Bay Area TRANSCRIPT: 4/23/20, The Rachel Maddow Show

Guests: Sara Cody, Anthony Romero

ELIZABETH KOLBERT, JOURNALIST: -- you know, let`s hope that in the next few weeks, as people start to think about reopening some of the major American cities, that we get some really innovative thinking.

CHRIS HAYES, MSNBC HOST, "ALL IN": Elizabeth Kolbert, always great to talk to you. Thank you so much.

KOLBERT: Thanks, Chris.

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. Thanks, my friend. Much appreciated.

Thanks to you at home for joining us this hour as well. Happy to have you here.

Sometimes when you go to a funeral, there`s a drive-in component, right? The funeral home, the funeral service, wherever it is held, may be a ways off from the cemetery. If there`s also going to be a graveside service, there will need to be a drive in the middle of it.

If you haven`t been at a funeral like that yourself, you have definitely seen them on the road, right? It`s a line of car, regular people`s cars but everyone driving slowly, often times everybody puts their flashers on, their hazard lights, to let you know that they are part of a funeral procession.

If you haven`t been in one of those, you have definitely seen it. That was a little bit of what it looked like today in the rain, in downtown Washington, D.C., as a long line of cars processed pretty slowly, from the White House, down through the streets of D.C., slowly, all in a line, with their hazards flashing.

But this was different for a couple of reasons. Number one, they were honking for the most part. And number two, they were not going to a cemetery. They were going to President Trump`s downtown Washington, D.C. hotel.

You can see the signs on some of the cars, Trump lies, people die. And then you can see the body bags. People got out of those vehicles, and laid body bags at the threshold of President Trump`s hotel. Trump lies, people die.

This was a protest today in Washington. Those aren`t real body bags but they are meant to symbolize the thousands of Americans who have died.

The U.S. death toll from coronavirus, as of today, is staggering. As of today, 48,902 Americans have been killed. And that`s just over the course of about a month.

For what it`s worth, and when you`re thinking about whether a protest like this might wake the president up, whether it might get the president`s attention a little bit, to have body bags laid out in front of his hotel, for what it`s worth, the president does not really seem up on the fact that 48,902 Americans have already been killed by this epidemic.

We know that he is not really up on that number. We know that for sure. Because this was the president at the beginning of this week, on Monday, of this week, talking about what he thought the U.S. death toll would end up being.

(BEGIN VIDEO CLIP)

DONALD TRUMP, PRESIDENT OF THE UNITED STATES: Now, we`re going toward 50, I`m hearing, or 60,000 people. We could end up at 50 --

(END VIDEO CLIP)

MADDOW: Fifty. We could end up at 50,000 people. That`s this week. The president positing that the American death toll in total could be 50,000 people, he thinks that`s where we will end up, that`s what he`s hearing as president. That`s as bad as it will get. Maybe 60,000, but it could be 60,000.

That`s what he wants people to know that the death toll could be when this is all over. He said that on Monday. Barring some kind of miracle, the U.S. death toll will hit 50,000 by this weekend. Easy. But I don`t know if the president knows that.

And so the people who are mad at the president about this response, people are starting to pile up body bags in front of his hotel, because maybe that at least might capture his attention, maybe that will let him know that the real body count is apparently beyond his kin, beyond what he understands it to be.

Today, in a number of stories, a number of news stories broken by a bunch of different news outlets, we learned some more important and serious information about how the president and his administration handled this epidemic from the very beginning. And one of those important things that we have just learned is key to the date of February 25th. On February 25th, you might remember this if you watch the show regularly, we actually played the sound from this on our show that night. On February 25th, the head of the respiratory disease section at the CDC gave a public briefing.

It was a press briefing over the phone to reporters. It was on the record. So you could record it. You could listen to it. That`s why we were able to play it on the air that night.

And in that briefing on February 25th, she warned the public that the coming tide of coronavirus was very serious, that this was a very contagious disease and Americans should prepare for significant disruption to our daily lives, because of this disease. And I remember playing that tape on the show, that night, on February 25th, and being sort of shaken by the CDC official saying that she had, you know, contacted the superintendent of her kid`s schools, to ask if there were plans in the works for distance learning for her kids because she assumes that schools were going to have to close and keep kids home, and we hadn`t heard anything like that from a public official before.

