the real CDC back TRANSCRIPT: 5/1/20, The Rachel Maddow Show

Guests: Ashish Jha

CHRIS HAYES, MSNBC HOST, "ALL IN": 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. Have a good weekend.

Thanks to you at home for joining us this hour. Happy to have you here with us. It is Friday night. Thank you for being here.

I want to start tonight by introducing you to Dr. Jane Wilcox. She`s a cardiologist. She works at Northwestern Medicine in Chicago.

(BEGIN VIDEO CLIP)

DR. JANE WILCOX, CARDIOLOGIST, NORTHWESTERN MEDICINE, CHICAGO, IL: Before I started this role, I was nervous and a little anxious facing a different disease process than I had ever seen before. I trained during H1N1, and while I remember the occasional bad case of the unhealthy person succumbing to this disease, I was not prepared to enter into an entire unit and multiple units with droves of relatively healthy patients who are now fighting for their life with COVID-19 pneumonia.

KAITLIN GILLIAM, ICU NURSE, ST. LUKE`S HOSPITAL, ST. LOUIS, MO: When we started getting these patients in the unit, we were putting down breathing tube after breathing tube in these patients. We got up to 14 and 15, ventilators in our 18-bed ICU, and it was just one after the other. And we were all scared.

Nobody knows how to navigate this. And we`re just taking it shift by shift and day by day, trying not to get overwhelmed. One of the things that is really hard for us, as ICU nurses, we`re used to having constant access to our patients, we have very sick patients and we`re used to going in there and assessing and reassessing them. But now, we have to really cluster our care to try to cut down exposure time in the room.

The less time in the room, the less time we have to be exposed to the disease, the less chance we have to bringing it home to our families, but that`s also really hard, because we`re under constant worry we`re going to miss something, we`re going to miss a new symptom, we`re going to miss a new vital part of information that comes from our assessments.

CHELSEA TOOKER, ICU NURSE, NORTHWESTERN MEDICINE, CHICAGO, IL: I wish I knew the shear volume of patients that we would have at Northwestern. I wish I knew how thick they would be because that would have helped me prepare better mentally. And then I`ve been an ICU nurse now for about 12, 13 years but I`ve never seen patients that are this sick. I just wish I knew how many resources each patient would be requiring.

These patients require a lot of care. It`s very heavy care. It`s a lot of specialized machines.

BAILEY SUH, ICU NURSE, MD NURSE HELPING IN NYC: These patients have no family around to be there, in their last moments. And you try everything, you try so hard, to keep people alive, to make them better, to help them get extubated and leave the ICU, but unfortunately I`ve just seen so many of them die. I think this is also taking a toll on all of the staff. We`ve run out of blood tubing, we`ve run out of suction devices for the mouth. We`ve run out of blood gas syringes. That we take for granted on a day-to- day basis. It`s hard to stay positive.

Like I said earlier, we are all trying so hard to be everything for these patients. We`re giving them maximum oxygen support. They`re on numerous medications to support them. And we`ll get these patients and have them for days. And we`ll think maybe they`ll get better. Maybe they just need time. And they still die. That`s hard.

(END VIDEO CLIP)

MADDOW: Front line health care providers. Doctors and nurses both working in Chicago, and St. Louis, Missouri, that last young woman there, is a nurse from Maryland, who volunteered to come to New York City, to serve on the front lines, at the apex of New York`s fight. You can see she`s pretty flattened by what she has gone through.

I want to show you one more tonight though that we just got in, from a senior physician at Mount Sinai in New York. His name is Dr. Umesh Gidwani and he is a cardiac critical care physician.

Watch this.

(BEGIN VIDEO CLIP)

DR. UMESH GIDWANI, CARDIAC CRITICAL CARE PHYSICIAN, THE MOUNT SINAI HOSPITAL: Welcome to another day in COVID land. It`s bright and sunny. And it seems like things may be slowing down a little bit. Not really for the ICU because we have been helping our sister hospitals in Brooklyn and Queens who really got disproportionately affected by this disease, and so we`ve been taking patients from there, and then a couple of patients from the feed hospital in Sanford Park.

So, the ICUs are going to stay busy for a while. There are lots of patients who are intubated, and on a breathing machine, whose really course is yet to be determined. And obviously, the hope is that we can save most if not all of them.

