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US has highest number TRANSCRIPT: 4/14/20, The Rachel Maddow Show

Guests: Paul Rieckhoff, Valerie Arkoosh, Chuck Schumer

CHRIS HAYES, MSNBC HOST: All right. Dr. Mark Poznansky, who took some time away from working on the vaccine which we`ll let him get back to right now -- thank you very much.


HAYES: That is ALL IN for this evening.

"THE RACHEL MADDOW SHOW" starts right now.

Good evening, Rachel.

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

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

Last night, we reported on one of the largest new coronavirus clusters that has been discovered in the United States. And it is right in the middle of the country. It`s at this meat processing plant, a pork processing plant in Sioux Falls, South Dakota.

Now, the number of cases in this one plant, one workplace was over 250 known cases as of Sunday when the plant was shut down. As of yesterday, it was up to 350 known cases associated with this facility. As of tonight, it is 545 known cases of coronavirus that are connected to this one plant so far, 545 cases. Again, this is Sioux Falls, South Dakota.

Now, Smithfield Foods has closed this plant indefinitely. That said, South Dakota now has to figure out how they`re going to cope with having one of the largest clusters of coronavirus in the entire country with hundreds of confirmed cases all at once in their state.

As of tonight, the CDC has dispatched a team to Sioux Falls to try to figure out what to do there. We confirmed that with the CDC this afternoon.

South Dakota, of course, is one of the states that has a Republican governor, Governor Kristi Noem, who has decided for whatever reason that everything`s fine in her state. There doesn`t need to be any stay-at-home order there. Last night, we showed you the mayor of Sioux Falls where the Smithfield plant is. That mayor, also a Republican, basically begging for a stay-at-home order given the huge number of cases they`ve now got surrounding this one plant in his city.

The Republican governor, Kristi Noem, has refused that request from the Sioux Falls mayor just as she refused a similar request last week from the South Dakota state medical association. Instead, she has spent the last 24 hours going on Fox News, bragging about how great South Dakota`s doing and saying how they don`t need a stay-at-home order. She`s also done a press conference in which she repeatedly bragged about how often she gets to speak to Jared Kushner now, which is definitely a bragging rights kind of thing.

She`s also talked publicly about how she`s looking forward to spending state money doing a trial in South Dakota of the malaria drug that the president and various Fox News personalities have decided might be a miracle cure for coronavirus even though there`s no evidence of it being a cure or anything close to it. That`s what she`s going to do with state resources is try the drug that the president likes so much, but no stay at home. Governor Kristi Noem in South Dakota has defended not trying to slow the spread of coronavirus in her state with any sort of stay-at-home order. She`s defended that by saying, South Dakota is not New York City, which by definition is true just like this pencil is not a brontosaurus and none of us are Miss America, except for Miss America, who actually is.

But for the people of South Dakota and for the people who work at this Smithfield plant, until this week were working shoulder to shoulder with it turns out hundreds of their colleagues who have now turned out to be positive for coronavirus, and for all people who are family members of the 3,700 people who work in that plant, for their friends, for every person all of those workers have come in contact with in a state that is not at all sheltering in place and everything`s open, there`s no shutdown of businesses in the state. There`s no restrictions on bars or restaurants or anything else. Thank you, Governor Noem.

I mean, for our fellow Americans among and around that cluster, which may in fact be the largest coronavirus cluster in the entire country now, for our fellow Americans who are there now staring into the precipice for want of a governor who understands what`s going on here and who understands how exponential curves work and how viruses work -- I mean, you should know if you are in proximity of this giant cluster in South Dakota now, you should know that even though you`re not New York City, New York does want to help you. New York health professionals want you and all of us to learn from them and from what they`re going through because they`re warning about what we`re all heading into with increasing speed and certainty the longer various parts of our government in this country continue to dither and not figure it out.


DR. MELANIE MALLOY, EMERGENCY MEDICINE, MOUNT SINAI BROOKLYN, MOUNT SINAI QUEENS, NY: Hello. My name is Dr. Melanie Malloy. I am an attending physician at Mt. Sinai Brooklyn and Mt. Sinai Queens. I`m on my way to work. I have just had a very nice and cathartic dance party in my car, which is a good transition to work from home because I had a little bit of a stressful morning with my children, trying to get them set up for home school, getting everything kind of situated.

I am a widow, so I don`t have a partner to help me with them, and I don`t want to send them to my in-laws or my parents because they`re getting older and some of them have health conditions that might put them a little bit more at risk for COVID. There`s nowhere else really to put them.

I`m going to get mask, face shield, everything that I need to be safe on my shift. And I am going to start my shift.

I walked in, and they said, everybody`s intubated, and it looks like it`s true actually. Most of our beds are taken up by intubated patients, meaning patients who can`t breathe on their own and who are on a ventilator.

Almost everybody is on oxygen, and almost everybody is a COVID patient.

Always a lot of ambulances outside. So, today, there are 43 people in the department. That`s pretty much full, but I have to say it`s doing a lot better than a couple weeks ago when we had 86 to 96 in the department, 30 people boarding. It was really tough. It was really a bad, bad week.

But things have gotten a lot better now that we`ve been able to transfer patients, take admitted patients. Some of them are going to Central Park to the hospital there, some of them are going to our other sites, and it`s really helped to offload from our department. But we`re still full. We`re still all the way full.