Now, of course, that`s the reality we`re all living but when Nancy Messonnier said that on February 25th, it was a bracing shot. Well, now, we have learned that the official that gave that briefing, Dr. Nancy Messonnier from the CDC, she was not only removed from her post after that briefing as the lead CDC official running the response to the coronavirus, she was not only removed from her post, because the president didn`t like she seemed so alarmist about the whole thing in that briefing.

In addition to taking her out of the position running that response, the CDC as an agency also thereafter stopped doing its own briefings all together about this crisis. Because the CDC briefings had the potential to upset the president. Because we have since learned that he likes to do the briefings himself.

And instead of CDC, bracing briefings from well-informed official, giving you real information about the real scope of what`s about to happen, he, you know, gets up there and tells you that there is only going to be 50,000 Americans dead by the end of this. Only 50,000. Whether that were true.

And he likes to tell you that there is a cure, that everybody should try, what do you have to lose, just try this unproven drug and he likes to say almost every single day, he says there is plenty of testing. He is now saying there is so much testing, it is more testing than the governors like, right?

He likes to do the briefings. Which are consistently full of happy talk, disinformation, and lies. And those are the briefings we get for this epidemic instead of CDC briefings from actual expert scientists, we now know, because he didn`t like the expert scientist briefings at the beginning so they moved that CDC official out of the job running the CDC`s response and the CDC as an agency learned to shut itself up all together.

We also learned in the past day now that, not to worry, the president`s health secretary, Alex Azar, who said the same day as Dr. Messonnier`s briefing that the virus was contained, Dr. Alex Azar, who is insistent to reporters for every day Americans, coronavirus should not be an impact on their day to day life. Alex Azar, the Trump administration health secretary, we have learned in the past day, he did make an early decision to tap a specific person in his department to coordinate the federal government`s overall response to the coronavirus crisis. He did pick somebody to delegate that to.

He picked somebody to delegate the task to run the coronavirus response in the government to a man named Brian Harrison, who, quote, had joined the department after running a dog breeding business for six years. Brian Harrison, age 37, was an unusual choice, with no formal education in public health, management, or medicine. Before joining the Trump administration in January 2018, Harrison`s official Health and Human Services biography says he ran a small business in Texas.

The biography does not disclose the name or nature of that business. But his financial disclosure form showed that it was a company called Dallas Labradoodles. That`s who Alex Azar put in charge of the coronavirus pandemic, the response for the U.S. government, for the person coordinating that, was this guy who he brought in HHS from his dog breeding business.

I mean, if you can go back in time to November, 2016, and show the American public one headline that was real and from the future, and it would make clear the stakes of their vote for president, in November 2016, this was the candidate. This "Reuters" headline today might be a contender. Special report, former labradoodle breeder was tapped to lead U.S. pandemic task force. That would give voters in November 2016 a lot of useful information. Number one, we`re about to have a pandemic. Number two, this is the way the Trump administration would try to head it off.

In the past day, we`ve also learned that the top vaccine development expert in the government who was working on coronavirus was also taken off his job and demoted. He says in an official whistle-blower complaint he plans to file, he was demoted because he wasn`t on board with the president promoting potentially dangerous drugs, promoted by those with political connections. And maybe that sounds like sour grapes to you. Oh, here`s a guy who was demoted, of course he wants to play the hero, but this guy is also now asking for an inspector general investigation into the, quote, manner in which this administration has pressured me and other conscientious scientists to fund companies with political connections, as well as efforts that lack scientific merit.

So the top U.S. official, life-long vaccine development expert, working on vaccine development for the U.S. government, on coronavirus, he`s out now. They`ve demoted him, moved him aside, because he was in the way of the president`s friends and stuff.

Meanwhile, multiple states, including the hard-hit state of Georgia, which has tested less than 0.01 percent of its population, they rank 40th out of a of states getting testing done. Georgia and other Republican-led states are steaming ahead with plans to reopen businesses and just trying to forget about this whole coronavirus thing, man, it`s been such a drag, we got to get everything reopened. The White House has zigged and zagged between encouraging these open it up governors, and then telling them not to do it, and then praising them for doing it, and then laying down guidelines, that tell the states what to do, and then telling the states they don`t have to follow the guidelines, they can do whatever they want.

And so now, naturally, we`ve got a number of Republican-led states jumping off the cliff now, in terms of this epidemic. As case numbers even in those states continue to rise.

