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Frontline medical workers TRANSCRIPT: 4/17/20, The Rachel Maddow Show

Guests: J.B. Pritzker, Ernest Patti

CHRIS HAYES, MSNBC HOST, "ALL IN": And that`s going to be a while. Tom Colicchio, always great to talk to you. Thank you so much.

That is "ALL IN" for this evening.

THE RACHEL MADDOW SHOW starts right now. Good evening, Rachel.

RACHEL MADDOW, MSNBC HOST: Good evening, Chris. Thanks, my friend. Enjoy your week. I appreciate it.

Thanks to you at home for joining us this hour.

You know, there were some positive signs over this past weekend, the holiday weekend, when the U.S. daily death toll from coronavirus seemed to be dropping. On Friday, a week ago today, you might remember the number of Americans who died from coronavirus that day topped 2,000 for the first time in this epidemic, which was a terrible milestone.

Again, that was a week ago today. We are over 2,000 deaths in one 24-hour period for the first time. But then over last weekend`s holiday weekend, over the Easter weekend, those numbers dropped, back, a little bit. And it seemed like maybe the numbers had maybe hit their peak, and would start to consistently drop, that`s obviously what everybody was hoping.

But since then, the numbers have been back up over 2,000 deaths each day. Or Tuesday this week, Wednesday, Thursday, and now, for today as well.

It`s just astonishing to be having that many Americans killed every day now, more than 2,000 Americans every day. But just look at how fast this thing has exploded.

If you go back seven weeks ago, to the last Friday in February, that Friday, February 28th, four Americans had been killed by coronavirus. A week later, March 6th, it was 26 Americans who had been killed. The week after that, March 13th, it was 55 Americans dead. The week after that, March 20th, 247 Americans dead. One week after that, we went from 247 to 1,574.

And the month of April has just been astonishing since then. In that one week, between Friday, March 27th and Friday, April 3rd, we went from about 1,500 Americans dead, to more than 7,000. Last Friday, April 10, that number had more than doubled, and now, since last Friday, we are having more than 2,000 Americans die every day.

Now, we`ve got more than 32,000 Americans dead overall now, and that has all happened, we`ve killed 32,000 Americans in less than eight weeks.

New York continues to have the worst toll. Even as we are seeing all these good signs, statistical signs in New York, the number of new infections each day, the slowing and its rise, the number of people hospitalized is falling, the number of people in ICU beds is falling, but still, the death toll is sky-high in New York, every day, and it is staying there.

Today, New York Governor Andrew Cuomo announced yet again, more than 600 deaths in New York, in the past 24 hours, 606 deaths yesterday, and 630 today. And those numbers, it has been above 600, 700, for all of the last week.

And of that 630 number today, the number of New Yorkers who have died in the last 24 hours, again today, Governor Cuomo took care to specify how many of those deaths in New York in the past 24 hours were in nursing homes. It was 40 of those 630 deaths.

We`re going to check in later this hour, with one of the front line intensive care doctors who has been serving in a bull`s eye New York City hospital, Saint Barnabas. Dr. Ernest Patti, we spoke to last week, you might remember about, the condition in his incredibly hard-hit ICU in Saint Barnabas. We`re going to check back in with Dr. Patti tonight live tonight, right at the end of his shift, to talk about what it is like in the ICUs now, as New York is seeing, in the data, a possible light at the end of the tunnel, but the tunnel is still so black and so long and so cold, with more than 600 New Yorkers dying every day.

And it is interesting, we watched Italy, so closely, from here, as a precursor, we were worried that Italy was going to be a precursor, as to what we would go through in this country, those warnings were exactly right in terms of us following Italy, and then them handing us the baton of having the worst outbreak on earth. Because we saw Italy go before us, we were also heartened when we saw Italy start to turn their curve, start to bend their curve, we started to see their infection, new infections, their new hospitalizations, their ICU utilization numbers, starting to go down.

But even as Italy turned the corner on those number, as New York is now, Italy`s death toll still holds steady at an incredibly high rate, even now. I mean they are a couple of weeks ahead of us. But Italy is still, even today, up over 500 deaths per day. And it is not coming down.

I mean, just like New York looks like it`s turning the corner, on some very important metrics, but New York deaths are staying high, high, high every day. Over 600, over 700. And that, the plateau of very high death numbers every day, that`s very worrying, in terms of thinking about the overall number of Americans who are going to lose their lives here by the end of this epidemic. I mean, we are seven weeks into it, we are over 30,000 Americans dead.