We`re going to start rounds. And with the rounds, the way the rounds are structured is typically in the normal ICU, there would be a senior resident doctor, known as a fellow who is specializing in that specialty. But right now, everybody`s specialties are all mixed up, it doesn`t matter what their specialty is, everyone is pitching in.

Talking about the next patient.

UNIDENTIFIED FEMALE: So, we have him on all of the drugs we have. He`s currently on levo and vaso and that`s he`s been stable. He`s sedated and paralyzed off flow line and he`s on an insulin drip for hyperglycemia.

GIDWANI: Is he also getting dialysis?

UNIDENTIFIED FEMALE: He is on the CVVH.

GIDWANI: Is he also getting mechanical ventilation support?

UNIDENTIFIED FEMALE: Everyone here is getting mechanical support.

GIDWANI: So, he`s mechanical ventilator, artificial kidney, and six I.V. drips at the same time.

Dr. Cohen, what are you going to do today?

UNIDENTIFIED MALE: Going to help Dr. Lee with the peritoneal dialysis catheter for this patient.

GIDWANI: Why are we putting in peritoneal dialysis catheters?

UNIDENTIFIED MALE: Well, that`s a good question. A lot of patients are going into kidney failure and we`re kind of short on the human dialysis machines. So this is an alternative method of performing dialysis for these patients.

GIDWANI: Right.

Do you think it is time to relax a little bit and back off on social distancing, and wearing masks?

UNIDENTIFIED FEMALE: Absolutely not. The population of patients is still very much active and we`re working really hard to take care of these patients and get them better.

GIDWANI: So, you think that if you back off, that there will be a resurgence in the cases?

UNIDENTIFIED FEMALE: Absolutely. It`s just too soon.

GIDWANI: Amina is a very experienced cardiac nurse, I want to ask her a very important question.

Amina, do you think it is time to start backing off on social distancing?

UNIDENTIFIED FEMALE: No, I think we have to continue what we`ve been doing, or else we are going to reverse everything that we`ve accomplished.

GIDWANI: There is still quite a substantial burden of illness and severity of multi-organ failure. We have patients really who have not responded to all of the usual inventions.

The big fear now is what happens next. Are we going to see a recurring of the illness, are we going to spikes coming back, especially as we start to relax and loosen some of the restrictions? We have to be prepared, because we have really learned a lot from this real eye-opening, life-changing series of events that have happened over the last two months or so.

(END VIDEO CLIP)

MADDOW: This eye-opening life-changing series of events that has happened over the these last two months or so. Eye-opening, life-changing, yes. I mean, we are all experiencing that, right? The last two months have been really freaking weird and terrible.

But none of us have had the life-changing, eye-opening experience that`s comparable to the 65,000 Americans who have lost their lives already, and their families. None of us have, you know, gone through what the tens of thousands of Americans have gone through, who fought this thing, almost to the death, and then survived. I think we`ve been asking for front line health care workers to send us stuff.

I think there`s a reason that hospital staff keep sending us videos like these. Celebrating, filming and capturing for posterity, the triumphant release of some of their patients from the hospital. It`s clear that they really feel like they need to uphold that it is possible for hospitalized coronavirus patients to still beat it, to still survive, to still finally get to go home, because people do get so, so sick from this virus, and they need such intense care in the hospital, I think the doctors and nurses want us to see this ourselves, so that we don`t give up hope so they need it for them, so they don`t give up hope because they`re working so hard with those who are so sick for which there is a confounding virus for which there is as of yet no treatment.

So, yes, we have all had an eye-opening life-changing last two months or so like Dr. Gidwani said. But none of us civilians have had what the doctors and nurses have had, who have been working in these swamped hospitals, in these COVID emergency rooms and converted COVID-only ICUs.

But then, of course, there is one other group of Americans who have been in, right at the front of the front line, just as much as the hospital workers have been, people who have been caring for tons of COVID patients, people who have been putting themselves at risk, getting infected in great numbers themselves, because they haven`t had enough protective equipment to keep themselves safe, while they care for large numbers of coronavirus patients. And those Americans have had a different couple of months than the rest of us have, too, a difficult dangerous life-changing past couple of months.

And they are the largely underpaid, often totally unrecognized people who work in nursing homes, right? Where we know the virus has been exacting a toll of biblical proportions among the population of Americans who reside in nursing homes and long-term care facilities. But because of that, there is something else that I want to show you tonight, this Friday night.

