 Developing overnight, President Trump activating the National Guard in three states that have been hit hardest by coronavirus, New York, California and Washington. It comes as governors across the country plead with the federal government for supplies. Joining us now, Dr. Daniel Varga, Chief Physician Executive at Hackensack Meridian Health, New Jersey's largest hospital system. He is leading their medical response to coronavirus. Also with us, Arlene Van Dyke, a critical care nurse at the Holy Name Medical Center in New Jersey. And CNN national security analyst Julia Kayem, she's a former assistant secretary at the Department of Homeland Security. And Julia, I want to start with you with the news of calling in the National Guard for these three states. What exactly does that mean and what can they do? So it means that essentially their status has changed from what's called state active duty, which is the governors control them and tell them what to do and pay to what's called Title 32. It is just a way for the governor still to be able to utilize them so they're not under Trump or the Secretary of Defense, but the feds pay. And generally the status is when there is a national crisis or national security crisis. We use this after 9-11 when the National Guard was used to protect airports. So it's just a money shift. It actually relieves the burden on the states. It's good that it was extended to those three states, but President Trump probably should prepare to extend it to all 50 states so that governors can begin to get their National Guard ready, building things, preparing, helping with logistics, supply chain, all the things that the military is really good at doing simply to relieve the stress on public safety and public health that are under tremendous stress right now because of patients. Erica? What's still to come. Dr. Varga, as you look at this and you're working on your preparations, how are you trying to game out this timeline so that you can make sure you're prepared all the way through? Well, I mean, right now the four biggest areas are clearly going to be testing masks and supplies and making sure the supply chain is there. Staffing is going to become a really big issue very soon and then also capacity management. We're right now at critical levels relative to the timing of getting tests done, relative to our access to masks. We have probably three to five days of N95 masks left. We're already reinstituting all sorts of different types of staffing models to be able to kind of stretch the highly skilled nurses that we have right now across as many patients as possible and we're reactivating and turning on new areas of capacity almost every day. Arlene, what are you seeing? You are on the front lines interacting with these patients as they come in. What has that been like? Well, you know, as we are all aware, these patients are extremely critical ill. This care becomes very challenging, very stressful for those of us at the bedside. There's obstacles that we become creative in trying to get around and then we have the emotional aspect that we are all dealing with. These patients are on ventilators. They're on multiple IV drips and medications somewhere, sometimes anywhere between five and 10 drips along with other medications and physical care that needs to be provided. So it's extremely challenging and stressful. Can I begin to imagine, Juliet, as we look at what could be done, there's so much talk about the Defense Production Act and the president having not really formally invoked this despite him going back and forth on it. There's a lot of reporting in the New York Times and the Washington Post this morning about companies being confused as well. What should happen at this point? What should and should have happened, if I could just pause for a second and thank my other panelists for what they're doing to protect all of us. It's remarkable. The Defense Production Act is actually genius in the sense that it allows a president to not simply invoke, that's what Trump has done, but to turn on manufacturing. So basically, the president would say to companies, look, I need half a million ventilators or a million masks or whatever the number is. And then they would be certain that there was a purchaser. That's the point of this. And so what you're seeing in the reporting is these companies are saying, I can switch my manufacturing. I just have not been guaranteed a purchaser, so I'm not going to waste my time building something where I don't know that there's a purchaser. The other important thing is that the Defense Production Act prevents price gouging. So basically, what we're hearing from the governors is that they're competing with each other rather than a unified approach. What would be the better thing is that Donald Trump not simply invokes the Defense Production Act, but he actually turns it on, starts surging. These materials that we already know we need pays the private sector. And the private sector is happy because they're not only satisfying a national interest, but they're getting paid for it. It is the simplest, most genius act coming out of the Korea, in response to the Korean War and why the president isn't moving forward has something, as he said yesterday, to do