ICU patients TRANSCRIPT: 4/9/20, The Rachel Maddow Show

Guests: Prakash Gatta, Lee Norman

RACHEL MADDOW, MSNBC HOST: Yes, exactly. And I mean, because you guys have that longstanding relationship, we`re all able to sort of join the conversation in process at a very high level. But people are just waking up to the disparities, and to hear you guys talk about yes, and what the disparity into in part is people approaching this in a wrong-headed way that minimizes the response for everyone.

I mean, he`s always -- he`s always ahead of the curve, you`re always ahead of the curve. But you guys together on this, it`s a -- it`s a blessing to be able to listen to you guys. Well done. Thank you.

CHRIS HAYES, MSNBC HOST, "ALL IN": Well, thank you very much. Have a great evening.

MADDOW: All right, thanks, Chris.

And thanks to you at home for joining us.

In the Jewish faith, Passover began last night. Lots of Passover Seder meals were held all over the country. I am willing to bet that a larger number of them than ever were held at least in part on the phone or over FaceTime or Skype or Zoom with distant family members who would otherwise usually try to be physically together for that holiday.

This is holy week for people of the Christian faith, as well. Today is Holy Thursday. Tomorrow is the most somber day of the year in the Christian calendar, Good Friday, which is the commemoration of the crucifixion.

For members of the Episcopal Church in the Christian faith, the Cathedral of the St. John the Divine is sort of the mother ship of the Episcopal diocese in New York. The Cathedral of St. John the Divine is uptown in New York City. I think it`s at 112th Street.

By coincidence, that puts it right next to one of the hospitals in the Mt. Sinai system, which has been so key the frontline response the coronavirus crisis in New York. In the midst of Holy Week, particularly if this building looks like the place you are used to celebrating the holy days of your faith, but even if they`re not, even if this is the first time you have ever seen the inside of a cathedral, these images we got today of the nave of the Cathedral of St. John the Divine being set up with hospital beds, with the blue tarp covering the stone floor and the beds lined up like a M*A*S*H ward, it`s hard to get your head around it. It`s hard to get your heart around it.

But here is the best possible news that could possibly emerge alongside these images we got today from the Cathedral of St. John the Divine. The best possible news you could get alongside those images is they may not have to use those beds. The plans were set up to put dozens of hospital beds, if not hundreds of hospital beds inside that cathedral. Those plans to set up the cathedral as a hospital site were set in motion.

But then today, they were set in motion as Mt. Sinai kept up its assessment of its needs and the trajectory of how many beds they need and where, and as the New York hospitalization numbers look like they`re starting to flatten out, the Cathedral of St. John the Divine may no longer need to be a hospital. And may that cathedral no longer be needed as a pop-up field hospital be a little ray of light for us all.

And let it stay true. You know, let the hospitalization rates in New York continue to flatten out and start to decline and then steep decline, right? That said, of course, if it doesn`t hold, if that situation does change for the worse, up on 112th and Amsterdam, inside that consecrated space with those beautiful stained glass windows, and the grand rose window on the avenue up in front in that beautiful space we now know that a hospital can be done there, if need be. Right now, it doesn`t need to be, which is a blessing.

I will tell you one other very small piece of good news today, and it is a small piece of good news. And it comes today from California. The governor of California announcing today that for the first time his state had an actual drop in the number of people in ICU beds.

This is not a drop in the rate of increase. This is not a drop in the number of new admissions to ICU wards. While the total number keeps going up, this was actually fewer people in ICU beds today compared to yesterday, an actual drop in California.

And it is a -- it is a small thing, it may be a one-day blip. But you know what? It`s a thing and I`ll take it.

(BEGIN VIDEO CLIP)

GOV. GAVIN NEWSOM (D), CALIFORNIA: And here, very importantly, is a statistic in terms of percentage drop that I haven`t been able to communicate in any of my daily briefings and that is the total number of individuals in the ICU, that number of 1,132 represents a drop of 1.9 percent from yesterday.

One data point is not a trend. One data point is not a headline. So I caution anybody to read too much into that one point of data. But nonetheless, it is encouraging and it just, again, reinforces the incredible work that all of you are doing to practice physical distancing.

