in other counties.

Incredibly both Georgia and Florida, big states contending with tons of cases already, South Carolina, Pennsylvania, Wyoming, all of those states have decided not to have statewide orders. Yeah, why not?

In Wyoming, the governor called a press conference yesterday to say that he didn`t feel like issuing a stay-at-home order for the state. Then he brought up the head of the Wyoming Medical Society who right there at the same podium, at the same event, said, yes, in Wyoming, we actually do need a stay-at-home order right now statewide.

Our cases have tripled in a week. We`re on pace to be out of critical supplies in Wyoming in a matter of weeks. But the governor at that same event, standing next to the head of the state medical society, who says, yes, you better do this, the governor says, no. No, no plans to. Why rush? Why bother? It will probably be fine, right?

Here`s the thing, though, that is really, really worth understanding about the kind of modeling that is driving, for example, that statement from the head of the Wyoming medical society and that statement from the governor of New York saying there will soon be tens of thousands of people in New York who all need to be in the hospital at the same time, and there will be no hospital beds to put them in.

I mean, here`s the thing that`s worth understanding about the kinds of models that are being cited now, even at the White House, even at this White House, to show us where we are headed and the gravity of that situation.

(BEGIN VIDEO CLIP)

DR. DEBORAH BIRX, WHITE HOUSE CORONAVIRUS RESPONSE COORDINATOR:  There is a model out of the university of Washington that modeled from cases up utilizing the experience around the globe to really understand how this information that we have from Italy and Spain and South Korea and China could really help us give insight into the hospital needs, the ventilator needs, and really the number of people who potentially could succumb to this illness.

It is this model that we are looking at now that provides us the most detail of the time course that is possible, but this model assumes full mitigation.

(END VIDEO CLIP)

MADDOW:  This model assumes full mitigation. A model out of the University of Washington modeling cases from -- modeling from cases up, utilizing the experiences around the globe, looking at Italy, Spain, South Korea, China, to give us insight into what`s going to happen, into hospital needs, ventilator needs, the number of people.

The models assume full mitigation. The models they`re using now assume full mitigation, that the United States is going to take policy steps to mitigate the spread of the virus. That the United States is going to have its citizens under orders to stay at home with nonessential businesses shut. That is the assumption for these models that are so dire in terms of the picture that they are painting.

The assumption is that we`re doing full mitigation even though that is not yet what is happening in huge swaths of this country. The University of Washington model that the White House is citing today is done by the Institute for Health Metrics and Evaluation at the University of Washington. It`s a big operation there, hundreds of epidemiologists and computer scientists and statisticians cranking out data and, luckily for us, posting it online in a very digestible, user-friendly format that`s easy to understand.

The White House is now using their models and their data to try to make the president understand, by all accounts, that this isn`t the flu, and it`s not going to zero cases, and it`s not going to evaporate like a miracle and all the other made-up nonsense he has been happy talking about it for weeks. They`re also now using this data to not just brief the president but to brief the country on why this is going to go on for a while longer and for how bad the U.S. trajectory is within this global pandemic because the U.S. trajectory is terrible. And the White House aim right now, the White House goal is to keep it between 100,000 and 240,000 Americans dead.

And in Florida yesterday, this modeling led to something that probably should have been a loud, loud wake-up call for the state of Florida but apparently it didn`t work. Here`s "The Miami Herald" reporting today. Here`s the headline: Epidemiologist behind COVID-19 model cited by White House advises Florida to shut down. Here`s the lead from "The Herald".

One of the epidemiologists behind a coronavirus model sight by the White House, has advised Florida`s state government to issue a statewide stay-at- home order, the kind of blanket decree that Florida Governor Ron DeSantis has so far insisted is unnecessary.

A professor at the University of Washington`s Institute for Health Metrics and Evaluation told Florida`s top health official Monday night, meaning last night, that the governor should issue a blanket stay-at-home order mandating the closure of nonessential businesses and mandating social isolation in order to control the spread of the virus. The institute`s model, which is updated daily as data changes, predicts that even if such an order is given, Florida`s coronavirus outbreak is on pace to peak in early May in numbers that will overwhelm intensive care units and potentially lead to thousands of deaths in Florida alone by the summer.

