Good to see you. Well 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 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 covid19. Today the reported number is more than a million and at least some of the death and i can domincom economic damage could have been avoided if we started testing earlier. As more states prepare to work out, were far from the end and mid crisis lesson to learn our past failures do not need to dictate actions. As former head of the world bank wrote in the new yorker next week, its not too late to go on the offense against the coronavirus and there are promising signs that our offense efforts are working but well only succeed if were guided but one thing, thats data. There is no other way to defeat coronavirus. Owl of our decisions must be based on the evidence available to us not on the basis of political advantage or 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 will give us a muchneeded reality check on the news of treatment, breakthroughs and vaccine development. Also ahead, Major Concerns about testing. Labs that are sitting idle, Antibody Tests wildly inaccurate and unregulated. Well talk about what is broken and more importantly how to fix it. Miami major Francis Suarez a covid19 survivor will be here in a few minutes. Mayor suarez is at the heart of the debate while florida is opening some as speblpects of i economy, the center of Miamidade County is staying shut. It a difficult state that playing out across this nation and that is so difficult because 30 million americans and thats most likely an under count are out of work, desperate for their next paycheck. Tonight, well 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 us it is safe to do so. So lets 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 issued an emergency authorization for Gilead Sciences anti viral drug remdesivir for patients with a severe case of covid19. The fdas nod came after dr. Anthony fauci said the trial data showed that the drug had a quote 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 drugs use for patients earlier in the course of their illness. Here is the ceo of Gilead Sciences on the today show. We were prepared and ready for this virus because of some of the work weve done with remdesivir for the past decade, and at that same time we put remdesivir in Clinical Trials, we 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. Meanwhile, america is starting to reopen. More than half the nations governors are relaxing pandemic restrictions in their states while hoping that the Novel Coronavirus doesnt spike setting off another round of closures but there is good reason for that caution. A new report from the university of minnesota suggestions that the coronavirus pandemic could stretch on for two more years with reoccurring spikes until roughly twothirds or more of the population has developed immunity. We have two pieces of news tonight from the white house. Nbc news is reporting that the white house 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 thats investigating the coronavirus outbreak in response. The white house said it would be counterproductive to take him away from his work but while hes blocked from testifying before the house, nbc news also learned late tonight that a spokesperson for the Senate HealthCommittee Says that dr. Fauci will testify before that committee on may the 12th. Okay. Thats the catchup on where we are in the news. I want to bring in dr. Zeke emanuel, a physician who served as a Health Policy advisor in the obama administration. Hes now the vice voice for initiatives. Great to see you as always and as always, were loaded with questions for you. And the first one starts with remdesivir, whats the situation with this drug . Lets 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 gwinnegenetic 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 theyve 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 oxygen 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, 8 of patients died who received remdesivir and 11. 6 died who received placebo. That didnt mean that it was enough. It could have happened by chance so that was the result. That led the fda to say theres enough information here probably the benefits are better than the risk and well give this an emergency approval. Dr. Fauci among others said this is an encouraging first step. Its clearly not a home run for anyone. Let me just say a couple words in caution. This is good but not great. Were 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 weve approved the drug, its going to be hard to do a placebo controlled trial. Well 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 will be. Right. And a statistic we talked about a little last week that it is much harder than you think when were trying these new drugs if you want to try and get a result that is statistically significant you need a whole lot of people in the drug, in the trial. So theres complexity in developing therapeutics and vaccines. Thanks, zeke. Lets continue this discussion with miami mayor Francis Suarez. In march he was quan attornrant 18 days after testing positive for coronavirus himself. Hes joining us now. Good to see you. How is your health, first of all . Im doing well, thank you, ali. I had to quarantine like you said for 18 days. Ive been out of quarantine since then. Thankfully, i have not had any sort of after effects of relapses of any kind so ive been very fortunate. Major, yomayor, we wanted to you because what you go through is refective a lot of the country. Youre a mayor of a major center with an interchange of a lot of people. You started restrictions in miami earlier. You are not ending them as early as other people are but its boundaries between your city and neighboring cities are pourous. 