Little hinky as we try out some new stuff, a, forgive me and please be patient, we will work it out. We are in this for the long haul and so we have to try to innovate. You are in this for the long haul as well. We all are. So lets jump right in. In italy they have crossed a new threshold today. The number of people who died in italy from the coronavirus over the last 24 hours hit an alltime high. 475 deaths reported in the last 24 hours. Thats the highest oneday death toll in any country, including china, since the start of the pandemic. 475 deaths in one day. Italy has reported more than 300 deaths per day in each of the last four days. That itself is a terrible new standard. China, when they were in the worst of it, they only once reported more than 200 deaths in a day. Again, italy is at more than 300 deaths a day for four Straight Days and today 475. The situation in italy remains the worst in the northern part of that country, particularly in the wealthy region of lombardy, which has now become basically the warning to the world of what will happen in countries all over the globe if they dont take serious steps to bring down the rate of infection as dramatically as possible and as quickly as possible. But its worth knowing that the reason its going so violently terribly wrong in italy, with more deaths per day than we have seen anywhere else, including china now, the reason its going so badly wrong in italy is not because of something that is inherently wrong with italy and their Health Care System. Quite the contrary. In 2017 the World Health Organization did a report on the Health Care System in italy, and they were critical of some stuff, they wanted them to, you know, up their spending on some stuff and realign their priorities in some ways, but honestly, by and large, the w. H. O. Report card for the Italian Health system was pretty good. Heres part of that report. Performance of the Italian Health system, quote, the relatively low mortality rates in italy suggest that the italian Health Care System is effective in dealing with lifethrtening conditions. Amenable mortality rates trended downward over the past decade. Italy has a strong acute care sector. Thats italy as a whole. Northern italy itself is even better. Northern italy, the richest part of italy, not some backwater when it comes to advanced medicine or advanced anything. I mean thats where they make the most expensive yachts in the world. Thats literally where they make ferraris. And there are big modern hospitals there, full of lots of fully qualified doctors and worldclass equipment. And there, that place, is where theyre now losing more than 300 people a day. 475 deaths in the last 24 hours. Reporter chico harlan wrote this up today for the Washington Post with a last line that will put a put your heart in your throat. Even as lockdown measures have gradually slowed the number of new cases, the countrys death toll has exploded, more than tripling in the span of a week. Italys death toll is tripling exponentially in a way that mirrors the growth total of cases earlier this month as people lose their battle with the disease after several weeks. Today the government of the hardest hit Lombardy Region said that medical facilities there will soon be unable to help the sick. Quote we will soon be unable to give a response to those who fall ill. We will be unable to give a response. What he means there is that the hospitals in that region in italy are about to be unable to treat people. As hundreds of people are dying every day. The hospitals are at the point of collapse. And that note there about the deaths in italy now mirroring the rise in new cases there earlier this month, thats really the whole ball game. If there is a relationship between two numbers or two things or two trends that you have to understand in order to know why all of the epidemiologists and Public Health people are so freaked out right now, as well as the political leaders who get it, its the different between these two numbers, the new cases followed three weeks later by the intensive care demand. Mark lipsich explained today in a piece for stats about what our options are as a country. Hes an epidemiologist who runs the center for are as a country, an epidemiologist who runs the center for Communicable Disease dynamics at hafrkd university. He said today very simply in a way that i think is actually memorable and therefore useful for all of us he said, intensive care demand lags new infections by about three weeks. Because it takes that long for a newly infected person to get critically ill. And again, not everybody who gets infected will become critically ill, but the people who need Critical Care will start showing up in icus about three weeks after they became infected. So if this is the past month, in italy, showing the rise, rise, rise, of infections in italy, we will add in a threeweek lag time and thats where you see the rise, rise, rise in hospitalizations. A slice of those same new infections from three weeks ago are the people who are now critically ill and needing to be treated in hospital. And that is why their hospitals are collapsing. The steep rise in infections foretells by about three weeks the collapse in their hospitals that is happening today. That regions governor again saying that we will no longer be able to treat people in hospitals. That is the terrible news from italy. Thats why you keep hearing people talk about italy like it is the bogeyman in this story. Thats why new york officials in particular are sounding the alarm about the mirror between new york cases and italy, about how the steep rise in cases in new york now foretells a crush in hospitals here coming very, very soon, just as we have seen it play out in realtime in northern italy. Theres some good news, though, from italy as