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Bill Gates TRANSCRIPT: 4/24/20, The Last Word w/ Lawrence O. Donnell

Guests: Bill Gates


RACHEL MADDOW, MSNBC HOST: Thanks for joining us tonight for this unexpectedly 100 percent no teleprompter version of the "Rachel Maddow Show." Sorry about all the looking down and around and saying "am." Our coverage is going to continue tonight. 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.


ALI VELSHI, MSNBC HOST: Welcome to another night of life in the time of coronavirus. We have come to a moment of growing restlessness in the United States as some people begin to protest what they see as oppressive, unnecessary closures of businesses and schools, and others are protesting what they see as inaction and a lack of straight talk by the administration.

Doctors, scientists, experts, and public health, they all say the country cannot return to normal until we have adequate testing for the virus and treatment for the disease. We don`t have either one, nor do we have the ultimate solution, a vaccine. But there are reasons for hope.

Tonight, we`re going to look at one attempt to develop a treatment. We`re going to get the latest on when and how kids might return to school, and we`re going to talk to Microsoft founder Bill Gates on his efforts to speed development of treatments and the all-important coronavirus vaccine.

With me once again for the hour is Dr. Zeke Emanuel. Dr. Emanuel is a physician who served as the health policy advisor in the Obama administration. He`s now the vice provost for Global Initiatives at the University of Pennsylvania. Dr. Emanuel is also an NBC News and MSNBC senior medical contributor.

Zeke, it is good to see you again today. Let`s start things off with you giving us a sense of where we are in this crisis and your vital signs for this moment in our national life.

ZEKE EMANUEL, MSNBC SENIOR MEDICAL CONTRIBUTOR: Nice to be here with you, Ali. I have three vital signs that really stand out for me tonight. First, we`re not going to get out of this crisis without testing. And right now, we`re not doing nearly enough testing compared to other countries when it comes to how much of our population can get a coronavirus test. You can see in this slide, we`re behind.

Second, in places where we`re able to test a lot like the Navy`s USS Theodore Roosevelt, they found that 17 percent of the crew have gotten the virus and an amazing 60 percent of the positives had no symptoms at all. Well, they are sailors. But if they hadn`t been tested, they never would have known that they had the virus, which shows you how important it is that we be able to test people so we can find the virus and stop its spread.

And the third vital sign, because we don`t have nearly enough testing, the only way to contain the virus has been to shut everything down. As a result, 26 million Americans in the last four weeks have filed for unemployment. That is a crazy painful number.

VELSHI: We don`t know that we`re through with it because last week we had 4.4 million after more than six million in the previous week. So we still may be looking at adding millions to that number. I don`t want to drag you into politics, Zeke, but 2020 and everything these days seems to be a little political. I want to get your take as a medical professional on something Donald Trump said yesterday at the White House. Let let`s listen together.


DONALD TRUMP, PRESIDENT OF THE UNITED STATES: So supposedly we hit the body with a tremendous -- whether it`s ultraviolet or just very powerful light, and I think you said that hasn`t been checked but you`re going to test it. And then I said suppose you brought the light inside the body, which you can do either through the skin or in some other way.

And then I see the disinfectant where it knocks it out in a minute, one minute, and is there way we can do something like that by injection inside or almost a cleaning because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that so that you`re going to have to use medical doctors. But it sounds -- it sounds interesting to me.


VELSHI: So Zeke, here is the thing. He`s not entirely wrong on both fronts, right? We know that these disinfectants kill the germs and we know that U.V. light from the sun kills the germ. But what do you make of how Trump put that all together?

EMANUEL: Well, I react to it as if I were a parent and I`m a parent. You know, you are in constant dread that your kid is going to get into the bleach or the Lysol or the fantastic (ph) --

VELSHI: Right.

EMANUEL: -- so you lock it under the sink and you make sure that there`s a secure lock on that cabinet. You have the poison control number on your refrigerator. You just hope that -- you know, you never leave the cabinet open and the kid gets into it. And now you have the president telling people, well, maybe we should take, you know, bleach or something, those disinfectants to treat this.

Everything parents fear is in that statement. It`s just, you know, blood curdling that someone would advocate this on television where kids could hear it.

VELSHI: Now, here is the thing, Zeke. I`m going to talk tomorrow morning to Ed Nardell, who is sort of studying UVC light and these sorts of things. There`s a sense that the president said today was being sarcastic although if you watch that video, it didn`t look like sarcasm. But there is a sense that some of these things are all have a little bit of truth in them. There is a bit of a danger about the president of the United States sort of leading that charge.

