♪ professionally, we all wish we knew to treat this like a marathon and not a sprint. >> these patients require a lot of care.

>> it is a very long road to recovery. >> i'm gravely concerned for a second wave. opening society back up to the world, you could have another heat of what we just experienced. >> there has to be a balance struck between the people that are being hurt from the economy being shut down, which is real pain. and from those of us that are worried and concerned that any premature re-opening would mean we would lose all the ground that we've made. >> i think, you know, things will happen slowly. i think it's unrealistic that the flood gates will just open. we need to keep each other safe. we'll be able to have things go back to normal, but it's not without the sacrifices we make right now. >> a little glimpse that we like to begin this show with each day are voices of some of the medical workers trying to share their front line stories on this fight. welcome to thursday.

this is "meet the press daily." i'm chuck todd. multiple sources have confirmed that president trump recently did lash out to his campaign manager after being briefed on a bunch of internal polling that showed him losing to joe biden in multiple key states. this comes as the virus's death toll crosses 60 thousands. it comes as americans are losing their jobs at a pace not seen since the great depression. 30 million americans have filed for unemployment benefits. and we reported 27,000 new cases and more than 2,100 new deaths. president trump said i don't believe the polls. and we've heard him say that he doesn't accept responsibility at all but he does seem desperate to find a way to turn the page in any way he can. he's been bringing in governors. he met with new jersey's democratic governor phil murphy today. we'll speak with him later in the show. the president is also dialing

back public briefings with health officials after those around him said that they weren't helping him politically. he's been pushing scientists to develop a vaccine in a project called "operation warpspeed. we at times he's whiplashed kpe between accepting the reality of what's in front of him while at times denying it. so far the president seems trapped in a cycle of what we've called mission accomplished moments. on re-opening the country, and on treating the virus. >> anybody that wants a test can get a test. i think easter sunday and you'll have packed churches all over our country. i think it would be a beautiful time. and it's just about the time line that i think is right. now we're going toward 50 i'm

hearing or 60,000 people. one is too many. i always say it, one is too many. but we're going toward 50 or 60,000 people. it's going to leave, it's going to be gone. it's going to be eradicated. >> out of that we should note we're still short of where we need to be on testing. public health officials are clearly uncomfortable with the idea of any large gatherings. we've also passed the 60,000 death mark. and we're nowhere near being able to say we've eradicated this virus any time soon. joining me now from the white house my nbc news colleague carol lee, and msnbc and an nbc political analyst and stephanie ruhle. let me start with what is clearly these meetings with governors. and i think the governor of tennessee is there now. if you are the president right now and he wants to put the

virus behind him, he wants to make re-opening the economy getting it back, i get it. it just doesn't seem as if the virus is on the president's time line. >> right. and there are people around the president who would like him to do both, which is acknowledge that you still have a pandemic that you need to deal with. and at the same time also try to move the country toward a re-opening of the economy. but everything that you just laid out inherently in there is a risk that he winds up looking very disconnected from what is happening across the country. and on top of that winds up putting forward policies and prescriptions for the economy that backfire on him, meaning today his stop the spread guidelines and the white house is pivoting toward these phases of re-opening the economy. there are questions about how many, if any, states meet even

the threshold of phase one. and if you push them too quickly, then what's it going to look like in two weeks or a month? and so these are things. and then you can tell the president feels very much boxed in by this. he says one thing, you know, that acknowledges there's a real problem here. and then says things like it's just going to go away, which i have to tell you, you know, gave some of his advisers some heartburn because they don't want him saying things like that. but he really -- what you see in those moments is exactly what he really wishes the reality would be. >> right. robert costa, i've had this theory that the president watches things getting better in new york and new jersey and applies that to the country as a whole. and as new york and new jersey begin to turn a corner, at least get past this part of the pandemic, he's thinking, well, that's where the rest of the country is. the problem is as we see it in

the death toll, the good news in the new york area is that it's been dropping dramatically. the problem is it is not on the decline in other parts of the country. it does seem as if he's letting the new york good news sort of color his view of where the rest of the country is. >> based on my reporting, new york and new jersey do color the president's view. and to build on what carol was just saying, i've had conversations in recent days with governors on both sides of the aisle. governor pritzker of illinois, governor hogan of maryland just a few hours ago. and they are nervous about testing because if states are reopened, they may have tests in hand. governor hogan has secured 500,000 tests from south korea. but if they don't have the supplies, the swabs that are needed to make those tests successful and to make sure that people have access to those tests, then just having tests doesn't really do anything for them. they need to have the full spectrum of supplies, materials,