So my surgery colleague, who is just kind of looking after patients, just let me know about a patient who looks like he`s having a lot of respiratory distress. He looks like he`s breathing at like 40 a minute. He`s got a breather on, but he looks really bad. So we`re going to call respiratory down and we`re going to put him on a ventilator.

So we have a full ICU. We have every patient in here on a ventilator. I wanted to point out how we have our IVs set up so that our nurses can get some protection by only using medications and hangs things outside the room instead of having to go in every time they need to change something on the pole.

As you can see, it`s not a huge space, but it`s quite full. Every bed is full. Every patient is getting multiple medications. Some are getting blood transfusions.

Everybody has coronavirus, but some people also have heart attacks at the same time. This happens, and it makes things even harder.

Well, my day is over. Well, my hospital day is over. It wasn`t the worst day I`ve had, but it`s always been draining. It`s hard. It`s hard to think that some of your patients that you diagnosed today might not be here tomorrow when you come back for your shift or, you know, all of it. I don`t know. I`m just tired.

So it`s almost 10:00 at night, and on my way home a got a FaceTime from my youngest child, who`s 4, who is still awake. She really was upset because she didn`t want to go to bed without seeing me. I kind of was hoping that she would be asleep because I`m tired, and I just want to just relax a little bit and go to sleep because it`s going to be an early day tomorrow with home school.

And I think that`s the hardest part. I think that`s like just being alone when I come home, knowing that, you know, my helpers are going home and it`s just me and whatever state my children are in. And I don`t really have a lot left in me, you know. So I -- I struggle with that because I wonder how much my children suffer from me kind of giving everything at work and coming home to it.

Tomorrow is going to be tough because I am going to home school all day, and I work overnight. I hope I can get a nap in at some point, but like I said, it`s just me. So, it really depends. It`s been a long day. Probably got a couple more minutes in me, and we`ll start again tomorrow.


MADDOW: That`s Dr. Melanie Malloy. Even as she points out that things are better this week at Mt. Sinai Booklyn where she works than they were last week, this week is better because they`re only completely full as opposed to being at 200 percent capacity in their ICU like they were last week. You see her there. She`s still sort of, you know, working past the point of human endurance right now.

New York City revised its count of the dead today to account for people whose deaths were attributed to COVID-19 causes even if they were never lab-tested for the disease, which seems like a pretty sensible recalibration of that data. I think most sharp observers have realized that New York was probably undercounting its dead. The refiguring that the city did today pushed the New York City death toll alone to more than 10,000. That pushed the American death toll overall to more than 29,000 dead.

Here`s Dr. Dean Babich at Long Island Community Hospital.


DR. DEAN BABICH, CHAIR OF INTERNAL MEDICINE LONG ISLAND COMMUNITY HOSPITAL NY: So corona or COVID-19 I think really took us by surprise. We weren`t properly prepared, not because of a lack of equipment, lack of PPE, or lack of ventilators, just by the daily onslaught of patients flowing into the emergency room day after day, hour after hour. It`s a mass casualty incident that just won`t stop.

Many patients are quite sick. Many of them require ventilators. Many of them requiring intensive care treatments, and they end up not making it. In fact, earlier this week we lost one of our own, a truly dedicated and wonderful critical care nurse that succumbed to the virus in the same unit where he for the better part of 15 years took care of our patients.

We`re throwing everything at this disease process from anti-malarial, two and three, (INAUDIBLE) inhibitors and convalescent plasma, and yet it`s simple. The way to kill this virus is simply just stay home. Stay home and wash your hands.

And if I can give any kind of advice to anyone, it would be just that. Leave the health care workers to take care of our patients and help us. Just stay home.


MADDOW: Help us. Just stay home.

Governors in the remaining U.S. states that are telling their residents no to stay home are flying in the face of this advice from the American health care workers who have faced this full-on first. And, you know, maybe it`s because New York got hit first, and no other places in America think of themselves as being anything like New York. But New York did go first, and they really are trying to tell the rest of it.

And so, I don`t know if heartland governors who are still resisting this advice find it easier to hear from a place like Indiana instead of New York, but here it is from Avon, Indiana.



Tonight, I`m working at I.U. West, which is in Avon, Indiana. It is 5:48 a.m., which means the end of my shift will be soon. The unit I`m working on is normally an eight-bed ICU. We are up to, I believe, 24 to 28 beds of intensive care patients.

I spent the first three hours of my night, intubating, lining chest tubes and stabilizing a patient that was going to code, but we were able to stabilize her.

Keep the quarantine going. I know we`ve been doing it for a long time, and it`s easy to get lax. But we keep getting more and more admissions, and these people might walk in through the emergency department, and within an hour, they`re on life support.

And their ages run from young to old to no comorbidities, meaning they didn`t have any medical problems before to having lots of medical problems before. But by the time they get to me, they are -- we`re trying really hard to keep them alive. And sadly, sometimes they get even sicker. Now their kidneys aren`t functioning.

You know, other organ systems start to fail. But keep the quarantine going. This is real. This isn`t the time to have a block party or go visit people you haven`t seen in a long time. Stay strong. Remember you`re doing this for a reason. You`re doing it for the patients that I`m trying to save and my co-workers are working hard trying to save.

And you`re doing it for you. You`re doing it for your family, your loved ones, your friends that you don`t want to get this.


MADDOW: You don`t want to get this. That is Brandie Kopsas-Kingsley, who is an ICU nurse in Indiana, one of the heartland states that is struggling now, too.