EMANUEL: Yeah. He is not a doctor. He is not an expert on how we assess whether things work or as you can tell from the clip about how we actually get therapeutic items into the body. You know, I don`t like to day people should stay in their own lane, but, you know, it does take some technical expertise to understand how we can deliver --

VELSHI: Right.

EMANUEL: -- therapies to people and we shouldn`t be talking about it casually.

VELSHI: Right. The president also talked about other treatments and one of them is a combination treatment that includes hydroxychloroquine. This week, there is a panel at the National Institute of Health which recommended against having doctors prescribe that combination. Are we any closer this week to having either a scientifically-sound treatment that doctors can draw on or some other form of therapeutic?

EMANUEL: We should be clear about the hydroxychloroquine and why they recommended against it. In studies, we`ve seen some rare complications, heart arrhythmia where the heart electrical system doesn`t beat -- doesn`t cause the heart to beat properly and that can be very dangerous and can be fatal. Are we closer to a therapy? Well, a few weeks ago, it was Remdesivir which became very popular for a short period of time --

VELSHI: Right.

EMANUEL: It appears that with more things coming out, we still don`t have a definitive study. But with more evidence, it doesn`t appear to be a home run. We are going to talk tonight about the convalescent serum. We are trying a lot of things. The important thing is to try them in controlled trials. So some people get the treatment and some people don`t so we can compare them head-to-head.


EMANUEL: Otherwise, we don`t get comprehensive data and information that allows us to make a decision. We just have a lot of stories and you can`t rely on those stories to tell you whether the treatment is working or not. The patient recovered but you don`t know was it the treatment or was the patient going to recover anyway. As a cancer, we`ve seen that many, many times and been frustrated by it. You can only prove what works when you do the right trial and get the data.

VELSHI: Yeah. The frustrating thing as oncologists is that you`ve seen that these trials take time and the answer doesn`t come as quickly as we all seem to want it right now.

In the search for coronavirus treatments and a coronavirus vaccine, much of the work is being done by private companies and by foundations with an interest in public health. Among them, the Bill and Melinda Gates Foundation which is funding seven different teams, all of whom are working toward the production of a possible vaccine.

Now, Bill Gates published a paper yesterday called "Pandemic One." It is 16 pages long and it is a good read. It outlines the challenges ahead in terms of testing, treatment, and ultimately a vaccine which is something Bill Gates knows a thing or two about. He sat down with Zeke and me to talk about it. Here is the first part of our conversation.


VELSHI (voice-over): Joining us is Microsoft co-founder and the co-chair of the Bill and Melinda Gates Foundation. Bill Gates, Mr. Gates, welcome. Thank you for joining us. Zeke, let`s get it kicked off.

EMANUEL (on camera): Thank you, Ali. Bill, you and I have known each other for more than a decade now. One of the things in this COVID-19 pandemic that a lot of people are worried about is that if we discover a vaccine, the bottleneck may turn out to be production, distribution, and administration of the vaccine. What are you personally prepared to do to accelerate the process of production and distribution?

BILL GATES, BILL AND MELINDA GATES FOUNDATION CO-CHAIR: Well, because we`re in a rush to get the vaccine done, we need to back up to 10 companies because we`re not sure which one will work. It`s a novel virus. We`ve never done a vaccine like this before.

There are some things in common like the last stage manufacturing. It is called fill finish (ph). And if you want to make seven billion or 14 billion doses, that is going to be a bottleneck. So we`re funding fill finish (ph) that will work for all the vaccines, and then together with the governments, we`ll fund the different manufacturing plants.

Unfortunately, they`re not the same because the process of making these things, like you make lipids, RNA vaccines and you have big 15K liter tanks for many of the more classic constructs. But, you know, these are the billions that we need to save to stop spending trillions in economic relief.

So I`d say between the rich world governments and the Gates` foundation, the financing of this should not be a bottleneck. We should be able to allow the most promising efforts to go at full speed.

EMANUEL (on camera): Are you building or going to begin building plans to actually produce vaccines whether it`s for the RNA vaccines or for some of the other big fermenting plants?

GATES: Yeah. At this point, a lot of what we`re doing is funding the early stage research, you know, so people can get into the phase one where you will actually see particularly if you go to the elderly, enough antibody response to understand which are the most promising and compare that antibody response to the natural disease immune system response. So most of the grants we`ve done so far are not in the manufacturing piece.

As we get further along, even in the next month, we want to do that, as well. Figuring out this coordination where it`s across many countries and you have to apply judgment about which of these are the ones to go for, there`s over 100 different efforts and, you know, some are being championed by the country that they`re in. So we`re within a few weeks of having a clear construct for prefunding manufacturing plants.