We`ve been in touch with front line health providers in hospitals. We have been talking about the fact that more Americans are dying from this epidemic in nursing homes than any other single place. The place you are most at risk of getting this virus and dying from it in America is in a nursing home.

So if we the American people have to save the most lives, we have to focus on the places where the most lives are at risk. We have to start to see the nursing homes and the long term care facilities around us. Literally, I mean, we need to know where they are -- in your town, in your county, wherever you live in America, listening to me right now. In your town, in your county, the place where the most lives are going to be stolen by this thing are the lives in nursing homes and long-term care facilities.

So, you should know where these communities, these facilities are in your community. You should know. If you are part of any activist group, any political group, any church or synagogue or mosque, any civic group, you should know, if the nursing homes around you, first of all, you should know who they are, you should know where they are, and you should know if the nursing homes around you need something. If they need things they don`t have. You should figure out if there is some way that you can help them get help.

I mean, I`m speaking very broadly here. I`m not trying to start a movement or anything. But I`m just saying in terms of where Americans are dying, that`s where Americans are dying. And there isn`t any help coming from the top.

There`s sort of happy talk coming from the top now about this, from Washington but there really hasn`t been any help coming from the top, coming from the federal government, to try to keep Americans alive in this most vulnerable place. And so, local communities are going to have to do this from the ground up in order to keep as many people alive as possible in these facilities where they are otherwise just being cut down.

And I want to show you this tonight, because people, look, really are starting to show up for their local nursing homes, all over the country. This is today. In Lexington, North Carolina, this is Davidson County, North Carolina. They have three residents die last week, at this one facility, from coronavirus. They`ve got 41 coronavirus cases among the residents there now, at Austin Brook nursing facility.

Well, this today, is the town, the county, the community they`re in, in North Carolina, showing up for them. And you know, you can`t visit the nursing home, you can`t come inside, you can`t put the residents to any further risk, but this is a way to try to connect. That`s North Carolina.

This is from Glen`s Falls, New York, yesterday. Five different nursing homes were visited. There were apparently 30 or so cars. People put signs on their car, thanking the people who work there, reaching out to the people who live there. These were from Tuesday and Wednesday this week, people again turning out to thank and connect with their local nursing homes and people working there, and living there. Literally the Americans whose lives are most endangered by this disaster.

This is Fountain Inn, South Carolina, I think we`ve also got footage from Albertville, Alabama. Now, Albertville has had a big outbreak centered on a big chicken plant there. But as we know, outbreaks in one kind of a facility do not tend to stay inside that facility, and so if you`ve got a big meat processing plant that`s got a whole bunch of cases, you are soon going to have a bunch of cases in your nursing home in your community today. This is a highly contagious communicable disease. That`s how it works.

I should say vice-versa. If you have a lot of cases in your nursing homes, you`re going to get a lot of cases in the community, you`re ultimately going to get cases in places where it is going to spread like wildfire, especially aggregate working environments like meat processing plants.

Here`s other pictures from other people turning up to support their local nursing homes and their communities. In Brunswick, Maine, Lubbock, Texas, we got some pictures. It`s everywhere. It`s happening now, everywhere, spontaneously, it`s really nice to see.

These are all just photos and videos taken over the past few days. We`ve also heard that a charity called Global Empowerment Mission that was working to get PPE donations to health care facilities, they also started organizing PPE donations for nursing home staff now, as well that had not been part of what they were working on from the outset, but now they realized that nursing homes need this material for their staff as well, and they started helping nursing homes, too. It`s a big charity effort.

Lots of high dollar donations, one of the places they`re now starting to focus on, is nursing homes. That`s great. Here`s one I want you to see from New Hope, Minnesota. And this was actually a week ago now. The story behind this is interesting.

Last week, this story ran in the "Minneapolis Star Tribune" about the Saint Therese of New Hope nursing home, right? A very worrying headline last week, very worrying situation. It`s a 258-bed nursing home. This is "The Star Tribune" reporting last Wednesday, that they had 12 deaths at that nursing home from coronavirus.

Later that day, this happened outside that nursing home. People coming out to support that nursing home. People who live there, people who work there, trying to lift them up, and see the signs that people are holding there, we stand united, thank you for all you do, you`re all sunshine for your residents, we stand united, I stand with Saint Therese, thank you.

But the situation at that facility, which it is great to see them getting that community support, the situation there is really bad. That facility, as I mentioned, was reporting 12 deaths as of last week. That appears to have been what prompted this rally in support of them, 12 deaths last week.