(END VIDEO CLIP)

MADDOW: To practice physical distancing. Physical distancing brings down the number of contacts between people, right? Which reduces the number of people who are getting newly infected, which reduces the number of people getting sick, which reduces the number of people that have to be hospitalized, which reduces the number of people that have to be put in the ICU, which reduces the number of people who ultimately have to be put on a ventilator, which ultimately reduces the number of people who have to be buried, right?

It is all one chain of consequences, and the governor is right there, to tie that one data point and may it not be a blip, may it be the start of a steady trend, to see the number of ICU beds in California in use drop for the first time since this crisis, maybe that`s, you know, maybe that`s something wrong in the data or maybe that`s an accident. But if that is the start, what you can trace it back to is people staying at home.

And that is why Americans are being told to stay at home, because of that chain of consequences. The only way that you personally can reduce the death toll in your city and your town and your county and your state is by staying at home. And it will matter if you do. That is why it is insane for these holdout Republican governors and legislators to keep saying -- well, we don`t have that many deaths yet here. So, we`ll keep waiting and not telling people to stay at home.

Well, while people are not staying home, human-to-human contact facilitated by people not staying home means there will be more spread of the virus, more infections, more illness, more hospitalizations, more ICU beds, more ventilators used and more death.

By delaying, even when they only have a few cases, all they`re doing is making their ultimate number of dead citizens larger at the end of the day. With each passing day, they don`t keep people at home, it`s just that simple. This is not rocket science.

We don`t have a vaccine. We don`t have a treatment. All we can do is keep people apart from each other so they stop giving it to more people. That`s it.

The only thing we can do. And if we don`t do that, nothing else we do will matter. It`s that simple.

Tonight, this hour, we`re going to have here on this show a guest who is right in the middle of one of those battles in the heartland tonight. We`re going to be speaking with a state health officer, who is basically tearing his hair out trying to do the right thing, while being foiled by the most remarkable cast of characters.

But as we continue to marvel at the states that still aren`t doing anything, while we look for bright spots in some of the states that are doing everything they can, that are fighting this thing as hard as they can, that are having some success in fighting this thing, because they started early and they started decisively, while we watch for those individual parameters, right? While we watch for those individual trajectories in places that are handling it better and worse in the country, our overall national picture as a country remains abjectly terrible.

The United States now has over 462,000 cases. Which means our outbreak is now more than three times the size of the next largest pandemic in any other country on earth. More than 16,000 Americans have been killed by coronavirus thus far, 1,846 Americans killed in the last 24 hours, which means that an American died today from coronavirus on average every 47 seconds.

In the geographically worth part of the U.S. epidemic in New York, over 7,000 people have died. In total, nearly 800 of them just in the past day, which is the largest daily death toll in New York thus far. But even as more than 18,000 people are hospitalized right now with coronavirus in New York tonight, we are still seeing a drop in the number of people needing to be newly hospitalized each day. That number was reportedly about 200 in the past 24 hours, only 200 new hospitalizations in New York today.

And that`s the smallest number of new hospitalizations in New York since New York instituted its stay at home policy to try to slow this thing down and lessen its impact. It remains a weird truth, though, about the data. That even as New York has these huge numbers of cases, right? New York as a state has more coronavirus cases than any other country in the world right now, let alone compared to other states.

But a weird sort of cloud hanging over the case numbers from New York every day, is that even as we understand more and more about what`s happening in New York and how their policy interventions may have started to flatten out the curve so they may be approaching their apex in a way that we can predict when it`s going to start to come down and we can start to have hope, there is this weird cloud hanging over that data in terms of how it helps us understand our overall outbreak as a country, which is that New York is still doing way more testing than any other part of the country is, because we still don`t have a federal testing policy, even all of these weeks and months into it. The Trump administration is still noodling on that one, still working on it. I mean, still every state for themselves when it comes to testing.

Now, there have been a few sites around the country where the federal government did step up to help get testing done at individual specific sites. But we learned yesterday that they were planning to stop that as of tomorrow. For example, Montgomery County, Pennsylvania, the Philly suburbs, they`ve got nearly 1,500 known coronavirus cases in just -- excuse me, just over 1,500 known coronavirus cases in just that county, which is a lot in that one county that`s more confirmed cases than a bunch of U.S. states have right now.