And the worst-hit places are still turning in unimaginable daily numbers. New York as I said, over 600 deaths minimum every day. New Jersey had 323 deaths in the past 24 hours. That`s their worst yet. New Jersey has had more than 1,400 deaths in the past four days.

I mean those numbers, you start to combine those numbers, day after day, and state next to state, and it is just, we are losing a lot of people, and we are going to lose a lot of people. But this is the challenge that we have as Americans now, who in our lifetimes are going through this, and who will have to answer for what we did in this trying time. We will have to answer for what we did as Americans, to minimize the number of lives lost. Save as many people as possible.

And toward that ends, there`s two things, I think, that will be worth keeping in mind tonight, this Friday night, and as we head into another weekend. The first is something that we`ve been talking about in this show a lot over the last, the past week or so, but I have some new news to share about it tonight, that I think you will find interesting, and different from the way we have been talking about it in recent days, and that`s the issue of nursing homes and long-term care facilities, which, as you know, has been, has robbed me of my ability to sleep the past week or so.

It`s because those are the places where the most American lives are at risk from the pandemic, where the most vulnerable patients are at most risk of infection, and at most risk of not getting the care they need to keep them alive.

Now, I want to tell you tonight, that we are starting to see some important movement on the issue of nursing homes and long-term care facilities. It`s not from the federal government of course, which is where we really immediate it to be. But we are at least seeing what I think is some important movement from some states.

Now, I went out of my way to mention a moment ago that New York Governor Andrew Cuomo has started briefing every day, not just on the death toll, in New York state, but he specifically started breaking out the number of those deaths in the past 24 hours, that came from nursing homes. And that is good. That is really good that he is doing that because as much rightful attention that there has been to the hospitals and the health workers at hospitals fighting for the lives of Americans suffering with coronavirus, the nursing homes and the long-term care facilities are the other place in our country where huge numbers of coronavirus patients will be and are being found, and ought to be tested and treated and either saved or not, right?

Making that visible, as one of the front lines alongside hospitals, is good, because that`s the way we need to think about those facilities, in terms of what places need resources, what places need our support, what places need additional staff. So, today, New York state -- as of this week, New York`s governor is breaking out the deaths in nursing homes alongside the deaths in hospitals. Very good.

Today, New York state also started releasing individual data about individual nursing homes that have had more than five deaths on their residents from coronavirus. I don`t know if you saw this today but I`m sort of surprised it didn`t get more attention than it did. It is a long and sobering list of New York nursing homes that have had more than five deaths among their residents but you know what, there is no information this information, no reason this information should be secret.

Just as hospitals and workplaces shouldn`t be keeping this information secret, this stuff can`t be secret in an epidemic, letting people know that you`ve got cases, that you`ve got an outbreak, that you`ve got deaths among your workplace population or your resident population, that information has to be known, it`s the only way that you can get help, that people know to try to get your resources, to try to limit the additional body count.

I don`t mean to be that blunt about it but that`s why this information needs to be made public even if under normal circumstances you wouldn`t expect facilities like this to publicize when people died in their facility, we now need to know. I mean, these places where dozens of Americans are dying, we need to know where they are.

First of all, because it`s right, that we know, right? But also, because the staff there, will need bolstering, will need help, will need PPE, the remaining living residents in these places where lots of other residents have died, they need us to see them, they need us to be able to see the danger they`re in, because they need to be given help.

We can`t help trouble spots that we don`t know about, but now we know a lot about them in New York state because New York state has started publishing individual facility data, so we know, for example, today in Cobble Hill, Brooklyn, this facility has had 55 residents die. In these two facilities in the Bronx, the one on the left has had 45 of its residents die, the one on the right had 35 of its residents die.

In this Manhattan nursing home on the left, 31 residents died, and the Staten Island home on the right, they have lost 44 souls. Here`s four facilities in Queens, new figures released by New York state saying that 148 Americans have died in these four facilities.

And I have to tell you, that may be an undercount, in just one of these facilities, in Queens, the one on the far left of your screen there, the Sapphire Center for Rehabilitation and Nursing, that is listed in New York`s data today as having 26 of the residents die but an article that appeared in "The New York Times" today says that the director of that facility, the Sapphire Center, told his local state representative, that the death toll there is actually higher than that, it is not 26, it`s 29. "The Times" also spoke to two workers of that facility, who spoke with "The Times" on the condition of anonymity, because they didn`t want to lose their jobs, those workers told the jobs that they believe the real death toll in that one facility in queens is more like 60 residents who have died, which just knocks you back on your heels to think that.