I mentioned at the top of the show, one of the biggest coronavirus clusters in the country, if not maybe the biggest, has just been discovered in South Dakota, which is a state where there is still no stay-at-home order. They`re not alone, sharing a big long border with the state of South Dakota is Nebraska, where there`s also still no stay-at-home order.

You want to check in on Nebraska for a second? Well, hospitals in Grand Island in central Nebraska said yesterday that that they are filling up, and they are starting protocols to ship their patients out to other Nebraska hospitals for relief.

Next to Nebraska and South Dakota is of course the great state of Iowa, which also has no stay-at-home order despite having more than 1,800 known cases in the state of Iowa. They`ve got another Republican governor there who thinks that`s fine.

Today, Iowa announced its largest one-day spike, which was 189 cases in one day driven by 86 new cases associated with one meat plant alone, another meat packing plant. This time it`s a Tyson pork plant in Louisa County, Iowa. They`ve got a total of 166 workers at that one plant who have tested positive so far in rural Iowa.

But, again, the governor thinks there shouldn`t be any sort of stay-at-home order in Iowa. No reason to do something like that to try to slow the spread. Same in South Dakota. Same in North Dakota. Same in Nebraska. Same in Arkansas.

All those Republican governors are just like, sure, no rush. It will be fine. I mean, literally, in Nebraska, the big coronavirus news today is that they are planning on reopening a big Nebraska crossing mall. It`s a mall called the Nebraska Crossing that`s out in Gretna, Nebraska, outside Omaha. They`re going to reopen that mall. They want to, at least.

Next week, quote, we are going to be the first shopping center that reopens in North America. They`re so excited to do that.

Why are they planning on reopening next week? Well, presumably they think things must not be that bad if there`s no stay-at-home order. Never mind the hospitals already overflowing inside one part of that state. Never mind that gigantic cluster in neighboring South Dakota. Never mind. It will probably be fine.

The World Health Organization has now outlined six things that need to be in place in any country, any place where officials want to start lifting restrictions and getting back to a normal way of living. Six things that you need before you can open back up according to best practices from the World Health Organization.

This is the whole list. You can see it there on your screen, as outlined by the WHO director. But if you don`t want to read all of that, I will tell you for our purposes, Americans, you really don`t need to read past step one, or if you`re ambitious, steps one and two because step one, the first thing you need in place before you can think about reopening is making sure that transmission is controlled.

Well, is transmission controlled in the United States right now? Hmm, here`s the global chart of new cases every day. And, yes, that`s us right up there at the top, way above everybody else in terms of new cases every day.

So if step one is making sure that transmission is under control in our country, we`re not there. Well, if you want to be ambitious, you might want to look ahead to step two. What we`re aiming for, step two out of six? What`s the second step you need it place before you can open back up?


TEDROS ADHANOM GHEBREYESUS, WORLD HEALTH ORGANIZATION DIRECTOR GENERAL: The new strategy summarized what we have learned and charts the way forward. It includes six criteria for countries as they consider lifting restrictions. First, that transmission is controlled. Second, that health system capacities are in place to detect, test, isolate, and treat every case and trace every contact.


MADDOW: Health system capacities are in place to detect, test, isolate and treat every case and trace every contact. So step two, before you can even think about opening up, is make sure you as a country have the capacity to detect every coronavirus case in the country, confirm that with a test for everyone, isolate every single person who tests positive, and then trace every contact that person has had so that you can test, isolate, and trace contacts for all of those people too.

How many of those things do we have in place as a country? Yes, none. None. We`ve got more than 600,000 confirmed cases in our country. We had more than 25,000 new cases reported just today.

The backlog to get a test result in New Jersey right now, which is the second most cases of any state in the country, is two weeks backlog to get your test result. At Mt. Sinai Brooklyn where you just met Dr. Melanie Malloy at the top of this segment, in the bull`s-eye of the bull`s-eye in Brooklyn, New York, there`s a sign up on the overflow tent letting people know, yeah, even there they can`t test you if you`ve got symptoms mild enough that they`re not going to hospitalize you.

No, we do not have systems in place in this country to stop transmission at all but also to deal with testing, isolating, contact tracing. We`re not doing -- it`s not happening. And so we`re going to open up now before we have any of those things in place? Twenty-five thousand new cases a day, 2,000 deaths a day. Sure, why not? Tear the lid off.

Pay no attention to, for example, the 500-plus cases just discovered in one cluster in one corner of South Dakota. Yes, tear the lid off. I`m sure it will be fine.


DONALD TRUMP, PRESIDENT OF THE UNITED STATES: I will then be authorizing each individual governor of each individual state to implement a reopening and a very powerful reopening plan of their state. It`s going to be very, very close, maybe even before the date of May 1st. So that will be for some states. Actually, there are over 20 that are in extremely good shape, and we think we`re going to be able to get them open fairly quickly.


MADDOW: Over 20 states in extremely good shape. Is one of those states South Dakota?

I try not to pay too much attention to things said by the president because they usually have no rational connection to things done by the president, and so why bother watching the lips flap when you can instead just watch what happens.

But what he did just say there this afternoon at the White House about over 20 states are in extremely good shape -- they`ll open up very soon, before the end of this month. That`s what I consider to be one of those Kate McKinnon Trump moments. You remember the "Saturday Night Live" skit where Kate McKinnon is in her Hillary Clinton role and she comes to the door with a "Love Actually" style set of cue cards to let us know what`s coming? Donald Trump becomes president. He will kill us all.