These estimations are based on the expectation that Florida will implement stay at home measures within a week from now. We are assuming next Monday this will be in place, said the professor, a former CDC epidemiologist. If they don`t, these numbers will go up.

So this model from the University of Washington is projecting absolutely dire circumstances in Florida, and they assume Florida has a better policy response to this than they have. I mean this is worth understanding about Florida. It`s worth understanding in general. The projections are terrible in terms of the numbers of American deaths that we are going to see. The U.S. has the worst epidemic in the world and one of the worst managed.

Ultimately, the pace at which U.S. hospital capacity is going to be overrun is daunting and terrible, all right? When U.S. hospital capacity is overrun, what that will mean is that severely ill patients who need to be in a hospital to try to keep themselves alive, they will not have hospital beds to hold them. The projections are just terrible.

In this -- in the case of this widely cited model from the University of Washington, the model is also built on the assumption that we Americans live in a country where we`re all going to be subject to stay-at-home measures and we`re all going to be subject to the closure of nonessential businesses to slow the virus` spread. Well, the U.S. federal government is not making that happen across the country, and so lots of governors aren`t doing that.

What happens to the parts of the country where that mitigation isn`t happening? What happens to all of us if big swaths of the country won`t do it or won`t do it until it is too late?

Joining us now, I`m honored to say, is Dr. Christopher Murray. He is the director of the University of Washington`s Institute for Health Metrics and Evaluation, IHME. The administration is using his institute`s models to project that two weeks from now, the U.S. could see a peak of over 2,200 deaths a day.

The institute is also issuing projections for when individual states will see their peak in terms of the crushing demand on their hospitals, states like New York, whose peak is currently estimated to occur next week as well as other states like Florida, which may not see their peak until a full month later in early may.

Dr. Christopher Murray, I do really appreciate you taking the time to talk with us tonight. Thank you for being here.

DR. CHRISTOPHER MURRAY, INSTITUTE FOR HEALTH METRICS AND EVALUATION DIRECTOR:  Pleasure to be here. Thanks.

MADDOW:  So, I am a layman when it comes to these things and I only know how to read them as well as your average bear. Let me just ask if the way that I have summarized this and put it in context right to you or if there`s anything that came out wrong or that you want to correct?

MURRAY:  No. I think you gave a really good description. We started out trying to help our own health system here in the university of Washington plan for the surge, and then other hospitals started to ask us for help. And then we quickly scaled it up for every state in the country.

Our goal is to help plan to, you know, help high-quality care continue to be delivered in these difficult settings. And that`s the reason we`ve assumed that given the crisis, given the scale-up, that at least within a week, those states that don`t have measures in place will adopt them.

And, of course, since we update every day, if they don`t adopt them tomorrow, then we push that a week out in our forecast.

MADDOW:  When you talk about these sort of dramatic peaks, the sort of apex numbers that your model suggests that the virus could ultimately be killing over 2,200 Americans a day, you`ve got very dramatic figures for individual states. Can you tell us how much of a difference there is between those apex numbers in the context of mitigation and those apex numbers in places where they don`t do it?

There are states where there aren`t any statewide measures in place right now. And I know your model assumes that they`ll get it together and they`ll do that. But how big of a delta is there between those two different scenarios, states that aren`t doing anything versus what they could do if they were following the sort of regimes that were designed to slow the virus?

MURRAY:  I think the way to think about that is every day you have unchecked transmission in the community, you`re going to get a percentage increase, 10 percent, 15 percent depending on the state. And so, every day you wait, you can multiply those numbers out. So an extra week really adds quite a lot to how many extra people eventually are going to die, how many extra people are going to have severe disease, and the load on the whole health system.

So every day counts because of that exponential growth that occurs through transmission, unchecked transmission in the community.