Well, now, as of this week, they are reporting 47 deaths at that facility, 47 people have died there. Of the remaining residents at that facility, they`ve got 130 positive cases. And they only know that because they were just this week able to finally get everybody tested at that facility.

I mean, listen, our government may have really screwed up the response to this crisis. And they may be continuing to screw it up. I will tell you, the administration yesterday finally announced that they`re thinking about maybe getting together some experts, some big brains, to maybe start thinking about talking about what we might maybe could do, about the fact that best guess, maybe 20,000 Americans, possibly more, have already been cut down in nursing homes in less than two months by this virus. They just yesterday announced that they`re going to think about getting a group together, at the federal level, to start thinking about that.

They want you to know how urgently they are considering this problem. They are going to meet, for the first time, they think, in late May sometime. They don`t even have a date, they`re just aiming at maybe trying to convene for the first time in late May.

Yes, our government has not been Johnny on the spot, when it comes to trying to keep Americans alive, in any significant numbers. And the glaring, I don`t know exactly what to call it, the glaring, it`s not ineptitude, it`s not incapability, I want to call it unwillingness, but I don`t know. The worst of what they had failed to do is evidenced in the places where the most Americans are dying. They have done nothing.

And the administration so screwed up the testing situation for the whole country, from the very outset, that now, even months into this, now with 65,000 Americans dead, it`s still hard to get testing even for facilities where the most people are dying, where they most desperately need to test people because they need to know who is positive so they can isolate foes who aren`t, who aren`t at grave risk of getting it and dying from it.

The federal government absolutely screwed this up and it is not going any better, but we know as Americans, we have lived long enough with this to know who needs priority access to tests and where the most help is needed and where people are at the most risk.

I mean, in Minnesota, where that facility, St. Therese of New Hope, is located, they think that nearly 80 percent of the deaths in the state have been in nursing homes. Nearly 80 percent of the deaths in Minnesota. Yet where do you think you ought to focus your resources there? Right?

It doesn`t -- the outbreak, the epidemic in Minnesota doesn`t have to start at these facility, but sure, that`s where it ends up and that`s where it will take the most lives. Test there. Try to keep the people there alive. They`re at the most risk of dying the quickest in the greatest numbers. Saint Therese of New Hope just got everybody tested.

In Sioux Falls, South Dakota, where the huge outbreak there was centered on the big Smithfield meat processing plant, today, one large nursing home in Sioux Falls announced seven new deaths, seven Americans.

In Grand Island, Nebraska, where the big outbreak there is also centered on a JBS meat processing plant, their local health director just announced ten new nursing home deaths yesterday. I mean, test and ye shall find.

We know where it is. We know where it is going to be. Go look there. And you will find a facility that needs help, and where the people living there and/or working there need more protection than they have got.

Why is this so hard to focus our efforts like this?

Montgomery County, Pennsylvania, this week, they finally got their hands on enough tests to test everybody at the Montgomery County Jail. As of last week, at that jail, they thought they knew how many cases they had. Once they tested everyone, they found out that the actual infection rate at that jail was 30 times higher than what they thought they were dealing with.

And that isn`t just like a whoa, math, moment, that then of course requires action, to prevent the other 80 percent of the prisoners in that facility from getting infected by the 15 to 20 percent they have just discovered already have it. And you can`t count on only testing people who have symptoms or isolating people with symptoms, it doesn`t matter if they have symptoms, if they`re positive, they can infect other people whether or not they have symptoms. It`s not rocket science. But you have to test.

As of today, we have the third largest prison outbreak in the country newly discovered at Trousdale Turner Correctional Center in Trousdale County, Tennessee. How did they find that they had 1,349 new cases at that prison in Trousdale County, Tennessee, today. They found out because they tested the freaking prison at long last. They tested 2,700 prisoners there. More than half have it.

OK. Now, you have to act to prevent everybody else from getting it, both prisoners and staff in that facility. It is a call to action. It tells you where the problem is and where what you need to do.

Tennessee`s governor says he`s now looking for resources to try to test all of the prisons in the state of Tennessee because this is the first one they tested and they turned up the third largest outbreak in America. I mean, it will be great when they test all of the other prisons in Tennessee, they don`t finds huge numbers in all of them, but if and when they do, that will be important information about what will likely be some of the biggest outbreaks in the country, some of the biggest outbreaks on earth. In a state that may or may not be prepared to handle what it means for the prisons and jails but also what it would already it would have meant for the communities around those facilities, right?

