Frontline Trauma Surgeon TRANSCRIPT: 4/24/20, The Rachel Maddow Show

Guests: Michael Wasserman, James Black

CHRIS HAYES, MSNBC HOST, "ALL IN": -- be absolutely essential in terms of determining this campaign. Sam Seder sporting a very fetching quarantine beard on this Friday night. Thank you for joining us.

SAM SEDER, RADIO HOST: Thank you. Thank you.

HAYES: That is "ALL IN" for this evening.

THE RACHEL MADDOW SHOW starts right now.

Good evening, Rachel.

RACHEL MADDOW, MSNBC HOST: No beard for you, Chris.

HAYES: I can`t grow a beard, Rachel. And if I could, I`d probably grow a quarantine beard but I can`t. So here I am, in all my flat face glory.

MADDOW: We all know that the problem is if you grew a quarantine beard, it would just go straight out from your face and become a barrier between you interacting with other humans. I know how you are grizzly.

(LAUGHTER)

HAYES: That`s exactly right.

MADDOW: Thanks, my friend.

HAYES: Have a great weekend. You`re doing amazing, would, I`ve got to say, I`ve been watching and it`s incredible.

MADDOW: Thank you, my friend. Thanks for saying that. Have a good weekend, grizzly.

Thanks to you at home for joining us this hour.

I`m really happy to have you with us on this Friday night. We`ve got a great show for you.

I would like to introduce you to at the start to Manny Khodadadi. He`s an E.R. nurse who works in southern California.

(BEGIN VIDEO CLIP)

MANNY KHODADADI, EMERGENCY ROOM NURSE, USC VERDUGO HILLS HOSPITAL: Another shift over, fourth one of the week. Not too bad.

I saw a family member today. One of the patients asked me, so, do you stay at a hotel? Do you go home? I told him, no, I don`t go home. I stay somewhere else.

My daughter has autoimmune disorder, so I try to protect her as much as I can. And they said, it must be tough you don`t see your family for a while. I thought to myself, it could be worse. It could be a situation where I don`t go home at all, ever. So thank the Lord that I`m still OK.

Now is the time to toughen up, everybody. We have to fight. We have to fight and win. I`ll continue to fight alongside of my fellow nurses and doctors and RTs and environmental service people, everybody in the hospital. We will win. Fight on.

(END VIDEO CLIP)

MADDOW: That is Manny Khodadi. He`s an emergency medicine nurse working in southern California.

Here`s Dr. Rishi Rattan. He`s a trauma surgeon. He works to save the lives of COVID-19 patients now in south Florida.

(BEGIN VIDEO CLIKP)

DR. RISHI RATTAN, TRAUMA SURGEON, UNIVERSITY OF MIAMI HOSPITAL: One of the things that keeps coming up is an analogy to the AIDS epidemic in the early 1980s. This was before we fully understood the disease, we fully understood the transmission risks, and when there were no medicines that could treat HIV. If you look at the past 40 years of treatment of HIV, only about 50 health care workers in the United States have contracted HIV on the job.

But if you look at the last few months of the coronavirus epidemic in the United States, over 9,200 health care workers have contracted coronavirus. Some of them have died. In one of the earliest weeks of the epidemic here in South Florida, one of my close colleagues who I worked with side by side for six years died from coronavirus.

Just last week, I had a colleague. We shared patients every once in a while. He also died of coronavirus before he could get any meaningful treatment.

The fear that permeates our day-to-day work, knowing that we`ve lost colleagues already, seeing our colleagues on full life support in the ICU and wondering if we`re going to be next, looking around at our teams and wondering who`s not going to make it through this is sometimes overwhelming. We try really hard to focus at work because we don`t have the time to process that.

But at the end of the shift when we peel off our PPE and peel off the mask and go home to wash our hands and shower, you can`t help but think about, who`s next? Is it my friend who I just signed out to, to take over my shift? Is it going to be me?

The way that this pandemic is infecting and killing U.S. health care workers hasn`t really been seen in our lifetime, and it`s very scary.

(END VIDEO CLIP)

MADDOW: That is Dr. Rishi Rattan in South Florida.

As the coronavirus death toll in the United States passed 50,000 today -- the number is 51,523 Americans who have now been killed by this virus in not much more than a month. The doctors and nurses who are treating coronavirus patients in American hospitals coast to coast are of course themselves putting their lives on the line to do this work, to try to keep their fellow Americans alive.