And then frankly, in Democratic-run states, you`ve got situations like this today. Governor Gretchen Whitmer of Michigan today was greeted by a whole bunch of men with pro-Trump signs in gear today pacing around at the end of her driveway yelling at her to open up the state while brandishing their AR-15s.

So that`s how it`s going so far in terms of federal leadership and its consequences.

Today, as members of Congress came back to Washington, leading to these surreal scenes, you can see them all in masks, and keeping social distance, they came back to Washington to pass the latest relief bill, and it passed with overwhelming bipartisan support. You see them all in their marches, they`re all trying to stay six feet apart and there is a looming overhanging issue as to whether and how they are going to keep convening in person, given the public health threat of all members of Congress getting together in the same place to conduct congressional business.

We saw these images today, I thought back to what I think was the first show that we did here, after we started basically covering coronavirus full-time. On that show, we had veteran science reporter Donald McNeil, from "The New York Times," on set, and I remember, in that first interview with McNeil, he kind of knocked us all back on our heels, we heard from a lot of viewer that they were pretty stunned by that interview.

McNeil having covered coronavirus in China, having done the first landmark reporting on it here in the United States and there was Don McNeil, that first night that we started covering this full-time, talking about how soon enough, our legislature, our Congress, would need to effectively shut down, that it wouldn`t be safe for them all to convene. He was talking about things like, you know, we`re going to need to start counting the ventilators that we have in this country. And this was February 28th. This was just a couple of days after that stark warning from Dr. Messonnier at the CDC that got her demoted and silenced because she said American lives were going to be profoundly changed by this epidemic. I mean, almost no one was talking in stark terms yet at that point, in late February.

I went back and looked at that show again recently, sort of to try to remind myself how far we`ve come in such a short period of time. It is less than two months ago. But I noticed that in that first show that we did, with that stark interview from Don McNeil, where he said all of those things that were so shocking then, which have all come to pass since, well, I noticed we also had one short prescient report that same night from California.

(BEGIN VIDEO CLIP)

DR. SARA CODY, SANTA CLARA COUNTY PUBLIC HEALTH OFFICER: Today, we`re reporting a new case of novel coronavirus in Santa Clara County. This is the third case to be identified in our county. But it`s different from our other two cases in an important way. Like the California case reported two days ago, our third case did not recently travel overseas, or have any known contact with a recent traveler or an infected person.

MADDOW: That was health officer in Santa Clara County, California, today, announcing what is the second known case of a person being diagnosed with coronavirus in this country, without there being a clear indication of where that person got it. The first one was two days ago in Solano County, California. The second one was Santa Clara County, today.

(END VIDEO CLIP)

MADDOW: That was February 28th. Me responding to comments that had been made moments earlier there from Santa Clara County Health Officer Sara Cody. What she was announcing that night, February 28th was the second case of coronavirus that night. And others had contact with those known to have coronavirus or traveled, that night, it was the second person in the country where a person had coronavirus and we didn`t know how they got it.

And we didn`t know it at the time, going back and seeing that footage, actually kind of puts a chill down my spine. We didn`t know it that night, certainly.

But Sara Cody, in Santa Clara County, California, would go on to become the public health official in America, who may have saved more lives than any other person in our country, because over the next two weeks, as the case number started to climb in the San Francisco Bay area, having early cases is bad, it means that there has been virus circulating in your community, for sometime, before people started to get sick, or people started to die.

With early cases, discovered, in the bay area, over those next couple of weeks, following that announcement that you just saw there, in late February, Sara Cody and her colleagues in the Bay Area started to compare the graph of the progression of the epidemic in Italy at that time, with the same progression that they were starting to see in the Bay Area at that time.

And as they saw cases mount in the Bay Area, they believed that the San Francisco Bay Area in northern California was on the same disastrous path that had overwhelmed the hospitals in Italy. And seeing that, and seeing their case numbers rise, and realizing what this would mean in terms of the contagiousness of this virus and its death rate, in what will go down in history, as a landmark moment, in this time, in this crisis, Sara Cody got together with her colleagues, from six other Bay Area counties, and they made a decision, what seemed like an incredibly radical, even shocking decision, at the time. But which is now obviously the model for what we ought to have done sooner, and for, for what it is so incredible that some states still haven`t done yet.