But that big number in Montgomery County, Pennsylvania, may be in part because Montgomery County, Pennsylvania, has been testing. They have a drive-through testing facility that has been open in that county since March 21st. And at that drive-through facility, they have been testing 250 people every day. And they are busy, testing 250 people every single day since they opened.

Well, now, as Pennsylvania`s caseload goes up and up and up and up, that test site was set to close down tomorrow, because the federal government, for some reason, decided that the end of this week would be the time that they would shut off all the funding to all these testing sites that they have been sponsoring around the country.

The same with another site in Philadelphia itself, same with another site in Colorado Springs, Colorado, same with more than three dozen sites in a dozen states, there was federal support for these individual testing sites, right? That`s basically the only thing the federal government has done toward actually getting Americans tested in any meaningfully available way.

And the government decided that as of the end of this week, they were going to end that support, as of tomorrow. The Trump administration was asked why on earth they were planning to do this. The Health and Human Services Administration told NPR that these sites, you shouldn`t think of them so much as closing. You should be thinking of them as transitioning.

Which, you know, you -- you know, I could go on. I will restrain myself. It`s a nice euphemism, I`ll put it that way. And maybe some of these testing sites would have transitioned into some other way of being once the federal government rescinded their funding, and their technical support for the testing labs that was doing all those tests and allowing those places to be open.

A bunch of these sites, Montgomery County, Pennsylvania, site, for example, the news yesterday that it`s not that they were going to transition into some other mode, they were going to close because the federal government was rescinding their support for that successful testing facility, right? Just as Pennsylvania needs testing more than ever. Just as Pennsylvania`s numbers start to ride up their fatal part of epidemic curve.

Well, after that was reported, that plan to close all those sites was reported by NPR, after a fitting backlash to that nonsense, the federal government just tonight, just within the past couple of hours, reversed course and said, OK, OK, we`ll change our mind. These test sites all across the country that we plan to close tomorrow, instead we`ll allow them to stay open. So, instead, we will allow them to stay open.

So, yay, thank you, NPR, for reporting this in such a way that caused the backlash that resulted in the federal government changing its mind, right? So, you know, we`ll continue to have this smattering of federally reported testing sites in a dozen states.

What this means the federal government didn`t inexplicably undo tomorrow the one damn thing they were doing in terms of getting Americans tested for this disease. But we remain beyond that, without any national testing plan and without good access to testing all over the country, our data continues to be all over the state. New York state is doing a lot of testing, but every state is having to make due on its own terms of how many people they`re testing, how they`re doing it, and how they`re getting access to the materials they need to do that testing.

With the patch work of systems and different levels of government trying to put together a response, we`re starting -- you know, we have some data about how many cases that we have got. We go some snap shot some places. Some states tell us more information than others.

And we know enough to know we have the worst outbreak on earth by far. But the details of where it`s the worst, frankly, they just have to trickle up through the seams. We don`t have a national response. So we don`t have national information.

And so, you look at local coverage sometimes to find out where things are at their worst. This was local news coverage today, for example, from Hayward, California. Coverage of a local nursing home in Hayward where of the 35 residents who have tested positive in that facility, six have already died. Staff has started to test positive at that facility in pretty good numbers, as well.

I only came across this local news report today because Hayward is the city in California where I was born. It`s right near where I was born and where I grew up. And so, this happened to catch my eye today, this tragedy in Hayward, California.

But just try this. If you have some spare Internet access, if you have few minutes, look around at the local press, where you grew up or where you were born or where your parents live now or where your grown kids or grand kids have moved off to.

Just pick a place somewhere in this country. Pick the last American place you went on vacation. Pick the last town where you got a speeding ticket when you were driving on a cross country trip.

Pick anywhere in this country and look at the local press there, and I will tell you what you will find more likely than not is a story, at least one, about a nursing home, an assisted living facility, a long-term care facility, a group home for adults with disabilities, a soldiers home for elderly veterans. You will find at least one local story about a congregant living facility particularly for disabled or elderly Americans where they`ve got cases, where they`ve got deaths, where the staff is testing positive, and they`ve got profound worries and do not know what they`re going to do.

Just pick it anywhere. I mean, here`s Kentucky just tonight. COVID-19 spreading quickly in dozens of Kentucky nursing homes, 152 infected, 16 dead.

Here`s "The Seattle Times." Coronavirus spreads to 163 long-term care facilities in Washington state, killing more than 200 people.