And their own fear of getting infected while they do this work to save the rest of us is very humbling for us civilians. It inspires something I don`t even -- it`s more than just gratitude. I`m not even quite sure how to describe it.

But I can show you something. I can show you that you are among fellow Americans who feel that same way. The Americans who have had a stay-at-home order in place longer than anyone else in the country are Californians. They had the first stay-at-home order, right? So they`ve been under this for the longest.

That state has also benefited from that stay-at-home order, and the fact that it was put into place so early, that has resulted in California having a much flatter curve, much less of a peak in their epidemic than other states had had.

Still, though, a new poll today of California residents finds that a vast majority of people in that state want their stay-at-home order to remain in place as long as needed to fight this epidemic. Quote: Support for sheltering in place was strong across all demographic groups. More than 70 percent in each age, income, and racial and ethnic group support continuation of the shelter in place policy.

Overall the support for California`s continued stay-at-home order as long as needed is 75 percent of the public, and it`s every strata of that population. And it`s not just California. ABC News has just released the results of their new nationwide poll asking the same question across the country.

Here`s the results, quote: overwhelming majorities of Americans favor restrictions related to containing the coronavirus and fear moving to quickly to reopen the economy. Concerns that break through party lines. In this week`s poll, the proportion of Americans who believe moving too quickly to loosen the stay-at-home orders is a greater threat to the country than moving too slowly is 72 percent.

The proportion of Americans who believe social distancing and stay-at-home orders are responsible policies, that proportion is 86 percent. And honestly, it`s not like this is a controversial thing or even partisan. Even among Republicans, 82 percent of Republican voters nationwide say that social distancing and stay-at-home orders are responsible, lifesaving actions, because Americans get it. Americans understand this broadly speaking, and Americans broadly speaking want to do the right thing.

And not incidentally, they are by and large something even more than grateful toward the doctors and nurses and other health care workers who these stay-at-home orders are designed to protect, right, so we don`t have too many infections at once, so we do not overwhelm our hospitals, so that they can do their work. The last couple of Friday nights here on the show we have checked in with Dr. Ernest Patti, who is an E.R. doc at St. Barnabas Hospital in the Bronx, which has been an incredibly hard-hit facility.

We`ve talked to him the last couple of Friday nights. Well, it`s Friday night again, and tonight he sent us some pictures. He sent us a picture of a bunch of origami hearts that kids in Texas sent to him in the E.R. at St. Barnabas to say thank you for what you`re doing. You can see each one has a little note on it.

Here`s Dr. Patti and his colleagues at the St. Barnabas emergency room being very happy to have them. You see how they`re holding them. I love this picture. And look at this. This is fascinating. One of the things we have noticed with Dr. Patti when he has sent us his sort of check-in videos from his shift in the E.R. at St. Barnabas is that he`s worried his patients can`t, like, connect with him, can`t see his face because of the mask and the shield he has to wear.

So, we`ve noticed, you see on his sort of -- where his lapel would be if he was wearing a suit? It`s backwards there because that`s the way it`s shot. But you can see he`s got his name. He drew his name and a little smiley face on his name tag so even if his patients can`t really see his face through all that gear, they can at least see that. It`s a very sweet human touch that we noticed about Dr. Patti in these videos.

Well, Dr. Patti says that someone else in the world was also struck by that, and they decided to come up with a solution to the problem that he`s trying to fix here. They printed a picture of Dr. Patti`s actual smiling face on a sticker. It`s kind of the size of a baseball card, and he can peel the back off that sticker and stick it onto the outside of his PPE Tyvek suit, so his patients who can`t see his face because of all the gear, they can at least see a smiling picture of what his face looks like that way, when he`s talking to them, because he`s got it pasted on the front of his gear now.

People are just sending this stuff to doctors who are working on the front lines because there`s so much support for them among the American people. And Americans, by huge bipartisan majorities, support these stay-at-home orders, which we know do work to slow the spread of the disease, which is the one most important thing we can all do collectively to save our health system and our doctors and our nurses, not to mention ourselves and our families. So you`re among good company in terms of the feelings that you`ve got for American health care workers right now, and the vast majority of Americans supporting these stay-at-home orders is the responsible thing to do. But nevertheless, some Republican governors are demanding that their states be opened back up right now. We are going to get a live report tonight from Georgia, from the chief of emergency medicine at the first hospital in Georgia that hit capacity and basically overflowed because of the huge numbers that they were seeing in that part of the state already. Georgia has got a real epidemic on its hands. They`ve got more than 22,000 known cases of the virus in that state, and the numbers are going up in Georgia, not down.