expertise, to execute. and at the same time many governors i've spoken to in recent weeks are very uneasy about liability issues. mitch mcconnell, the majority leader, is trying to give a republican plan, protection to businesses should they reopen so they don't get a lawsuit. but many advocates for workers in unions are concerned about that possible legislation wondering why couldn't a worker sue his own business or even sue the state if they feel they are being put in unsafe working conditions? a lot of gray areas here as states move closer to re-opening. and they're looking to the white house, to the president, for clarity. >> right. and, robert, i have one political question to you. the fact that the trump campaign, and you and i both know they do this a lot. they seem to want to let the world know that a whole bunch of their polling show the president not doing well. this is sometimes a way for them to try to talk to the president that if he doesn't listen to them, he goes through the press. should we be looking at this

current round of leaks through that prism? >> based on my conversations with white house officials, it's not so much they're trying to use polling to convince the president to step away from the briefings or that the fair assumption of yours, chuck. what it really is, is a reflection of reality. and they need to tell him reality. even if they are loyalists behind the scenes and they often tell him things that are positive. when it comes to polling, it's facts, it's data. and if they feel the president is slipping in the midwestern states, they need to be aware of it. you see his political strategist saying, mr. president, you are on pace to lose these states unless something changes. >> and, stephanie, i want to pivot to the economy because i want you to try to deal with a contradiction. i just got one of my breaking news alerts a few minutes ago that talked about an amazing

month that the stock market had. and yet it feels as if we're about a quarter away from a catastrophic, you know, from catastrophic unemployment numbers. they're bad now. they may continue to go. bankruptcies haven't even begun to rise and there's fear of that. has the stock market giving a rosy picture that doesn't exist? >> we always have to remember the stock market is forward looking. the stock market is based on future assumptions. and, remember, just yesterday fed chair jay powell reassuring investors we'll do whatever it takes. but the stock market is clearly disconnected from the real economy. and, yes, we're now facing 30 million people in the last six weeks now on unemployment. that number will most likely go down as we start to reopen. remember, this was a self-imposed financial crisis. we told people to shut down. so we will see that number tick

down. we also see some businesses hire back employees. but i want to mention what robert said because i think this is a huge part of this re-opening. the biggest issue for states is liability. because you've got governors who know that they can't have this many people on unemployment. they can't afford it. but you've got businesses knocking on their doors saying who is liable. if i open back up, will i face lawsuits from my employees and from my customers? and so you've got those governors now turning to the white house. this is going to be a really important issue for business. >> this liability -- i hear you on that. i guess the question is, okay, somebody's going to be liable. so is business want the federal government to basically be the backstop for everybody on this? >> well, here's the thing, chuck. if business isn't liable and the government doesn't touch this, if i'm a worker, do i feel safe

going to work? if i'm a customer, do i feel safe going into a business knowing that that business doesn't have to worry about safety guardrails? and then that takes you to a state like iowa where the governor is saying, well, if you choose not to go to work, you don't get unemployment. this is a really complicated issue. and for those states, they're also going to have to answer for childcare. because if all of us were sent back to work while our kids aren't in school and there is no daycare open, well, then what are we going to do? so it's not just the simple we know that the president is looking at the poll numbers, he wants the economy to match the market. it's super important to him. but it's just not flipping a switch on. it's very complicated. >> carol lee, one of the things that has surprised me is how much the president has allowed, essentially, congress and steven mnuchin to sign the various economic rescue ideas. he really doesn't seem to have expressed an opinion of whether he'd like to see more payroll

covered, more this, more that. he doesn't seem to have a philosophy yet of how he would bring back the economy other than we'll do some infrastructure. >> yeah. he turns to infrastructure quite frequently. we've heard him say things like payroll tax cut and things like that, and he's floated various ideas that have been shot down in congress. there are certain things that the white house wants to try that just aren't going to go anywhere. but he is largely ceding to steve mnuchin, to lawmakers on capitol hill to come up with stimulus plans or recovery plans. and he's more focused on the kind of like a cheerleader, pushing people to believe that the economy is going in the direction that he wants it to be going. he's more focused on that aspect. he is doing an event with