Here`s Richmond, Virginia. One facility, 39 deaths among residents at that one facility, 49 other residents with symptoms already, 25 staff testing positive.

Here`s San Antonio, Texas, 84 residents, 67 of those 84 residents already known to be infected.

Here`s footage of the Magnolia Rehabilitation and Nursing Care Center in Riverside County, California, in southern California. This footage looks like disaster response because it is. What this shows is the one-by-one evacuation of all of the residents in that facility. They found out that of the 84 residents in that facility, at least 34 of them were positive, and the staff was starting to test positive too.

And when most of the staff just started not showing up, when the staff just didn`t show up to staff that facility for two days in a row, first they sent in nurses. They sent in extra medical care workers to try to bolster capacity at that facility to keep people alive. But when too much of the staff just didn`t turn up two days in a row, they called it off. They evacuated.

The patients were taken one by one to other facilities they will find for them somewhere in southern California, talking about maybe even some of them will go to the Navy hospital ship, the Mercy, that`s in Los Angeles.

The crisis of coronavirus ripping through American nursing homes and American long-term care facilities, that is everywhere. That story is ubiquitous, but you have to look in the local news to find it. Apparently, you know, occasionally you`ll get national news outlets covering it in a survey way the way I just did or a national scope paper like "The New York Times" will do a survey piece about it.

But look in local news outlets. You will find that all over this country, rural, urban, suburban, everywhere, there long-term care facilities, the places where elderly people are held in congregant, are already creaking under the weight of this thing, and they have no idea what to do. The crisis in nursing homes and long-term care facilities will account for a huge swath in the American death toll unless something is done to address this systematically.

I mean, there is as yet no national help for this. There is no national strategy for this. There`s no national information about this. You literally have to follow local news outlets around the country to try to get your arms around it.

But without a federal response to speak of on anything, let alone on this, the most acute crises for the most vulnerable people, it`s just part of the scramble we need to do just as citizens to even follow what`s happening in our country, to follow who`s dying and who`s most at risk of dying and who needs help, and who`s trying to keep people from dying and doesn`t know how to do it, doesn`t know how to staff these facilities safely now that the test is testing positive too, now that the staff is sometimes not showing up.

So we`re trying to follow it. That emerging disaster in every state in the country, we`re trying to follow it. One of the other ways we`re trying to follow the real contours of this catastrophe despite all the happy talk from the White House is that we`ve been trying to make contact with individual health providers in different parts of the country, to have them just let us know some of what they`re facing. Like, for example, this doctor. Chief medical officer of his hospital in Newark, New Jersey, interviewed here by WNBC.

He says that, you know, as anticipatory and hopeful everybody is about curves starting to flatten, and things starting to ease up, at least at his facility in Newark, that`s still just hope. He says it`s not happening there, at least not yet, and they`re pretty sure they know why.

(BEGIN VIDEO CLIP)

DR. HAMID SHAABAN, CHIEF MEDICAL OFFICER AT ST. MICHAEL`S MEDICAL CENTER IN NEWARK, NJ: Unfortunately, I mean, in the past couple of weeks, it`s been very hectic. I mean the emergency room, our hospital has been inundated with a lot of admissions. We`re anticipating the surge this week, and I`m not going to lie to you. It is a source of concern.

We did have those two weeks of social distancing that we were supposed to adhere to, and, unfortunately, we are not seeing the impact that we anticipated, at least in our inner city hospital here at St. Michael`s.

REPORTER: The numbers are still going up?

SHAABAN: The numbers are still going up. And, yes, I mean in the face of PPE shortages, staffing shortages, it`s a challenge. But we`re rising up to the challenge, and we understand what our role is, which is to serve our community.

When it comes to low-income population -- the low-income population, it`s not easy to stay home. A lot of their jobs require them to still show up for work. So social distancing is not easy in that particular situation. So things like that need to be factored in when we address the viral pandemic, especially in the underserved population.

The E.R. is very busy. It`s inundated with cases. The ICU, we have a lot of mechanical ventilators that are in use right now, and we just keep increasing capacity to accommodate all those ventilators.

But we`re rising up to the challenge. I mean we`re ready for this, and I think the community as a whole is ready for this. And my only message out to, again, the people in Newark and everywhere else, practice social distancing.