This is one of those Kate McKinnon/Trump moments. Sure, Mr. President. Just open everything up. May 1st sounds like it`s way too long to wait. Sure, at least 20 states. Just rip the lid off.

Dr. Tony Fauci told the "Associated Press" today, quote, we`re not there yet when it comes to opening back up. We do not have in place the things we need to open the country back up now, and thank God Tony Fauci is still willing to say that.

California`s Governor Gavin Newsom today released a set of six steps that California will follow before they open back up, and those six steps track basically with what the world health organization is laying out as well. So maybe California will continue to lead here despite what the president is saying. If so, I think you could expect to hear more talk from that state`s governor about California being a nation state instead of just a state.

We`re going to talk with the top Democrat in the Senate, Chuck Schumer, tonight about what`s going on with the federal response and this reported $25 billion airline bailout deal tonight and the president saying he`s going to cut all U.S. funding of the World Health Organization and all the rest.

But big picture for all of us in terms of the stuff the federal government needs to get in place, the stuff that we as a country need to get in place so we can start to imagine the end of this thing, honestly, we are nowhere near having in place what we need to open up. We`re nowhere near having in place what we need to open up that mall in Nebraska let alone anything else. We are still not even coping with where we have the very worst outbreaks with the most Americans on track to die.

The worst case scenarios we are not even confronting at a national level yet, and that`s what we`re going to talk about tonight. Stay with us.


MADDOW: This was in "The Wall Street Journal" just a few days ago. Quote: The Department of Veteran Affairs is experiencing serious shortages of protective gear for its medical workers treating patients infected by coronavirus according to excerpts of internal memos shared with "the Wall Street Journal."

A few days ago in "The Journal", one of those memos, something that was circulated among a group of top ranking V.A. officials. It said, quote, experiencing serious PPE shortages. Several sites doing 3-D printing but it is not enough. Soon, PPE will be rationed.

Those are the kinds of alarm bells that were going off this month within the V.A. at the highest levels inside the department. To the public, though, the V.A. was taking a stance that was very different than that. On the same day that that internal memo circulated at the highest levels of the V.A. warning about serious shortages and rationing of PPE, a spokeswoman for the department said publicly that there was no concern about any shortage of equipment.

Quote: All V.A. facilities are equipped with essential items and supplies and we`re continually monitoring the status of those items to ensure a robust supply chain, which sounds great. Good talk.

The only problem is, right, internal memos showing exactly the opposite ground truth inside real V.A. medical facilities kept leaking out. After that initial report, the journal soon got their hands on another internal V.A. memo that had again been sent to top V.A. level -- top level V.A. officials saying that the rationing of PPE had officially begun, by which point V.A. workers on the front lines were already dealing with that reality.

At one Kansas City facility, personnel were being given one mask per day. They were told to make it last unless it is, quote, irredeemably soiled. In the days since, "The Journal" has reported that the situation has deteriorated further. Quote, a shortage of face masks and N95 respirators has led the Department of Veterans Affairs to tell hospitals to decide which employees get masks and which don`t. Again, according to internal memos reviewed by "The Wall Street Journal."

One of those memos said, quote: Mask supply levels in V.A. health administration do not support providing masks to all other employees. They also told hospital administrators that the department will allow staff to bring their own masks or respirators when hospitals don`t have them available. Bring your own. See what you can cobble together from stuff you find around the house while you treat America`s veterans at V.A. medical facilities.

I will say that bring it from home anecdote tracks with information we received from one V.A. medical facility in Georgia where staff were told the medical center was seeking donations from the public for basic things like disinfecting wipes, paper towels, and bleach, let alone gloves and face shields and masks. They`re soliciting bleach donations from the public for a V.A. medical center?

Despite all this evidence of what`s actually happening inside V.A. facilities, the public line from the V.A. has continued to be, incredibly, that everything is just fine. There`s nothing wrong at all.

When "The Wall Street Journal" went to the V.A. for comment, V.A. spokeswoman Christina Noel told the paper, quote, the premise of your question is false. All employees who need PPE have it.

It doesn`t seem like that`s true. Why won`t the V.A. admit it? The V.A. is trying to sort of happy talk the public about this, but there is a real crisis taking place.

I mean, we`ve learned that as of today, more than 1,500 V.A. staff have tested positive for coronavirus. Thirteen staff members are already known to have died. There are more than 4,200 coronavirus cases among veterans within the V.A. system, 257 vets are already known to have died.

And that`s separate and apart from the situation in state-run veterans homes, the ones run by various states. In those facilities, we have seen deterioration at a rapid clip. Within the past day alone, we`ve seen reporting on an explosion of cases in state-run veterans homes in Alabama, in New Jersey, in Maine, in Washington state, in North Carolina.

In the worst case, which you have been hearing about over the last several days, 44 residents, 44 veteran residents have now died at just one veterans home in Holyoke, Massachusetts. 44, one facility.

The Trump administration secretary of veterans affairs, Robert Wilkie, has been largely absent amid all of this. He has held no daily public briefings. He has done little to no press. We know from "The Wall Street Journal`s" reporting he is being briefed about equipment shortages but he hasn`t said anything about that in recent weeks.