That all of the staff go home to at the end of every shift, because once I find out that you`ve got more than 1300 cases inside the prison, guess what you`re about to learn about what is going on in the community outside your prison?

It`s here, in huge numbers. We have an absolutely enormous coronavirus epidemic in this country. We`ve got more than 1.1 million known cases, and bupkis for testing. When we do have tests, when we test the places that we know by now where it is likely to be places where it is spreading unchecked, we are consistently finding super-sized numbers everywhere.

Yesterday, we reported on the results of testing at the Tyson meat plant in Logansport, Indiana. This is Cass County, Indiana, where the start of the week, local county officials declared a county-wide public health emergency. They started testing all of the employees at that Tyson plant and found nearly 900 of them were positive for coronavirus.

That`s what we learned yesterday, 890 workers at one plant, positive. Today, we learned they`re going to reopen the plant. With nearly 900 people who work there positive already.

In Nobles County, Minnesota, where the epidemic has centered on a big JBS meat processing plant, they have nearly 900 cases now in that county, that county has only 20,000 people. That`s an increase in Nobles County of 235 percent in one week in terms of their number of cases. I wonder where that`s all coming from.

In St. Joseph, Missouri, a meat plant there, reported that they had zero cases as of two weeks ago, last week they reported 46 cases, yesterday, they reported 126 cases, and today, they reported 295 cases. The company who owns that plant telling "The Kansas City Star", quote: We will continue to use this information at Triumph Foods, in developing our daily staffing and work plans.

Yes. That`s, yes, at least. Right? But at least you can now do that. Because you have test results that tell you, you know, at a bare minimum who really can`t be coming to work right now, symptoms or no.

In Nebraska, where the state government doesn`t track cases in meat plants, where the governor says he doesn`t think the virus spreads in meat plants at all, the workers must all be getting it at home, in Nebraska, where the meat plants are not being pushed by the government to disclose the employee, and all coincidentally turn out to keep getting coronavirus, the meat plant in Dakota City, Nebraska, did just test their employees, that plant has steadfastly refused to release the number of positive employees at that plant, it has been open all this time, but there are suspicions of what is going on because the surrounding metro area there, it`s Dakota City, Nebraska. But surrounding metro area there is actually Sioux City, Iowa, and the Sioux City, Iowa area, has started to notice a big spike in cases in the community, and people turning up at the hospitals, in unexpectedly large numbers, and local mayors in the Sioux City area, have been pleading to the governors, to the companies, please, to get some information about where all these cases in the Sioux City area might be coming from.

Well, that plant in Dakota City, Nebraska, has now done testing of their employees. And somebody leaked to "The Sioux City Journal" the results, 669 positives, among people working at that plant, nearly 700 cases among people who work at that plant. That`s over 15 percent of the adult work force of all of Dakota City, Nebraska.

It`s amazing what happens when you test for it, even if your governor chooses not to believe it`s happening.

This was a protest today in Lebanon County, Pennsylvania, where people who work at the huge local Bell and Evans chicken plant say that multiple workers at that facility have died from coronavirus already. That Bell and Evans plant has released zero public information about coronavirus cases among its employees. They won`t even address whether any of their employees have died from it.

And so, today, that earned them a mock funeral procession around the plant to try to get someone`s attention.

Our government`s response to this is terrible. But we can all see the places that need attention. Not looking is not a safe way to hide this stuff. And on that point, we have an exclusive story, we have not seen anywhere else, we think we dug up something that might be important, and we got that story here, exclusively, next.

(COMMERCIAL BREAK)

MADDOW: Earlier this week, I raised a worry about a CDC investigation that recently happened at the Smithfield meat processing plant in Sioux Falls, South Dakota, that`s been linked to well over a thousand cases in the Sioux Falls area. The CDC, of course, has a long history of investigating public health emergencies. They`ve got world class specialized disease detectives that work on things like this. They have an epidemic intelligence service at the CDC, and these are the folks that get dispatched in a field when there is an E. coli outbreak or TB outbreak or sudden outbreak of Legionnaires` cases at veterans homes somewhere.

They`re great scientists, they`re brave and interesting and intrepid, and they go out in the field in small teams in the field and investigate and then they write a short punching report that explains what happened and have actionable guidance in it, so local officials can get a handle on whatever health crisis they have been dealing with. You invite in the CDC, they send their elite disease detectives, that team figures out what happened, they tell you in no uncertain terms, with no minced words what you need to do to fix it, and then you fix it.