(END VIDEO CLIP)

MADDOW: Practice social distancing. Take it from him if no one else. That`s a doctor in Newark, New Jersey.

Here`s a nurse in southeastern, Michigan.

(BEGIN VIDEO CLIP)

MAUREEN BIDDINGER-GRISIUS, NURSE AT BEAUMONT HOSPITAL IN FARMINGTON HILLS, MICHIGAN: Hi. My name is Maureen Grisius. Today is Friday, April 3rd.

And I`m just wrapping up kind of a long 12-hour shift. I`m feeling a little bit defeated tonight. I was really hoping that one of my patients was going to be taken off of a breathing machine today, and it didn`t happen.

We had another death today that the whole ICU took pretty hard. So that was tough. The last few days have been hard, and there`s been so much anxiety. We`re still watching as patients are just becoming critical so quick quickly.

I don`t know. One of the nurses I worked with today walked around and just told jokes all day because we`ve just been crying so much. She just wanted everybody to keep laughing and keep moving, and so that`s what we`re doing.

And that`s what I got for today. We`re just -- we`re just going to keep moving.

April the 5th, Sunday. Today I worked in the E.R., the situation, the heaviness, the impact of all of it, on the workload and the emotional toll that it takes and just looking around and seeing my colleagues, my team who have looked tired.

But there`s the other side of me that is hopeful, hopeful that maybe social distancing is starting to make a difference, that maybe all of the people who are listening to the guidelines and following them and staying home are saving lives. I hope so. I think I`ll hang on to that today.

(END VIDEO CLIP)

MADDOW: She is in Michigan.

I should tell you, today, Republicans in the Michigan state legislature started advocating that Michigan should loosen up some, start loosening up these stay-at-home orders. They`re such a drag. Yes, why would we want people to stay at home right now when their health care providers are coping with that?

One of these frontline providers who we have been talking to, one who has had coronavirus himself and fought it off and come back to work himself, had a really big response to some footage that we had of him within the last couple of days. He`s going to join us live here next, and you will want to meet him. He has an incredible story.

Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

DR. PRAKASH GATTA, ESOPHAGEAL SURGEON: This is Dr. Gatta in the midst of all the COVID craziness, we`re still in the operating room taking care of really sick patients that really can`t wait. We`re being very careful about conservations of PPE, reusing masks, and some occasions gowns and sometimes not leaving the operating room to take a bathroom break because we don`t want to waste our gowns. I`m proud to work here.

(END VIDEO CLIP)

MADDOW: Proud to work here.

That dispatch from the front lines came to us from Dr. Prakash Gatta, who is a surgeon at Multicare Tacoma General Hospital in Washington state.

We played that clip from him on the show last night, and it hit a nerve. We got a big reaction about the footage that we showed of Dr. Gatta.

Dr. Gatta is an esophageal surgeon, which is not only something I can`t do, it`s something I can barely say, and I`ve been practicing all day. He`s an esophageal surgeon. Maybe I think that`s the way you say it.

He specializes in robotic surgery, which is impressive just on the face of it. But consider too how he got to this point.

As a child, Dr. Gatta and his parents and brother were refugees. They fled Kuwait during the Iraqi invasion. They later emigrated to the U.S., whereupon he literally grew up to become an esophageal robotic surgeon.

Now with that remarkable life arc, he can also say that he personally survived becoming infected with COVID-19. He got sick. He recovered. And as soon as he was recovered and cleared to get back to work, he went right back to the hospital, right back to the front lines.

(BEGIN VIDEO CLIP)

GATTA: Here I am back to work after COVID-19. And for my patients out there, for the people with fear, know that no matter what happens, you never work from home.

The lights are always on. Babies are being born. Bones are being set. This hospital, this profession, we`re in a league of our own. We`ll take care of you, I promise.

(END VIDEO CLIP)

MADDOW: Joining us now is Dr. Prakash Gatta. He`s a surgeon at Multicare Tacoma General Hospital in Washington state.

Dr. Gatta, I know you`re working more than full-time right now. Thanks for making time to talk to us.

GATTA: Well, thank you, Rachel, for featuring this and me. This is an incredible amount of effort that was put into having me up here, so I appreciate it.

MADDOW: Well, sure. I`m happy to do it.