MADDOW:  One of the things that was dramatic today in the White House use of your models was the slide they showed today showing how far New York is ahead of the rest of the country in terms of the size of its epidemic. New Jersey also very worrying numbers. The other 48 states in terms of cumulative cases, trailing behind in a way that looks like a very significant difference.

Is it your expectation that the states that are worse off now, particularly New York, which has such a worse situation than everybody else, that they will always be ahead of everybody else in terms of their cumulative cases and the cumulative illness load and death load? Or do you think it`s possible that other states will ultimately get to those kinds of numbers as well?

MURRAY:  So I think there`s two factors that go into the size of that peak. One is, you know, what we`ve been talking about, getting social distancing in place. I think we`re seeing really good news here in Washington where we`re starting to see the peak of cases, at least in King County. We expect the peak of deaths maybe in another seven to ten days, and that`s also what our models are suggesting.

So, that`s good news about the impact of social distancing. But if you don`t have it in place and there are other factors that seem to lead to a rapid increase in New York in particular, and I think there`s a lot of debate and discussion. You know, is it widespread use of mass transit? Is it population density? Are there other factors that go into that rapid ascent? So both of those factors are going to play into how bad it`s going to be for different states.

MADDOW:  Dr. Murray, is there anything that you feel like is being widely misconstrued about the data in this epidemic? I feel like what you and your colleagues have done at the Institute for Health Metrics and Evaluation at the University of Washington has not only produced very robust data based on complicated models, but you presented it in a way that is really designed to foil our best civilian instincts at screwing this up and our understanding. You`ve presented it in a way that is designed to be foolproof in terms of not getting it wrong.

Is there -- is there anything that you feel like is wrong or wrong-headed in the way that Americans understand what`s going to happen here, what our options are, and what we should be preparing for?

MURRAY:  Well, you know, I think it`s a pretty terrifying event for the nation, a pretty terrifying in every community. And, you know, we started out with really just trying to help our colleagues in the health services and sort of thought about this as a tool for planners. And then as we`ve been developing this, we realized that these forecasts for death, for cases, for how the epidemic will unfold are important for the public, and they`re important for sort of the public debate.

So I think it`s -- we`re, you know, trying hard, and we try to update this with a big team here on a daily basis to give the public and planners the best insight as to what`s coming so they can prepare and also to find ways to communicate the importance of putting in place the social distancing and maintaining it. I think the other thing to remind everybody is that our models assume that the social distancing stays in place right through the end of May to get the trajectory that we see and, you know, we hope that could be as few as 80,000 deaths or even less if those conditions take place.

MADDOW:  Not only if we keep those social distancing measures in place but that the states in places that don`t have them right now get to it.

MURRAY:  Yes.

MADDOW:  In short order.

Dr. Christopher Murray, director of the University of Washington`s Institute for Health Metrics and Evaluation, your modeling has been helpful, I know, to the government. It`s helpful to us in the public and in journalism trying to understand this. Thanks for helping us. Thanks for your work.

MURRAY:  Thank you very much and thank you to our big team here working hard 24/7.

MADDOW:  I do want to say to our viewers at home, I`ve talked about how this is user-friendly data what they`re producing in Dr. Murray`s operation at the University of Washington. I mean it. If you have a minute tonight, go to COVID-19.health data.org. That`s the dashboard that they`ve set up where you can look at these national projections and you can just toggle through and go state by state.

And it`s the projected hospital resource use in the United States as a whole and state by state presuming that social distancing measures are put in place and kept there, at least until the end of May. It`s sobering stuff. It led to this incredibly sober briefing, I think, for the first time today from the White House. It has led to these estimations about huge numbers of Americans being killed by this thing even in the best of cases.

But the best of cases really is what we have to aim at. COVID-19.health data.org.

We`ll be right back. Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

GOV. ANDREW CUOMO (D), NEW YORK:  Look at the bizarre situation we wind up in. Every state does its own purchasing, so New York is purchasing. California is purchasing. Illinois is purchasing. We`re all trying to buy the same commodity, literally the same exact item.

