FDA authorizes remdesivir TRANSCRIPT: 5/1/20, The Last Word w/ Lawrence O. Donnell

Guests: Francis Suarez, Raja Krishnamoorthi, Sylvia Allegretto

(COMMERCIAL BREAK)

RACHEL MADDOW, MSNBC HOST: One quick las 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 that you think maybe everyone should do or at least we should all know about it, 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. Now it`s time for a special hour here on MSNBC. It`s `Life in the Time of Coronavirus` hosted by Dr. Zeke Emanuel and the great Ali Velshi. Good evening, Ali.

ALI VELSHI, MSNBC HOST: Thank you my friend. Good to see you and we`ll see you again on Monday. How many people are sick with the coronavirus in the United States and when did they get sick?

Answering these questions are crucial but they have never been answered well and it seems that the federal government dramatically misunderstood what was happening in America as the coronavirus outbreak began. On the last day of February, the CDC reported that 15 Americans had tested positive for COVID-19.

Today the reported number is more than a million and at least some of the death and economic damage sweeping the United States could have been avoided if we had only started testing for the virus earlier.

But even as more states prepare to open back up for business, we`re far from the end of this scourge and the mid crisis lesson to learn is that our past failures do not need to dictate our future actions.

As global health official and former head of the World Bank, Jim Yong Kim, wrote in `The New Yorker` last week, `It`s not too late to go on the offense against the coronavirus and there are promising signs that our nascent offensive efforts are working, but we`ll only succeed if we`re guided but one thing, and that one thing is data.

There is no other way to defeat coronavirus. All of our decisions must be based on the evidence available to us, not on the basis of political advantage or on the basis or misdirected protests. We can only succeed if we follow the science, and that much is going to be our focus in the hour ahead.

Tonight, in a week with so many medical and science headlines to keep track of, I am once again grateful to be joined by Dr. Zeke Emanuel for the hour. Dr. Emanuel is an NBC News and MSNBC senior medical contributor. Zeke`s going to give us a much-needed reality check on the news of treatment, breakthroughs and vaccine development.

Also ahead, major new concerns about testing. Labs that are sitting idle, antibody tests that are wildly inaccurate and unregulated. We`re going to talk about what is broken and more importantly how to fix it.

Also, Miami Mayor Francis Suarez, himself a COVID-19 survivor is going to be here in a few minutes. Mayor Suarez is at the heart of the reopening debate in the country while Florida is opening some aspects of its economy. The population center of Miami-Dade County is staying shut.

It is a difficult state versus city dichotomy that is playing out across this nation, and that is so difficult because 30 million Americans and that`s most likely an under count are out of work, desperate for their next paycheck.

Tonight, we`re going to examine the push to open up to get back to work versus the concerns of triggering a second wave of coronavirus if we open up before the science, before the data tells it is safe to do so. So let`s begin with the numbers.

The United States now has 1.1 million reported cases of coronavirus. The United States has 64,950 reported deaths from the coronavirus. The FDA has issued an emergency youth (ph) authorization for Gilead Sciences antiviral drug remdesivir for patients hospitalized with a severe case of COVID-19.

The FDA`s nod came after Dr. Anthony Fauci, the nation`s top infectious disease expert said the trial data showed that the drug had a, `clear-cut significant positive effect in diminishing the time to recovery.`

Now, we should note this does not mean the drug should be used for all hospitalized patients. Previous research suggested the drug may have potentially dangerous side effects in some patients.

But the maker of remdesivir, Gilead Sciences, is hoping that they can expand the drug`s use for patients earlier in the course of their illness. Here is the CEO of Gilead Sciences on the `Today Show.`

(BEGIN VIDEO CLIP)

DANIEL O`DAY, CEO GILEAD SCIENCES: We were prepared and ready for this virus because of some of the work we`ve done with remdesivir for the past decade.

And at that same time that we put remdesivir in the clinical trials, we also made the decision before knowing it was going to be effective to expand our capacity knowing the global crisis this was and knowing we would have to be ready in the event that this turned out to be effective for patients.

So, we have gone from around 5,000 treatment courses to today almost 100,000 treatment courses. And because of our investments early, we think we will get to millions of treatment courses by the end of the year.

(END VIDEO CLIP)

VELSHI: Meanwhile, America is starting to reopen. More than half the nation`s governors are relaxing pandemic restrictions in their states while hoping that the novel coronavirus doesn`t spike setting off another round of closures.

But there is good reason for that caution. A new report from the University of Minnesota suggests that the coronavirus pandemic could stretch on for two more years with recurring spikes until roughly two-thirds or more of the population has developed immunity.

And we have two pieces of news tonight from the White House. NBC News is reporting that the White House has whittled the field of possible vaccines in its operation warp speed program from 93 to 14, which will undergo more testing in the next couple of weeks.