seniors here right now at the white house. that seems to be the role that he's taking on more so than getting down in the numbers and figuring out what specific policies need to go where. >> you know, robert, it seems as if you could actually talk president trump into saying, hey, you need a bunch of contract tracers in this country. new york needs it, new jersey needs it. frankly, the whole country needs it. you, mr. president, can hire a whole bunch of people yourself. you can create jobs. you know, or he could have done that through the national testing strategy. it seems as if there isn't any of that kind of thinking, at least, penetrating the west wing right now. >> this is something, to your point, chuck, that the president and the white house are delegating a lot of these decisions to congress. and when you look at the 500 billion, governor cuomo, governor hogan have asked for in this next round of legislation, a lot of it would go to contract tracing, to testing materials, testing supplies.

and states are looking for those things in this next round. and the white house knows secretary mnuchin and speaker pelosi and leader mcconnell, those are the real players to haggel out the details at this point. >> well, it's true. and i think it's pretty clear. i think speaker pelosi and chuck schumer have decided it's better to negotiate with mnuchin than mcconnell. thank you all for helping kicking off this hour. up ahead, the white house is calling it operation warp speed. but how quickly are we actually likely to see a coronavirus vaccine that works injected into us? we'll get a reality check. and later a closer look at the toll this pandemic is taking on front line workers. the growing concern not just for their physical safety but for their mental health as well. l.h! whoo! don't do it. don't you dare. i don't think so! [ sighs ] it's okay, big fella.

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can scale up rapidly. in other words, you don't wait until you get an answer before you start manufacturing. you at-risk proactively start making it assuming it's going to work. so we want to go quickly, but we want to make sure it's safe and it's effective. i think that is doable. >> well, that was dr. anthony fauci this morning on nbc's "today" show confirming that he believes it is possible 300 million doses of a coronavirus vaccine could be ready to be distributed by january. it's part of what the white house is calling "operation warp speed." it's a plan to fast track vaccine development, to make it possible doses of vaccines will be manufactured while clinical trials are still happening under the assumption that the vaccine works. dr. peter hotez is a doctor at the baylor college of medicine. how often is this done where

potential vaccines, and in this case it sounds like we're going to do this with multiple answers, are manufactured essentially in realtime so that we could, if one is deemed useable, boom, we go to market? >> well, it's almost unprecedented. we have a little bit of that during ebola. if you remember ebola in 2014 in west africa, there was a lot of worry about a pandemic, and there was an effort accelerate a couple of vaccines to start clinical trials in 2015. by then we had implemented a public health infrastructure. we had sent in the 101st airborne division. and eventually it stopped ebola and we didn't really get to test it fully until five years later in 2019. and it actually worked. and that's one of the great public health stories never told, how we vaccinated 200,000 people under very difficult circumstances leading to licensure. this is a bit different. we're trying to do this in the middle of a pandemic with a

brand new virus agent and try to hit the ground not quite from zero because we've had previous coronaviruses. we have a little bit of experience like our vaccines but trying to do this in an 18-month time frame is unprecedented, it would break all records. and we're trying to make a vaccine. we've got two now that we're moving into hopefully clinical trials by at least one by this summer. so none of us sleep anymore. those of us who are involved in vaccine development to try to meet dr. fauci's charge. but he can talk about the advantages and disadvantages of trying to do this. >> i was just going to say, first of all, i know there's more sharing going on in the scientific community than we've seen at any time. and i know while pharmaceutical development is sometimes very competitive, in this case, everybody wants to get this answer. so i'm curious, how much information sharing are you having with the folks at oxford who believe they've got a bit of a head start simply because they were working on a coronavirus

vaccine beforehand? >> yeah. we've been working on a coronavirus vaccine for ten years i've been putting up all of our information in the public domain either on a pre-print servers or in the scientific literature, as has the oxford group. the actual technical hurdle of making a covid-19 vaccine is not that complicated. it's all about using the immune response to interfere with the binding of the spike protein to the receptor. if you've ever seen that cartoon of what a coronavirus looks like, it looks like a doughnut with a piece of rna sticking out in the middle. so the vaccine is working by using the immune response to block that spike protein by binding to the receptor. the question is how do you best deliver a vaccine to do that? do you use an rna vaccine, a dna vaccine? do you use an adeno virus, and nobody really knows what's going to work the best and what's going to be the safest? so if you really want to meet that 18-month time frame, it