That`s what is supposed to happen. That`s what does happen. Every time we know of that the CDC has done an epidemiological investigation in a public health emergency. That is the system, that is how it works.

That is not what happened though when the CDC visited that meat packing plant in Sioux Falls, South Dakota, with that big important scary outbreak there.

Now, I want to be clear, there is no reason to think there was anything wrong with the investigation, or with what those scientists figured out about the outbreak at the Smithfield plant or what needed to be done to run that plant without continuing to spread the virus, like wildfire there, among its employees. The investigation itself seems to have been totally normal CDC, totally normal and sound.

What was not normal was the report that was issued at the end of it. Instead of issuing a CDC report with clear-cut directives like CDC always does, weirdly, in a way that I have never seen before, CDC instead put out a report on what happened at that plant in Sioux Falls that repeatedly told the plant there to consider implementing certain protocols, to do things if feasible and when possible. Right at the top of that report, it even said this, quote, these recommendations are discretionary and are not required or mandated by CDC.

The CDC does not say things like that in these kinds of reports. What is that doing in here? Where did that come from? Who added that?

So, on Tuesday night, we brought you that report, I sort of raised that worry, that`s why I asked, the CDC, are you OK?

As of tonight, we still don`t know exactly what has gone wrong at CDC. We have an idea. But we haven`t yet nailed it down totally. But we have narrowed it down to a two-day period, in terms of exactly when it seems things went bad. And I can show you what happened before and after in that two-day window.

All right. So here it is. This is a report that hasn`t previously been made public. This is a report that was issued by a CDC team after they visited the big JBS meat plant in Greeley, Colorado, that has also been dealing with its own large coronavirus outbreak. And as you can see, this report on the Colorado situation, it is dated April 20th.

Unlike the report that was written about the Smithfield South Dakota plant just two days later, this one is totally normal. This one is very straightforward. Quote: These recommendations are intended specifically for the JBS Greeley beef plant. The health and safety committee and labor representatives should develop an implementation peculiar for these and any other interventions to be rolled out in the workforce.

That`s how the CDC talks, right? Officials should develop an implementation plan. Here`s what you`re going to do, right? I mean, that is a far cry from what we saw just two days later, in this Sioux Falls Smithfield report, these recommendations are discretionary and not required or mandated, right?

This is the same agency visiting meat plants, right around the exact same time, and they`re confronting exactly the same kind of crises, but something happened at CDC, in the span of those two days, right? I mean, they put out the Greeley report, Colorado report, it`s normal, two days later, they put out their Sioux Falls report and there`s all this mealy- mouthed non-CDC language that tells the plant they don`t actually have to do anything.

Look at the juxtaposition. Here is what the CDC told the plant in Greeley, Colorado, on April 20th. Emphasize that face coverings must cover the nose and mouth at all times, and should remain in place until taken off safely. Two days later, here`s what they told the Smithfield plant in Sioux Falls. Face coverings are generally recommended. So you go from must cover the nose and mouth at all times to generally recommended.

Here`s the Colorado guidance from April 20th. Provide all entrants to the plant with a face covering and show them how it needs to be worn. Two days later, from the South Dakota report, quote, it`s feasible, all employees should wear the face covering, if feasible. But if not, you`re fine.

The CDC in the April 20th, Colorado report says teach workers to ask for new face coverings when theirs becomes dirty, wet or difficult to breathe through. Two days later, in the South Dakota report, it`s not nearly so stern, quote, the facial covering should be discarded and replaced when dirty or wet, if possible. Do that if possible.

But, you know. Colorado plant, April 20th, stagger breaks to minimize the total number of workers who are in common areas of locker rooms, lunchrooms and hallways at the same time. And some how, two days later, the guidance becomes stagger shifts, start times and break times as much as feasible.

The CDC on April 20th tells the Colorado plant put hand washing stations near the break areas to encourage hand washing. They were also told to install hand washing stations or additional sanitizer stations in the lunchroom. Two days later in the South Dakota report, that plant was told, portable hand washing facilities could be utilized. They could be, if you want.

April 20th, in Colorado, it says this: physical barriers should not be used as a replacement for maintaining at least six feet between workers. However, when that is not possible, barriers can be in installed. Two days later in South Dakota, the CDC was feeling a little different about that, telling that plant to, quote, consider the following actions to physically separate employees. Consider them. Think about these.