And breaking tonight, the White House is blocking Dr. Fauci from testifying before a House Subcommittee that`s investigating the coronavirus outbreak in response. The White House said it would be counterproductive to take him away from his work.

But while he`s been blocked from testifying before the House, NBC News has also learned like tonight, that a spokesperson for the Senate Health Committee says that Dr. Fauci will testify before that committee on May the 12th.

Okay. That`s the catch-up on where we are in the news. I want to bring in Dr. Zeke Emanuel. He is a physician who served as a health policy advisor in the Obama administration. He`s now the vice provost for global initiatives at the University of Pennsylvania.

Zeke, great to see you as always. And as always, we`re loaded with questions for you. And the first one starts with remdesivir. What`s the situation with this drug?

DR. ZEKE EMANUEL, SENIOR FELLOW, CENTER FOR AMERICAN PROGRESS: So, let`s first talk about how remdesivir works. The virus, remember, comes into the cell, into a lung cell and then gets ingested and has to reproduce and make a lot more viruses.

Remdesivir blocks that because it incorporates into the genetic code of the virus and basically breaks it up. And that stops it from reproducing. So what are these test results that Dr. Fauci was talking about?

Basically, they started in the first of February and they`ve gone on for three months with over 1,000 patients involved in the United States, Europe and Asia. The results were in relatively sick patients, those needing oxygenation or being on a ventilator, and they left the hospital sooner after 11 days.

Patients who got the placebo left after 15 days. When you looked at the mortality, what proportion of patients died in each, eight percent of patients died who received remdesivir and about 11.6 percent died who received placebo.

But that wasn`t what we call statistically significant. It didn`t mean that it was enough. It could have happened by chance so that was the result. That led the FDA to say there`s enough information here. Probably the benefits are better than the risk and we`re going to give this an emergency approval.

Dr. Fauci among others said that this was an encouraging first step. It`s clearly not a home run for anyone. Let me just say a couple of words in caution. This is good but not great. We`re probably going to need multiple drugs to treat this virus again.

We might have to move remdesivir up earlier. And the last thing I want to say is now that we`ve approved the drug, it`s going to be hard to do a placebo-controlled trial.

So, we`re going to have to test all new drugs against remdesivir and that makes it harder and will require more patients in any trial. For this trial, we needed three months. That gives you a sense for how long the next trials of new therapeutics are going to be.

VELSHI: Right. And a statistic we talked about a little bit last week that it is much harder than you think when we`re trying these new drugs. If you want to try and get a result out of it, that is statistically significant.

You actually need a whole lot of people in the drug, in the trial. So there`s complexity in developing therapeutics and vaccines. Thanks, Zeke. Let`s continue this discussion with Miami Mayor Francis Suarez.

In March, Mayor Suarez was quarantined for 18 days after testing positive for coronavirus himself. He`s joining us now. Mayor, it`s good to see you. How is your health, first of all?

MAYOR FRANCIS SUAREZ (R-FL), MIAMI: I`m doing well, thank you, Ali. I had to quarantine like you said for 18 days. I`ve been out of quarantine since then. Thankfully, I have not had any sort of aftereffects of relapses of any kind and so I`ve been very fortunate.

VELSHI: Major, we wanted to talk to you tonight because what you go through is reflective a lot of the country. You are the mayor of a major center that has a lot of interchange with different people. You started restrictions in Miami earlier.

You are not ending them as early as other people are but its parse, right? Boundaries between your city and neighboring cities are porous. Tell me about your concerns about people who continued going to the beach, people who want to go back outside enjoy the great weather, but the fact is you got a city that is still under stay-at-home orders.

SUAREZ: Right. And it`s not only porous, but we also have a very large international airport. And to give you a perspective, our international airport receives 50 million passengers a year. That is twice the population of the state of Florida.

Even now when it`s operating at a diminished capacity, maybe 10 percent of it`s capacity, it`s still 5 million people which is twice the size of our county, which is a large county of about 3 million people - population. So, it`s almost twice the size.

So we`re grappling with not only internal threats of, of course, maintaining social distancing, staying at home and making sure the residents remain disciplined so that we can continue to reduce the number of new cases, but we`re also dealing with external threats.

So, you know, it`s a very challenging dynamic and we`re doing the very best that we can and we`re trying to be as proactive and as careful as possible because of so many lives are at stake.

VELSHI: Mayor, let me ask you about the idea that in many states, there`s a tension between those resident whose don`t live in major centers like Miami or Atlanta where the mayors of these cities want to keep things a little more tightly controlled for a while.