(BEGIN VIDEO CLIP)

CODY: Today, we stand together to announce additional legal orders that will apply to all seven jurisdictions covering Silicon Valley and the core of the Bay Area region. These new orders direct all individuals to shelter at their place of residence and maintain social distancing of at least six feet from any other person when outside their residence.

(END VIDEO CLIP)

MADDOW: That was the first one. That was the first one. When Dr. Sara Cody, health officer of Santa Clara County, announced that on March 16th, it was the first thing, like that, in the country, it was a stunning thing.

This was the front page of "The San Francisco Chronicle" the next day. Stay at home. But that order went into effect at midnight the night that she announced it because they knew time was of the essence.

And Bay Area residents heeded that order, in large part. All of California actually followed with a similar order within just a few days following the Bay Area`s lead and then the rest of the country would eventually catch up to the bay area and the rest of California, ultimately. The rest of the country would ultimately get there, after of course, they had given the virus some more time to spread, to infect more people, to make the overall level of infections larger.

But they didn`t wait in northern California. They didn`t wait in the Bay Area. And that quick action by Santa Clara County Health Officer Sara Cody, and the other Bay Area health officers she acted with, that appears to have saved the San Francisco Bay Area.

I mean, going early is a bad sign, right? It means that you have got, if you`ve got people sick and dying in your community, it means that the virus has been circulating there, and people have been getting infected there, the first death in your community is a really bad sign, and it is a sign that you have waited too long, and that public health intervention is necessary. When they started reporting those very early deaths, in this very, very early, first indications of community transmission, it was a signal that the San Francisco Bay Area was just going to get absolutely shellacked, if they hadn`t done what they did. If they hadn`t had that prescient, smart, aggressive, brave, public health intervention, earlier than anybody else was prepared to think it.

"San Francisco Chronicle" today posted this graph, comparing what happened in other metro areas around the country, to what happened in the Bay Area, with that aggressive intervention. These are weekly case rates per capita.

You can see the big black line there, that is New York. The orange line with the huge peak, the spike, that`s New Orleans. And the turquoise colored line, that`s Detroit.

And then, I think you can see there, it`s a little bit hard to see, but it is a dotted line in gray, that`s the U.S. average in terms of cases per 100,000 residents, cases per week.

But to see what happened to the Bay Area, which again got hit before any of those places, you actually have to go down to the very bottom, to what actually looks like the X axis there if you squint, that super flat line at the bottom, just barely off the X axis, that`s the bay area, because early action absolutely squashed their curve.

And you know, California is not out of it by any means. California has a worse outbreak in Southern California than they do in northern California which you would expect given the aggression of the Northern California response.

California had its highest daily death toll today. And they certainly have a live epidemic, including in Santa Clara County, and in the Bay Area. Sara Cody told her board of supervisors in Santa Clara County two days ago that they`re going to be contending this for months yet.

But those smart public health officers, finding their first cases, recognizing what it means, acting fast, they changed the course of the epidemic in the United States of America. And they`re doing it again now. Because now, after taking samples from people, who died much earlier than the first known cases, Santa Clara County has changed our understanding of the course of the pandemic, by finding out that the first-known death in the United States was in Santa Clara County, and it was actually about three weeks earlier than any previous death we thought we knew of.

And that`s important, because it does tell you that the virus was circulating in that county weeks earlier than we even knew. The person who they now know of as the -- is now known as the earliest U.S. coronavirus death is somebody who died on February 6th, that is believed that she was infected in early January, it`s not believed to be a case where she was infected because of overseas travel, or contact with a known coronavirus- positive person. It was community transmission, in the San Francisco Bay Area, in early January.

Think about what that means. Think about the opportunity cost of that. Think about how many thousands of Americans have died because we didn`t know that.

The federal government was in charge of getting us tests. Alex Azar and President Trump didn`t get around to it. The day after this first now-known case, this 57-year-old woman died in Santa Clara County, was the day that the Trump administration actually sent out testing kits to public health labs around the country, those tests didn`t work. They didn`t even get them out until the first week of February. And they didn`t work. And they had to, everybody had to start from scratch there, because the Trump administration blew it.

Think about how many lives would have been saved if there had been a frickin`, fracking` reasonably confident federal government response. Think about how many lives would have been saved in that part of the pandemic, if there was early testing at that point in the epidemic when there was community transmission happening in early January in San Francisco Bay area.