So, you have 50 states competing to buy the same item. We all wind up bidding up each other and competing against other where you now literally will have a company call you up and said, well, California just outbid you. It`s like being on eBay with 50 other states bidding on a ventilator.

And now, FEMA is bidding on top of the 50. So FEMA is driving up the price. What sense does this make?

The federal government, FEMA, should have been the purchasing agent, buy everything, and then allocate it by need to the states.

(END VIDEO CLIP)

MADDOW:  The epicenter of the coronavirus outbreak in the United States remains in the state of New York, 332 more people have died of the virus since yesterday, which brings the state`s total number of deaths to 1,550. Over 1,000 of those deaths have been in New York City.

We`ve been tracking the hospitalizations in New York City as well. Last night the number was pushing toward 8,000 people hospitalized for coronavirus in the city. Tonight, that number is over 8,500.

The number of hospitalizations keeps increasing though as we said last night, the rate of increase may be slowing down, which would be good. But with New York`s peak in cases not expected for another week or two weeks, the city`s mayor and the state`s governor have been sounding the alarm that they really do not have enough equipment, particularly ventilators to handle all the hospitalizations that they have now and expect to have over the next couple of weeks.

New York`s governor said today his state is working to create essentially a state depot of ventilators and other supplies so the equipment can be pooled and sent to hospitals where it`s most needed in the state. He says the federal government should be handling the purchasing of these items and then allocating them. But for whatever reason, they`ve shown they cannot do that or at least they will not do it. So New York is trying to do its own statewide system.

That alone will not be enough. The state simply needs more ventilators than it has. It has more patients than it can handle.

I mean, take a moment to absorb the lead of this "Wall Street Journal" report today. Quote, NYU Langone Health, one of the nation`s top academy medical centers, told emergency room doctors they have sole discretion to place patients on ventilators, and they have institutional backing to withhold futile intubations.

An email from the department of emergency medicine to doctors told them to, quote, think more critically about who we intubate. Quote: for those patients who you feel intubation will not change their ultimate clinical outcome, you will have support in your decision-making at the department and institutional level to withhold futile intubations. The hospital says it is not at the point where these kinds of decisions need to be made yet, but that one medical center had 332 coronavirus patients as of yesterday, which was up 84 percent in four days. Its number of patients in intensive care more than doubled in that time.

Again, this is one of the most prestigious medical centers in the country telling their frontline doctors, you may have to decide not to intubate people who need it as their last desperate attempt to keep them alive. You are going to have to start thinking about the fact that you may need to deny some of your patients access to a ventilator because we`re not going to have enough ventilators.

And the desperate cries for help continue from health workers across the country, particularly in New York right now where the crisis is most severe, desperate pleas for more personal protective equipment to keep our health workers alive and on the job. Masks and face shields and gowns.

In terms of stuff that can be supplied by the federal government, there doesn`t seem to be any rhyme or reason as to which states are getting what and how much from the federal government. Some states are reporting that they`re getting stuff that they didn`t ask for. Other states are reporting they`re getting almost nothing that they asked for.

At the moment, New York and the 49 other states in the country and even individual hospitals are all competing against each other and competing against the federal market -- against the federal government on the open market to try to get needed equipment.

And even when the military has tried to help, the administration has just absolutely fumbled it. The Pentagon telling reporters now that although they offered more than two weeks ago to make 2,000 ventilators from military supplies available for U.S. civilian use, the Trump administration, FEMA, and HHS never bothered to tell them where to send any of those ventilators. So the Pentagon is just sitting on those thousands of unused ventilators that they would like to make available to civilian hospitals, but they don`t have anywhere to send them. The Trump administration hasn`t gotten it together to give them any addresses or tell them where the stuff maybe should go.

Similarly, the Pentagon made a public announcement more than two weeks ago that more than a dozen U.S. military leaders were certified and ready to process coronavirus tests, and the military said it would be happy to make those dozen-plus labs available for that work for the civilian population. But the Trump administration never bothered to respond or accede to that request from the military, and so those military labs have been sitting idle, not doing any coronavirus testing while all over the country, states large and small are struggling to get their tests processed.