This was a helpful data visualization on Georgia from "The New York Times" today. This was Georgia`s new coronavirus cases per capita six weeks ago. You see the map of Georgia. It`s divided county by county there. This was six weeks ago.

This was Georgia`s new cases four weeks ago. And then this was Georgia`s new cases two weeks ago. And this was Georgia`s new cases as of two days ago.

This is not the portrait of a state that has licked this thing and is ready to move on and get better now. But I should mention that even those bad Georgia case numbers are likely a wild undercount because Georgia is among the worst states in the nation in terms of the proportion of their population that they`ve had tested for the virus. They`ve only tested maximum about 1 percent of their population.

I mean not to sledgehammer this point home or anything, but look also at the kinds of facilities in which we, the American people, have had the worst track record so far in terms of keeping Americans safe, keeping them from being infected, keeping them from dying.

Look at those facilities in Georgia. Georgia is very rich in those facilities. We got this map today from the gat data visualization folks at Topos, showing red dots where there are prisons or jails where there are known to be coronavirus outbreaks. The bigger the dot, the bigger the size of the known outbreak.

But honestly part of the problem in jails and prisons is, well, A, there`s not very much testing in most of them. But, B, once you`ve got it in there, it`s proving very, very, very difficult to keep the rest of the people who live in that facility and work in that facility from getting infected as well. So, even small outbreaks in jails and prisons tend to become big outbreaks very fast, and they`re then a prime vector for spreading the infection to the surrounding community as staff from that jail or prison go home to their families at the end of every shift.

So it`s kind of on this map, it`s kind of remarkable to see the spread. You know, even with terrible access to testing, just the spread of prisons and jail cases across the country. But just look for a second at Georgia, look at how many of these red-dot jail and prison outbreaks there are specifically in the state of Georgia. And, again, Georgia today is opening back up because that state`s Republican governor has decided, I guess, he just doesn`t want to deal with this anymore, so he`s going to pretend like it`s fine.

As for other facilities we have been having a really hard time as a country keeping people uninfected, keeping people alive, the other top two nominees besides jails and prisons would be nursing homes, right? And meat processing plants of all places, right? But it makes sense, and we`re seeing it all over the country. It`s places where workers work in large numbers in close contact, in aggregate, and those places have been kept going. They`ve been kept running, kept open.

Even where there`s stay-at-home orders, those plants are open, right? So, those are the places where we`ve really seen a hard time getting our hands around this epidemic. Well, in terms of nursing homes, Georgia already says that 40 percent of its deaths from coronavirus in the state of Georgia are in nursing homes. So that means the epidemic is already raging through Georgia nursing homes. Georgia nursing homes are already responsible for the deaths of hundreds of Americans.

Now look at meatpacking plants. Georgia is tied with Arkansas and Texas basically for the largest number of meat processing facilities of any state. Georgia calls itself the poultry capital of the world. They`ve already had multiple meatpacking workers die even as they`ve kept these meat plants open and there seems to be no strong urgency to get the rest of the workers in these facilities tested. I should also mention just for good measure, just so you know, the state of Georgia also has a nuclear power plant where 118 workers have tested positive as well. No worries, I`m sure that`s fine too.

But I mean you add all this up. There`s the nuclear power plant thing, probably that`s no big deal maybe. Also, tons of meatpacking plants with known spread of the virus and deaths already. An out of control situation in the state`s nursing homes.

The hospital system in one corner of the state already overtopped. Cases rising in every county in the state. And some of the worst testing in America.

So that`s the state that`s opening everything back up and where you can get tattoos again as of today. Go, Georgia.

You know, if we are going to pay so much attention to the fringe pro-Trump open it all back up protests, I think we should also note protests like this one today against Georgia Governor Brian Kemp opening that state back up. You can see the signs here. Your life is what is essential. Keep your family safe at home.

Keep your family healthy. Stay home. Stay home. It`s not time to reopen.

Believe in science, not Kemp. Life over money. Science matters.

But you know what? Despite the fact that Americans, by and large, do get it and do understand what it`s going to take to fight this pandemic and try to save American lives, it turns out that ignorance among our nation`s leaders is not a lonely condition.

This will today go down in history as the day that everybody from the Lysol company to the U.S. surgeon general had to try to figure out the responsible way to deal with the fact that the president of the United States suggested, in all seriousness from the White House briefing room, that maybe people should try to ingest disinfectants of some kind or maybe light, some kind of light that you could get inside the body because that could work, right?