I mean, other countries had tests at that point. We didn`t. We didn`t. Imagine how many more lives could have been saved, had somebody like Dr. Sara Cody in Santa Clara County and her colleagues in the Bay Area who were on so on top of this, had they known weeks earlier that people were already dying, they would having acted weeks earlier.

And yes, probably the rest of the country would probably still have followed behind them. Yes, they`d still probably would have been more aggressive and smarter than anybody else, but if our entire time line had moved up several weeks, had moved up three weeks, thousands if not tens of thousands fewer Americans would have died, because everybody would have squashed the curve earlier, everybody`s curve would look like San Francisco`s does compared to the rest of the country right now.

Sara Cody told "The San Francisco Chronicle", upon learning of this earlier case, she said, quote: I know that in late January and for the month of February, we were very anxious at our inability to test people who we thought might have had COVID-19. There just wasn`t the capacity there. We were anxious that there was a lot of transmission that was going undetected. What these cases that have just been detected now tell us is that we were right to be anxious.

They were looking for it. They were looking for signs to act. Once they got one, they acted faster than anybody. Had they known, three weeks earlier, had they been able to test, they would have acted three weeks earlier.

Early action in northern California saved tons of American lives. And now, with the epidemiological work they keep doing, we know the earliest cases we have in this country were even earlier than we previously knew. Had there been tests, had that been the one thing the Trump administration did, even with the labradoodle guy in charge and firing the vaccine guy and being scared of the lady at the CDC who tells too much of the truth, had they just gotten testing done, had Alex Azar and the Trump administration not been lying when they said testing was fine, we could have acted weeks earlier.

At least in the best-run parts of the country, they would have acted weeks earlier. And there wouldn`t be going on 50,000 Americans dead by the end of this week.

Simple as that. That`s why there`s the body bags on the threshold of the Trump Hotel today. That`s why they`re there.

Dr. Sara Cody joins us next.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

CODY: We must come together to do this. And we have done this as a collective of health officers. We know we need to do this. And we know we need a regional approach.

We all must do our part to slow the spread of COVID-19 and ensure that our essential services remain intact and open, most especially our hospitals and health care facilities.

(END VIDEO CLIP)

MADDOW: That was Dr. Sara Cody, on March 16th, as she announced that 7 million Californians would be told to stay home for weeks at least, it was the first such order in the United States. Dr. Cody and the other health officers in the San Francisco Bay Area acted faster and more decisively than anyone else in the country and as a result, they did successfully, as they say, flatten the curve. And hospitals in the Bay Area did remain intact, an not get overrun.

Now, Dr. Cody and her colleagues are continuing to advance our national understanding of how coronavirus has spread in the U.S. They just figured out that the earliest known death from the virus in this country was in Santa Clara County, three weeks earlier than we previously knew anyone had died from it, in the United States.

Joining us now is Dr. Sara Cody, public health officer for Santa Clara County and the great state of California.

Dr. Cody, I imagine that talking on television is the least -- your least favorite part of your job. I really appreciate you doing it and being here tonight.

CODY: Thank you. It`s a pleasure to be here.

MADDOW: I wanted to ask you about the clarity and decisiveness with which you and your colleagues in the Bay Area acted back in mid-March. I didn`t know about the idea of shelter in place except for an active shooter situation. I didn`t know that stay-at-home orders were within the public health tool kit.

How prepared were you? How did you all know to think about these things as options, once you started to see the data that worried you in the Bay Area?

CODY: We had a number of factors working in our favor, and I would say the first is that we have a very collaborative group of health officers from around the Bay Area. We`ve all known each other for a very long time, but we know each other well. And we`re accustomed to working together.

So that`s the first thing that was incredibly important. The second is, is that we live in an area with a lot of academic partners, who were continually advising us around, you know, infectious disease, modeling infectious disease epidemiology.

And the I think the third is that many of us who are health officers in the Bay Area had previously done a lot of work in communicable disease control so we`re really control with communicable disease control and the various strategies that we use to, you know, basic prevention and control of communicable disease. So I think all of those factors, not that it was a comfortable action to take, but they were sort of helpful and key to our preparation.

MADDOW: Was there an element of bravery involved, or a sort of hold your breath and jump feeling about it, when you had to make that announcement? I went back and watched some of your public statements, when you first announced for example, restrictions on large gatherings, in the county, and I felt like I could, I felt like I could see you wrestling with the gravity of what you were asking people to confront.