Problems at the V.A. are not a surprise. Lots of different health systems are having problems. But they`re not going to get any better simply by avoiding answering questions about them and pretending everything`s fine. They`re not going to get better by happy talking the public and saying there are plenty of supplies when clearly there are not.

The V.A. is the largest health care system in the entire country, run directly by the federal government, serving more than 9 million of our nation`s veterans. Baghdad-Bobbing your way through this is not going to work. It`s not even going to work as P.R.

Joining us now is Paul Rieckhoff, the founder of Iraq and Afghanistan Veterans of America. He`s now the host of "Angry Americans," a podcast.

Paul, thanks very much for joining us this evening. It`s good to see you, my friend. It`s -- I`m glad you`re able to be here.

PAUL RIECKHOFF, FOUNDER OF IRAQ AND AFGHANISTAN VETERANS OF AMERICA: Good to see you, my friend. Thank you for all your leadership.

MADDOW: Well, talk to me about how you feel about this V.A. story. I feel like I do not want to be reductive, and I do not want to think about every V.A. medical center as being the same as every other. I know that state-run veterans homes are having different challenges that V.A. medical facilities.

But it strikes me as nuts and increasingly actually just weird that the V.A. is maintaining this public front that everything`s fine. They don`t have any shortages. They`ve got no problems.

RIECKHOFF: Well, it`s dangerous and potentially devastating. Here`s the big picture. We now know we`re a nation at war against the virus. We`re a globe against the virus.

But here at home, there are two major forces that could add tremendous resources and either be the cavalry or be a deck of cards. The Department of Defense on one side, and the Department of Veterans Affairs on the other side. The Department of Veterans Affairs serves 9 million people nationally. You`ve talked about the resources they bring to bear. They have a sacred duty to care for our veterans and that`s important.

But this time, it`s much bigger than that. They are the nation`s backstop. Every time I`ve come on your show for over 10 years, we`ve talked about V.A. problems. We`ve talked about data issues and it`s always affected mostly veterans.

Now, it affects you. It affects everyone because if your hospital overflows, the V.A. is tasked nationally to be there to control that overflow.

So, they haven`t been clear. They`ve been slow. They haven`t been transparent, and the bottom line is the V.A. is not ready.

The Department of Defense, I would argue, is not ready either. But the V.A. is not ready and the secretary of veterans affairs, he wasn`t seen in public for over a week. He wasn`t just not doing briefings, and he takes -- he apparently takes Easter off. He`s not putting anything out on Twitter. He`s totally AWOL.

That`s why I`ve used the hashtag #whereiswilkie? He should be the lead element on combating the virus and providing support, not just for veterans but for the entire public, and he`s been M.I.A., and that`s a failure of leadership that should concern everybody.

MADDOW: Paul, one of the things that you have raised both online and on "Angry Americans" is concerns about testing. As far as we can tell, the V.A. has only conducted about 37,000 coronavirus tests, and I know that just sounds like a random big number. But for perspective, New York state has conducted more than 12 times that amount.

The V.A. is putting out daily numbers. They do have a lot of facilities. We know about a lot of V.A. staff and veterans in the V.A. system who are positive, but it seems like the testing numbers should be a lot higher, particularly since they are a health system directly run by the federal government.

RIECKHOFF: One hundred percent. I mean, think about it -- they serve 9 million people. They`re supposed to be the nation`s backstop, and they`ve only tested about 35,000 people. I mean, there was a point where New York state was testing more daily than the entire Veterans Affairs Department had tested so far.

And what we found at the Veterans Affairs Department is the more they test, the more they find. And you`ve touched on this on your show. You can see where outbreaks are coming. You can see where problems are emerging.

New Orleans has a number of cases that`s about three times the number of most other places. Then you see places like New Jersey and New York where the deaths are concentrated. You`re starting to see Detroit and Washington, D.C., and then you see where things are working like California.

So this is a real insight into how the coronavirus could hit other cities, could hit rural areas, but also you`ve got to underscore the fact that this is an extremely vulnerable population. More than half of patients at the V.A. serve are over 65. They`ve got tons of these retirement communities and retirement homes, and the state ones are maybe just the canary in the coal mine. Maybe we push tons of resources and it`s not a problem down the line, or maybe this is the tip of the iceberg.

So everything that happens having to do with the coronavirus in the United States should center around and with the V.A. they can be our cavalry, or they can be a house of cards that falls beneath us when we need them the most.

MADDOW: Paul Rieckhoff, the founder of Iraq and Afghanistan Veterans in America, the host of the "Angry Americans" podcast -- Paul, thank you so much for your time on this. Thank you for sticking with this. Come back and talk to us about this as this story develops.

I think the first thing that has to break here is the V.A. needs to be honest about what`s going on, but we are talking about substantively what needs to be done. I want to continue tracking that with you, my friend. Thanks for being here.

RIECKHOFF: A hundred percent. My pleasure. I hope the secretary will join you before I join you again.

MADDOW: I`ll do my best.

All right. Thanks, Paul.

All right. We`ve got much more to get to tonight. The top Democrat in the Senate, Chuck Schumer, is going to be joining us live in just a few minutes.

Do stay with us.


MADDOW: This was the headline out of KOKI dateline, Bartlesville, Oklahoma, today. Oklahoma nursing home hit with 45 positive COVID-19 cases.