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 stayathome orders. Right. And its not only pothat but we have a very Large International airport. To give perspective, our International Airport receives 50 million passengers a year. That is twice the population of the state of florida. Even now when its operating at a diminished capacity, 10 of its capacity, its still 5 Million People which is twice the size of our county, which is a large county of about 3 Million People population. Its almost twice the size. So were grappling with not only internal threats of of course maintaining social distancing, staying at home and making sure residents remain disciplined so that we can continue to reduce the number of new cases, but were also dealing with external threats. So you know, its a very challenging dynamic and were doing the very best we can trying to be as proactive and careful as possible because of so many lives at stake. Mayor, let me ask you about the idea in many states, theres a tension between those resident whose dont live in mayor centers like miami or atlanta where the mayors want to keep things a little more tightly controlled for awhile and people in other more spread out areas where theyre not seeing the same incidents of coronavirus and putting pressure on governors to open up. How is that working in florida because you have a governor ready to open things up . Yeah, 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 thats why we have done that. The data that were 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, and 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 were trying to interpret the data, the criteria that everybody talked about is of course, 14 consecutive days of diminishing covid19 new cases and also, diminishing complaints of influenzalike symptoms. And were not quite there in terms of how we feel the data should be interpreted. Were looking at it every day. We get two reports a day, two reports of hospitalizations every day and looking at all that to make a prudent decision. Its a very fine balancing act we as a major city have to make. 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 . Of course, we are, doctor. You have to understand that i was patient number two, literally, in all of Miamidade 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 covid19 from a delegation 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 were at right now. So, you know, were trying to be careful and do everything that we can to avoid that second wave from happening. 12,257 and more than 350 deaths. Mayor, thanks very much for joining us and for your leadership on this right from the beginning. Francis suarez. Still to coal come, youve the news of a vaccine being hailed as a breakthrough but should we believe the hype . The squeeze on workers that just cant work from home. President trump orders meat packing plants open and some republican governors say if you dont return to work, you wont get unemployment, either. Up next, important questions about accuracy of testing and a new theory about how long you could spread the virus if you have it. Ow long you could spread the virus if you have it. When managing diabetes you cant always stop for a fingerstick. With the freestyle libre 14 day system, a continuous glucose monitor, you dont have to. With a painless, onesecond scan you can check your glucose with a smart phone or reader so you can stay in the moment. No matter where you are or what youre doing. Ask your doctor for a prescription for the freestyle libre 14 day system. You can do it without fingersticks. Learn more at freestylelibre. Us. Since the coronavirus pandemic began, there is 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. Anybody that wants a test can get a test. Thats what we started tonight, the United States has 1,102,937 confirmed cases of coronavirus. Now the actual number of cases is likely much higher, but we dont 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 used 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 according to an op ed in the wall street journal written by two neuro sicientists from Michigan State university. Our Research Team used food and Drug Administration guidelines in a scientific report from wuhan, china to develop a covid19 test in early march. It took one week. Our test doesnt use the reagents other labs 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 clea. Most 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 chance National Neuro science at Michigan State sorry, translation neuro science and talked about his labs diagno diagnostic test known as a pcr test and what it would mean for the fight against coronavirus. 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 get a saliva swab and you 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 . 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 take it and 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 signal and through that signal, we end up seeing whether weve amplified the genetic code virus and if we did, well get a bright signal and that produces a reading on our machine and that tells us if we are indeed having the presence of the virus. Now youve been reported to be out there saying that, you know, if we got harnessed a lot of act dem maademic labs like y that arent doing research because of covid19, you could generate 500,000 to 1 million copies you were quoted as saying, 1 million tests a day, 500,000 to 1 million tests a day. Is that really plausible . I think its absolutely plausible. I think its basic math. There is easily 10,000 labs out there that can run this kind of test. The realtime pcr system is very common in biology laboratories and anyone from a plant biologist to a neuro scientist, i happen to be a neuro scientist, we all use these tools. Youve seen a barrier youve 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 . So, the main problem is that in order to run any of these ac. It involves getting a Board Certified laboratory director, thats something as an example i cant 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 were 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 the scientists and precertify them for this kind of work, we could stand this up whenever we need to without developing huge amount of infrastructure, right now the test costs for reimbursing for coronavirus testing is now at 100 a sample. Cms, which is the center for medicare and Medicaid Services is paying 100 per sample and thats because they need to hire more people and buy more equipment at places like Quest Diagnostics or lab core and if we were able to use the existing infrastructure we had, that universities, we would be much better equipped and wouldnt be spending money on equipment and lab labor. We can utilize the people for 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. Whats the most interesting thing you found since doing covid19 t