Tell me, Doctor, there`s a lot of different things I want to ask you about. But first because you`re practicing and working right now in Tacoma and because the whole country has been watching Washington state deal with early cases, deal with large numbers of patients coming in, let me just ask how things are in your hospital and what your daily workload is like these days.

GATTA: So that`s a great question. If there`s any silver lining from the tragedy in the nursing home up in Kirkland, it`s that it allowed our local state and local leaders as well as our health care administrators to prepare for the pandemic better or earlier than the rest of the country. It allowed us -- sort of raised our awareness not just amongst the planning side but from the health care provider perspective to be able to be ready mentally and physically for this onslaught that was about to come.

So because of that and because of the scientific modeling that has been used, we have been able to flatten the curve. And by that I mean which is the goal that the rest of the company has aimed for, flatten the curve basically has allowed the hospital system to not get overwhelmed. So, it has allowed our capacity within our hospital system to manage our patients -- incoming flow of patients to be well-matched so that, therefore, a long answer to your question is we have been able to manage well, enough to the point where the field hospital that was being built in CenturyLink Stadium, our Seahawk stadium, is being dismantled and moved to a different part of the country.

So, from a planning perspective, that has worked, and we have to commend our health care administrators and our local and state leaders for taking the lead on this.

MADDOW: One of the things you talked about in one of the clips I just showed of you was even in the operating room, even if the context of surgery, you`re having to be mindful about conserving personal protective equipment, gowns and face masks and the other things that you and your colleagues use to protect yourselves from getting infected.

I imagine that everybody is in a protective mode toward that type of equipment right now, but is it critical right now in terms of the amount of equipment that people have and what you and your colleagues need to keep yourselves safe?

GATTA: So it is critical, and we have been taking -- making sacrifices in terms of utilization. It has forced us to rethink how many times we use PPEs and masks, how frequently we change gowns or masks, and how infrequently we actually need to do that. Primarily because of our concern about if -- have we peaked or have we not peaked? We don`t know what the next week or the next day is going to look like.

So the underlying aspect of our daily lives has been determined by our continual fear that we may be OK today, but we want to plan for tomorrow. A lot of what medicine is and even surgery is essentially planning for the worst-case scenario. So, everyone is very mindful. You know, in the operating room, we have nurses literally guarding the boxes of masks and being very conscientious about when and if we need to use things.

MADDOW: Now, your situation is different than some of your colleagues in a material way because you, yourself, got sick. You, yourself, have been infected with COVID-19 and survived it and recovered. I imagine that the idea that you may have immunity to getting further -- to being infected again must change your whole mindset in terms of how you`re approaching your job now.

GATTA: This -- again, a great point. This is the reason I felt that this was an important message, because there is no good way to describe the amount of anxiety a health care worker such as me or the nurses, the environmental service worker that comes to work, the unsung heroes of this hospital and of medicine in general -- there is no way to describe the fear and the anxiety you would have of coming to work knowing that there is a disease out there that`s an invisible disease that may actually take your life.

I never served in the military. The closest I would ever come to serving in uniform for this country is to do the job that I am doing today. And by that I mean, I liken it to listening to the whistle as you go up over the trenches to face the enemy bayonet.

That nervous fear that you would have to know that to do my job, to save lives, to follow my calling, it may take my life. But, yet, people show up to work. The degree of selflessness that people have demonstrated have really been reinvigorating for me, for my profession, and why I do this.

I stand on the shoulders of giants, and I stand alongside the most fearless people I`ve ever seen.

MADDOW: Dr. Prakash Gatta, surgeon at Multicare Tacoma General Hospital in Washington -- sir, thank you for your work and thanks for taking time to talk to us about it. I really appreciate you doing it. I hope you`ll stay in touch in these coming days and weeks.

GATTA: Thank you, Rachel. This is a great honor. I appreciate it.

MADDOW: Appreciate it.

All right. Thanks. We got much more to get to tonight. Stay with us.

(COMMERCIAL BREAK)

MADDOW: It`s a little like going to an old drive-in movie theater. You pull your car into the parking lot. You find a suitable spot. You turn your radio to a certain low power F.M. frequency and then you watch the show.