I mean, this will also go down in the record books as the day the vice president said that the coronavirus epidemic would be well and truly behind us by Memorial Day weekend. It will all be over by then, OK?

This will also be remembered in the medical journals as the day the Food and Drug Administration, the FDA had to put out an actual warning about the dangers of an unproven drug that the president and the Fox News Channel have insistently, repeatedly, inexplicably touted as some kind of miracle cure for weeks on end.

I mean, ignorance is not a lonely status at the top right now. But do you remember at the beginning of this month more than three weeks ago now, the general sort of shock and astonishment when Georgia Governor Brian Kemp got up in April, in April 2020, the year of our lord, and he said into a microphone in public that he had just learned -- he had just learned that day that people who don`t have symptoms can still be infectious with this disease.

Yes, hold the phone. He had no idea before then.

(BEGIN VIDEO CLIP)

GOV. BRIAN KEMP (R), GEORGIA: Individuals can be infected and begin to spread coronavirus earlier than previously thought even if they have no symptoms. From a public health standpoint, this is a revelation and a game- changer.

(END VIDEO CLIP)

MADDOW: A revelation, a game-changer, right? Cue the national laugh track as Georgia`s governor announces he has just learned something that everybody else has known for months, that has been driving the public health response in the richest nation on earth to the deadliest pandemic in a century. Surprise, news to him, right?

That was April 1st when he said that, which was astonishing.

But it turns out Georgia Governor Brian Kemp was actually ahead of the curve on that because it wasn`t until 17 days after that, that the Trump administration`s secretary of defense announced that he too had just learned that same fact himself. He had just learned it that very day.

(BEGIN VIDEO CLIP)

MARK ESPER, SECRETARY OF DEFENSE: What we found of the 600 or so that have been infected, what`s disconcerting is a majority of those, 350-plus, are asymptomatic. So it has revealed a new dynamic of this virus that it can be carried by normal, healthy people who have no idea whatsoever that they`re carrying it. So we`re learning a lesson there and making sure we communicate that to our broader force.

(END VIDEO CLIP)

MADDOW: Oh, we`re learning a lesson there, yeah. Yeah, it turns out a new dynamic of this virus we just discovered. Turns out people are asymptomatic and they have this thing. We just learned that.

Then I love how he finishes that comment by saying, listen, we`re letting everybody in Navy know this, because we`re pretty sure nobody else had any idea about this. So better alert everyone. We`ve nearly discovered the fact.

That was less than a week ago that the defense secretary said that. He`s just figuring it out, which is, you know, disconcerting given that that is the person who President Trump has put in charge of running the largest military on earth.

It`s also disconcerting when the whole reason it came up with Secretary Esper is because there really has been an outbreak of more than 850 coronavirus cases among U.S. Navy sailors on board one nuclear-powered aircraft carrier and where today another deployed U.S. Navy vessel, a deployed vessel, a destroyer called the USS Kidd emerged as the site of an outbreak at sea with 18 U.S. sailors tested positive so far.

The commanding officer of the aircraft carrier with that giant outbreak, Captain Brett Crozier, was, of course, fired by Trump`s navy secretary after he raised the alarm about the burgeoning outbreak on his ship and the need to test and treat his sailors. The Navy secretary himself has since resigned in disgrace for having taken that action.

Today, "The New York Times" reported that a Navy review of Captain Crozier`s performance recommended reinstating him as captain of the USS Theodore Roosevelt. Trump Defense Secretary Mark Esper was expected to announce Captain Crozier`s fate this afternoon after he received the recommendation of that report.

But then he decided not to. "The Washington Post" first to report that the decision on Crozier`s fate has now been apparently delayed, deferred for some reason, presumably because they need to figure out some new revelation that they can blame their actions on or some way to try to make this something the president likes, or who knows.

Meanwhile, our nation`s veterans continue to suffer almost unimaginable death tolls from this virus. The death toll in the soldiers` home in Holyoke, Massachusetts, in western Massachusetts, is now up to 73, 73 veterans dead at that one facility.

On Long Island in New York, at the Long Island state veterans home which is in Stony Brook, New York, the death toll among veterans is now 46 dead -- 46 dead out of a total of 350 veterans at that facility. The management there actually sent out an urgent plea to the public this past week for help getting PPE to their staff. They`re just asking anybody in the community to please help them, 46 dead already.