And then this last one. Here is what the CDC recommended in the Colorado report on April 20th. Quote: Ensure all workers who have a fever of 100.4 degrees or more are sent directly to secondary screening, provide specimen collection and ordering of COVID-19 testing on-site for workers during secondary screening who are found to have fever and or symptoms. The Colorado report says quote entrants who are not workers at the plant who indicate they had a fever or symptoms should not be allowed entry to the plant.

Now, that`s the report from Colorado, April 20th. How in the span of two days did that guidance get morphed moo into this for the South Dakota report? Quote, if possible, specifically ask employees about recent history of fever. If possible. But we know it might not be possible.

We don`t know what happened at CDC between April 20th when they were still behaving like the CDC, and April 22nd when they were this new thing. But I`m telling you something happened and the CDC is not behaving the way it always has been, and the way we really need them to be behaving right now.

We have narrowed it down now to a two-day window where something broke and I`m telling you we are going to figure this out. Got more on this story straight ahead. Stay with us.

(COMMERCIAL BREAK)

MADDOW: This is the headline at the medical news outlet "STAT News" today, quote: We need the real CDC back, and we immediate it now. Quote: Since the beginning of the COVID-19 pandemic, the CDC has been inexplicably absent and Americans are suffering and dying for it. The CDC has been slow in its response, inadequate, in an area where it has always excelled, evidence- based guidance.

Throughout this pandemic, it has been slow in coming, confusing, and not necessarily evidence-based. Americans rely on CDC for evidence-based guidance. We have not received it.

This piece at "STAT News" was written by Dr. Ashish Jha. He`s the director of the Harvard Public Health Institute. He`s professor at Harvard Medical School. He`s also a practicing physician and public health expert who says he`s worried among other things about the mushy, weak watered-down guidance dribbling out of the CDC in the middle of the greatest health threat this country has seen.

What is screwing things up at the CDC right now, at this time, when we need them the most?

Joining us now is Dr. Ashish Jha. He`s director of the Harvard Global Health Institute.

Dr. Jha, thank you for taking the time to be here. I know there are a lot of demands on your time right now.

DR. ASHISH JHA, HARVARD GLOBAL HEALTH INSTITUTE: Rachel, thank you so much for having me on.

MADDOW: I wanted to talk to you tonight, because honestly, I was struck by the bluntness of your criticism of CDC in this piece. I have been chasing something that is driving me crazy, which is that I feel like the CDC started to produce very non-CDC-like guidance, or lack of guidance, when it came to them investigating the meat plant outbreak in Sioux falls, South Dakota. I`m worried that there`s something broken inside CDC which is why we`re not getting the kind of guidance that you say we really need.

JHA: Yes. So, Rachel, this has been baffling to all of us in the public health world. And by the way, writing this piece was one of the most painful things I`ve done in a long time. I grew up as a public health person loving and admiring the CDC, arguing and believing that it is the best public health agency in the world. And the scientists are still there.

But in this entire pandemic, it`s been one fiasco after another. And it`s either possible that all of scientists all of a sudden forgot their science, or there`s something at the leadership level that`s really hindering them. And my theory is, it is much more the latter.

And we`ve just seen it repeatedly, they messed up the testing. They haven`t collected the data. The guidance that you`ve been laying out has been mushy and often not evidence-based.

And my sense is that the leadership in the CDC has been side-lined in a way that is really, really harmful to the American people.

MADDOW: I will say that one of the things that I kind of woke up the other day, I don`t sleep well anymore, I know everybody sort of feels this way, but I woke up the other day, with just thinking, you know, in the movie version of this, would I have imagined America being in a major public health crisis that captures all of our attention and changes our lives, I think we should be getting briefings from doctors every day, like I don`t think we should be getting, I don`t care if we are getting noise from the president every day but shouldn`t there be a CDC briefing every day?

At the very start of this, there was and just something as simple as that, with the CDC itself, speaking on its own terms, independent of any politician offering scientific information and explaining it seems like a basic thing that we, I think we expected, and it`s weird that we don`t have it.

JHA: Absolutely. And so, you would think that the CDC would be the source of data and evidence for this pandemic. And when I started writing this piece, I called up public health friends around the country and I said, look, if you want to have the number of COVID-19 cases in the U.S., where do you start? No one said the CDC.