But in this case this is not going to the movies. It is going to church. This is how Triumph Church in Detroit, Michigan, is holding regular services these days. The pastor delivers his sermon from a big screen that`s attached to a small semi truck and you can tune in and listen on your car radio, stay in your car.

Here`s the Detroit free press describing it. Quote: Churchgoers sing worship songs from their cars or trucks. They lift their hands in praise if moved by something the pastor said. They honk their horns to praise collectively.

And that`s just one snapshot from Michigan, from one state. Other services are being held online all over the country.

Susan and I get emailed what we call Church in a Box, which is audio files of sermons and songs from our pastor. A lot of different kinds of worship together but physically apart. People of all faiths are being innovated all over the country right now.

And there is now pretty good clinical data to show that there is good reason for it to be done that way. Last night on this show, I spoke with Mayor Lori Lightfoot of Chicago, one of the cities that has been very hard hit by the coronavirus epidemic. The CDC has just published a report tracing the origins and spread of one large cluster of coronavirus in the city of Chicago. This is the headline out of that report as covered by the "Chicago Sun Times."

Quote: How COVID-19 raced through meals, funeral hugs, a birthday party, and a church collection plate. "The Washington Post" describing the chain of events in the CDC report this way. Quote, in February family members gathered for a Chicago area funeral. A family friend who had been out of state attended and was just a bit sick with mild respiratory symptoms. Before long, 16 people between the ages of 5 and 86 had been infected with the novel coronavirus. Three had died.

The transmissions, which were traced to a funeral and a birthday party held three days apart, took place before major social distancing policies were implemented and may have facilitated transmission of COVID-19 to the broader Chicago community.

How did they transmit it to the broader Chicago community exactly? Well, for example, try church. Quote: Three of the symptomatic birthday party attendees went to church six days after developing their first symptoms. Another church attendee who sat within one row of them for 90 minutes and talked to them and passed them the offering plate also developed symptoms.

And so, at least part of Chicago`s now big, scary epidemic, may be traceable to a church service where nobody did anything wrong other than go to church as normal. And it`s not just Chicago. Take, for example, the great state of Kansas, where that state`s health secretary has been tracking more than a dozen clusters of coronavirus cases in Kansas. He says that four of the clusters he has been tracking have been linked to religious services and events.

And you would not believe the controversy that has just unfolded in Kansas politics over those findings and the effort to stop coronavirus in that state. It`s an amazing story, and that is next.

Stay with us.

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MADDOW: At the end of March, Kansas became the 22nd state to institute a statewide stay-at-home order, as well as a ban on large public gatherings. Thereafter, the Democratic governor of Kansas, Laura Kelly, clarified the large gatherings order to be explicit about the fact that it includes limits on all gatherings, including religious gatherings.

Governor Kelly acted amid a growing number of coronavirus clusters in the state of Kansas, a third of which are believed to have stemmed from people attending religious services and events and getting infected there.

Despite that clear pattern in the state, a group of Republicans in the state legislature yesterday voted to overturn the governor`s order on large gatherings because they want Kansans gathering in large numbers right now with the state`s coronavirus cases at like 1,100 and rising with dozens of deaths in the state already?

Governor Kelly today said she would sue those legislators who overturned her order. She would sue to reinstate her order, calling on the state Supreme Court to settle the matter.

But while this plays out, here`s what the state`s health director, Dr. Lee Norman, had to say.

He said this, quote: Whatever Kansas legislators do doesn`t reverse what The Public, capital "T," capital "P," The Public needs to do. Stay home so we can beat this scourge. Despite what the leaders of the legislature say, we are so close and they are doing politics. Don`t fall for it.

He says, quote: I am so angry. Shame.

We should mention that Dr. Norman knows of what he speaks. His medical career spans more than four decades of service as an Air Force flight surgeon, as a family physician, as the chief medical officer of the University of Kansas health system. He`s also a colonel in the Army National Guard.

As the chief health official in the state of Kansas, his daily livestreamed briefings on coronavirus have basically become much-watched TV in the state of -- must-watch TV in the state of Kansas. Dr. Norman has been praised on both sides of the aisle when it comes to his handling of this current crisis and the blunt way in which he has tried to explain it to Kansas residents.

But tonight, he is making clear he is not having it with this decision from the Kansas legislature.

Joining us now is Dr. Lee Norman, who is secretary of the Kansas state health department.