And there area people in other more spread out areas where they`re not seeing the same incidents of coronavirus and they area putting pressure on their governors to open things up. How is that working for you in Florida because you`ve got a governor who is ready to open things up?

SUAREZ: Ye. Thankfully this week, although he did open up a large part of the state of Florida, he gave the mayors in the southern part of Florida, which is the densest part of Florida, the ability to remain closed and that`s why we have done that.

The data that we`re looking at is kind of all over the place. We had yesterday the ninth highest amount of new cases in the last, basically, two months. Ad then the two days that preceded that, we had some of the lowest number of new cases since the beginning, as well.

So, part of the issue is we`re trying to interpret the data, the criteria that everybody talked about is of course, 14 consecutive days of diminishing COVID-19 new cases and also diminishing complaints of influenza-like symptoms.

And we`re not quite there in terms of how we feel the data should be interpreted. We`re looking at it every single day. We get two reports a day, we get two reports from the hospitalizations every single day and we`re looking at all that to make a prudent decision. It`s a very fine balancing act we as a major city have to make.

EMANUEL: Are you worried about a second wave and how are you going to handle it if you do get a second wave that everyone seems to worry about?

SUAREZ: Of course, we are, doctor. You have to understand that I was patient number two, literally, in all of Miami-Dade County. I was the second person at least that we knew of that tested positive.

I was an asymptomatic person and I was tested because I happened to be in the same room with one of the early, you know, people who had said publicly that they tested positive for COVID-19 from a delegation that came from Brazil.

So, we are absolutely concerned that there could be a second wave, and we realize how quickly you can go from patient number two, which was me, to patient number 12,257 which is where we`re at right now. So, you know, we`re trying to be careful and do everything that we can to avoid that second wave from happening.

VELSHI: 12,257 and more than 350 deaths. Mayor, thanks very much for joining us and for your leadership on this right from the beginning. Miami Mayor Francis Suarez.

All right, still to come. You`ve no doubt heard the news out of Oxford about progress on a coronavirus vaccine. It`s being hailed as a breakthrough, but should we believe the hype?

Also, the squeeze on workers who just can`t work from home. President Trump orders meat packing plants open and some republican governors say if you don`t return to work, you won`t get unemployment, either.

But up next, important questions about accuracy of testing and a new theory about how long you could spread the virus if you have it.

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VELSHI: Since the coronavirus pandemic began, there has been one constant among all experts, the need for more testing. On March 6th when the United States had only 217 confirmed cases of coronavirus, this is what President Trump said while visiting the Centers for Disease Control in Atlanta.

(BEGIN VIDEO CLIP)

DONALD TRUMP, PRESIDENT OF THE UNITED STATES: Anybody that wants a test can get a test. That`s what the bottom line is.

GOV. BRIAN KEMP (R-GA): And I would just say that we started -

(END VIDEO CLIP)

VELSHI: Tonight, the United States has 1,102,937 confirmed cases of coronavirus. Now, the actual number of cases is likely much higher, but we don`t really know because we still do not have enough tests.

There have been shortages at times of everything necessary to conduct those tests including personal protective equipment, specialized swabs, the reagent chemicals needed by labs and machines to run the samples.

Across the country, there are thousands of academic labs that could test for the virus that are being unused, that`s according to an op-ed in the `Wall Street Journal` written by two neuroscientists from Michigan State University.

They write that, `Our research team used Food and Drug Administration guidelines and a scientific report from Wuhan, China to develop a COVID-19 test in early March. It took one week. Our test doesn`t use the reagents other labs are desperately seeking and it could identify levels of virus so low that a typical test could miss them entirely. Yet, our lab sits idle.`

The sticking point is something called Clinical Laboratory Improvement Amendment Certification, also known as CLIA. Most academic labs currently do not have this certification but with it, these labs could help drastically increase testing in the United States.

Jack Lipton is chair of Transnational Neuroscience at Michigan State - sorry - Translational Neuroscience at Michigan State University College of Human Medicine, and he co-authored that op-ed. He

talked to Zeke about his lab`s diagnostic test also known as a PCR test and what a prompt accreditation from federal government could mean for America`s fight against coronavirus.

(BEGIN VIDEOTAPE)

EMANUEL: I wanted to talk to you first to explain to people what a PCR test is and what the steps we have to go through are. So first, you get a nasal swab or you get a saliva swab and then you and the lab isolate the RNA, the genetic code in the virus, then what do you do to get the test and determine if the person has been infected or not?

JACK LIPTON, CHAIR, TRANSLATIONAL NUEROSCIENCE, MICHIGAN STATE UNIVERSITY: So, we take that RNA and we turn it into something stable, which is DNA and we take that bit and we amplify it and we take it - and we run it through several cycles with some enzymes and those allow it to double for each cycle.