But again, New York state reported 26 deaths from that facility today. Two workers there telling "The New York Times" they believe it is more like 60. And it is its own problem. Not just something to lament, literally something to fix, it is something that needs to be fixed, that we don`t know the real count at that facility, or in other facilities around the country.

We need to know, we need to know, because those places need help, and they need targeted resources. If you`re associated with one of those facilities and you don`t want people to know how bad your problem is, this is not the time to be defensive or to be worried about your liability, this is the time to stop the body count, by being public about your troubles, so you can get help.

"The Times" today redid its own national count of nursing home deaths as well. "The Times" concluded that more than 7,000 Americans have died from coronavirus in nursing homes so far. But "The Times" acknowledges, as does everybody, who has tries to do these counts, "USA Today" has a count, "A.P." has a count, NBC News has a count, "The Times" acknowledges that that`s probably a huge undercut because some state, some county, some facilities just aren`t reporting their deaths which is astonishing, but it needs to be fixed, we need to have real data, real number, because Americans just can`t be allowed to die in large numbers in secret, unknown and therefore unlamented.

I mean, we`re a freaking first world country last I checked, we don`t allow thousands of people elderly or not to die with no record of it, and without giving all of us at least a chance to get help to them. And so, we need to know.

Multiple states, the federal government has been absolutely useless on this score but multiple states this week are trying to change it. Ohio Republican Governor Mark DeWine this week signed an executive order to mandate reporting, public reporting by facilities in his state. Good.

Same thing from Democratic Michigan Governor Gretchen Whitmer who we spoke with last night on this show, that executive order in Michigan, good.

New York, as we showed you is now breaking out the death toll in aggregate from nursing homes and publishing information, as of today, on individual facilities and the numbers that have died there, as painful as it is to see that information, it is absolutely necessary.

And I want to tell you tonight that other states are stepping up, in other ways. Yes, the federal government is still failing to do anything in this part of this crisis at all. But the states in the absence of any federal leadership are now innovating. And as new states, by necessity, innovate, some of them will start to develop new best practices for how to deal with this pandemic in the most vulnerable places in the country.

And as that happens, every state in the country should start to emulate those best practices. And so we`ll try to track them as they develop. In Massachusetts, for example, where half the state`s deaths have been in nursing homes so far, the state has now told every nursing home and assisted living facility in the commonwealth of Massachusetts that the state will come in and do testing for free for all residents and all staff, regardless of symptoms. That`s a good start.

I mean, those tests need to be repeated frequently. It can`t just be a one- time thing. But the state, taking responsibility, for getting testing to every facility in the state for all residents, for all staff, that is a good start.

In some facilities, they`re using the National Guard to go in and do the testing in Massachusetts nursing homes because the state says we`ll get everybody tested in every facility. Good. It`s a good start. It`s just a start. It`s a good start.

In the state of Oklahoma, today, word that will get somebody in heaven some day if they are not empty words. The state health department announcing within the past 24 hours in Oklahoma that getting testing and PPE, personal protective equipment, into nursing homes, is now the top priority of the Oklahoma state health department. I`ve been waiting for a state health department to say that.

In Oklahoma, they have formed a state long-term health task force. OK? Call it, whatever you want. They`ve got somebody working on the problem. They broke the state into 11 regions, each region has reportedly been assigned an epidemiologist, a dedicated nursing team, and long term care consultants.

Those teams will each be responsible in each of their 11 regions for getting testing at each facility in their part of the state and the Oklahoma newspaper today reports that those teams will work on how to isolate residents who have it, they will beef up infection control protocols in nursing homes and they will quote work with facilities, on their personal protective equipment needs.

Now, working with them on those needs is not the same thing as committing to get those facilities what they need. But at least they`re pointing in the right direction, right? At least they`re point can at the part of the problem where the most Americans will lose their lives if we don`t change course and start helping.

Now, I will say the state of Oklahoma is also doing some really dumb things at the same time. The state`s governor now says he wants to restart elective surgeries next week for some reason. The Oklahoma Hospital Association, the Oklahoma Medical Association, the Oklahoma Nurses Association, are all screaming bloody murder about what a terrible idea that is, particularly because Oklahoma has a dire shortage of PPE, and that matters both for its hospital staff and also for its nursing home staff.

So, you don`t want to be burning PPE on surgeries you, by definition, don`t have to do. "The Tulsa World" quotes the person in charge of the state`s PPE supply saying that Oklahoma has roughly 10 percent of the masks they believe they need right now, so choosing to go back to reopening elective surgeries to use a ton of them is insane.