VELSHI (on camera): Bill Gates, you`ve wrote this great paper that I -- it`s about 16 pages. I think it is a worthwhile read for everybody. You talk about these PCR machines, the machines that would test -- the swabs and shortage of them. And something you wrote caught my attention. You said there will be a temptation for companies to buy testing machines for their employers or customers.

A hotel or cruise ship operator would like to be able to test everyone even if they don`t have symptoms. They want to get the PCR machines that give quick results or the rapid diagnostic tests. These companies will be able to bid very high prices well above what the public health system would bid.

How do we prevent this from being a bidding war in which only those who can afford it get the testing and the rest of the world sits around and waits?

GATES: Well, of all the things I`m most surprised about the federal government response, the unwillingness to get involved in test prioritization, is the most amazing. You know, other countries who wrote their pandemic plans, the idea of getting the PCR capacity up and making sure it`s going to the right people with quick results, you know, that was sort of their day one thing. And it shouldn`t be that hard.

You know, still to this day, we have PCR machines that aren`t being used that well, understanding the bottleneck. Our foundation is driven the work to get the front end, the swabbing greatly simplified so you can actually have these cheap swabs you can have out everywhere. So as soon as you feel symptoms, you can get the swab, take it, and then send it in to have the PCR machine test it.

Today, a lot of the tests, you get the results so late or it`s the wrong person being tested. So our capacity, when people look at those numbers, the U.S. is the worst at tests prioritization. And it`s going -- if we`re not careful, it will get even worse because, of course, people want to -- an employer wants to make sure that nobody is coming in and infecting people. And so if we had infinite testing capacity, hallelujah, go ahead, eye those machines, test your asymptomatic employees every day.

But that, you know, we have 330 million people and our testing capacity is under 200,000 a day right now. And so, you know, you can`t test a meaningful percentage of the population even in, say, a week. You can`t even do one percent or about a third below that. So, it`s kind of insane that we`re not prioritizing the testing capacity even as it grows to go to the right applications.

EMANUEL: Maybe, Bill, I can follow up on that question which is, you in your paper that Ali referred to, you are advocating testing symptomatic people. Some of us like myself and others have recommended testing people who are trying to find asymptomatic spreaders who really meet with a lot of other people because we think that`s the most serious threat and the most serious way that we might spread the disease. Why do you think testing symptomatic people is -- should be our top priority?

GATES: Well, there are asymptomatics who have antibodies. That`s being vastly overstated in most cases because of false positives on serology tests. All these tests shouldn`t be a binary value. PCR gives you back the CT value. And what you see in asymptomatics is really reduced viral load. And so the Singapore study is the best one on this which they show about six percent of the infections coming from asymptomatics.

You now, we need to understand the role of asymptomatics in that because the degree to which you can open up is greatly affected by how much of the force of infection comes from people who would never seek out a test. But we don`t have -- you know, unless there is some breakthrough and we`re working on a few, we don`t have the ability to broadly test asymptomatics.

We need to do that to understand, you know, in a statistical sense, understand these sources of infection. But where that`s been done like the Singapore study was the best on that, it`s not a huge percentage in this case of the infections taking place.

EMANUEL: So I want to switch now to talk about treatment for a second. In your white paper that you released yesterday, you have a sentence which struck me as very interesting. You said we need a treatment that is 95 percent effective in order for people to feel safe in big public gatherings.

So I`m a little curious how you got to the 95 percent and then what do you think is a timeline to get to any kind of treatment that is going to be 95 percent effective to give people confidence that going out in public is a good idea?

GATES: Well, people have a mental model about, you know, fear of death and what things they particularly worry about. Some that are statistically modest like airplane crashes loom larger, some like car crashes that are greater. You know, in the extreme, you could say we don`t -- when we have flu, which is often, say, 40,000 deaths a year, we don`t close schools in a typical flu season. We don`t empty the football stadiums.

And so if you take the extreme case where you really are letting the infection spread throughout the population and yet you have the therapeutic that avoids the overload and greatly reduces the deaths, how much below the seasonal flu level would you have to get before it isn`t the dominant thing affecting people`s willingness to travel and do activities?

So I don`t know what that percentage number is, but there is some level at which people realize, OK, even if you let the exponential growth take place, you know, the bound of what is at risk which without the therapeutic one percent death rate would be three million in the U.S. alone. You know, if you got that down to typical flu season levels, you know, would that, you know, encourage the idea that, OK, economic activity is appropriate?


VELSHI: All right. We`re going to have more of our conversation with Bill Gates coming up this hour, including his reaction to states like Georgia beginning a partial reopening today and the pressures that President Trump is putting on those states.