And the larger that we amplify it, the more we start to develop a lengthy signal. And through that signal, we end up seeing whether we`ve amplified the genetic code of the virus. And if we did, we`ll get a bright signal and that produces a reading on our machine and that tells us if we are indeed have the presence of the virus into any individual.

EMANUEL: Now you`ve been reported to be out there saying that, you know, if we got harnessed a lot of the academic labs like your own that aren`t doing research because of COVID-19, you could generate 500,000 to 1 million copies I think you were quoted as saying, 1 million tests a day, 500,000 to 1 million tests a day. Is that really plausible?

LIPTON: I think it`s absolutely plausible. I think its basic math. There are easily 10,000 labs out there in academia that can run this kind of test. The realtime PCR system is very common in molecular biology laboratories and anyone from a plant biologist to a neuroscientist, I happen to be a neuroscientist, we all use these tools.

EMANUEL: And you`ve seen a barrier, you`ve reported a barrier in getting your type of lab and your type of tests approved and a lot - have the government sanction it, allow it to be used for clinical determinations. What are those barriers in your experience?

LIPTON: So, the main problem is that in order to run any of these tests you must be CLIA accredited. The CLIA accreditation process involves getting a board certified laboratory director, that is something that as an example I can`t do.

But in the middle of a pandemic, I think we need to think about liberalizing our criteria while not sacrificing quality for the kind of work that we`re trying to do here, which is get everyone to stand up and do what they can for this crisis.

And I think if we can develop a pandemic national guard of biomedical scientists and pre-certify them for this kind of work, we could stand this up whenever we need to without developing huge amount of infrastructure like, you know, right now the test costs for reimbursing for coronavirus testing is now at $100 a sample.

So CMS, which is the center for Medicare and Medicaid services, is paying $100 per sample and that`s because they need to hire more people and buy more equipment at places like Quest Diagnostics or LabCorp.

And if we were able to use the existing infrastructure that we had, at the universities, we would be much better equipped and we wouldn`t be spending money on equipment and labor that is going to be (inaudible) at the end of this.

We can utilize the people that we have for us, some of the most highly skilled researchers in the world to be able to do something they do all the time in a relatively standardized and simple way.

EMANUEL: What`s the most interesting thing you found since doing COVID-19 testing?

LIPTON: Well --

EMANUEL: Or the most surprising thing to you.

LIPTON: I think the most surprising thing to me was the length of time that individuals shed the virus. So when you hear people talk about if you`re exposed to someone that has had COVID-19 or you think you have to isolate for 14 days, people tend to think that means that this disease is a 14-day course. It`s not.

People can be shedding this virus for four, five weeks and longer. So I think that people really need to understand the length of this disease and how sneaky it is. Because people can feel better and, you know, we talked to our subjects and they feel better but they are still shedding virus. And so that means that when you feel better and you`re like, hey, I`m going to go outside now. You shouldn`t do. You can just stay at home.

(END VIDEOTAPE)

VELSHI: All right, that`s Jack Lipton, the chair of Transitional Neuroscience in Michigan State. The certification he is looking for is CLIA, not CLEA (ph) like I said which is why I need to let Zeke handle these things.

Zeke, that was fascinating, the last thing. You know, the whole thing was fascinating but the last thing, he said that it`s possible that you could be shedding this virus if you have it for four to five weeks.

EMANUEL: Well, again, we know that some people can shed for a long time. What we don`t know are two important variables there, which is how many people shed for a long time? What`s that curve look like? Are most people stopping to shed after a few days, 14 days, or do we actually have a sizable number that go out many days?

And if they`re shedding, are they really infective? How contagious are they? And that again is something we don`t know. Those are two important questions, but we have known that some people can shed for a very long time and as Dr. Lipton said, even when they`re feeling good, and that`s one of the problems of this illness, that`s why it can spread so easily and opening up can be so dangerous because people feel good and they are still shedding.

VELSHI: Thanks, Zeke for clarifying that. While there is still some issues about accessibility when it comes to getting a test to see whether you have COVID-19, it`s getting much easier to find a different kind of test, the kind that can tell you whether you`ve had the virus and recovered.

The second kind of test checks for antibodies in your blood but many of those tests have not been federally approved and could be producing unreliable results.

NBC`s Josh Letterman reports, `As of this week, 150 antibody tests also known as serology tests, are on the U.S. market without having faced government review, according to data from the Food and Drug Administration. Another 24 labs are conducting their own antibody testing without having obtained FDA authorization.`

Several companies which produced these antibody tests are now the subject of an ongoing congressional investigation. Joining me now is Congressman Raja Krishnamoorthi who is a Democrat from Illinois. He is the chairman of the House Oversight Subcommittee and Economic and Consumer Policy.