Oklahoma is making some terrible decisions, too, or at least the governor is trying to make some terrible decisions but people can do good things and bad things at the same time. And the state deciding to zero in on nursing homes as the stated explicit top priority of the health department in that state, yes, yes. Other states, honestly, should be doing that, too, if you are trying to save the most lives and if you are looking at the numbers of who is at the most risk, and who is dying at the quickest clip.

So that`s your update today in terms of nursing homes. Watch the states as they try to figure this out. And then hopefully watch the states learn from each other, as the federal government abdicates the lives of these tens of thousands of Americans with that are at risk in these facilities. As the states start to pick it up, other states should feel pressure to do what the well-run states are doing, reporting that information, making it public, making exceptions to your previous rules, to make that information public, and then committed committing to get help to those places.

Use the National Guard if you need to. Use National Guard medics if you need to. If you called up your medical reserve corps and asked recently retired health care people to come back into the field, one of the places you could be using them is uplift nursing homes and long-term care facilities to staff them up, to shore them up, to help them develop better infection control facilities around the other things that they`re going to need to surge the medical care that they`re able to provide to their residents.

Do it. All right. So watch that.

The other place to keep your eyes on right now, and watch this over the weekend, as this is going to develop because I`m worried about this, a cluster of states in the middle of the country that have no stay-at-home orders in place, but where there are now big burgeoning epidemics, a number of which seem to be springing from large meat processing facilities, where lots and lots of people are working very, very close quarters, and where circumstances have been such that it seems like we`ve got many burgeoning outbreaks in many of these facilities. I mean big clusters, big outbreaks are bad anywhere, they are particularly bad in states that are light on hospital beds, while simultaneously being blessed with governors who don`t want to do anything statewide to stop what are now fast-growing epidemics in those place, and we`ve got a cluster of three states where that is happening right now that shoe keep an eye on.

One of them, South Dakota. One of the fastest-growing case counts in the country right now. They`ve got this huge cluster of cases at a Sioux Falls meat processing plant. That cluster alone has now ballooned to 777 known cases.

There aren`t even a million people in South Dakota. They`ve got 777 known cases in that one cluster. There`s no stay-at-home order in South Dakota. After total rejection of his requests for a stay-at-home order from the governor, the mayor of Sioux Falls as of today has now dropped his own effort to try to put it in place, a stay-at-home order, just for his city.

I mean, the South Dakota situation here, with the largest known cluster in the country, it`s just like watching a slow motion train wreck. Nearly 800 known cases at that one plant, 250 at the start of the week. We are told reliably that they still have not tested everyone who works at that plant.

There`s no stay-at-home order. The local paper, "The Argus Leader", is running a running tally every day now of all of the new workplaces in and around Sioux Falls that have decided to shut themselves down or have otherwise reported that they too now have coronavirus cases among their workers. Well, that`s because everybody is still going to work, because there`s no stay-at-home order in South Dakota, because the governor thinks it`s fine.

South Dakota has one of the most rapidly-increasing case loads in the country. The entire state of South Dakota has a grand total of 2,300 hospital beds. The governor though is unperturbed.


GOV. KRISTI NOEM (R), SOUTH DAKOTA: We do have a hot spot in Sioux Falls, I think everybody`s well aware of that, and people are talking about that.

I also want to give you a little bit of perspective on the situation. I know that the national news is talking about the fact that this is a hot spot in the nation. You know, that`s fine, however they want to classify it, we`ll take it,

We`ve given our businesses an opportunity to be innovative. They`ve had the opportunity to still deliver services to their customers. We just have a really business-friendly environment.


MADDOW: It is very friendly.

South Dakota borders both Nebraska and Iowa, both of whom also have Republican governors, who have not put in place stay-at-home orders. The Iowa Governor Kim Reynolds has spent the last couple of days talking about what appears to be a new burgeoning outbreak at a meat processing plant in Waterloo, Iowa. Several meat processing plants in Iowa have already closed.

The one in Waterloo, though, is open. The local mayor in Waterloo has asked for the plant to be closed given the burgeoning number of cases there. Workers at the plant say they were only even told to cover their faces at work as of Tuesday of this week.

The governor is repeatedly now acknowledging what looks like an outbreak at the plant there but the plant for now is staying open. Worryingly the governor keeps saying at press conferences this week that she believes the USDA is probably doing something to keep workers safe at that plant. Nobody knows what she is talking about with that, as the USDA appears to be doing no such thing.