We`re going to examine the question as well of when the nation`s children are going to be able to go back to school. And Zeke is going to explain one of the coronavirus treatments that are under development that is offering some promise. "Life in the times of coronavirus" will be right back.


VELSHI: Welcome back to "Life in the time of Coronavirus." I`m here with Dr. Zeke Emanuel. We just heard from Bill Gates about the hunt for a treatment that would work for 95 percent of the population. Now, Zeke, there is one idea of a treatment that comes from the blood of people who`ve had the virus and recovered.

EMANUEL: It`s called convalescent plasma and I`m going to show you how it works with some of our images from our good friends at BioDigital. Let`s remember how the virus works. Using the spike protein on the outer shell of the virus, the coronavirus enters a healthy cell in your lungs through a receptor and it then hijacks its machinery to replicate exponentially. From there, your experience depends in part in your immune reaction and any underlying conditions you may have.

Though we just passed 50,000 deaths in the United States, the vast majority of patients with the disease will actually recover. When they do, we hope that they will possess antibodies and other key immune molecules and cells that are specifically built to fight the coronavirus. These antibodies can be safely donated and potentially used to help other patients with coronavirus. For that, we extract the convalescent plasma from the patients. The process is like giving blood but with a twist.

Whole blood, which contains red blood cells, white blood cells, platelets, antibodies and lot of other molecules is drawn from your arm and immediately put into a centrifuge. The spinning, much faster than what you see here, causes the various cells and molecules to separate. Everything but the plasma is sent right back into the body of the person who donates. The plasma eventually goes to a patient sick with COVID-1919.

Different antibodies are targeted at different proteins. But the ones for the coronavirus know their mission. They attach to the spike protein on the outside and that prevents the virus from binding to the receptors on your healthy lung cells. So the antibody may also tag the virus for targeting by the big guns that are killer cells from your immune system. So that`s how convalescent serum works.

VELSHI: So where are we in that process? Is it already in play where people had coronavirus and recovered are able to do this?

EMANUEL: Yes. There are lots of places around the country that are collecting convalescent serum and are trying to re-infuse it into patient and seeing if patients who are sick with the coronavirus actually get better, a study at Johns Hopkins, a study at the University of Pennsylvania where I am from, and at other institutions around the country.

So this is a very promising treatment, but like everything else, we need to subject it to rigorous scientific evaluation, giving the plasma to some patients and not to others who look identical.

VELSHI: Let me ask you this because you and I talked to Bill Gates about this. Anything we do, whether it`s a treatment, a therapeutic as we call it or a vaccine requires replication at scale, right? The point is we got to be able to do this for a lot of people. Is convalescent plasma the kind of thing that we can scale or does it all depend on donors giving the specific plasma that gets given to patients who need it to recover?

EMANUEL: Well, you`re absolutely right. You have to collect it from patients who have recovered and then re-infuse it. It`s clearly a process that can only be done at hospitals and it`s not a process that can scale to hundreds of thousands or even millions of patients. But it is a process that can be used for thousands of patients who are particularly sick if it works effectively.

VELSHI: We`ll take whatever hope we can get right now. In the second part of our interview with Bill Gates, he explained to Zeke and me why it is vital to prioritize coronavirus testing and contact tracing as a way to reopen the economy and what changes in our behavior are going to last beyond this period of stay-at-home orders. Here is a little more from our interview.


VELSHI (on camera): We just happen to be sitting in that place right now where this debate is raging across this country with some governors wanting to open up more quickly. The governor of Georgia talking about the need to open up bowling alleys and tattoo parlours, which I would have thought would be at the far end of the scale when you reopen things.

But, you know, I`m not sure this is the conversation that is as rooted in science and fact and infectious disease study as it should be. What`s the way in which you think we should be governing the decisions as to how we reopen society as opposed to it being the political decision it seems to be right now?

GATES: We`re serious about this when we prioritize the testing and we do serious contact tracing. You know, without that, opening up is dangerous because you`re blind. You`ll only see it with a 20-day leg as you start to see hospitals fill up and the deaths. And by then, you`re up at meaningful percentages of the population and that`s absolutely horrific. We don`t want to get back to those -- to this first peak-type situation which in many locations, including New York, has been absolutely awful.

So, that whole opening up discussion should be conditioned on a serious testing prioritization system and serious contract tracing system and asking scientists, OK, which activities as we look back through the Singapore records, the South Korea records, which activities are creating the highest risk?