This is rural Wayne, West Virginia, which is about a half hour south of Huntington, West Virginia. Right now, the city of Wayne has 67 confirmed cases of coronavirus. Of those 67 cases, 66 of them come from a single nursing home.

This is the headline in Richmond, Virginia, today. A long-term care facility there has had 45 of its residents die from coronavirus. It`s one of the deadliest outbreaks anywhere in the country. The medical director there calling nursing homes, quote, a virus` dream.

Richmond, Virginia. Oklahoma. Wayne, West Virginia -- this is not a regional problem. No regional problem would affect those places alone. This is not a sort of hot spots only sort of issue. It`s now shaping up clearer and clearer every day.

One of the things that we are all going to have to answer for as Americans, as citizens who lived through this, is the fact that it was clear by now that the places we are most likely to see the most American deaths from this thing are congregate living places like nursing homes and long-term care facilities. It is clearer than day right now. What are we doing about it?

You want to save the most American lives in this crisis? Figure out how to save them there, nursing homes, long-term care facilities.

Take Montgomery County, Pennsylvania, as a kind of case study. It`s Southeast Pennsylvania. It`s a decent sized suburb of Philadelphia. More than 8,000 people live in Montgomery County.

They`ve got the second largest outbreak in the state of Pennsylvania. More than 2,300 cases in that county. Now, got news out of Montgomery County thus far is even though cases are still doubling every seven days or so, the spread of the virus does seem to be slowing down there, which is giving hospitals in Montgomery County a chance to keep up with the patient load.

That is not something they were sure they were going to be able to do. It`s good news that they are. But look what`s happening in long-term care facilities in that same Philly suburb.

Of the more than 600 facilities that county is tracking, at least 73 of them have confirmed cases of coronavirus thus far. That is 10 more than they had just on Friday. At least seven facilities in the county have 25 cases or more. So far, 61 percent of all the coronavirus deaths in that one county are coming from congregate care facilities of one kind or another. Sixty-one percent of the deaths in a county that`s got a good sized epidemic.

Now, the reason I`m able to give you that granular snapshot from that one county in Pennsylvania is not because there`s some kind of national database I tapped to get that kind of information. There`s no national information about this. The federal government isn`t even keeping track of this. This is the place where most Americans will die, federal government not even counting. Not even keeping track let alone working on it.

But in Montgomery County, Pennsylvania, there is a concerned local official in charge there who is keeping track, which allows me to give you that data. Her name is Dr. Valerie Arkoosh. She`s the chair of the Montgomery County board of commissioners, and she has been holding a press conference every day about the state of coronavirus in her county. And every day a feature of her updates is a snapshot of how coronavirus is ripping through long-term care facilities in her county.

She`s watching them because they`re on her patch and because that`s the place where Americans are most at risk of dying, where the most Americans will be killed. Just imagine if we had that kind of attention from leaders everywhere. Imagine if we had that kind of attention from leaders in Washington.

I mean, it is very useful to have that kind of granular information, to have that kind of daily focus on where the most Americans are most at risk of getting killed. But having that focus and getting that clear picture, having the data is half the battle. The other half is being able to do something about it without any federal help.

And in the absence of any kind of national plan or even national acknowledgement that coronavirus is spreading through congregate care facilities like wildfire in this country and poses a real risk of basically a cull nationwide of elderly people and vulnerable people in these facilities coast to coast.

Given that risk, given the start of that happening, what are local officials even concerned local officials supposed to do here? What can they do? I have just the person to ask next.


MADDOW: Valerie Arkoosh is the chair of the board of commissioners in Montgomery County, Pennsylvania. She`s also a physician. She`s worked on health care reform. She`s worked on fighting the opioid epidemic.

She now finds herself in the center of responding to a new public health crisis with a significant coronavirus outbreak in Pennsylvania, in her county. And with long-term care facilities being particularly hard hit, Dr. Arkush has been making daily check ins with those facilities, daily discussions of what`s going on in those facilities part of her county`s response and part of how she`s keeping her county informed about what`s going on in their community.

Dr. Valerie Arkoosh, thank you for being here.

DR. VALERIE ARKOOSH, MONTGOMERY COUNTY, PA, BOARD OF COMMISSIONER CHAIR: Thank you, Rachel. I appreciate you shining a light on this incredibly important issue.

MADDOW: So, I was -- oh, do we not have sound?

Tell me in the control room whether you can hear Dr. Arkush because I can`t hear her. You can hear her.

Doctor, can you still hear me?


MADDOW: All right. I`m going to give it a last college try. We`re going to take a quick break. I promise I will fix this, and we`ll be right back.

Stay with us.


MADDOW: I have said the magic spell to banish the technical gremlins that made that break necessary. So therefore I`m confident in introducing to you Dr. Valerie Arkoosh. She`s the chair of the board of commissioners in Montgomery County, Pennsylvania.

Dr. Arkoosh, thank you so much for being here. I`m sorry about that glitch.

ARKOOSH: No worries. It`s an interesting time that we`re working through here. So I appreciate the opportunity to speak with you.

MADDOW: Generous of you to put it that way.

One of the reasons I wanted to talk to you is because I have watched your press conferences in Montgomery County, and I have noticed that the first - - one of the first things you do after giving a general overview of what`s going on in the county is you`ve been giving a granular snapshot of how the virus is spreading through long-term care facilities and nursing homes in your county. And I have latched onto that, and I`ve latched onto the way you have communicated to the public about that because I think that is the part of this response where the most American lives are at stake, where the most American lives can potentially be saved if we get it right, and the most will be lost if we screw it up.