But she thinks that`s happening, and so they are blundering on in Iowa, again, no stay-at-home order in Iowa. In Nebraska, this was the front page of the "Omaha World Herald" today, lamenting that the outbreak in Grand Island, Nebraska, which is the state`s third largest city, Grand Island, Nebraska, has a per capita case rate on par with hard-hit states like Louisiana and Michigan. Michigan which now has the third highest death rate in the country.

They`ve only got one hospital in Grand Island. They`ve got hundreds of cases in that community. Eleven patients at that one hospital were on ventilators already, as of yesterday. But the state health director keeps saying that everything will be fine there. They`re reporting that they`ve got a beat on a few other ventilators they might be able to scare up from a few other places maybe for that one hospital.

The local health director and the mayor of Grand Island, again this is the local health director, not the state health director who says everything is fine, the local health director and the mayor of Grand Island, Nebraska, have asked the governor, please, for a stay-at-home order, shelter at home order, please, maybe even for just a couple of weeks so they can try to get their hands around this fast-growing outbreak there.

Governor Ricketts in Nebraska has told Grand Island, no, they can`t do that, because everything`s fine. Governor Ricketts of Nebraska said today, quote, our plan is working.

I don`t know what the plan is exactly, but it apparently involves opening up the giant Nebraska Crossing Mall, as of next week, they`re planning on reopening a big outlet mall next week, while they don`t deal with this huge outbreak in the middle of the state that`s already pretty well full-up, filled up the one hospital in that community.

The Nebraska Hospital Association is up in arms about them planning to reopen this gigantic mall, saying doing that would quote pose a serious threat to the health of all Nebraskans, but Governor Pete Ricketts is not listening to the Nebraska Hospital Association. He`s got no plans to stop the opening of that big shopping center. Open it all back up.

The real truth of what`s going on in America`s coronavirus outbreak is not something that you are going to find by listening to whatever is said into the podium at the White House daily briefings. The real truth of what`s going on in America`s coronavirus epidemic isn`t just on the coasts, and in the places that we know are the hardest hit already, like New York and New Jersey. The real truth of what`s happening in our country, where we`ve got 30,000 Americans dead already, the real truth of it is right in the middle of our heartland now, too.

Some of the biggest worries we`ve got right now are right in the center of the country. And they`re also in those little-noticed, low-profile, nursing homes and care facilities, and rest homes, that are in every city, in every suburb, and every little town in the country, that are used to get nothing attention. Well, it`s all of our business now, because that`s where the most Americans need the most help.

Heads up. Eyes open. This is going to be a trying time.


REPORTER: Four minutes ahead of schedule, Flight 9738 from China couldn`t get to Illinois fast enough. Loaded with millions of masks and gloves for Illinois first responders, we`re told security was heightened out of an abundance of caution, some saying that there was concern the feds might somehow intercept this precious cargo.

The state calling it a herculean task. The flight which began in Shanghai, costing Illinois taxpayers $888,000, according to these state receipts, saw its final leg take off from Anchorage, Alaska, a second flight with similar cargo, scheduled for next week, dubbed by some as secret flights, to keep Washington from muddying the pricey delivery.


MADDOW: At 3:21 p.m. local time, a chartered FedEx flight landed at O`Hare International Airport in Chicago yesterday, carrying two dozen pallets of masks and gloves, PPE, bought by the state of Illinois, brought to Illinois, basically in stealth mode, so the federal government couldn`t swoop in and try to seize the supplies.

The reason they`re worried about is that is because the federal government has been doing that with shipments to other states. Illinois managed to land that plane full of supplies less than an hour after announcing the state`s highest single day death toll so far.

Today, Illinois reported the highest single day rise in new confirmed cases. And Governor J.B. Pritzker announced what Illinois parents and families have honestly been expecting to hear about the rest of their lost school year.


GOV. J.B. PRITZKER (D), ILLINOIS: I`ve said time and time again, my decisions are hard ones but they will follow the science. And the science says our students can`t go back to their normal routine. Therefore, I am suspending in-person learning in schools for the remainder of the 2019-2020 school year.


MADDOW: That announcement today affects two million school kids across Illinois.

And Illinois, they`ve got a big epidemic. They`ve got hospitals struggling with surging patient loads. They got very worrying outbreaks in nursing homes and other worrying outbreaks behind bars.

Now, like other Midwestern states, Illinois has multiple cases in an important meat packaging plant.

Well (ph), Illinois state officials say the peak there is yet to come.