Congressman, good to see you. Thank you for being with us.

REP. RAKA KRISHNAMOORTHI (D-IL): Same here.

VELSHI: Tell me about this. I mean, we have this real excitement about getting these tests out there and I think it may not even occur to people that even the test needs FDA approval. Is it because of potential dangers in the tests or is it because they just might not be that accurate?

KRISHNAMORTHI: Well, you`re right that these serological tests hold great promise. However, what we`ve learned is that the FDA has allowed hundreds of unregulated, potentially fraudulent tests to flood the market. And here is the problem, Ali.

And that is a large proportion of them have high false positives, meaning that if you were to take this antibody test and it yielded a false positive result, you could be fooled into thinking that you have antibodies to COVID-19 and potentially immunity when you actually do not.

And so you could relax your social distancing, go out and interact with a bunch of people, catch COVID-19 and then get other people sick as well. So, you could make some really dangerous life decisions based on these unregulated potentially very fraudulent tests.

VELSHI: The other issue we have, I want to just show you a `New York Times` report that one in four New Yorkers had contracted COVID-19. The preliminary data suggests that many more New Yorkers may have been infected than was previously believed and there are reports like this from all around the country.

What does that tell us because there are a lot of people who are anxious to know if they were exposed to it because it might allow them to either make decisions or know who to support in what sometimes feels like a very political fight about whether we should be going back to work or continuing to stay at home.

KRISHNAMOORTHI: The short answer is that the science is still unsettled. We don`t know exactly what the presence of these COVID antibodies means in terms of how much immunity they confer if any on people for what length of time.

And what that really means in terms of what you can and can`t do in your daily activities. This is where the FDA has to step into the void and give us precise standards so that even if you get the results back from these COVID-19 tests, you know what to do with them.

Besides that, we think that the FDA should clear the market of all those junk tests and only allow authorized tests to be on the market. Today there are only eight authorized tests according to the FDA`s website whereas there is more than 150 unauthorized tests, which as I`ve said, could be very faulty in terms of their results.

EMANUEL: Congressman, given all this uncertainty, do you think it`s safe to open up based upon whether people have antibodies or not or is that just way too premature given what we know about the faultiness of these serology tests?

KRISHNAMORTHI: Doctor, I think it`s too premature. We just don`t know yet. It`s true that it holds great potential, but if you`re rushing to reopen your economy based on these serological tests that are on the market place, I think you better think twice because right now in the absence of precise standards and science telling us what it means to have these antibodies in terms of what you can and can`t do in engaging with other people, I don`t you can just reopen the economy and say, hey, you have Covid-19 antibodies, you can go out and relax social distancing and do whatever you want. We`re not there yet.

ALI VELSHI, MSNBC HOST: Congressman Krishnamoorthi, thanks for joining us. Coming up the extended unemployment crisis and what it means for Americans.

(COMMERCIAL BREAK)

VELSHI: In Georgia today, most kinds of businesses were open again after the governor decided not to extend his order for staying at home. Already Georgia and they got a line restaurants to serve a limited number of dine- in customers which led to scenes of waiters in masks reading customers over custom order waffles and cups of coffee.

In states that have begun reopening people who cannot work from home are being given what feels like an impossible choice. Go back to work and risk their health or stay at home and continue to miss wages. The most pressing example are workers in meat processing plants.

The Centers for Disease Control said today that 115 meat and poultry plants in 19 states have reported outbreaks involving thousands of workers. At least 20 meatpacking workers have died of coronavirus.

This week the president signed an order designed to keep the plants open. At a poultry plant in Pennsylvania today workers protested for more protective equipment. They also want the plant closed for cleaning after they say more than 20 workers tested positive. At a beef plant in Colorado, which reopened a week ago, several workers have died of coronavirus.

A worker there told NBC news, he`s happy to work but he`s pleading for every worker to get tested.

(BEGIN VIDEO CLIP)

DUSTIN HIBBS, MEAT PROCESSING WORKER: We`re supposed to be practicing social distance and some of the areas, you can`t have social distance of the six feet and so like today I was working and next to a guy and we kept bumping into each other and like my first worry why what if he has the virus and he keeps bumping into me and like it`s going to - it`s going to come to me and then I`m going to bring it home and then like all my roommates, my son, my everybody is going to get it.

(END VIDEO CLIP)

VELSHI: All right, stay at home and lose pay or go to work and risk spreading the virus. As more states reopen, that`s becoming the inescapable dilemma for millions of Americans. Joining me now is Sylvia Allegretto. She`s a labor economist and Co-chair of the Center on Wage and Employment Dynamics at the University of California, Berkeley.