You know, are young people involved in the chain of infection? Why are places like boats and meat packing plants so extreme? Do we have much outdoor infection at all and what does that say in terms of things that could be done in that format? There`s a lot of insight in this but, you know, it needs analysis and we need to get that to the political leaders. And it looks like we`re going to have to get it to every state governor, some of whom will pay attention to it and some of whom won`t. Traditionally, this is a CDC function, but it sort of moved up to the White House for - to sort of non-scientific level. And so each governor is going to have to figure it out.

DR. ZEKE EMANUEL, MSNBC SENIOR MEDICAL CONTRIBUTOR: So, Bill, one of the things I noticed that wasn`t in the white paper was mention of Sweden and discussion of opening up the way Sweden has tried it, which is let the virus go, I won`t say wild, but let it percolate. They`re supposed to get close to herd immunity in the country I guess in 40 days or something. You don`t - you`re not a big fan of that, I take by implication. Why not?

GATES: Well, Sweden - you have to understand the activity levels are not just determined by the government mandates. Even if the government is allowing things to happen, people change their behavior.

And so if you look at the Google mobility data or Facebook mobility out of Sweden, their behavior is nothing like it was before the epidemic hit. Nothing at all. So we have to be careful not to equate government policy with human behavior even as you go into opening up because you`ll have such wide spread of things.

Sweden is not getting an infection level that will sweep through their population in 40 days. They backed off enough on their activities. So they will probably stay at a reproductive rate above one and experience more deaths. I think I doubt their policies are the right ones, but if they`re going to go down that path, we should observe what`s going on there and have that as a piece of understanding.

To be frank, if you had said to me a year ago, hey, as soon as this infectious disease comes out, which I saw has a very serious risk, everybody is going to shut down, I would have said, wow, really? It has to do with the human - how we`re affected by - we read about these deaths. We don`t want our parents to die.

And so even if it`s not very numeric, there`s a much stronger response to not have even the 1 percent death rate, which - that would be 3 million for the U.S., not to have that take place. And you can`t control human behavior just when somebody wants to keep the GDP high.

ALI VELSHI, ANCHOR MSNBC: One of the things that Zeke and I both found interesting in your paper was the reference you made to the fact that this is going to be era-defining in a way not like the recession, not even like 9/11, not even like Vietnam. You`re talking about World War II level, redefining how we think and how we behave.

And obviously, some of that is yet to be seen, right, when these stay-at- home orders get lifted, who actually rushes out because they`ve been craving it and who doesn`t believe that it`s safe to do so. But in what ways do you think we will fundamentally change once this is behind us?

GATES: Well, I definitely think we`ll take the risk of a second pandemic seriously and make some of the foundational investments. And many of those will create medical tools that will be beneficial for diseases in both infectious diseases and (inaudible) diseases like cancer that it`s great to make progress on those things.

I do think using digital approaches and maybe not traveling quite as much that even after you get rid of this threat, that people will have been so immersed in it, and the tools and techniques will have improved enough that we`ll take what would have been 10 to 15 years of digital adoption and cram it into a very short period. Likewise, behaviors around shopping or how people get in touch with each other. And so a lot of it is an acceleration of trends, like a move to online shopping that we`re already there.

Thank goodness the Internet has enough capacity that its ability to let us connect, share information is very strong. Ten years ago, that would not have been the case. And so we`ve jumped on that, and it`s helped some. Particularly for white collar jobs, it`s actually surprising to me the productivity levels for some activities are not greatly reduced. And I wouldn`t have expected that to go as well. Sadly, for lower income people who do physical service type jobs, there is no digital substitute.


VELSHI: And that`s a key point for many of us who are able to be as productive as we otherwise are, working from home. Some people arguably are even more productive working from home than they were otherwise. But for some people, that choice simply doesn`t exist, either because they can`t afford to do it or because they work in places or in industries in which they can`t make that choice.

All right. Coming up, children are back in school in Denmark. And Denmark is the first country in Europe to reopen elementary schools since the pandemic started, but it does not look like the school of two months ago. How are kids doing in this new normal in the class room? And is it a preview of what school life is going to be like in the U.S. when schools are able to reopen? We`re going to have that report when we come back.


VELSHI: All right. Back to school in Denmark, it`s the first country in Europe to reopen elementary schools since the start of the coronavirus pandemic. And it`s a bold move. It`s turned the Danish education system and do a real-time experiment on whether elementary schools can reopen while containing the virus.

Denmark has tested over 2 percent of its population. This week, it expanded testing to anyone who has symptoms. But Denmark was one of the first countries in Europe to lock down, and it has a low mortality rate from coronavirus.

Let`s go to the Danish capital, Copenhagen, where NBC News Foreign Correspondent Molly Hunter reports on why and how Danish schools reopened.