Joining us now for the interview is a man who has a lot to do at the moment, J.B. Pritzker is governor of the great state of Illinois.

Sir, I know that you are incredibly busy right now. Thank you for making time to talk with us.

PRITZKER: Thanks for having me on, Rachel.

MADDOW: Let me ask you how concerned you are about what you know is coming, in terms of apex patient loads and what you`re expecting in terms of case numbers, and the resources that your state has to handle them. You`ve obviously had to go to pretty extreme lengths to try to make sure that those pallets full of equipment landed safely and actually got to the right place in Illinois.

What are you most worried about in terms of scaling up to meet the challenge?

PRITZKER: Well, I`d remind you that we put our stay-at-home order in place, we`re actually second in the nation, to do so, and so we were in a very good position from the start in terms of bending the curve, and we`ve seen a bending of the curve. So, originally, you know, we had estimates of thousands and thousands of deaths that would come to Illinois, if we didn`t put the stay-at-home order in place.

And we believe that based upon hospitalization numbers, based upon even the new cases, even with the high of new cases today, that we`re reaching an apex. It`s going to be a couple of weeks. But we have been preparing for some time now.

So, in addition to expanding hospital beds, at existing hospitals, I also contracted to build out McCormick Place, our convention center in Chicago, so that we would have plenty of space -- 3,000 beds, in fact -- for any overflow that might occur at our hospitals.

MADDOW: You`ve been pretty outspoken about your frustrations with the federal response and with what feels like the sort of random approach from the federal government toward individual states, in terms of what the federal government is willing to help with. Is that relationship getting any more rational over time? Are you seeing improvement at all from the federal government in terms of what they`re offering the states and what they`re willing to help with?

PRITZKER: Well, we`ve gotten a lot of terrific help from the Army Corps of Engineers and the Army. And FEMA and HHS on the ground, they`ve really been very good to us.

But the irrationality has come out of the White House, it`s when they make promises from the White House directly to me and then don`t deliver. Originally, they promised tens of thousands of tests. We never got those.

Then, they promised hundreds of thousands of PPE. We never got what we asked for.

In fact, I got -- I asked for 300,000 N95 masks directly to the president, and his staff, and they said, we`ll deliver that -- in fact, they said, in Trump time. And then a few days later, 300,000 surgical masks arrived. As you know, those are very different things.

So, we`ve been very disappointed over time about the promises and the failure to deliver on those promises by the White House.

Having said that, you should see what the Army Corps of Engineers has done at McCormick place, and three other hospitals across the state, that we`ve been building out, to make sure that we have surge capacity. They really are heroes. They work together with our union laborers across the state. And I`m just so pleased and proud.

And I am hopeful, very hopeful that we`ll be able to manage the surge.

MADDOW: Governor, let me ask you about nursing homes in your state. We are watching the federal government essentially abdicate any responsibility for overseeing or helping nursing homes, but we are starting to see states innovate. Just in the past week, we`ve seen the states of Michigan and Ohio put in place executive orders from their governors, among other things, requiring nursing homes to make public account of their cases, and/or their death counts. In some cases, other states are going further in terms of guaranteeing that all residents and staff at every nursing home can get tested at state expense.

What are you doing in Illinois? What are you doing specifically on the issue of Illinois nursing homes publishing information about the case load that they`re dealing with?

PRITZKER: Well, let me start by saying that we`ve been on top of our nursing homes from very early on. In fact, before our stay-at-home order was in place, I was on the phone with Governor Inslee in Washington, I was on the phone with Governor Cuomo in New York, both of which have had terrible times with their nursing homes, to learn what went wrong and what should we be doing to get it right.

And so, from early on, we created a strike team, each nursing home where something has flared up, we`ve thrown that strike team on top of it, made sure that they have the proper PPE, that they know how to use the PPE, that they separate out the COVID-positive patients from those who are negative, and make sure generally that we`ve clamped down on, with a quarantine.

Now, we also closed down to visitors, very early on, and we`ve been taking temperatures, and generally checking the medical condition of all of the staff at those nursing homes, again from the middle of March. So, those are the things that we did back then.

Now, what we`re making sure we do, because I`m a big believer in transparency, I don`t need an executive order to put this information up. In fact, over the weekend, we`re going to put every single nursing home and every single case, whether it`s staff or a nursing home resident, online, everybody will be able to take a look at it. But we`ve already known that data, and we`ve been looking at it internally to make sure that we take care of those staff and those patients.