means getting them all out there. that's why you're hearing about 20, 30 vaccine candidates because the vast majority are not going to make it all the way through. but that's the first step towards accelerating, getting as many vaccine candidates out there as you can in a short period of time. >> what's the -- what's your theory of the case here? are we going to end up with some sort of hybrid where it's like a flu shot every year we may have to get? it's a recurring shot? or do you think we'll get a, you know, vaccine a la measles and mumps? >> i think -- first of all i think we might have two or three vaccines, one targeting older individuals who are at risk, our health care providers. i think the other point to make is the first vaccine, the first couple of vaccines that we have may not be the best vaccines. and we have a long history of that where the first generation of vaccines may not be the best

and we may get further refinements. we've done this with so many of our vaccines in the past. so i think we have to get away from this notion like the old vaccine, they brought all the press into the auditorium at the university of michigan, and they pulled the screen like the wizard of oz and all of a sudden everyone went dancing in the streets. it's not going to be that way. it's going to roll out over a period of time and it's going to be a long, complicated process. i think the first step is doing the right communications to get over some of the magical thinking about how this vaccine's actually going to get rolled out or multiple vaccines. >> i'm curious, how much -- can you be doing research -- does research on therapeutics help in the research on a vaccine? can it distract? does it have to be totally separate? and are we putting enough effort into the therapeutic line of research?

>> yeah. well, there's certainly a whole program of therapeutics in parallel. in some sense yes because the first wave of therapeutics are different types of antibody therapies. so if those work, and i think there's a likelihood they will because they work by targeting that same spike protein. if they work that kind of provides a proof of concept that we're on the right strategy for vaccination. so, yes, we can apply some of that information towards making a covid-19 vaccine. the thing that i'm a little bit worried about is some of the messaging we've been using. and some of my colleagues have not been well behaved in terms of the messages they put out there, especially some of the biotechs in pharma say we're going to have a vaccine in six weeks or two months or using a term like "operation warp speed." that doesn't help us because we have a very ago ago aggressive anti-vaccine lobby here in

america. their major assertion is that vaccines are not adequately tested for safety. in fact, the opposite's true. i get involved in this because i'm not only a vaccine scientist and pediatrician, but my youngest daughter rachel has autism and i wrote a book called "vaccines did not cause rachel's autism." because then we're going to have to do a lot of damage control even if we have the vaccines. >> we're all going to be watching. and of course if one doesn't work as well as we thought, then that could lead to all sorts of unintended consequences there. i totally see what you're saying there, dr. hotez. and i hope folks heard your message there, if you get my drift. doctor, thanks for coming on and sharing your expertise. i know i just learned a lot. so i hope viewers did as well. >> thanks so much. up ahead, california governor gavin newsom turns the tide appearing to abandon a plan

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working to provide an alternative source of power... ...for a cleaner way forward. welcome back. today we're launching a new series called "open questions" just focusing on the many questions facing lawmakers and businesses over how to approach a new normal that we're going to live in for a bit. we start in california where governor gavin newsom announced a short time ago that he was temporarily shutting down

beaches just in orange county after those beaches were packed last weekend. >> my job as governor is to keep you safe. and when our health folks tell me they can't promise that if we promote another weekend like we had, then i have to make this adjustment. those closures come as newsom announced more than 2,400 new coronavirus cases and an additional 95 deaths in california. it's the third consecutive day that the number of deaths has increased there. doctor, when the day began, it began with this news story that maybe all beaches were going to be closed. the governor ended up just doing it for orange county. where are you on this issue? and do you think it is -- in a perfect world would you shut the beaches if you could simply for the health reason?

>> sure. l.a. county beaches are all closed, so obviously we agree that it's not safe at this moment in time for our residents to be crowding on beaches as well. we started the month in april with about 79 deaths attributed to covid-19. and we're ending the month of april with over 1,100 deaths attributed to covid-19. we started the month with about 900 people in the hospital, you know, with conditions related to covid-19. and we're ending the month with about 1,900 people in the hospital today with covid-19. so we've got a lot of concerns here and need to continue to ask our residents who have been absolutely wonderful about staying away from our beaches to continue to follow the health officer order, which is in effect until may 15th. and it does have our beaches closed. i agree with the governor and lots of other public health officials, this is heartbreaking. all of the losses that people