MOLLY HUNTER, NBC NEWS FOREIGN CORRESPONDENT (voice-over): Denmark has become a laboratory, a possible template for the rest of the world, classes in the time of contagion. Today marks one week since schools reopened for students under the age of 12, after a month of lockdown. But it all looks different, and so far, it`s working.

MARIANN MANICUS, CHILDREN`S WELL-BEING ADMINISTRATOR: Yes, outside here in a tent. We are sitting two meters apart. We have to do as much as outside teaching as possible. So you have to do anything in a new way.

HUNTER (on-camera): Kids seem really happy to be back.

MANICUS: The kids seem really happy.

HUNTER (on-camera): Really happy--

MANICUS: They were as like, first day of school, yes! Yes.

HUNTER (on-camera): Finally no more home schooling.

MANICUS: Yes. Exactly.

HUNTER (voice-over): And the teachers are just trying to make it feel the same.

UNIDENTIFIED FEMALE: We try to keep up all these small little things that we did before corona, and yes, now we just try to do it in a different way.

HUNTER (voice-over): (inaudible), in her first year of teaching, worried less about the missed school work and worried a lot more about the missed socializing.

UNIDENTIFIED FEMALE: (Inaudible) days I think is a really good thing because we have talked to the children about this and they say that seeing their friends face-to-face, not only talking to them on the phone, was a really good thing.

HUNTER (on-camera): I mean, have you ever seen kids this excited to come to school?


HUNTER (on-camera): Hey, guys. Hi. So, are you happy to be back? Are you excited?


HUNTER (on-camera): What did you miss the most? Do you miss your friends?


UNIDENTIFIED MALE: My friends. My friends.

HUNTER (on-camera): Your friends? What else?


HUNTER (on-camera): Teacher. Oh.

HUNTER (voice-over): In a matter of days, schools here built outdoor tents and started mandating hand-washing five times a day. But not everyone was comfortable. Some parents, including Rion Kim (ph) kept her kids home just for the first day to see how it all played out.

HUNTER (on-camera): What was the conversation among parents?

UNIDENTIFIED FEMALE: Kind of was this balance between OK, we`ve got to do our work, they`re really, really bored.

HUNTER (on-camera): Yes.

UNIDENTIFIED FEMALE: Some of the smaller kids actually really need to be stimulated into (inaudible).

HUNTER (voice-over): But Kim (ph), like other parents, questioned, why the youngest return first. Denmark locked down on March 11th when the only other country in Europe doing so was Italy with its hundreds of deaths and more than 12,000 infections.

At that time, Denmark had around 500 known cases and no deaths. Around the same time, New York State, later that week, on March 15th, also closed schools with 729 known cases and five deaths. Now, six weeks later, Denmark has just over 8,000 known cases and about 400 deaths.

HUNTER (on-camera): Copenhagen feels and looks fairly relaxed. Bars, restaurants, cafes still closed, but people are outside, hanging out, eating ice cream, drinking, eating. Hair salons and beauty salons also opened this week, and all because Denmark locked down early.

PERNILLE ROSENKRANTZ-THEIL, DENMARK`S EDUCATION MINISTER: The curve flattened out, and it has been possible not to reopen because of that. And that is obviously very positive.

HUNTER (voice-over): But it`s still too early to tell if this was the right move. A warning for the rest of the world.

Molly Hunter, NBC News, Copenhagen.


VELSHI: All right. Here in the United States, three quarters of states have now officially closed their schools for the rest of the academic year. And in our conversation with Bill Gates, we asked him how he envisions U.S. elementary schools returning to in-person classes, when he envisions that being able to happen and whether Denmark and other European countries could be an example to follow.


EMANUEL: Bill, I wanted to ask you about schooling, and not college, but primary schooling, and what you think of opening that up, given the fact that children don`t seem to be affected, or if infected, have no symptoms and hardly ever die.

Denmark seems to be going ahead. I just got off the phone this morning with Norway, and they`re thinking of doing a big randomized trial, randomizing half the municipalities to opening school and half not. How are you thinking about opening school, and should we think about it in September?

GATES: Well, I think, for the younger ages, the fact that some European countries, including parts of Germany and the countries you mentioned, are going to try that out, if you have a testing framework and as you`re doing those tests - again, you got to go quantitative. You can`t just be binary because that tells you not just do they have the virus but are they likely to be a source of infection, and so go to the households that those kids are participating in.

We need to learn that because schooling has a huge benefit. And the younger you get, the least less capable online is to substitute for what you`re able to do face-to-face there. So, for a country like Germany that`s really been exemplary in how well organized and having clarity from their federal level, the idea they`re opening up some of those younger aged schools, I think that`s not crazy, and we should all learn from that.