CODY: I was wrestling with the gravity, and it was a difficult situation, and I remember on Friday the 13th, when we announced that we were going to ban mass gathering, greater than 100, and I remember that was, that felt like an enormously difficult decision, because of how it would impact so many people, and restrict so many activities.

And you know, on Friday the 13th, I really couldn`t each wrap my mind around what we then did on Monday. There was a very long weekend with a lot of discussions with fellow health officer, and I think we were looking at our local data, and we were looking at trends around the world, and we were listening to our colleagues, who were infectious disease modelers, and it just became clear that we either acted now, and created a lot of social and economic disruption, or we acted later, and still created a lot of social and economic disruption, but didn`t get the benefit of early action.

And so it was enormously helpful to do it as a group of trusted colleagues. And it did sort of feel like we were all holding hands and jumping. So I didn`t feel alone. I felt like I was doing it with a really solid, a really solid group, and that made a big difference.

MADDOW: Well, the effectiveness of what you did, the way that the Bay Area, the actions that you all took in the bay area, appear to have grabbed this thing and wrestled it down, in terms of how many people would get infected and the pace at which new infections would unfold. It does feel particularly for those of us in the rest of the country, looking I think with envy, with that, with the way that you flat than curve, it does just look like an incredibly effective intervention.

But I wonder, now that you have discovered that you actually had coronavirus deaths and you had, apparently had community transmission of coronavirus, even earlier than you previously expected, when you look back on that decision now, do you wish you had acted even earlier than did you?

CODY: What I wish is we had more information. Much of this response has felt like we, you know, well, it`s not unusual in public health to have less information than you want to make decisions, so in some ways, we`re somewhat accustomed to making decisions with some degree of uncertainty, but I do remember in early February, we were looking at how many cases did we have compared to the country, how many persons under investigation did we have compared to the country, and compared to our population.

And even early on, the numbers were small. But the trend was, it looks like, we were having a good probability that the virus would be introduced in our community first, and so you needed to be ready. So we were looking, looking, looking, for signs, but we didn`t have the capacity to test and to document that the virus was present.

So, now, of course, in retrospect, identifying the coronavirus and the woman who died on February 6th, you know, we were thinking we had two travel-associated cases and we were at risk for community transmission, but we couldn`t see it. And we couldn`t see it. And if we don`t have data to show to the public, also I don`t think we would have brought the public on board with the actions that they had taken since March 16th.

MADDOW: Yes, had there been testing, had there been visibility, had there been data, not only to guide decision making, but to guide public education, not only you, but everybody around the country, could have made better decisions at that time. We`re still paying for that.

Dr. Sara Cody, public health officer for Santa Clara County in northern California, I do think that you and your colleagues have a lot to be proud of. I know that you are by no means out of the woods in terms of what you`re still contending with, but thanks for your leadership and thanks for helping us understand.

CODY: My pleasure. Thank you so much.

MADDOW: All right. A lot more to get to tonight. Stay with us.

(COMMERCIAL BREAK)

MADDOW: Today, we got this sobering headline, courtesy of the World Health Organization, nursing homes linked to up to half of all coronavirus deaths in Europe.

There`s a "Washington Post" report on it today, the risk for the already fragile population in Europe`s nursing homes has been exacerbated by an acute lack of testing in nursing homes. When countries use the limited testing they have, in hospitals instead.

It sounds familiar, right? Except even here, sometimes hospitals can`t get their testing done. I mean, here in the U.S., one thing we have learned thus far, over the course of our epidemic, is that the place you are most likely to get coronavirus and die from it is in an American nursing home.

The "Associated Press" today reports that more than 11,000 Americans have died in nursing homes so far, 11,000. Also, that the vast majority, two out of three nursing homes in the United States, don`t have ready access to testing, which, of course, is leading to ever-louder calls to prioritize the testing on all staff and patients at these facilities nationwide. So, the nursing home situation is dire, and continues to be. That really does appear to be the place where you are most likely to get infected, and die from coronavirus in the United States.

The other place where you are most likely to get infected, whether or not you die from it, appears to be in our nation`s large meat processing facilities. Meat packing plants.