Mr. Secretary, Dr. Norman, thank you so much for your time this evening. I know you are very busy and right in the middle of it. Thanks for being here.

DR. LEE NORMAN, SECRETARY OF KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT: Thank you, Rachel. Appreciate being here.

MADDOW: I was struck by not just your blunt language about what the public in Kansas needs to do, whatever is happening with the legislature, what`s happening with this political fight as you described it, the public needs to stay home so we can beat this scourge.

I know you`ve been blunt-spoken throughout this crisis, but I`m also struck by the fact that you`re expressing anger here. I am so angry, you said. Shame with an exclamation point.

Tell me about what is animating you on this. You do seem like this is something that has really got to you.

NORMAN: Well, I`m a very moderately tempered individual normally, but this one was a mistake. I have nothing against religious gatherings now. I have it against all gatherings now. And I just don`t think that a religious gathering should be singled out.

We`re not limiting people`s ability to worship. You pointed that out in the earlier segment, that there`s all sorts of novel and interesting, creative ways, and I think most churches and church leaders are actually doing that. But to reverse it for the people to stand down and feel less the need to -- especially coming into Easter weekend, I think it`s just a big mistake. It`s very political, I think.

MADDOW: One of the things I was struck by in reading about this catastrophe in your state and this political sort of confrontation now is how you and your office and the authorities in Kansas have been tracking clusters within the state. You have been trying to map individual clusters of the virus and where people got it and how it was transmitted.

It seems from the public reporting on this that you have been able to track some of the spread of the virus in Kansas to religious gatherings of different kinds.

NORMAN: Yes, that`s true. There`s been four gatherings that have been quite specifically related to church events or services. There`s been three deaths that have related to that.

One was a woman who went back to her home county, infected her husband, and they both died. And we don`t even know all of the people that they might have contacted because they died. So it`s a whole cluster of them.

We know that four of them had between 10 and 40 people that have become infected because of that, and it`s just a -- it`s just a bad idea for that kind of a gathering. And it`s unfortunate coming into Easter weekend, and it`s not really about religious freedom. It`s really about not gathering in such a manner.

MADDOW: Mm-hmm. What are your projections for your state? How well-equipped do you feel like your state is given what you think is going to happen in terms of the trajectory of the epidemic and the measures that Kansans are taking or not to prevent continued spread of it?

NORMAN: We`ve been watching this, of course, Rachel because it hit the coast before it came to the heartland. So we`ve been able to stand up, organize our medical care facilities, our public health departments in the 105 counties. I think that we are going to be in pretty good shape this round.

Well, there`s a couple of things we don`t know. One is, is it going to be seasonal or not? Is it going to go away in the late spring, summertime and come back in the fall? You know, when I was deployed in the Middle East in 2017 and 2018, so I saw firsthand the Middle East Respiratory Syndrome, which is a coronavirus. It didn`t hit the peak until the fourth year, and it`s still seven years later grinding along.

Will this one act that way? We just don`t know this particular virus well enough to answer that question yet.

MADDOW: Dr. Lee Norman, the secretary of the Kansas State Health Department, Secretary Norman, I really appreciate you making time. I know there has been a lot more attention to the coasts than there has to the heartland, but we are interested in this story everywhere in the country, and we hope you`ll come back and keep us apprised as you keep fighting this in your state, sir.

NORMAN: Sure. Happy to do so, Rachel.

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

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MADDOW: Last week, one of the more remarkable, head-snappingly terrible Washington decisions of this epidemic was the firing of the captain of the USS Theodore Roosevelt, whose firing offense was apparently that he pled for help amid a coronavirus outbreak on his vessel that has now infected more than 400 sailors, including that captain himself.

Since that firing, the Trump-appointed Navy secretary has himself resigned for his role in that debacle. Well, today, we learned from the chief of naval operations, Admiral Michael Gilday, that an investigation into this matter has been completed. The admiral says he`s taking no options off the table, including the possibility of reinstating Captain Crozier as commanding officer of the Theodore Roosevelt if the investigation deems that necessary.

I don`t know if that is going to be the way this thing ends. But if it does, my God.

All right. That does it for us tonight. Thank you very much for being with us.

And now, it`s time for "THE LAST WORD WITH LAWRENCE O`DONNELL".

Good evening, Lawrence.

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