well today. And it is smallerscale good news but i will take good news where i can get it. The town in northern italy that recorded the first death from coronavirus is a town called vo. That i can remember. Vo is the name of the town. Its in the venetto region. Forgive me, i dont speak italian. My pronunciation is terrible. But there are about 3,300 people in that town of vo where they had the first deaths. And they did a study with the local university, and they decided that what they were going to do in that town is that they were going to test every single resident of the town. 3,300 people. They tested everybody. They got 90 positive tests. Including at least half a dozen people who were completely asymptomatic and would never have been otherwise identified had they not done this experiment in which they tested everyone regardless of symptoms. But they tested everybody, everybody who tested positive, they isolated them, and then after the period of isolation they tested the whole town again. Anybody newly positive again isolated. Well, after having done, that after having done universal testing and universal isolation of all positive cases, they have now gone days with no new cases in that town. And you dont want to extrapolate globally from one experiment in one town. But as a matter of principle, mass testing does find asymptomatic people who are positive and therefore still infectious. And once youve identified positive people, isolation can work to stop people who are positive from giving it to anyone else. And if those are the principles which which you can extrapolate from that experiment, that at least gives you a way to plan for moving ahead. If only we could get a test for the fricking virus in this country, maybe we could even start to think about the implications of that for our big country and the thousands of cases weve got here now. As our numbers really skyrocket. New york city had 814 cases as of yesterday. As of today, the number is 1,871. That is way more than doubling in a day in new york city. New york state has enough cases that if new york state were a country there would only be ten other countries on earth with more known cases. Around the United States the worries about testing and our Hospital Capacity and how well were taking care of our health workers, who after all, will be the people who run the hospitals and take care of the sick, they are really screaming now as the american case numbers take off. Tom bossert is one of the people who is supposed to coordinate the National Response to a pandemic for our federal government before he and his colleagues were all fired by the Trump Administration and the Trump Administration then just never hired anybody else to take that job, here is tom bosserts take on what we need to be doing now as of today, and what in two weeks we will wish we had spent today working on. If were like italy, and theres every reason to believe our numbers are going to grow along that line, we could see 2,500 dead in two weeks time and we could see over 100,000 cases. And those are planning assumptions, not predictions. But if thats the case, in two weeks ill look back on today and say i wish i had done three things and theyd be personal protective equipment, personal protective equipment, and personal protective equipment because these doctors that we just saw interviewed, in their absence they cant take care of us and they cant use those ventilators. Thats my fear today and thats where i think we should be focused. Were going to look back on this day two weeks from now and what we wish we would have focused on is three things, personal protective equipment, personal protective equipment, personal protective equipment. Tom bossert was one of the officials who would have been in charge of coordinating this response for the u. S. Federal government had the Trump Administration not fired all of the Pandemic Response teams from the federal government two years ago. This is from the wall street journal today, quote, administrators at renton, Washington Headquarters at the renton, Washington Headquarters of the providence Health System are in Conference Rooms assembling makeshift face shields from vinyl elastic and twosided tape because supplies are drying up. Providence, a system of 51 hospitals across seven states has less than a weeks supply of face shields and medical masks at its seattlearea hospitals. Literally, thats how were dealing with this in this country. In one of the places that had the earliest experience with large numbers of cases. At the hospital they are making face masks themselves. Like the hr people and the accountants and the managers at the hospital are all sitting in Conference Rooms with stuff they got at hobby stores and Hardware Stores macgyvering face masks for the doctors and nurses to use to protect themselves in their hospital. Thats our level of preparedness as a country. Even though we got advanced notice of countries that had it worse than us before us so we can see how its going to go. Thats how were coping. In massachusetts hospitals they are rationing testing for coronavirus as of today not only because of a shortage of test, which we still have all over the country, but because in massachusetts theyve even got a shortage of just the swabs, just the big qtiplike things they need to collect the samples for the test. They dont have those either. A new study of the nursing home clusters of coronavirus in kirkland, washington shows part of the way the virus spread to nine different Nursing Homes there was this Chain Reaction that led to 129 new cases in 11 days. Theyve done an epidemiological study now of how that happened, how it spread to those nine Nursing Homes. They found that part of what happened is that staff spread it from facility to facility in part because they