Today, the CDC put out its report on how the Smithfield meat packing plant in Sioux Falls, South Dakota, can basically substantially reorganize itself to try to reopen, now that 801 workers and more than 200 community cases have been traced to that one plant. There`s more than a thousand coronavirus cases associated with that one plant in South Dakota, more than 800 of them workers in the plant.

The CDC`s report today includes an extremely, extremely lengthy list of recommendations for the plant. Page after page after page of steps the plant should take to try and stop the virus from spreading among the people who work there. Everything from staggering shifts, and start times, to adding plexiglass and stainless steel barriers between work stations and sanitizing the hardhats and face shields at the end of every shift, adding visual cues to help people stand six feet apart, more room for storage of lunch box, more pictures of the signs and viruses, and convey in more languages. I mean, try this, try that, try everything -- it`s a huge list of changes they need to make.

That 15-page report today from the CDC was released about that one plant as we get word of more and more plants in more and more states closing down, due to rising case loads. They`re trying to figure out how to slow the line, or otherwise stay open, while they`ve got dozens or maybe even hundreds of their workers testing positive.

So the place you`re most likely to get coronavirus and die is an American nursing home. One of the places at least that you are most likely to get it appears to be a large aggregate work environment like a meat packing plant which is still open, where we still got people working, despite close conditions.

And there`s the third environment in which you are most likely to get infected with coronavirus in this country, which appears to be our jails and prisons and detention centers. And there`s some really interesting new information and new work that is happening on that side of it right now, we`ve got that coming up. Stay with us.

(COMMERCIAL BREAK)

MADDOW: This next clip I`m about to show you first appeared on April 9th, part of a national TV campaign by the ACLU.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: My sister Elaine has been incarcerated for 10 years. She has diabetes and is recovering from recent surgery. If this virus, given her age, I worry she may not survive.

AD ANNOUNCER: Thousands of elderly and vulnerable people in America`s prisons are in danger due to coronavirus.

UNIDENTIFIED FEMALE: I`m terrified. Please don`t let my sister die in prison.

AD ANNOUNCER: Tell your elected leaders to save lives. Release elderly and vulnerable populations from jail and prisons before it`s too late.

(END VIDEO CLIP)

MADDOW: Tell your elected leaders to save lives.

Like I said, that ad was released on April 9th. The following week, that prisoner featured in that ad, Elaine White, was released from the correctional facility she was in in North Carolina, she is now living with her sister at home.

That ad campaign is just one of the many efforts by the ACLU and other advocates on what is now a big nationwide push to get vulnerable populations released from prisons and jails specifically because prisons and jails are proven to be rabid accelerators for the spread of coronavirus.

And, you know, you expect the ACLU to bring lawsuits on this issue and they have, but they have done interesting stuff like this. They put out a model executive order basically draft executive orders for governors that outline measures governors can take to try to put a relief valve on prisons and jails as coronavirus takes root in these places. And, you know, the stuff they recommend isn`t rocket science. It`s stuff like telling state parole boards to identify prisoners for early release.

But having a list of things that governors can do, having a draft executive order is an efficient way to get these changes put in place quickly. To date, the ACLU says they`ve secured executive actions in 15 states, not just blue states, either.

Just the other week, the Oklahoma governor commuted the sentences of more than 450 Oklahoma prisoners, more than 100 of them have been released.

But still, it seems like every day, there are huge, huge numbers of coronavirus cases being reported out of some new prison or jail. Anywhere they are testing, numbers are astonishing.

Just yesterday, a judge ordered the transfer or release of hundreds of elderly and otherwise vulnerable prisoners out of a federal correctional facility in Ohio -- Elkton, Ohio. Six prisoners in Elkton have died in the last few weeks. Another 52 are known to have the virus.

That facility also has the highest number of infected staff of any federal prison in the country but those numbers -- I mean, 52 inmates with confirmed infections, they tested less than 100 of the prisoners at that -- at that facility. And they got more than 50 positive cases. There`s 2,400 prisoners at that facility.

And all these staff who are positive, all these people who are dying already, I mean, literally God knows how high the actual infection rate is and what we`ll learn if they ultimately test all 2,400 people there. It`s not going to be good.

It`s kind of hard to see how this works out over the long haul of the pandemic unless we`re going to just allow millions of incarcerated Americans who live in prisons, the tons of Americans who work in prisons or adjacent to prisons, we can`t just let them all become positive for the virus. That is the trajectory that this will take unless the de-carceral measures and other sort of radical steps are taken.