I didn`t know Norway was doing that in a randomized way. That will be very, very helpful because - I`d like to see schools reopened in September, and I - of all the things that`s right on the line of will it be wise, will it not be wise, that`s the one that I hope we figure out how to make it work.


VELSHI: All right. When we come back, what the pandemic crisis is doing to the conversation about access to health care in the United States. We`re going to hear from Senator Bernie Sanders. But first, we introduce you to some of the heroes on the frontlines of this crisis. Medical professionals stepping out of their area of expertise to do everything they can to help every COVID patient.


ASHLEY, REGISTERED NURSE, NORTHWESTERN MEDICINE CENTRAL DUPAGE HOSPITAL, WINFIELD, ILLINOIS: I`ve recently made the switch into the COVID world, dealing with adult ICU. My days have gone from helping bring life into the world to helping many of my patients battle for theirs.

AMY ESPINOSA, EMERGENCY ROOM NURSE FROM COLORADO VOLUNTEERING AT ST. JOSEPH`S HEALTH, PATERSON, NEW JERSEY: I`m learning a tremendous amount, but I`m also balancing learning and caring for these extremely sick patients.

TERRY GALLAGHER, DIRECTOR GENERALIST EDUCATION, RUSH UNIVERSITY COLLEGE OF NURSING, CHICAGO, ILLINOIS: Prior to the COVID-19 pandemic, I helped to staff a weekly clinic at a homeless shelter. We opened the doors to our medical respite shelter. The shelter serves those who are COVID positive and experiencing homelessness.

ARTHUR GORDON, RETIRED MILITARY VETERAN/CURRENT FIRE FIGHTER, TEAM RUBICON OPERATION KICK THE KING, CHARLOTTE, NORTH CAROLINA: I was able to learn how to swab. Never swabbed before. I was able to use some of the technology that they use on a day-in-and-day-out basis, basic stuff or taking vital signs and stuff like that, that I`ve not been exposed to.

CINDY ROBISON, RETIRED AIR FORCE VETERAN/REGISTERED NURSE, TEAM RUBICON VOLUNTEER AT KAYENTA HEALTH CENTER, KAYENTA, ARIZONA: Got to the point where I couldn`t ignore the call for medical professionals to come out of retirement.

ROCKY WALKER, HOSPITAL CHAPLAIN, MOUNT SINAI HOSPITAL, NEW YORK, NEW YORK: I played football, and after that, I was a soldier. And I thought I was safe coming into chaplaincy, coming into medicine, and all of a sudden, I`m learning there is battle scars with that, as well.

ABHI KOLE, MD, HOSPITAL PHYSICIAN, NORTHWESTERN MEDICINE CENTRAL DUPAGE HOSPITAL, UCSF MEDICAL VOLUNTEER ON THE NAVAJO NATION, ARIZONA: We`ve had to do a lot of family meetings over Zoom or over the phone, really challenging discussions that I would normally do in person where I can look a person in the eye or touch their hand.

CRAIG SPENCER, MD, DIRECTOR OF GLOBAL HEALTH AND EMERGENCY MEDICINE, COLUMBIA UNIVERSITY MEDICAL CENTER, NEW YORK, NEW YORK: This is something that we aren`t really trained to do in emergency medicine. Our goal is to save lives at all costs, not sit by and watch them pass. So this is really new and tough and hard for us, but in many respects, this is one of the most helpful and important things that we can be doing.

DANIEL KAONOHI, REGISTERED NURSE FROM COLORADO, VOLUNTEERING AT TRINITAS REGIONAL MEDICAL CENTER, ELIZABETH, NEW JERSEY: They`re training us to be warriors ourselves to fight this pandemic, and it`s - we`re really excited to really lend a hand in any way we can.



VELSHI: Since suspending his presidential campaign, Vermont Senator Bernie Sanders has returned to Capitol Hill where he`s working to find a solution to health care problems in America that have been exacerbated by COVID-19 and record unemployment. In a "New York Times" op-ed this week, Sanders made his case for why guaranteed universal health care is needed now more than ever. I spoke to Bernie Sanders earlier today.


SEN. BERNIE SANDERS (I-VT): If there`s anything that the American people are now learning, it`s how absurd, how irrational it is to have your health care tied to your job, because when you lose your job, you`ll lose your health care. That`s why we have got to fight, in my view, for a Medicare- for-all single-payer system. It will cost the average American substantially less than they are paying today and cover all of us in a comprehensive manner with freedom of choice for the doctor or the hospital you want to go to.