are suffering, the economic losses, the emotional losses. but our health and safety is really paramount. and we can't have crowding on our beaches. there are 10 million people who live in l.a. county. on a good day in the summer a million people will go to the beach. it's impossible to do physical distancing with that many people going to our beaches. so we're asking our residents to please stay away from the beaches for now. >> i want to turn to the issue of testing. the mayor announced that everybody in l.a. county could get a test. it does seem as if though that the issue is not tests, it's the ability to process the tests. can you guarantee that everybody in l.a. county can get the results of a test in a timely way, that it can be effective to use, you know, for contact tracing or things like that? >> it's a really good question, chuck. thanks a lot. the city is prepared to be able

to offer in all of the city testing sites testing for everyone. they have resources. there's about 4 million people that live in the city of l.a. the county has another 6 million people that live throughout the rest of l.a. county. and we're still prioritizing testing, particularly for, you know, high-risk populations. and that includes all of our front line workers. but it also means we're digging in deep on institutional settings. you know, today, unfortunately, i had to announce that 47% of people who have died in l.a. county from covid-19 were residents in our institutional settings. the vast majority were our skilled nursing homes. we are out there every day starting last friday making sure that we're testing everybody. asymptomatic and symptomatic people in all 380 skilled nursing facilities. this is a big priority for us. we know that the day needs to

come where everyone can get tested. but right now we're really still prioritizing some populations because the risk is just so high in some places. >> you brought up the nursing home thing, and the president just held an event talking about they're going to set up a separate task force to try to dive into this larger problem that we've seen at senior facilities around the country. i'm just curious, dr. ferrer, based on what you've seen as you've dealt with this crisis, is it the way these senior centers are run that has made them so vulnerable? or is just this simply how lethal this virus is to those older folks? >> well, the virus is lethal, particularly to older folks with underlying health conditions. but i think we missed the boat with the nursing facilities because we didn't recognize how much asymptomatic -- how many

asymptomatic people were capable of actually infecting others. and that's turned out to be a huge problem. we've done some testing for everybody in nursing homes. and you'd be surprised about what we found. we went into a nursing home where seven residents were showing symptoms of covid-19. when we tested all the residents, 80 residents were positive. the vast majority had absolutely no symptoms. they were either asymptomatic or presymptomatic. and the same result with the staff. we did, you know, working with all of our nursing homes have been trying their best. we have lots of active screening, taking everyone's temperatures before the staff came in. but that wasn't what was causing the spread. the spread was actually happening because we had asymptomatic people. now that we know that, we have to change our strategy, we have to get in quickly. we have to test everyone. and then we're going to have to retest. it's not a one-time only test at the skilled nursing facilities. we've got to go back on a very regular basis and make sure that people aren't able to pass along

the infection without even knowing that they're infected themselves. >> i have to say, dr. ferrer, you've given me the best explanation yet on the issue with these senior facilities of any of these public health officials we've talked to. thank you for that. thank you for coming on and sharing your expertise with us with a national audience. much appreciated. up ahead, new jersey governor phil murphy joins us. h. who has time for wrinkles? neutrogena® rapid wrinkle repair®.

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in addition to the substitute teaching. i honestly feel that that's my calling-- to give back to younger people. i think most adults will start realizing that they don't recall things as quickly as they used to or they don't remember things as vividly as they once did. i've been taking prevagen for about three years now. people say to me periodically, "man, you've got a memory like an elephant." it's really, really helped me tremendously. prevagen. healthier brain. better life. this virus is testing all of us. and it's testing the people on the front lines of this fight most of all. so abbott is getting new tests into their hands, delivering the critical results they need. and until this fight is over, we...will...never...quit. because they never quit.

welcome back. in an oval office appearance earlier today, president trump and new jersey democratic governor phil murhpy were quite cordial. but moments ago president trump mentioned that blue states are struggling more than red ones. >> they want to help the states. they want to help bailouts. bailouts are very tough. they happen to be democratic states. it's california, it's new york, it's illinois. you start with those three. and the republican states are in strong shape.

i don't know. is that luck or is that talent? or is it just a different mentality? but the republican-run states are in strong shape. >> joining me now just hours after that oval office meeting with president trump is new jersey governor phil murhpy. so, governor murphy, let me get a reaction to just that comment. how would you respond to the president if he said, boy, you blue state governors, you must be doing something different. all these red state governors are in great shape. >> good to be with you, chuck, first of all. secondly, i haven't seen the clip till you just played it. that wasn't reflective of -- we had a very productive conversation i have to say. i thanked the president for a lot of help from his administration, everything from ventilators to we just announced a huge amount of testing supplies and ppe going to nursing homes, really helpful and thanked him for that. and we had a very good discussion about finances.