In Louisiana, at the veterans home in Reserve, Louisiana, there were 150 veterans there at that home at the start of the epidemic, but they`ve had 43 deaths over the past two months. Today, "The Times Picayune" reports that there are 91 veterans left at that home plus five who are fighting for their lives in the hospital right now.

Today, that home announced the result of testing all the remaining vets who are still there. It turns out that half of them are positive. It almost feels like a miracle that they`re not all positive.

But, you know, the hardest places to fight this thing are the places that you have to fight the hardest. And coming up for you next tonight, we`ve got a constructive, practical, instructive story about how to do that and how to do it really well. And that`s next.

(COMMERCIAL BREAK)

MADDOW: At the end of last month, two nursing home residents in Los Angeles who had just been discharged from the hospital began showing coronavirus symptoms. So their nursing home, Brier Oak on Sunset, isolated those two residents and tested them. And when their tests came back positive, Brier Oak decided they were going to test all of the staff in their facility who had been in contact with those two residents even though none of the staff were showing symptoms.

Even though none of the staff were showing symptoms, 15 of those staff tests came back positive. According to Brier Oaks director of clinical operations, quote, with that number of positives, now you have to be concerned about the possible exposure of everybody.

Now, the problem, of course, is that Brier Oak couldn`t test everybody. Despite being the place where the most Americans are dying from coronavirus, nursing homes have largely been on their own as individual facilities in terms of trying to get a hold of tests for their residents and their staff. So, pretty much no one at any facility anywhere could test everybody.

But some nursing home leaders in L.A. were trying, and it turns out there was a larger long-term care facility, the Los Angeles Jewish home, that had managed to get itself several hundred coronavirus tests from the city. And the L.A. Jewish home agreed that they would give this other facility, Brier Oak, enough tests to screen all their residents and all of their staff, which was a really stand-up thing for them to do.

And Brier Oak as able to do all that testing, and what they found will curl your hair. Seventy-five percent of the residents have the virus, 90 percent of the staff had it as well. Which meant that Brier Oak immediately became possibly the worst outbreak in the entire state of California.

As of today, 77 residents and 70 staff at Brier Oak have tested positive for the virus. Three of their residents have died.

But the key here is that this one nursing home appears -- right? Appears to have this extra terrible outbreak than other facilities, but maybe that`s because they`re the only one that tested everybody, right? And the only reason they were able to test anybody is because of this sort of accidental circumstance in which they got this incredibly neighborly help from a nearby facility.

Maybe if every nursing home had universal testing, we would discover that lots and lots of places are as bad as Brier Oak and we could get them resources to try to deal with their problems.

You know, we`d at least be able to see the scale of the problem that clearly needs to be tackled in these facilities where the most Americans are the most at risk of death. Well, this week the Los Angeles County health director announced that nursing homes are now being advised to test all residents and all staff. The county announced that they had given this previous guidance that only people who had symptoms should be tested. The county, to their credit, announced that that previous guidance was a mistake. The health director said bluntly in public, quote, we were wrong. And now regardless of symptoms, everybody should be tested in every nursing home and long-term care facility.

Well, the Los Angeles Jewish home, the facility that got those hundreds of tests from the city and then gave some of those tests to this other facility, to Brier Oak, that had this problem so they could figure out what was going on in their facility and so we could all see what it looks like when a nursing home tests everybody -- the L.A. Jewish home`s medical director is a man named Dr. Michael Wasserman.

Dr. Wasserman is also the president of the California Association of Long- Term Care Medicine, which represents doctors, nurses and others working in long-term care facilities. Expanded testing is one of several measures he`s been advocating for to try to better protect these facilities and their residents and their workers. Now that L.A. County is going to try to do universal testing in its nursing homes, Dr. Wasserman told the "L.A. Times" this, quote.

We expect to see the number of cases that get reported to skyrocket, and we expect to see the number of deaths that get reported to skyrocket.

Joining us now is Dr. Michael Wasserman. He`s president of the California Association of Long-Term Care Medicine. He`s also the medical director of Eisenberg Village at the Los Angeles Jewish home.

Dr. Wasserman, thank you so much for being with us tonight. You`ve been in the middle of an interesting and important circumstance. Thanks for taking time to talk to us.

DR. MICHAEL WASSERMAN, CALIFORNIA ASSOCIATION OF LONG TERM CARE MEDICINE PRESIDENT: Thank you so much, Rachel.