VELSHI: Given that you are not the candidate right now - I know you`re staying in the race, but given that you`re not likely to be the Democratic nominee and given that Joe Biden hasn`t fully endorsed this idea and given that Donald Trump and Republican senators aren`t endorsing the idea, what`s your best outcome right now in your mission to try and get people to embrace this?

SANDERS: Well, my best outcome is to go forward in the direction of Medicare for all, but not do it perhaps as quickly as I would want. For example, Ali, in my view, if Joe Biden said tomorrow that every American 55 years of age or older would be eligible for Medicare, I think that would be enormously popular and an enormously effective policy program.

At least what we should do is lower the eligibility age for Medicare from 65 to 55 and cover all of the children in this country. And then we can figure out ways that we can expand and improve the ACA. Those are some of the things that Joe Biden can do without embracing a full Medicare-for-all concept.


VELSHI: OK. You`re starting to see outlines of what might be a compromise between Bernie Sanders and Joe Biden. You could see more of my interview with Senator Bernie Sanders tomorrow morning on "Velshi" at 8:00 a.m.

Zeke, he knows he`s not getting Medicare for all. He knows Joe Biden won`t embrace it, but he`s talking about lowering the age for Medicare to 55 and covering all the children. So he`s trying to broaden the base of people covered by health care in the United States.

EMANUEL: Yes. I agree with lots of stuff that Bernie said. We do need universal coverage, and COVID-19 has made it clear we need universal coverage.

Second, it`s also made clear we probably shouldn`t tie health care insurance to employment, which a lot of economists, mainstream economists, have said for years. But that doesn`t get you to we need universal coverage. I mean, that doesn`t get you to we need Medicare for all. It gets you to we need a plan for universal coverage, and there are many, many different ways we can get there.

One way, as Bernie Sanders said, is we could expand Medicare down. We could guarantee all children have health care. We still have about 4 million children in this country - 4 million to 5 million children in this country who don`t have health insurance. That is a travesty if you ask me. We still have 28 million Americans who also don`t have coverage. That`s also a big problem.

We need to get coverage for everyone in the country. And I agree with him. That is going to be one of the legacies of the COVID-19 situation. The American public is not going to put up with a system that doesn`t guarantee them health insurance and then asks them to go to the doctor, asks them to stay off of work. I think he`s absolutely right.

VELSHI: Right. There are people in America who may have symptoms or may think they`ve got coronavirus and they`re not going to the doctor because they can`t get the verdict that they`re sick because they can`t leave work. So it`s not familiar to a lot of Americans, but every other developed country in the world has figured out some way to cover everyone.

Zeke, we are at the end of a week in which some states are opening up and a number of other states are seriously mulling opening up again for business. Talk to me about what your closing thoughts or your final thoughts this week.

EMANUEL: We won`t know exactly how many Americans have lost jobs, freelance gigs, and businesses for a long time, if ever. It now appears that one in five workers are out of a job. Over 33 million people involuntarily idled. That`s horrible, and it`s heartbreaking.

No empathetic person can endure seeing the anxiety, the anguish of Americans who never imagined waiting in a food pantry line to feed their kids. It`s no wonder there`s pressure to relax the physical distancing measures and reopen the economy. But the closing of non-essential businesses isn`t what pulled the plug on the economy. Fear did.

Right now, if we relax the public health measures and rush to open restaurants and gyms, bowling alleys, beauty salons and tattoo parlors, few people are likely to show up. We`ll have the worst of both worlds; little economic activity but lots of COVID spread.

I ask myself, what would convince me to dine out and shop and travel. I need confidence that I`ll not die or suffer irreversible harm from the virus. Personally, I won`t go back to normal until we have a vaccine or a reliable treatment. I think I`m in the majority on that.

Despite the economic pain, four out of fire Americans say they endorse the restrictions. We`re seeing solidarity even on voluntary terms. Trains and airports are empty even though no law forbids people from buying a ticket. What we have here is a public health crisis, first and foremost. The economic crisis that goes along with it can be abated only if the virus is finally defeated.

Our first responsibility is to honor the lifesaving physical-distancing efforts that Americans have already undertaken, not squander them by opening up too soon. Philanthropists like Bill Gates can pay for labs and research, but the rest of us can help to buy time for them to find a way out of it.

Our ordinary part in this is heroic. It comes with real sacrifices that a single $1,200 check from Washington cannot erase. We need more long-term income support. We need expansion of food stamps for all needy Americans. The sooner we make it economically feasible for Americans to stay at home regardless of whether they`re able to work from home, the sooner we can bring the infection down to a safe level and create a livable environment for us to return to.

VELSHI: Well said, Zeke. Pleasure having you on. Let`s do this again next week. Many thanks.

"The 11th Hour with Brian Williams" is up next.