Sylvia, thank you for joining us. Look, this is a tough one and it is tougher yet for those people who have no choice in the matter. Often wage earning workers have less choice than most people do but in this case the President has invoked the Defense Production Act to keep some of these folks at work.

And even though many of them are unionized, the union can`t override that so what do you make of this situation? This is - this is people who may want to work but they don`t want to die.

SYLVIA ALLEGRETTO, LABOR ECONOMIST: Well, I think the first half of your show really sums it up. Without adequate, testing, tracing, isolating, PPE, we`re just sending a lot of these workers, their families and spreading this into the community to their deaths.

We know there are correlations between all of this. And you know even though you know Trump signed the executive order to send them to work, he did so without any guidance. I mean there`s some guidance from OSHA but there`s no real hard and fast regulation with any tooth to it.

It`s clear that it`s much too soon to be doing this and as you said, we have hot spots all over the country where these meat packing plants exist.

EMANUEL: This seems like a complicated problem and it would seem like the communities in which the meat packing plants are located would actually be against opening them prematurely without testing because of we saw in South Dakota, you can spread it not just within a plant but outside the plant once someone gets infected or as that worker said you know, I could bring it home.

Why are we seeing more of the communities railing to the side of the workers and objecting to keeping or to not cleaning these plants or not testing the workers?

ALLEGRETTO: I think one of the issues is again, coming from Washington DC that we need relief, we needed relief for workers, families and the communities. This has been far too slow. It hasn`t reached a lot of workers yet and it has not been anywhere near enough.

And so people are getting desperate. They`re going into debt. Here we are May 1. Another months of rent and mortgages due and so I think you know people are becoming desperate but really in the richest country in the world, we shouldn`t be here. We should be able to do better.

And if you look at these meat packing plants any reasonable response would be we need to close them down because the way they`re running now is simply really exacerbating the situation and spreading the virus through the community as you mentioned.

And so we could do a lot more, we should do a lot more and this is way too premature.

VELSHI: Sylvia, one of the things that we have tried to do is these rebate checks that go to Americans, the federal top up on unemployment insurance which is run by the states. The Paycheck Protection Program in which companies get grants if they keep their people on payroll and the remarkably interesting effort that went through the airlines in which the airlines received grants to keep their people on payroll.

This is a much more European concept than it is an American concept but it`s actually not a bad one. If the government pays companies to keep people on payroll rather than have them you know get off their payroll, apply for unemployment, that`s an unwieldy process, apply for healthcare, that`s an unwieldy process. What can we do once we`re out of this emergency period?

This first period that we thought about, the first three months in terms of keeping workers going?

ALLEGRETTO: Well, I mean what you`re saying is exactly right. A lot of the European countries are doing and they`re doing a much more efficiently than we were to directly take over payroll, nationalize payroll. That would have been the best thing to do right off the bat.

Instead we have a lot of people unemployed, some are temporary - on temporary layoff, that`s good because you`re - you`re keeping the link between workers and their jobs. We had the PPP which is going to help small and medium sized businesses, hopefully stay afloat and be viable when we can start to reasonably open up.

And they`ll have workers to go because you know, on the ready - on the ready because what we do not want to have everybody being delinked from their employer and their employment and small businesses, mini businesses closing down in droves because that means we`re going to take a situation where I try to remind people, don`t forget we did this on purpose.

You know we have 30 million people filing UI claims, unemployment insurance claims and to my mind, that`s a good thing because we were trying to do this. We`re simply moving too quickly into the next phase to opening up but you know, as much as we can keep workers tied to their jobs, the better off we`ll be in the long run.

EMANUEL: Do you really think the government can keep people on the payroll for the length of this until we get a vaccine? Isn`t that going to be a huge stretch on the government and the economy and for the long term?

ALLEGRETTO: Well, it`s certainly huge stretch but don`t forget we`re in the nascent stage here. There`s a lot of work being done which was just discussed quite a bit here at the top of your program. We`re the richest country in the world. We can do a lot more.

Countries with you know, not as much as we have are doing a lot more so I think yes, we can do it. Can we do it until there`s a vaccine, I`m not so sure but certainly we have to keep things in place as the medical community is all saying until we have some reasonable amount of testing, tracing and isolating.

So we can do a better job at keeping people safe and healthy and certainly to keep tampering down the rate of growth of the infection so we don`t have such you know, explosions in infections that we overwhelm the health care system.

So I think we`re really early, in the early stages we`re at 22, annually a $22 trillion economy. I think there`s a lot of room to move here and one of the biggest things we have to do is make sure that DC delivered to state and local governments so we don`t start adding teachers and firemen and policemen to the unemployment racks.