had a lack of access to personal protective equipment. Because we havent prioritized that. Even for staff who are working in cases, in places where there are known clusters, and with patients who are known to have been exposed. So things are moving very fast now. Obviously. The response, obviously, is nowhere near the size of the task. The first member of congress to test positive for the virus is marie diazbalart, Florida Republican congressman. He announced tonight that he is the first member of congress known to have tested positive for the virus. If his name is familiar to you, that maybe because Mario Diazbalart is the brother of our own beloved colleague jose diazbalart whom you know from msnbc and telemundo. Just in the last hour a second member of congress, ben mcadams from utah, has announced he too has tested positive for the virus. The federal government announced today that they will deploy hospital ship, u. S. Navy hospital ships to try to provide hospital overflow capacity, one in new york, one in some undetermined location on the west coast. While that seems good, it should be noted that that will take a number of weeks to get up and running. And all major u. S. Automakers announced the shutdown of their plants in the u. S. And canada and mexico today. Theres been some nonspecific murmurs from the administration that u. S. Manufacturing facilities, including potentially auto facilities might be rerepurposed to Start Building ventilators instead for intensive care units, since were going to need tens of thousands more of those than we have. Again that seems more aspirational or brainstormy at the moment but you may have seen headlines about that today as the administration tries to advance that concept at least. Tonight ford motor put out a statement confirming they have had preliminary discussions with the federal government about the possibility of producing ventilators and other equipment. Palm springs, california today adopted a shelter in place order thats like the one that is in effect now for seven Million People in the San Francisco bay area but so far those shelter in place orders are just in california. The u. S. Canada border is closed for nonessential travel in both directions now. The economys crash continues unabated with another 1,300point loss in the dow today even as the federal government unveiled new proposals for big stimulus spending to try to shore things up. Were going to get expert advice on those proposals coming up later this hour. Delta Airlines Announced today that theyre cutting 70 of their flights. The nations airports announced today that without their own bailout, they may start defaulting on the bonds that were sold to pay for their construction. The largest Shopping Mall operator in the country announced that it is shutting all of its properties nationwide after a fourstate consortium of new york, new jersey, pennsylvania, connecticut order ed the closin of all indoor retail Shopping Mall spaces along with amusement parks and bowling alleys. But even as there is more and more focus on what states are pioneering new ideas, about what they can do to shut down and slow the spread of the virus, its also worth noting, we spend all of this time saying california is trying, this the bay is trying this, this city is trying this, schools are shut down here, weve been talking about the places where new stuff is being tried, where new strictures are being announced, look at it from the other side, too. It is worth noting that there are a bunch of states in this country that really arent doing much at all. We checked with the National Governors association today which is tracking state by state responses. I was honestly shocked to find that there are seven states as of right now where there are no mandated bans on gatherings of any size, there are no state mandates ordering restaurants or bars or any other businesses to close. Theres no state mandate for school closures. None of those things. In idaho, mississippi, missouri, oklahoma, tennessee, texas, wyoming. No statemandated school closures. No statemandated limits on large gatherings. No state mandates on the operations of businesses like bars and restaurants. Now, in some of these cases there are, you know, nonbinding recommendations, urgings, strong feelings expressed by leaders, and within these states some schools and some businesses have followed their own lead, or followed those urgings and nonbinding recommendations. You know, local School Districts having to make those calls themselves. But in all seven of those states no statewide rules. Because sure, why not, make it up yourself. See how it goes. Now, no reason to panic, right . No reason to hustle. Lets see how this plays out. Joining us now is donald nic mcneill. Hes a veteran science and Health Reporter at the New York Times. He has covered aids, ebola, swine flu, bird flu, sars for the times and mr. Mcneil did some of the pioneering reporting on the pandemic at its inception. Hes not a bit of a voice in the wilderness from those early days warning of how bad this could wo get and how quickly. Thank you, mr. Mcneil for coming back. I appreciate your time. Im going to start by asking you what i ask you every time, which is have i said anything since the show started that strikes you as wrong or wrongheaded . I know you felt like those of us in the media have sometimes put the emphasis in the wrong place here. No, everything you said is correct. Im shocked at those states that are doing nothing. There is just i mean theyre asking for it. When donald trump uses the expression, you know, the virus is going to wash through the country and he does it with this hand motion like its washing through like a gentle breeze, that is a very common expression among epipeople doll gists that the virus is going to wash