I know it feels so late in the game for the national response to still be this screwed up, with way more people dead already than died on 9/11, with the White House saying today that their goal is to keep the death toll to 100,000 to 240,000. I know it feels late for it to be this screwed up, but there`s still so much more to be done.

Can the medical equipment supply chain be made to function? What needs to be done to make that happen? We should ask the experts on these things.

Joining us now is Nick Vyas. He`s executive director and co-founder of USC`s Marshall Center for Global Supply Chain Management.

Doctor Vyas, thank you very much for joining us. I appreciate you being here.

NICK VYAS, USC MARSHALL SCHOOOL OF BUSINESS:  Thanks for having me, Rachel.

MADDOW:  Global supply chain management is an art form, an academic discipline, and an important part of military and business logistics and nonprofit disaster response logistics all over the world. There`s people who, like yourself, spend their career studying these things and developing best practices.

What`s your top-line assessment of how the U.S. is doing on global supply chain management for the types of medical equipment that we need to keep our pandemic response on its feet?

VYAS:  So I think in my view, we have the public health crisis underpinned by lack of supply chain infrastructure. So let me qualify what I mean by that.

I think we just saw various models that`s predicting the need for the bed space, the need for the patients in ICU. If you back that up just a little bit, from a supply chain perspective, we can estimate the PPE equipments, you know, the gloves and the gowns and the masks, and I can actually go down to every skew, every items and ventilators in each of these hospitals, each of the region, and by what time we have to have those in place.

So we do this very well in commercial space. If we just deploy the similar intelligence in our current crisis in the public health area, I think we could be much better prepared to address this issue.

MADDOW:  Is that the sort of skill, that the sort of skill set and understanding of how these things are supposed to go, does that exist in the U.S. military? Is that expertise that the U.S. civilian administration should be calling on the military to put into place because they know how to do that stuff, or is this the sort of thing that the administration should be looking elsewhere to, to academia and to the business world?

VYAS:  So I think it`s a combination. Military is very good. In fact, our military is the best in supply chain expertise. We also have an industry that has done a phenomenal job over the last 25 years in driving efficiencies in supply chain. And obviously academic institutes, this is what we do for a living, which is teaching the next generation`s leaders.

So if you bring all of these experts together and solve this problem, the data we have available and also learning from various models from Italy, Spain, China, South Korea, and we can actually build those parameters in, I think we can approach this issue much more intelligently and much more better prepared to handle the upcoming peak demand for our hospitals.

MADDOW:  The type of reform that you`re talking about, the type of approach that you`re talking about, it feels like the sort of thing that the government should have been doing preparing for the next global pandemic before they even knew what the particular virus was going to be. The type of thing that you`re describing, how quickly could it be done? How quickly could we get this sort of thing in shape?

VYAS:  So I spoke about this a few weeks ago, that we need to enact DPA about three to four weeks ago when we knew this was likely to make it to all 50 states and a global pandemic. What it would allow us to do is bring all these critical resources together and take the models of epidemiologists and enter into the supply chain dimensions. Imagine the creativity we have, the resource, the manufacturing capacity we could enable to start to anticipate the ventilators, masks, gowns.

These things could be done now, but it would have been much better addressed three to four weeks ago where we build the inventory necessary to dispose to what Governor Cuomo was talking about in New York, in other places, where they`re in dire need now, and then the rest of the states will need sometime in the next week, two, or maybe four weeks from now.

MADDOW:  Dr. Nick Vyas of USC`s Center for Global Supply Chain Management - - really, thank you -- thank you for joining us tonight. I hope you are getting the kinds of high-level calls that I would expect a well-managed operation would direct to somebody like you in this situation. I think you and your colleagues have a lot to offer here. Thanks for being with us tonight.

VYAS:  Thanks. Thank you.

MADDOW:  All right. We`ve got much more news to get to tonight. Stay with us.

(COMMERCIAL BREAK)

MADDOW:  The USS Theodore Roosevelt is absolutely massive. It`s called the TR. It`s an aircraft carrier. It sits 20 stories above the water. It`s over 1,000 feet long, on its head about as tall as the Empire State Building.