I mean, if we let everybody in jails and prisons in this country get infected and the staff who work there too, even if you don`t care about prison staff and you don`t care about prisoners, it will otherwise mean that we`ll never get this epidemic under control in this country. It doesn`t work that way.

Joining us now is Anthony Romero, who`s the executive director of the ACLU.

Mr. Romero, I know you are very busy right now. Thank you for taking time to join us this evening.

ANTHONY ROMERO, EXECUTIVE DIRECTOR, ACLU: I`m busy. It`s great to see you, Rachel. You`re a sight for sore eyes.

MADDOW: It`s great to see you too.

Well, let me ask you about how I summed that up about prisons and jails.

ROMERO: Yes.

MADDOW: I mean, I feel like it`s easy for a lot of American people to say, well, you know, they`re at risk. But what did you expect? You got in trouble.

Prison staff and jail staff know that they`ve got those risks. But there is this situation which is both the dire number of cases we`re seeing in these facilities.

ROMERO: Yes.

MADDOW: And the fact that these will be reservoirs of infection for the entire population.

ROMERO: Volcanoes for the pandemic.

And we have to think about the fact that you can`t just wall them off and pretend that let the folks die behind bars. It`s first inhumane. It`s cruel. It would be unlawful.

But it`s also not practical. In fact, there are 420,000 people who work in our prisons and jails. They`re our neighbors. They`re people in our churches, in our synagogues, in our mosques. They come in and out of the facilities.

So the same concern we`ve had for nurses and doctors who are in the hospitals without PPE are the same concerns we have now for the prison guards and the workers in prisons and jails. And they will become the vectors.

My next door neighbor may very well come back and infect his entire family because he works in Rikers. And so, the concern isn`t just about the incarcerates, but the entire community.

We estimate, there`s new epidemiological study that we released just yesterday, estimates we could be underestimating the fatalities by 100,000 deaths. That`s an astronomical number. That`s not just people dying behind bars. Those are people in our communities dying because the jails are the vectors for the pandemic.

Seven hundred and forty thousand people in jail any given day. One person goes to jail every three seconds, 70 percent of them are not even guilty. They`re pre-adjudication. They`re pretrial detainees. Average time in jail, 25 days.

They`re revolving doors. So when people go into jail, they`re incarcerated, they`re held there. There`s no hand washing. There`s no sanitizing. There`s no cleaning of the surfaces. There`s no social distancing.

They come back out and they infect their families and their communities and their loved ones. We`re all going to pay the price unless we pay much closer attention to it.

MADDOW: How receptive are public officials are to these arguments that the ACLU is making? I think the public is very receptive to these arguments. I think that public ad campaign was wise because that`s credibly resonant.

But are you pushing on an open door in terms of governors and sheriffs who are looking for a way to try and help?

ROMERO: And some have done very well. None of them have done what they need to do. So far, we`ve released maybe 1 percent of the entire incarcerated population in the U.S.

Italy by comparison has released 10 percent of its prison population because of the COVID crisis. So we have secured maybe 17,000 people who have been released.

 And Governor Polis in Colorado has done very well. Forty percent of the statewide jail population has been released.

In Kentucky, a red state, not a place I like very much because of the senator, the ranking senator, but they reduced their jail population by 28 percent.

But then you have some states and some governors who really dug in. Governor Abbott in Texas needs to be taken out behind the woodshed the way he has dragged his feet on what is playing out in his out in his jails, in his prisons, that will inure to the detriment of his residents.

What we`ve seen, even among liberals and Democrats, The prosecuting attorney and the district attorney in Louisiana, in New Orleans, they`re Democrat, also dragging his feet. So, we have to hold them accountable because our health is on the line for what they don`t do with regard to prisons and jails.

MADDOW: Anthony Romero, executive director of the ACLU -- sir, it is very good to see you. Thanks for being here.

ROMERO: It`s great to see you. See you next time in person.

MADDOW: All right. Indeed, for sure.

We`ll be right back.

(COMMERCIAL BREAK)

MADDOW: Stay right there for a special that`s upright now hosted by Brian Williams and Nicolle Wallace. It`s called "Testing and the Road to Reopening". Among their guests tonight, Bill Gates, Governor Andrew Cuomo of New York.

That starts right now.

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