You`ve actually said it better than I can to be honest with you. This is such an important issue right now. One thing I do want to let people know, an outbreak has no reflection on the quality of a nursing home. It`s what you do about it that matters. And nursing homes across the country cannot be afraid to test. That is -- it`s really critical.

MADDOW: You know, I will underscore that by saying as I have been reading far and wide -- and you really have to read local news reports in order to get a handle on this because there isn`t national federal reporting on these things yet. I will -- there is certainly circumstances in which there`s been large outbreaks in facilities, and people in the community say, that was never a well-run facility and there were earlier complaints.

But there have been large outbreaks in some facilities that are described as the absolute gold standard, you know, places where there`s been no complaints and where people see it as the best facility in the area. There doesn`t really seem to be any way of escaping this in these facilities just for being a well-organized, well-administered place.

I would hope that would lead to a loss of defensiveness, a loss of a sense of shame around these outbreaks so we could get more public information about them.

WASSERMAN: There`s no question, Rachel. Nursing homes are accelerators for this virus, and we literally have to literally put a moat around them. And so, if we test and we test all the staff and we test all the residents as they did at Brier Oaks, what they did immediately, once they knew they had positive staff and positive residents, was they went into lockdown mode. Every staff wore personal protective equipment. Everyone had masks.

And I believe and a number of my colleagues around the country believe that once you know you`ve got the virus in your nursing home, if you move into going full-bore on your protection and, again, stellar infection prevention and control, you can actually make a difference.

And, you know, an article came out in the New England Journal today that showed again that you don`t know what you don`t know. And there`s a lot of facilities out there right now that have staff and residents with the virus, and they don`t know it. And if they just go on about their regular day, they`re going to become another Kirkland.

MADDOW: In terms of trying to maintain a practical and constructive approach to this, since we`ve been talking about nursing homes a lot, we`ve heard a lot of people expressing real despair, especially if they`ve got relatives that are in one of these facilities who need to be in a facility like this because they can`t be cared for at home. We`ve heard people really distraught, worried that there`s no way to protect them.

So what you just said about how there are protocols that work, that there are ways to protect people I think is important to hear. What I want to know is how we can try to up that standard. We can get more facilities up to those kinds of high standards nationwide. We have seen individual facilities, you know, pleading for donated PPE for staff. We`ve seen so many facilities where they say they don`t have access to testing.

Do you think that we could act systematically as a country to get testing and get PPE and get medical consultation into these facilities to bring more facilities up to that high standard that you`re describing quickly?

WASSERMAN: Not only can we, we have no choice. We have to. This is where the virus grows and accelerates and then leads to more people back in the hospital.

So, if we don`t focus on our nursing homes and assisted living facilities and protect the individuals there, you know, I used the word skyrocket. That is true. The number of folks with the virus and the number who will succumb will dramatically go up. I think it`s absolutely critical as a country that we focus on getting personal protective equipment and make testing readily available.

We`ve actually developed what we call our quadruple aim, which is abundant personal protective equipment, readily available testing, stellar infection control. And then the final piece is all nursing homes need to be running in their emergency preparedness mode because it`s a lot of hard work. And, you know, that`s one comment I just have to make is the frontline staff in these nursing homes are putting their lives on the line, and often some of these folks barely make a living wage, if that. And they`re doing incredible work right now protecting the older adults, the vulnerable older adults in our country.

MADDOW: Do you think that it makes sense in the absence of real community mobilization to support nursing homes, the way we have seen community mobilization to support doctors and nurses and other frontline healthcare providers? Do you think it makes sense that community groups and local governments and civic organizations should be like adopting their local nursing home and trying to figure out what they need that can be either donated or organized for to try to surface their problems, to try to get them help and to make them more visible in terms of what they need?

WASSERMAN: Absolutely. Honestly, in a lot of places, the state, the federal, the counties have failed in this. You know, that`s what makes our country great is that we do step up and we help each other. And I think absolutely everyone should be doing everything they can right now to bring support to nursing homes and assisted living, and I`ll mention one other group.

There`s these small group homes which have like six or seven seniors living in them. They`re also at very high risk. So all those areas, we all need to be doing everything in our power to help prevent the virus from sort of running amok within the walls of those living facilities.

MADDOW: Dr. Michael Wasserman, president of the California association of long-term care medicine, medical director of Eisenberg Village at the L.A. Jewish home, which played such a remarkable role in this epidemiological find basically in L.A. senior centers. Doctor, thank you for helping us make sense of all this.