Even the USS Theodore Roosevelt is absolutely enormous on the outside, the living quarters on the inside of the ship are tight. The ship is home to 4,000 crew members all very densely packed together. The sailors onboard sleep in bunks like this with three beds stacked on top of one another.

They share bathrooms. They eat together in communal mess halls. The ceilings are low. The stairwells are cramped.

This video was shot onboard a similar carrier, the USS Nimitz. You can see the hallways are narrow enough that you`d need to use your hands to steady yourself to keep yourself going forward.

Imagine trying to stop the spread of coronavirus in an environment like this among 4,000 sailors on board a ship like this. That is exactly what is happening right now on board the USS Theodore Roosevelt.

A week ago, the Navy first reported that three crew members on the TR were found to be infected with the coronavirus. They managed to get those infected sailors off the ship, but the number of cases on board ship have only grown since then. As of today, more than 100 crew members have tested positive.

The captain of the TR is now pleading for help. In a March 30th letter, so a letter yesterday, that was first made public by "The San Francisco Chronicle", Captain Brett Crozier requests the vast majority of his crew be quarantined onshore in Guam, which is where that ship is now docked, so the ship`s command can try to get the outbreak under control.

The captain says in his letter, quote, removing the majority of personnel from a deployed U.S. nuclear aircraft carrier and isolating them for two weeks may seem like an extraordinary measure, but it is necessary. Decisive action is required.

Keeping over 4,000 young men and women on board the TR is an unnecessary risk and breaks faith with those sailors entrusted to our care. We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset -- our sailors.

The acting secretary of the Navy told MSNBC today that more than 1,000 members of the 4,000-person crew have been taken off the ship and that more sailors are coming off all the time. But as of tonight, the defense secretary says the carrier doesn`t need to be evacuated, at least not yet, despite what the captain of the ship says.

Of course, even if the Navy were to get everyone off the ship, Guam is not particularly well-equipped to handle a crisis like this one. For one thing, hospitals in Guam are equipped with a grand total of 15 staffed ICU beds. There is a navy hospital on the island. That`s got another six ICU beds. Remember, they`ve got over 100 cases among the 4,000-person crew on this ship.

So this is yet another crisis unfolding in real time. How do you begin to get something like this under control? What`s the range of choices available to the captain but also to the Navy? I mean, is there -- is there a playbook for this?

I have just the person to ask. That`s next.

(COMMERCIAL BREAK)

MADDOW:  This is from an op-ed in "The Jackson Free Press" in Mississippi, which is a state where they`ve got more than 700 confirmed coronavirus cases. They`ve got 14 deaths. It`s bad. It`s not as bad as some other states, but the state`s response to the virus leaves something to be desired.

This is from the op-ed. Quote: The places which do not have as many recorded cases as others cannot think they are somehow immune or lucky. This is a human problem, an American problem, and a Mississippi problem. If statewide orders aren`t put in effect, the state`s hospitals and health care workers will soon be overwhelmed.

Any direction you look, Louisiana, Tennessee, Alabama, the numbers of those infected and those dying are going up with frightening speed. To think that parts of Mississippi will somehow be spared is not only delusional, it`s dangerous and deadly.

The governor of Mississippi needs to immediately order a statewide shelter in place and enforce it. To do anything less will almost certainly needlessly condemn Mississippians to serious illness and death.

The author of that op-ed in "The Jackson Free Press" today knows of what he speaks. Ray Mabus is the former governor of Mississippi. He also served as secretary of the Navy under President Obama.

Governor, thank you very much for being here tonight. I really appreciate you making the time.

RAY MABUS, FORMER SECRETARY OF THE NAVY:  Thank you, Rachel. Glad to be here.

MADDOW:  I want to ask you a navy question first, if you don`t mind. The country is sort of transfixed by the story with the aircraft carrier, the USS Theodore Roosevelt. They got more than 100 sailors onboard that have tested positive. The captain, commanding officer, saying he can`t distance people onboard an aircraft carrier, he can`t stop the spread of this virus among his crew. He wants the whole crew taken off and quarantined.