I wanted to ask you why you decided to make that part of your daily briefing and why that`s been so much of your own focus.

ARKOOSH: Well, Rachel, as you mentioned, I`m a physician, and I also have a degree in public health. And in the years that I practiced medicine, I have to tell you this is one of the most heartbreaking things that I`ve seen. And I`ve learned through the beginning -- since the beginning of this pandemic that the more information that you give people while still protecting people`s privacy, the easier it is for them to understand why we`re asking them to do a lot of really difficult things like close their businesses and keep their kids out of school and stay home.

When it comes to our long-term care facilities, they have some of our most vulnerable members of our community, our parents and our grandparents. They are taken care of by incredibly hardworking people, and in the case of our county, we see that 61 percent of the lives that are lost to the coronavirus are happening in long-term care facilities. And we just want to make sure people understand how serious an issue this is.

MADDOW: And you mentioned there right at the top that giving people information while still protecting privacy is a way to get people to do the right thing even when what they`re being asked to do is hard. Is there any reason why every county in the country that`s dealing with this, every state in the country that`s dealing with this couldn`t do that kind of public disclosure that you`ve been doing in Montgomery County?

We have heard from a lot of local officials and from a lot of governors a real resistance to releasing information about how bad the problem is in nursing homes and long-term care facilities. They don`t, in a lot of cases, Democratic states and Republican states, they don`t want that information out there. And we`ve had a number of different excuses.

What do you say to those officials about why you`ve been able to release that information when others haven`t?

ARKOOSH: I think it`s important to just give people the truth and the facts while still protecting personal information and privacy. But this is a very real issue that we`re experiencing in our county, and I think that one of the ways that we can help draw more attention to issues around how long it takes to get tests back, how difficult it still is to get personal protective equipment for these workers, is to have people understand the impact in their neighborhoods and in their communities by the lack of these really critical items.

And so, hopefully, by just shining the light on the fact that just like everyone else, nursing homes take three to six days to get their test results back. So when they`re trying to protect patients, isolate patients, they`re waiting as long as everybody else is waiting to get those test results back. And in those intervening days, a lot of other people can be exposed if those workers don`t have enough personal protective equipment. And so, that`s just one example of how really vulnerable people can be impacted by this.

MADDOW: Dr. Valerie Arkoosh, chair of the board of commissioners in Montgomery County, Pennsylvania, who has been, I think, modeling good civic behavior by being really up front about the fact that 60 percent of the deaths in your county have been people in long-term care facilities already. Thanks for helping us understand what`s going on where you are and thanks for making time for us tonight.

ARKOOSH: Thank you. Take care.

MADDOW: All right. Right about now, I`m usually racing to end of the show or to subtly and guiltily bleed over into the next MSNBC hour that starts right now. But I don`t have to get off the air by my deadline of 10:00 p.m. tonight, because our network colleagues at NBC are hosting a special live report on the coronavirus pandemic tonight, which starts at 10:10. I don`t know.

But that means that we get 10 extra minutes. And so, we have gone into what I consider a multiball extra time. And what we have scheduled for this time is a very important interview that I`ve been looking forward to all day with the Democratic leader of the United States Senate, the senior senator from New York, Senator Chuck Schumer.

Senator Schumer, thank you so much for being -- being with us here tonight. I really appreciate you making the time.

SEN. CHUCK SCHUMER (D-NY), SENATE MINORITY LEADER: Good evening. It`s good to be playing multiball with you.

MADDOW: Exactly. It`s always the most exciting part of the game.

Senator Schumer, there`s a lot of things I want to talk about today, stuff going on in Washington, also stuff going on in New York.

Let me ask you first about an event that you did today in Elmhurst, Queens. Elmhurst, Queens, you were there with Congresswoman Alexandria Ocasio- Cortez. Obviously, Queens is really the epicenter within the epicenter of New York City. And you and the congresswoman are -- have an interesting request. You`re calling on FEMA to help families pay for the funerals of their loved ones.

Is that -- is this a novel idea that you have -- that you guys have developed around the coronavirus crisis, or is this something the federal government has done in past disasters?

SCHUMER: Well, it is not a novel idea, although it was first suggested to me by the congresswoman when we had a call of the delegation.

And I said, this is awful. Corona is in neighborhood, in so many neighbors throughout New York and the country of hardworking people, they struggle, they don`t have that much money, but they`re trying to build a better life for themselves and their family. And corona struck so hard on communities of color, on poor people.

And one of the worst indignities that a family can have is a loved one that passes away and you can`t give them a decent funeral or a decent burial. So, the congresswoman suggested to me, we do something about it.

And guess what? We found out that FEMA has done this in the past. It has allowed money, its own money, to go forward for burial and funeral expenses. In fact, they did it in Sandy, which hit New York about seven or eight years ago.

Well, if they can do it for Sandy, they can do it for poor communities like this. And she and I have written a letter to FEMA. We`re hoping they`ll say yes.

If not, we`ll put it in legislation in the next corona bill, Corona 4 or CARES II, whatever you want to call it. And I think it will pass. It`s so - - it`s only the right thing to do for people who have suffered so.

MADDOW: Senator, what is your perspective on where New York is in the course of its epidemic?