MADDOW: You`re going to put that, as of this weekend, you`re going to start making that data public?

PRITZKER: That`s correct, every nursing home in the state of Illinois. And again, we know who they are, we know who the private owners are, and we`ve made sure that we have all of the right information, because we`ve been actually collecting that for some time, and looking at it ourselves. But now, we want to make sure that the public can see it, too.

MADDOW: I`m glad to hear it, sir.

Governor J.B. Pritzker of the great state of Illinois -- sir, you`ve got a lot on your plate with this. Stay in touch with us. Let us know when -- if there`s things going on in Illinois that the country needs to know, if you want to talk about it here, we`ll have you back any time, sir. Thank you.

PRITZER: Thanks, Rachel.

MADDOW: All right. Much more ahead here. Stay with us.



DR. SAMPSON DAVIS, EMERGENCY MEDICINE PHYSICIAN: Hey, Dr. Sampson Davis, emergency medicine physician. Our volume I thought was going down but realized we were on divert which means that we were filled to capacity at the hospital and not accepting any patients at this time.

But I went off of divert today, and the volume was spiked again. We had about 20 patients today, all very, very, very, very sick, multiple code blues called. Lost one patient here in the emergency department today that passed away, and most of the people that we`re seeing now again, we`re seeing an older population of people, some nursing home patients now as well. So if you have family members or friends in the nursing home, you want to check on them as well to make sure they`re OK and the message to young people is to make sure that you keep the physical social distancing going.

It`s very important, because you can be carriers of this virus. And do you not want to spread it. It is so imperative at this time right now, that we stay the course, and do not gather, in order to prevent, prevent re- expansion of this virus.

Again, people are dying. This is real. This is happening. And we will get there, we will guest past this moment, we just have to stay the course.

DR. STEVEN MCDONALD, ER DOCTOR, COLUMBIA UNIVERSITY IRVING MEDICAL CENTER, NEW YORK CITY: I do have an update which is that today was meaningfully different than shifts in the last couple of weeks. I did not pronounce a single patient dead today, as opposed to the last few weeks, where it`s been multiple people per shift. I still have many patients today come in very ill and while not through death`s door, definitely knocking on it, so we`re still having those conversations with patients, and with families, about end of life wishes, round the clock.

So while no one died today, this is still very much a threat, and still very much with us, and part of our society, but positive news. So --


MADDOW: One emergency medicine physician in New Jersey, saying he thought the volume was going down, but then he realized he was on divert status, so their patients were going to other hospital, once they took themselves off divert status, the volume came right back up.

And the New York physicians saying while things are still bad, there are good signs.

New York continues to lap all other states in terms of the toll of this virus. But there have been signs of improvement. New infection, new hospitalization, ICU bed usage, all down. That`s good.

But still, the death toll is coming out of New York state every day, huge, more than 600 deaths in the last 24 hours alone, and that has been true every day this week. Last week, we heard from an emergency room physician, one of the hardest hit hospitals in New York, Dr. Ernest Patti, at St. Barnabas Hospital in the Bronx.

Here he was a week ago tonight.


DR. ERNEST PATTI, EMERGENCY ROOM PHYSICIAN, ST. BARNABAS HOSPITAL: Well, the battle continues, the end of another shift. We still have a large number of people intubated down here. I believe there are 13 intubated, and about five or six on CPAP.


MADDOW: As you heard him there, Dr. Patti sort of fighting to be heard over the background noise in the ICU, in the E.R., not your garden variety hospital background noise, that`s the sound of multiple patients being mechanically kept alive. That`s the sound of more than a dozen ventilators being used.

Well, today, we heard from Dr. Patti again, with an update on the situation for him at St. Barnabas.


PATTI: Today is Friday, April 17th, the first thing you notice is the noise level is much less than last Friday, significantly decreased. I have to say the hospital is still full and still running at max capacity, but the emergency department is definitely a little less congested.

Let`s hope it stays this way. I`ll report at the end of the shift. Stay safe. Stay healthy. Stay strong.


MADDOW: Dr. Patti recorded that today, just before he started his shift, as you heard there, he promised to update us when his shift was over. His shift has just ended and he`s going to join us live next.


MADDOW: Joining us now because he said yes to coming back and I`ve been happy about it all day is Dr. Ernest Patti. He`s a senior emergency medicine physician at St. Barnabas Hospital in the Bronx.

Dr. Patti, I appreciate you coming back a week after we last spoke. Thank you so much.

PATTI: My pleasure, Rachel. Thank you for having me back on. I appreciate it.