and this has been a body blow not just to new jersey, and i think it's been to blue and red states alike. and i think there's a myth that this is somehow connected to legacy issues. and we had a constructive discussion about the fact that that's not what it is. this is about firefighters and police and teachers and ems folks keeping them employed, keeping them in the service of our residents. so, i think this is a huge priority nationally. i know it is in new jersey. i think states need that financial support to keep doing what we're doing. >> you know, governor, you've taken a different tact with this president than others have. and i think many people would totally get it. in that you've got to have a relationship with him right now. it's necessary. are you uncomfortable when he does political bashing with you sitting there, he beat up the obama administration, you sat there pretty mute. you've chosen a different

tactic. explain. >> i mean, chuck, here's the reality. i don't get the luxury of waking up this morning and figuring out or picking who my president is going to be. the president is donald trump. the vice president is mike pence. that's the team that we've worked with since moment one on this pandemic. do we have disagreements? do we see history differently in some cases? do we see issues differently? you betcha. my job is the chief executive of this state is to represent the 9 million of us as best i can including save as many lives as i can. and there's no substitution for the existential role that the federal government can play. and so we've been able to find that common ground. and, again, i'm grateful for it, i thank the president for it. that doesn't mean we disagree and stuff, we do. but for the stuff that we need right now for this pandemic, we've found a significant amount of common ground and i'm

grateful. >> i'm curious behind closed doors, when you would tell him, he'd say, hey, i want to reopen new jersey, got to see it going, got to see atlantic city, all those things. and you tell him, well, here's why i'm not doing it yet. where has he pushed back, and where has he backed off? >> i'd say it's been largely in private, very constructive as it relates to re-opening. he knows that we put out a six-point plan on monday, which the health pieces of which are very consistent with the guidance we got from the white house. we put a commission on tuesday including a bipartisan group of wise women and men. we announced yesterday that assuming people social distance and cover their face and don't congregate that we're going to be opening upstate and county parks and golf this weekend is sort of an experiment. are we able to get back out there?

that's a discussion he and i had constructively two or three weeks ago. but it was, hey, what's your thinking on this, what are you looking at as opposed to you should do this or you this do that. that's not been the nature of our deliberations publicly or privately. >> well, his favorite place to golf in new jersey is his golf club there in bedminster. i'm curious on the issue of tests. have you gotten a better explanation from him in person as to why he doesn't want the federal government to play point on this that he wants to continue to play more of a supporting role and let you guys take the lead? >> we got today -- listen. i would describe it as a partnership, and that's sort of what i think it is and what it's going to be. and my view is if that's what the terms of arrangements look like, let's maximize that. so today we got over a half a million test kits, over 750,000

swabs. i would call it a joint venture. we needed a certain amount -- a significant amount of the supply chain from the administration to allow us to at least double testing in new jersey. we got it. and we're going to take care of the responsibilities on our side. we've come from nowhere to being the third or fourth highest tested state in america. so we've come a long way. but we need to keep going to a much higher number, and they're helping us out. >> all right. governor phil murhpy, democrat of new jersey, you've had a busy day going up and down the east coast. thanks for spending a little bit of time with us as well. much appreciate it. >> good to be with you, chuck. thank you. up next, protecting our front line workers from the psychological toll of working to save lives in a pandemic. oh, that's a good one. wait, what's that? that's just the low-battery warning. oh, alright. now it's all, "check out my rv," and, "let's go four-wheeling." maybe there's a little part of me that wanted to be seen.