with his concerns that we would be like Venezuela. This is not a taking of the private sector. This isn't taking over manufacturing. It is just prioritizing the production schedule and guaranteeing to the private sector that they actually have a market. And it ought to be used. It should have been used two months ago when we knew what we would have. And we're hearing that the private sector is ready. They're ready. They just need an order. Let's be clear. The president's talking about the act, but he is not using it yet. And he could, and that's a choice right now. Yeah, he's turned. I described it as he's plugged in the microwave, but he hasn't pressed start. Right? That's all he's done. Well, what's the use of having it plugged in if you're not going to use it? Right. That's his choice right now. We're waiting on that. Dr. Varga, you say you are spending a lot of your time now creating space, opening up beds, creating systems to take in, I think, what you consider to be a wave that is beginning to come right now. Tell us how you're doing this. Creating the space. Why? And also these triage tents, I understand, that you're going to erect outside some of these facilities. That's right. We actually have multiple things we're doing right now. We've erected tents outside several of our facilities, which are largely for triage of infectious patients as they come to the hospital. We've also relocated to mobile emergency rooms to two of our largest campuses, and those are actually in place right now. Some of the most amazing stuff I've seen, though, is we're actually turning regular medical surgical units in our hospitals. For example, Hackensack University Medical Center has kind of almost overnight is turning med surge units into ICUs in the most creative ways. I mean, they're cutting holes in doors and putting windows so nurses can look and observe patients. They're taking windows out of the rooms and putting big filters that help ventilate contaminated air outside. And literally, we are filling them up as we bring them online. As we're hearing about some of these changes that are happening at Dr. Vargas Hospital, Arlena, I'm curious, we're talking so much about what you are facing on the front lines. How much input have you and your colleagues have in terms of the changes that are coming your way as you adapt really? I'm imagining on an hourly basis, not just a daily basis. Right, yeah. So, you know, as I mentioned, we every day are dealing with obstacles that we are becoming very creative and overcoming. Our administration has been extremely receptive and responsive to things that as critical care nurses, we have come up with different ideas that could be done. And if it's feasible and it's safe, they do it for us. And pretty much whatever we question or ask, they are very compliant with us. Our hospital is going through changes every day. They are creating rooms of negative pressure. Our ICU went from two negative pressure rooms to 19 negative pressure rooms within a matter of three days. We are constantly 24-7 expanding our capability to accept more patients and be able to take for them. Juliet, I want to read you something that President Trump wrote overnight. And I want your help trying to understanding and understanding what it means and the significance going forward. He writes, quote, we cannot let the cure be worse than the problem itself. At the end of the 15-day period, we will make a decision as to which way we want to go. We cannot let the cure be worse than the problem itself. And I will tell you, that's something that you do hear out there in the world right now that by shutting everything down, we're creating problems that may not be as bad as if we just let coronavirus run its course. But there seems to be a suggestion that the 15-day period may be it. It's hanging in the balance. What do you take from this? So it's a surprising tweet. So let me just make it clear, no country has done this in 15 days, not even the most aggressive totalitarian countries. So this 15 days is just, I think, was a way of sort of making it easy on us. We are not doing aggressive national, nationwide social distancing. So it's a bit of an experiment. Social distancing buys us time. What does it buy us time for? Well, on the far end is a vaccine which no one thinks is going to be distributed for another 18 months. But well before that, there's going to be mitigation measures. There's going to be treatment. There's going to be greater capacity to help the doctor and the nurse. There's going to be other ways that we can protect people, more testing, for example. So we're just buying time. This 15 days is bogus. I mean, it's just a number out there. We will see where we are in 15 days and my concern with this tweet, and I've been wondering what Trump's plans are, is that he has been looking for a quick fix, a vaccine, a treatment and now a date certain. There's no quick fix. And I think an honest White House, as you see even Dr. Fauci trying to sort of prepare us, would prepare us that this is really hard. And in fact, it's going to get harder until it gets easier. We've got to sort of flatten the curve, protect our hospitals and then surge resources. But people who want to get out, right, we do have to balance