We saw a dramatic increase today in the number of reported deaths out of New York City. It`s actually led to a pretty dramatic growth in the number of deaths reported in the United States today.

That was both because a lot of people died in the last 24 hours and because there was a revision in the way that New York is counting. Some people had not previously been reported as COVID-19 deaths, even though they had died with symptoms or signs of the infection now have been counted.

What do you think about how New York is doing in terms of getting its arms around the size of the crisis, and whether or not you believe that New York is on the down slope in terms of things getting better?

SCHUMER: Well, the downslope might be a little optimistic. But it`s certainly not going up. It`s flat and hopefully beginning to trend down.

One of the things you look down is who is intubated, who is put into these machines, which means the people with the most serious illnesses. And that is beginning to decline. The number of hospital admissions is beginning to decline, even though the number of deaths isn`t.

So, we`re hopeful. You know, as you go through New York and look out -- I look out my window, the streets are deserted. People are practicing -- praise God, thank God -- social distancing very, very seriously.

I go out for a walk every day, that`s my one little bit of relaxation during this 24/7 period where you`re working all the time, with so many problems and so many issues, and people are not going near each other.

So I think people are learning that that`s important to do, and hopefully we`ll begin to see the trend go down. But I -- keep your fingers crossed is how I put it.

MADDOW: Senator, what some of the news that we`re getting tonight from Washington is a remarkable story that the president is insisting that his name has to physically be printed on the stimulus checks that are going to go out to taxpayers as part of one of the relief bills. It was reported tonight in "The Washington Post" that the president insisting on having his name personally on the check, will slow down the receipt of those checks by several days.

Now, the White House is pushing back on that to NBC News, but that is what "The Washington Post" is reporting. I wanted to ask you. I mean, the president isn`t a legal signatory to checks like this. I think they`re --

SCHUMER: No (ph) --

MADDOW: -- "The Washington Post" describes it they`re going to have to put his name on the memo line instead of the signature line. This seems like sort of a remarkable ego trip from the president, particularly if it`s going to have material consequences in terms of when people get their money.

SCHUMER: I agree. Rachel, I wish it were the only ego trip. It seems almost every day, the president thinks this crisis revolves around him and his desires, his needs, his enemies.

I mean, look at today. Let`s take two things side by side. He goes after the WHO.

What good is it? How is it going to make the country better by going after the WHO one day or the press one day or the governors one day or Pelosi one day or me one day? That`s all he seems to -- that`s seems to be where his energy is.

At the same time, we don`t have a regime of testing. Everyone knows if we want to get out of this crisis, we need a nationwide testing regime. Everyone knows if we want to avoid going back into a crisis some months later, we need this.

And yet the plans of the White House are almost nonexistent. They`re helter-skelter. No one is really in charge.

And that`s why I have asked them to create the -- use the DPA, the Defense Production Act, which is a Truman relic almost from the Korean War, which could be needed, which could be used. You could appoint a czar, that czar that could command factories to make this amount of tests, command supply lines to supply them with what they need, distribute those tests to where they`re needed and have a nationwide plan. This is what Korea has done.

There`s a story in today`s I think "Washington Post", the reason that Germany has so many fewer deaths than Britain is they had a nationwide regime of testing and then tracing and following-up.

So, instead of calling names or deciding who signs the check, the president ought to be rolling his sleeves and helping solve the problem. And it seems like too much of what he says, does and thinks about is about himself.

MADDOW: Do you think that it`s possible that the federal government will never get its act together to do those things and that those kinds of -- those kinds of solutions, the actual things we`ll need to safely open up the country at all will inevitably have to be done by some states and those places will be safer and better off than other places that never happen -- where it never happens because the federal government can`t do it?

SCHUMER: Well, right now, that`s where it seems to be where the action is. The states seem to have their act together much more than the administration, much more than the national government. And I hope that doesn`t happen.

Look, we all want this administration to succeed. It`s life and death. It`s the health, the economy, the jobs, the wealth of this country.

But so far, I think the people who watch the president`s press conference every day, a large number of them, including from what I`m told, that a good chunk of Trump supporters, are really so disappointed to put it mildly on how things are being run up there.

MADDOW: Senator Chuck Schumer, Democratic leader of the United States Senate -- sir, I know this is a time when everybody is working 24/7 and there are so many problems to work on. Thanks for making time to be with us tonight. I appreciate you being here, sir.

SCHUMER: Good to be with you. Thank you, Rachel.

MADDOW: I will say, I just want to -- before we go tonight, I want to just underscore something that I mentioned at the top of the show tonight, and that we`ve been trying to make as clear as possible through this broadcast every evening, which is that if you think about this crisis in terms of saving the largest numbers of Americans, the largest numbers of Americans whose lives are at stake are among the most vulnerable and powerless Americans in the country.

And by that I mean people who are living in congregated care facilities, people in jails and prisons, people in long-term care facilities, people in nursing homes. And these are people who are largely invisible and have zero political power and zero voice in our political system right now.

It is not going to be up to us as a country to listen to them for what we need. It is going to be up to us, the citizens of this country, to make sure that the most lives are saved by virtue of the fact that we are focusing on them even when we are trained to not hear their voices themselves.

It`s a moral imperative that we`ve got tonight, that is -- in all honesty, we`re all going to have to answer for it.

It`s now time now for NBC News special report on the coronavirus pandemic. We`ll see you again tomorrow night. Thanks for being with us.

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