If you want to find out how many hospitalizations there are for COVID, where do you go? No one said the CDC.

The CDC has just been absent. And it isn`t because they all of a sudden forgot how to do all of this. There`s clearly been a decision to sideline the CDC, to make sure that they`re not collecting and presenting data to the American people.

And it makes the work of all public health officials across the country much, much harder. We need the CDC back. We really do. We`re going to have a much harder time getting through it without them.

MADDOW: Do you know how we get them back? I mean I understand that in public health, you have to know both the science but also the political science, and you`ve been part of, you know, fighting for these, for agencies like this, to get their due, in terms of resources, and respect, and bureaucratic world, that is federal government.

Is there somebody who could fix this, could Congress fix this, through better oversight? Could public pressure fix this? How do you imagine this getting righted? We really need them back.

JHA: Yes, so the good news is all of the great people at the CDC, most of them are still there, they have hung on, and so when I look at who is still hanging in, the top scientists, they`re still there, so we don`t have to like bring them back. That`s the good news.

The bad news is that they`ve been muzzled. And they are not getting to do what they know how to do well. And we have to find a way to unmuzzle them. We have to find a way to let them do their job.

And I don`t know who does that. Congress? I think public pressure, all of those things, would help.

Ultimately, I think Dr. Redfield who was the appointed head of the CDC, I think he has to look himself in the mirror, and ask, is this the public health agency he wants to lead, in the greatest pandemic in a century? And if he can`t do it, he should step aside, and make sure that somebody else can lead that agency, and help the American people get through this period.

MADDOW: Dr. Ashish Jha, director of the Harvard Global Health Institute -- super helpful to have you here tonight, Doctor. Thank you for your time.

JHA: Thanks, Rachel.

MADDOW: All right. We`ve got more ahead. Stay with us.

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MADDOW: 1928 was a rough year to work on Capitol Hill. Three congressmen collapsed in a single month and one died in his office. They weren`t all collapsing and dying from the same thing but for whatever reason there 1928, they weren`t a hardly lot that year.

Nevertheless when one member of Congress died in his office, it took two hours for a doctor to show up to the scene. That`s because there was no doctor who actually worked in the House or the Senate.

To make sure that never happened again, the Office of the Attending Physician was created at the capitol. It sole mission was to oversee the wellbeing of both representatives and senators.

Well, on Monday, the U.S. Senate is due back in session, in person on orders of the 78-year-old Republican leader of the Senate, Mitch McConnell. Senators will be forced to make their way back to Washington D.C. in person despite the fact that yesterday was the single deadliest day yet in the epidemic in Washington D.C., and despite the fact that nearly half of all senators are age 65 or older. Six of them are age 80 or older, seven if you count Lamar Alexander about to turn 80 soon.

I mean, per the CDC that means they are at higher risk, nearly half the Senate and now the attending physician whose only job is to oversee the well being of representatives and senators, the attending physician is sounding a fog horn about this plan to bring all the senators back on Monday, warning that quote, coronavirus tests will be available for staffers and senators who are ill but there are not enough to proactively test all 100 senators.

Oh, and even if a senator can get a test, it will take days to get the results. Nevertheless, they are all coming back to work together.

Late this afternoon, the attending physician gave senator as list of things to do before Monday, like installing sneeze guards and rearranging office furniture so people don`t sit too close together. Reengineering air flows so the virus doesn`t spread that way. No rush, right? Plenty of time to get that stuff done this weekend.

So, a high risk and kind of high importance group is about to board planes and trains back to a city that`s blinking red with coronavirus and when they get there, there aren`t enough tests to figure out who has it before they all get together. Seems like an excellent plan.

Watch this space.

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MADDOW: One quick last thing before we go tonight, if you by any chance have some information that you could share about the politicization or artificial weakening of scientific investigations of meat plant coronavirus outbreaks, or if you have some information to share about nursing home in your area or if your community is doing something to help or support first responders or health care providers and it`s something you think maybe everyone should do or we should all know about, I want to know about that. I want you to tell me.

If there is ever anything you think that we should know here on this show, please tell us about it. Go to www.sendittorachel.com. No story is too small. No tip goes unnoticed, www.sendittorachel.com. I mean it.

All right. It`s time for a special hour here in MSNBC, it`s "Life in the Time of Coronavirus" hosted by Dr. Zeke Emanuel and the great Ali Velshi.

Good evening, Ali.

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