the economy and other needs. We know that. But for people who want to get out at day 15, what they won't answer is what do you do when our health care system collapses? As we're hearing from the doctor and nurse, they're barely a day from that happening. You can't have a functioning society where people cannot access health care. So those people who want to date certain answer that question, and I think Donald Trump's not able to. So we will see a week from tomorrow, I believe, whether Donald Trump is willing to sort of prepare us for the long road ahead and surge resources to protect our health community and to protect people like the doctor and nurse here who are on the front lines. It also begs the question, how many deaths is he willing to accept? It's a provocative statement. It really is. It is. All right. Juliet, thank you. Guys, stand by, much more to discuss coming up. The number of coronavirus cases in the world, top 340,000 in the United States, we have more than 400 deaths as cities across the country, including some of the largest, are saying that they are bracing for a wave and they do not have the supplies that they need. Back with us, Dr. Daniel Varga, Chief Physician Executive at Hackensack Meridian Health and Arlene Van Dyke, a critical care nurse at Holy Name Medical Center, both in New Jersey. And Arlene, I just want people to understand what it is like for you to interact with these patients who come in concerned that they have coronavirus. What is the actual interaction like? Well, in the critical care department that I'm in, we're at the front line where these patients, unfortunately, have already taken a turn for the worse. They are the sickest of the sick and they're coming to us on respirators. Emotionally, we're dealing with the families who cannot be with their loved ones, cannot see their loved ones, and the care becomes very challenging. Yeah, I was going to ask you about that. These are people who, by definition, need to be alone, separated from their families. What's the protocol there and how difficult is that? Right. So, you know, emotionally for the nurses, that's a very difficult aspect because, you know, in providing quality care, the families are included. And in this crisis, the families cannot personally, physically be included at the bedside like we usually would do. So ways that we're adapting to that is we will put families on iPad Skyping just as like what we're doing now so that they can see their loved ones. And more importantly, that they can speak to them and feel that they're connected to them even though they cannot be personally at the bedside. Dr. Varga, I don't want you to wait into politics because it's more important that you save lives. But I do want your take on something the President said and what the possible implications of it would be. The President said in a statement overnight, he wants to make sure that the cure isn't worse than the problem and that he would reassess this 15-day call for social distancing at the end of the period based on what you're seeing. What would happen in your hospitals if at the end of this 15-day period, we're only a few days in right now, the President were to say, okay, we're done. What if we stopped now in terms of social distancing? What would happen, Dr.? You know, it's hard to say. The one thing you can say for sure right now is that the spike in cases is continuing and it's on its exponential part of a curve. So we haven't seen the peak yet. And anything to do, as Juliet was mentioned earlier, to flatten the curve is going to be incredibly valuable. But the way this virus works, its incubation period, et cetera, we don't know who's infected right now. The best thing we can do is to actually maintain the social distancing, wash your hands, not come to the ER if you're, you know, minimally sick. If you can, take advantage of the testing centers that are around so that you know, more importantly than anything, take care of each other. But I don't think we're going to see even the peak of this for several weeks. Are you set up at this point to handle what you fear might be the peak? You know, it's a good question. I mean, I think we've done a lot of things just like a lot of health systems have done. I mean, we've canceled elective procedures. We've done, you know, as I already mentioned, a marvelous job of trying to convert space to create critical care capacity. My big concern going forward is really going to, is really material and the toll this takes on our folks on the front line. I mean, these folks are the most collaborative, compassionate, courageous and creative people you've ever seen in your life. They're standing in the breach. We're trying to get them the stuff that they need to really manage what they're seeing every day. But the big issue is going to be material and the ability to continue to support our frontline caregivers. We'll find space. It's really more of the supply chain and the human cost. It's physically exhausting. It's emotionally exhausting. And what you are both doing is saving lives and keeping us safe. So we appreciate it. I wanted to thank both of you, Dr. Daniel Varga, Arlie Van Dyke. Thank you very much for what you do. We know how hard it is. Thank you. Thank you.