I hope you`ll come back and talk to us about this. This is not something we plan on abandoning as a story line. We`re going to stay on this until somebody makes us not.

WASSERMAN: I`d love that Rachel, anytime.

MADDOW: All right. Thank you, Doctor.

We`ll be right back. Stay with us.

(COMMERCIAL BREAK)

MADDOW: This was the headline on the front page of the "Atlanta Journal Constitution" tonight. "Scenes from Georgia`s cautious reopening. Lines start early for haircuts."

Today, the Republican governor of Georgia, Brian Kemp, took steps to reopen businesses in Georgia amid the growing coronavirus epidemic in his state. He nevertheless allowed salons and tattoo parlors and gyms and a whole slew of other businesses to open up in his state.

Here`s something to know about American leadership in the context of this brilliant decision.

Earlier this week, the president of the United States was asked whether he thought reopening all these businesses in the state of Georgia -- the president was asked whether that was a good decision by Governor Kemp.

(BEGIN VIDEO CLIP)

REPORTER: Mr. President, what do you say to concerns, like Georgia is opening up barbershops and bowling alleys?

DONALD TRUMP, PRESIDENT OF THE UNITED STATES: He`s a very capable man. He knows what he`s doing.

(END VIDEO CLIP)

MADDOW: That`s basically the slogan for the federal response to this national crisis so far, right? You want to know when it`s time to do anything? Don`t ask me. Ask a governor. He`s a Republican governor. I`m sure that governor is doing a great job.

Ask Governor Kemp. He`s a very capable man. He knows what he`s doing, right?

Well, that was the answer from the president on Tuesday. If you ask him again the next day on Wednesday, it went differently.

(BEGIN VIDEO CLIP)

TRUMP: I told the governor of Georgia, Brian Kemp, that I disagree strongly with his decision to open certain facilities. I disagree with him on what he`s doing.

(END VIDEO CLIP)

MADDOW: It`s not like the president, you know, said these things like a few days apart or a week apart and then had a change of heart or something. I mean that only took 24 hours.

Honestly, I mean, it gives you whiplash.

(BEGIN VIDEO CLIP)

TRUMP: He`s a very capable man. He knows what he`s doing.

I disagree with him on what he`s doing.

(END VIDEO CLIP)

MADDOW: Leadership, one 24-hour period.

We do not have a national response to our national epidemic. Instead, we have a president who reverses course in a matter of hours on how he feels about the kinds of policy that will decide whether people live or die, and that`s one thing to know that about this president and what this will forever do to the American presidency and expectations thereof. But we are starting to see now how it is affecting real people right now on the ground, other among other places, in the great state of Georgia, and that`s next.

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MADDOW: When the early history of this epidemic in the United States is written, the state of Georgia will have a starring role, not just because of what they are doing by reopening businesses today in the face of a large and escalating epidemic with no substantial access to testing of any kind. But the other reason Georgia will have a starring role in the history of this American epidemic is because of the role that the town of Albany, Georgia, played in the early days of this experience, how the virus there kneecapped the town`s modest little hospital system, where in the blink of an eye, all 38 ICU beds that they had were full. In the blink of an eye, they burned through a six-month supply of PPE that they had socked away just to be careful. They burned through that six-month supply in one week.

Albany, Georgia, has been radiating heat in terms of infections and hospitalizations and deaths from the very beginning in Georgia. But now, so are other parts of the state. Places like Hall County, Georgia, which is up north of Atlanta, where their reported cases are ticking up now and where according to "The New York Times," the north Georgia medical center there believes they are on track to be overtopped, to be at capacity very soon, as soon as May 4th.

Cases are still on the upswing there. According to their models, Hall County is not due to peak until early June, but they`re expecting the hospital to be at capacity by May 4th. And who knows what the models will say once Georgia`s restaurants and nail salons and tattoo parlors and gyms have been open for a week or two, and that all started today.

As Georgia enters these uncharted waters, the lessons from Albany, Georgia, where they had to navigate this pandemic without a compass, those lessons are going to be more important than ever before.

Joining us now, I`m honored to say, is Dr. James Black. He is the medical director of emergency services at the Phoebe Putney health system in Albany, Georgia. Dr. Black joined us earlier this month to talk about what was happening in his hospital.

Dr. Black, I`m really glad you were able to come back. Thanks for making time for us tonight.

DR. JAMES BLACK, PHOEBE PUTNEY MEMORIAL HOSPITAL MEDICAL DIRECTOR OF EMERGENCY SERVICES: Thank you, Rachel.