VELSHI: Which is what happens when the states are unable to raise the money because they can`t go into debt and they can`t print money. Sylvia, thanks very much. Sylvia Allegretto from Berkeley. She`s a labor economist and the co-chair of the Center on Wage and Employment Dynamics at the University of California, Berkeley.

Coming up next, how much optimism should we put in the news about vaccine breakthrough from Oxford. I`m going to ask Zeke about that but first here`s a look at the heroes on the front lines at the grocery store.

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UNIDENTIFIED FEMALE: How much I feel a sense of pride being an essential worker. How much I am grateful for the opportunity to serve our community, to nourish them.

UNIDENTIFIED MALE: The job has a little bit more responsibility now and that makes you feel like somewhat of a hero. I know that, I`m hoping someone can eat healthier if I work in the fruits department.

UNIDENTIFIED FEMALE: I`m shopping for people who literally cannot leave their homes because they`re in chemotherapy, because they have a newborn, because they`re elderly.

UNIDENTIFIED FEMALE: Our cafe has been working every single day to make over 100 box lunches for all of our employees as a way of thank you for coming in every day.

UNIDENTIFIED FEMALE: The customers had no clue. They came in to do their regular shopping and then when to checkout, it was a very heartfelt moment as they realized all their groceries were paid by (inaudible).

UNIDENTIFIED FEMALE: I`m taking it off just so I could - it`s good to open. There was one particular customer when he saw that we had our big wall for - they were just over the moon, ecstatic. It was really lovely to see.

UNIDENTIFIED FEMALE: One of our head clerks, he had T-Rex costume and it was really nice that he went around the store. We even had the customers and they were all taking pictures and they loved it.

UNIDENTIFIED FEMALE: Our customers are like our family. We`ve been getting utmost support from them.

UNIDENTIFIED FEMALE: They`ve been putting signs out in front of the store, appreciating what we do. They thank us every day for being here.

UNIDENTIFIED MALE: It`s such a tough time but at least people are thanking and they`re grateful for your hard work.

UNIDENTIFIED FEMALE: Thank you for what you do and I really appreciate you. Thank you so much. It`s just very touching to me because I feel like I`m not really anybody special. I`m just doing my job.

UNIDENTIFIED FEMALE: I don`t think I realized how important we all are to people, not just for getting groceries but for socializing and connecting with people, just simple things like giving them a smile and taking an interest in them, asking them how they`re doing and letting it be more than an experience of just getting groceries, I think is really important right now.

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BILL GATES, CEO, MICROSOFT: Because we`re in a rush to get the vaccines 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.

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VELSHI: Dr. Zeke Emanuel, I spoke with Bill Gates last week about the unprecedented race to find and produce a coronavirus vaccine with dozens of teams looking for a vaccine, it`s inevitable that we`re going to get occasional news of possible breakthroughs.

The New York Times this week reported that scientists at Oxford University Jenner Institute are preparing for human trials of a coronavirus vaccine that was effective in earlier tests with monkeys. The vaccine is a modification of a vaccine for the MERS coronavirus. Zeke, I see these headline through the course of the week and my first thought is always I need to ask Zeke. What do we make of this?

EMANUEL: So let`s begin with what this vaccine is. They`ve taken a chimp adenovirus, that is a virus that causes the common cold in the chimp and they`ve taken a piece of the genetic code that makes the spike protein for the coronavirus and put it in that virus and then they infected the person and that produces a lot of immune reaction.

And yes, the test, they tried it on six monkeys and they seem to be immune to the coronavirus. The adenovirus is very common but the effectiveness of this vaccine remains a big question in people. This platform is relatively new and it`s no slam dunk.

Yes, they`ve tried it out on MERS but it was never approved it could work. Larger scale clinical trials are obviously going to be important. That have started in human beings but one of the big problems with the adenovirus platform for a vaccine is production.

It`s hard to produce millions and millions of doses of this. India`s - India`s already got a firm ramping up production before we know whether this vaccine`s even going to work but that`s you know, it`s a big challenge and it`s going to be a big challenge if this turns out to be positive to produce enough for the whole world.

VELSHI: So week ago when you and I were reading Bill Gates` paper and we were talking about it, one of the things is, it`s hard to short circuit the process for a vaccine because it has to be tested on enough people to determine that it`s safe, right?

We can`t get and then manufacture and then scale up a vaccine until we know that it doesn`t have a detrimental affect or effect that might be more detrimental than not having vaccinated people in the first place?

EMANUEL: Right. One of the things we need to know is that it`s not going to cause serious problems and again these coronavirus vaccines could cause a serious problem called antibody enhancement problem that if they could actually make the virus worse.

The second problem is that we need to know that they actually produce enough antibody and then the third challenge is do those antibodies and other immune cells actually protect you from infection with coronavirus and those are all biology and it takes time for the biological system to work and for people to actually see if they can`t get infected. Can`t rush that.