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what do we wburger...inner? i want a sugar cookie... wait... i want a bucket of chicken... i want... ♪ it's the easiest because it's the cheesiest. kraft. for the win win. too much detachment, and you stop caring for your patients. you lose your humanity. too much empathy, and your humanity swallows you whole. you're paralyzed by an ocean of tears and heartbreak. >> welcome back. that particular sound bite from a couple of weeks ago struck me so much when we first heard it that i wanted to play it again for you tonight. it's gut wrenching to hear from the health care workers as they're speaking up about the significant mental and emotional strain of treating coronavirus patients that strain was driven home earlier this week after dr.

lorna breen who treated covid patients at a hospital, got covid herself and took her own life. after working around the clock to help a number of patients took a heavy toll. >> she had 12-hour shifts, and when she finished, she said i can't leave. nobody is leaving. i have to stay and help. and i kept telling my sister, if you can't function, you can't help anybody. you have to sleep. you to rest. she didn't want to give up. she would not give up. she would not let it break her, which of course it did. >> even before the virus, health care workers had high rates of burnout. in a study nearly 44% of physicians reported burnout symptoms. joining me is dr. collin west, professor of medicine at mayo clinic. he has studied well-being, stress, burnout in health care workers for more than 15 years. dr. west, i know that there are

systems in place where you try to keep health care workers from getting too emotionally attached. for instance, i remember when my own father was in the intensive care unit, they made sure the rotation in intensive care was in such a way where the goal was no medical worker would get to know a patient because ideally they'd be gone after a week one way or another. sadly, my dad was there for a long time, so we did get to know these folks. bhau can be done here? this feels like this is going to be an ongoing struggle for health care workers for months and years to come. >> good to be with you, chuck. thanks for having me. i think you're right, and i think, you know, the stories with health care workers such as dr. breen and others are heartbreaking. medicine is a caring profession. and as your sound bite at the

beginning told, there is a balance we have to be very careful about. we can't detach from our patients, and we're not physicians. we're not providing the care that provides meaning for us and that our patients need. we've studied this for a long time, and i think that's important to keep in the background. because even before covid-19 arrived, the health care profession was facing struggles. burnout rates that were far above the general population. and then covid-19 hits us. and we have especially in the hardest affected areas long hours, wave after wave of critically ill patients, you know, unclear if resources are going to be adequate to meet the demands. all of that is incredibly stressful. and so approaching solutions to that issue i think first has to acknowledge that the stress is real and our physicians are health care workers, because this is not just physicians.

this is nurses. this is respiratory therapists. this is our learners, our emts, our custodial staff. they're in medicine to care for people. so we need to be able to support them while they're caring for people, not suggest that they should care less. >> this issue of this trauma, we know that the members of the military can experience too in the same seeing all of that. is there any have you been studying the amount of work -- i know the military community has done studying ptsd. how much similarity is there here? >> i think there is overlap, and i don't want to be careful because i'm not a mental health professional. i'm an internist. but i think there are analogies to be drawn, and i think some of those lessons include when you go into the fray, when you're

going into the stressful situation, one of the keys to promote well-being is you go in with as great a sense of safety as possible. so people need to have good nutrition. they need to have good sleep/wake cycles. they need to have personal protective equipment. all that of is really important. but we also need to support them emotionally. so when they come out of a traumatic experience, are there debriefing sessions where they can process those experiences in a potentially more effective way, rather than internalizing them and having them fester. are there counsel ling availability, and again, back to the trained mental health profess professionals. are they available to allow people to navigate these challenges while they're taking care of patients to the best of their abilities. >> are you concerned that the incentives sometimes create a problem? if you're on the front line, you're on the nursing staff,

maybe you can get paid more if you work an extra shift or longer hours, and yet that could mentally deteriorate you and cause you more problems. do you think we've got to change some of these financial incentive structures? >> well, i think, you know, i'm fortunate where i am because we're on a salaried structure here. so the extra work hour, i'm incented to take the best possible care of patients. i would love to see that something be more widespread, dweend have literature that suggests just to your point that purely productivity-based payment models are associated with increased distress. we're not very good in medicine at understanding our own boundaries. and sometimes we will run toward a problem so energetically that we don't realize that it's penny-wise, pound foolish. >> got you. >> we're using ourselves up in the short-term, and we can't be there for our patients in the

long-term. we need our systems to help protect us from that. . >> right. dr. colin west, thanks for bringing some thoughtful expertise to this issue. much appreciated. and we want to remind you of the following. if you or someone you know needs help right now, then call the national suicide prevention lifeline. it's available 24 hours a day, seven days a week. don't be shy. the number is 1-800-273-talk. that's 1-800-273-8255. and that does it for me this hour. thank you all for trusting us and watching us. msnbc's breaking news coverage continues after this short break. break. ing you can be certain of. the men and women of the united states postal service. we're here to deliver cards and packages from loved ones and also deliver the peace of mind of knowing that essentials like prescriptions are on their way. every day, all across america, we deliver for you.

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