MADDOW: When we last spoke, you were talking about a really incredible amount of utilization at your hospital and in your E.R., your worries about supplies in terms of being able to keep your staff safe.

How has the last few -- how have the last few weeks been, and what`s your utilization rates like now?

BLACK: They`re still pretty heavy, but we kind of developed a rhythm of reaching out to our vendor sources and our supply chain guys who are in charge of keeping track of the critical inventory as well as medications. And we have managed to avoid running out. We`ve come dangerously close on a lot of different fronts, but we haven`t run out of anything critical thus far.

MADDOW: How has your staff been coping just with the pace at which you have been seeing coronavirus patients with the serious illness that I know a lot of patients present with, with this illness? I imagine that it`s been stressful on the staff just in terms of the number of hours that everybody`s been working, but also the seriousness of the cases that you`ve been handling.

BLACK: Without question. You know, I guess we`re sort of used to taking care of critically ill patients in the emergency department, but the sheer numbers and then the numbers that come in grouped together who are in critical condition has been something that none of us has ever really experienced for any sustained period of time. But over the course of the past several weeks, it`s been a steady dose, and we keep, you know, wondering one day you`re going to come in and not have any, but it just doesn`t happen.

MADDOW: Well, given that, given how hard-hit you were early and how it has been such a sustained flow of patients and such heartbreak in the community in terms of the number of people infected, the number of people sick, the number of people died, I feel like you were the person more than anybody else in Georgia who I want to ask about opening businesses back up and what the governor has decided in terms of loosening all these restrictions and letting people go back to doing all sorts of business activity and all sorts of collective activity that`s likely to spread this virus more.

BLACK: Well, I think we understand that Governor Kemp and other leaders have to strike a balance between the economic health of the state and the well-being physically of the residents. And I guess it`s not really our place to endorse or criticize those decisions, but we`re kind of tasked with remaining focused on taking care of the citizens no matter the landscape of the context.

I think, you know, we`ve made some pretty good gains. I guess two weeks ago, we had over 155 COVID patients in the hospital. This afternoon, we were just under 90, at 89. So we felt like we are at that point where we`re not having to transfer patients out. We`re actually having people transfer patients to us, and that we`re seeing fewer patients -- fewer new patients on a daily basis, but still seeing a significant amount of COVID patients.

So I think we`re concerned that, you know, we might see another spike. An ill-timed, or ill-conceived get-together, however innocent, might send us back to where we were a couple weeks ago.

MADDOW: In terms of being concerned about that spike, obviously you in Albany, you and your hospital system really had the early worst of it in Georgia. We are seeing real worries about some other facilities in other parts of Georgia, Hall County, for example, is really worried right now that they`re having large numbers and a peak that`s going to hit later than they might top out their capacity at the hospital.

Do you have advice for your fellow emergency medicine chiefs, for your fellow frontline physicians in other parts of Georgia who may be looking at a steeper peak and a larger number of cases now that the state`s opening back up?

BLACK: I guess some of the early advice is number one you have to take care of yourself and take care of the staff. Certainly I would ask that they, you know, try to look two to three weeks into the future and just assume that the patients are going to keep increasing. I think that`s one of the things that was a little disheartening early on for us is every day we kept coming in. You would hope there would be two or three less patients, but every day it was always two or three or 10 or 15 more patients, and they were all ill.

So, we were opening up additional units, opening up additional ICUs, again going through a lot of equipment, and just, you know, making sure that your staff stays engaged and you have people looking out because they`re going to work hard every day, but they`re going to see a tremendous amount of illness and a tremendous amount of death that no one is used to, you know, not in our country, in our day and age.

So it`s kind of uncharted territory, and just expect that it`s going to continue to come until it starts to get slightly better.

MADDOW: Dr. James Black, the medical director of emergency services at Phoebe Putney Health System in Albany, Georgia, who has dealt with so much of the brunt of it in Georgia already -- good luck to you and your colleagues. God bless you for what you do, and thanks for being with us, sir.

BLACK: Thank you so much, Rachel.

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

(COMMERCIAL BREAK)

MADDOW: Thanks for joining us tonight for this unexpectedly, 100 percent no teleprompter version of THE RACHEL MADDOW SHOW. I`m sorry about all of the looking down and around and saying "um".

Our coverage is going to continue now. You should stay right where you are. When I return on Monday night, however, there will be 100 percent more apparent eye contact between me and you. I`ll see you then. Good night.

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