MADDOW: We`ve been watching some of the metrics kind of turn in the right direction in New York, writ large. But you said today at the start of your shirt that St. Barnabas is still full, still at capacity. Are things different this week compared to last week?

PATTI: Well, I definitely felt that way during the week, Rachel. When I came in for my shifts in the middle of the week, we happened to be on divert status as well for a bit, and we seem to be decompressing the emergency department.

You spoke to one of my colleagues yesterday, Dr. Chris Grantham (ph) or your MSNBC did, forgive me, and he had mentioned that the ICU is still running at max capacity. It is. But I`ve noticed today that the volume coming in has slightly decreased. I didn`t pronounce anybody today, which was wonderful, and I didn`t have to put -- we didn`t have to put very many people on ventilators today.

It was actually a day where we felt maybe we were plateauing out a bit, and we`re very optimistic. We still have -- are getting sick patients in because I had a number of sick folks but not to the extent that I reported to you last Friday.

MADDOW: I`m so glad to hear you say it, although, I recognize the situation is still incredibly taxing.

Is anything improving in terms of patient prospects? I mean, by the time they get to you in the E.R., I know people are in trouble. They don`t end up there by accident.

But with this incredible volume of patients that you and your colleagues have seen, do you feel like you`ve learned anything in terms of how to maximize patient outcomes, how to optimize what`s going to happen in terms of outcomes to these patients overtime?

PATTI: Well, we have learned a number of things. We learned, you know, there was a lot of information being sent back and forth from institution to institution, trying to, you know, give colleagues a hence or helpful way to approach the patients. A lot of it revolved around PPE and creative ways to use it and, you know, and reuse it.

Others, though, death with the way in which we actually treated these folks, as far as how much oxygen to put them on, what goals to set our oxygen levels at and those things have been helpful. We`ve learned about giving intravenous fluids, how much to give, how little to give, and how to approach the process as folks come in. It`s a steep learning curve for us. We learned a tremendous amount.

What we do know is, though, that the folks who come in that have lots of comorbidities, meaning other illnesses like COPD, asthma, diabetes, cardiopulmonary issues, obesity, those folks tend to be more challenging because they present other problems in addition to having the COVID-19 infections.

So, yes, we`re learning a lot. Every day I`m learning something. I`m a lifelong student, Rachel.

MADDOW: Well, your position on the learning curve is going to be a position of incredible power and is going to be an incredible asset to medicine. I feel like you and your colleagues seeing the number of patients that you`ve seen, seeing the volume that you`ve seen, when other places in the country, I was just talking with the governor of Illinois a moment ago, when other cities have patient apexes, I feel like you and your colleagues are going to have so much to offer in terms of best practices.

Does the system of medicine and emergency medicine work in such a way that you`ll be able to share this with your colleagues around the country?

PATTI: Definitely. We are -- all of us, I know many of my colleagues that I work with, remember, I told you it`s a team sport, emergency medicine, and the team doesn`t just necessarily live within the four walls of your hospital. The teams lie in the greater good for the United States.

I mean, we all are in communication with our different medical societies and groups and circle of friends, and we definitely share the information. It`s been a really, really amazing experience.

You know, I do have to tell you, though, we did get a bit of bad news and when I was talking to some of my senior members of the hospital, as well, we actually did lose so far four staff members at our hospital, in addition to Dr. Verrier, who we mentioned last week.

So, it`s been -- it`s been a battle for us where we`ve done a lot of, you know, leaning on a lot on each other, leaning on each other because many of us knew all of these staff members quite well. Like I said, we`re a big family at St. Barnabas, or as I affectionately refer to it as the Barn, you know? It`s been a challenge.

MADDOW: Dr. Ernest Patti, senior emergency medicine physician at St. Barnabas and the Bronx, I am sorry for your loss and thankful for your sacrifice. Thank you for your time tonight, sir.

PATTI: It`s my pleasure. Thanks for having me.

And everyone should please remember to practice social distancing, check in on all your relatives and loved ones and really, really practice good hygiene, it`s super important. And one day, I`ll tell you a funny story growing up with my kids. I noticed hygiene was decreasing years ago and now I guess we`re paying the price.

MADDOW: I will have you -- I will have you back to tell that story. Thank you, Dr. Patti. Appreciate it.

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

PATTI: Thank you.


MADDOW: That`s going to do it for us tonight.

Now, it`s time for "THE LAST WORD" with Ali Velshi filling in for Lawrence tonight.

Good evening, Ali.

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