VELSHI: Yes as much as one would like to in the most serious and - and great results of vaccines, it is been difficult to rush. Well, the president has made almost a habit of telling the American public that the death toll from the virus wouldn`t be so bad.

At a briefing on April 20, he said the toll could be as low as 50,000. That was NBC news reported this morning, the very next day after from said that his administration placed an order for 100,000 body bags.

Now of course since then the death toll has passed 64,000 and it is still climbing so Zeke, I have to ask you as a doctor, where do you see this going?

EMANUEL: Well, I have to say that you know these predictions are all hard. It was just about six weeks ago that two teams from Stanford University were saying well, we`ll get to 10,000 that`s maybe it`s only 20,000 to 40,000 and here we are, just six weeks later and we`re well beyond those deaths.

And a model the White House likes to use called by IHME, up at the University of Washington. They have a model that shows plateauing in the number of deaths. It`s 72,422 or something like that. That obviously isn`t going to happen. We`re just 8,000 deaths shy of that and there`s three months between now and August 4.

We`re getting to the top of the curve, it appears but remember, the number of deaths on the way up is equal to the number of deaths on the way down right that curve which means we`re on track to have clearly more than 100,000 deaths and unfortunately looks like 110,0000 - 120,000, it`s more likely by August and that is really painful, it seems to me.

VELSHI: Let me ask you before we get your final thoughts. Does the number of deaths on the downside have to be equal to the number of deaths on the upside or is there a way to make that curve drop fast?

EMANUEL: Probably not a way to make a drop fast because you`re still circulating virus and it`s going to go down so we know - we know that -

VELSHI: Got it.

EMANUEL: - it looks symmetric.

VELSHI: Yes, all right. A lot of these deaths probably most of them are happening in as you and I discussed, the saddest way possible with the dying person separated from their family alone in a hospital room on a breathing machine. I know you`ve got some thoughts about that are very personal, Zeke.

EMANUEL: Yes, my 92-year-old father died from brain cancer this past October after a short illness. I got to say that maybe the most meaningful time I had with him was our last moments together. We were lying side by side on my parent`s bed. He just put his fingers on my hand and began caressing my hand. It brought back memories of my childhood when he used to run his fingers through my hair, squeezing my hand at my college graduation or when he gently put his hand on my back when we watched my newborn daughter.

As an oncologist, I often encourage family members of dying patients to grasp the hands of their loved ones and talk to them. Invariably they stood by the side of the bed and I took their hand and smooth the hair on the relative`s head. Those final touches and the final words made the passing feel much more meaningful.

They made everyone`s pain more tolerable and helped bring them to closure. I`m very heartbroken for the Covid-19 families who can`t lie side by side with their loved ones the way I did or are deprived of those final caresses and moments of being together and who then cannot grieve together at funerals and memorial services because of physical distancing.

I have to say, I almost feel blessed that my father died before Covid-19. Not only could I be at his side but my family was able to come together to agree with friends at his very impressive memorial service. More than 64,000 Americans that have died from Covid-19 and that`s a massive national tragedy but it hurts so much to think of those tens of thousands of families who grieve alone in this pandemic.

VELSHI: Zeke, it`s remarkable. I do have to ask you this. You know there are milestones in in our years. We are coming into a very warm weekend and the New York police department has announced it`s going to have put patrols out there to make sure people are social distancing. People want normalcy.

And something you brought up last week when we talked to Bill Gates was the idea that the resumption of school feels like normalcy. Here in New York Governor Cuomo said, there will be no more school to the end of this school year but the idea that come September, there are going to be parents who have kids at home who cannot afford to be at home, they`ve got - they may have to go back to work.

There are going to be students wanting to go to colleges. There are going to be colleges that may be in a position not to graduate some of the students that are necessary for the work force. What`s your sense of how that that milestone, education, back to school for K through 12 and for college students looks like?

EMANUEL: Well, I will - I will say to you that this week, I`ve talked to a number of college presidents, all debating this question and trying to figure out how it`s going to be possible to open. I know that we`re looking actively at Denmark and Germany and other places that have opened schools in the hope that we can open it.

I think it was governor Cuomo who said that opening schools, opening business and transportation are all interlinked and we have to do them conjointly so that`s really important.

VELSHI: All right Zeke, thanks as always for spending the hour with me. We`ll do it again next week and a reminder, if you want more of Zeke`s insights into the coronavirus and you do, check out his podcast, Making the Call with new episodes every Wednesday. You can find it on Apple and wherever you get your podcasts. I`m going to see you back here tomorrow morning and Sunday morning for Velshi beginning at 8 AM.

The 11th hour with Brian Williams begins right now.

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