As a former navy secretary, I just have to ask how you read this situation.

MABUS:  Well, number one, it`s really extraordinary, that a captain reaches out like this, and just pleads to get his sailors off and says we`re not in a war, people don`t have to die. That`s astounding.

But you`re going to have to do something like this. You can`t socially distance on a ship, on any navy ship, particularly on something this big with this many people on it.

And the Navy is going to -- they`re stuck in a tough place. You`re right about Guam. They don`t have many facilities.

But if you don`t slow the spread, if you don`t get people off, if you don`t thoroughly clean the ship, and if the Navy doesn`t start proactively doesn`t doing this, not just on the TR, but on ships all over the world and on ships that are going to have to surge if other ships go down, if you don`t do some of these basic things, the readiness of the Navy is just going to go away.

Because if you don`t have the sailors, and if you don`t have the protocols in place to make sure this is not being spread in such close quarters, I believe this ship was called a Petri dish for the spread of this virus. So the navy has to become more proactive here.

MADDOW:  You can understand the upset and the worry in Guam. Guam put in very strict restrictions to try to limit their exposure to the virus. They do have very limited resources. As I mentioned, 15 ICU beds on the whole island, another six in the Navy hospital, to try to alleviate the potential impact on Guam, and the concerns of the people there, while the ship is docked there and the captain wants everybody off boarded.

Is there any -- is there anything else in terms of what the military can do that they could kind of surge into place to try to alleviate the concerns of the local people there? I just -- I can`t -- it feels just like an irretrievable breach.

MABUS:  Well, you can surge things like global field hospitals that the Marines have. You can get things there to take care of as many people as you can. The Navy and the Marines are both completely expeditionary. They can get stuff to a place very quickly.

And I feel for Guam. But you`ve got to -- you`ve got to begin to do this. And I feel for the Navy. They`re in a very tough spot, because they`re being told, number one, take care of your people, but number two, keep doing all your missions. Keep being ready for anything.

And that captain put it very well. In you`re in a war, then yes, we`re going to take a chance. We`re going to take a chance on this virus spreading. But if you`re not, don`t do it. Take the precautions. Surge a marine field hospital that`s got some ICU beds, that can take care of people.

The carrier itself has a fairly large hospital on it. Not many ICU facilities, but to take care of the people who don`t need the intensive ICU things. There are things that can be done.

But they`re in a very tough place, because they`re being told by the secretary of defense do both these things, and he`s keying off what this president is saying. You know, keep doing your normal things, but by the way, protect yourself.

MADDOW:  Ray Mabus, former governor of the great state of Mississippi, former secretary of the navy, former Governor Mabus speaking out today about the fact that state does not yet have a shelter in place or stay at home orders in effect statewide -- Governor, thank you for making time to be here tonight. I really appreciate being able to tap your expertise on this.

MABUS:  Thank you, Rachel.

MADDOW:  Ii will tell you that in Mississippi, despite the pressure on that governor, who has issued a series of conflicting and confusing orders, there is now but one county in that state that has a stay at home order. The rest of the state, the governor said don`t do it.

We`ll be right back. Stay with us.

(COMMERCIAL BREAK)

MADDOW:  The nation`s largest private employer is Walmart. If you look at Walmart, you are a part of a workforce of 1.5 million people.

Today, that gigantic low-wage employer announced they`re going to use infrared thermometers to take the temperatures of all employees before they come into work. Anybody with a fever of 100 degrees or higher will get sent home with pay. Walmart also says they`ll provide gloves and masks to any worker who wants them in a job site.

This is the kind of policy, this temperature policy that a bunch of countries instituted for all kinds of workplaces and places in public life, places like grocery stores and transit.

Here in the U.S., apparently, we`re going start it at Walmart. Well, at least we`re starting somewhere.

That does it for us tonight.

Now it`s time for a NBC News special night on the coronavirus pandemic. That starts now. Good night.

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