A single line often inverts meaning once you see what it
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November 25, 2020 - Global USA 11:00 AM call with Azar regarding the role of ACIP in the recommendation for the prioritization of the distribution of vaccine starting in December. Azar feels (with advice from Bob Charrow) that ACIP has no statuary authority of being involved in the process. Azar wants to act early to without ACIP involvement get vaccine to both HCWs and nursing home and other vulnerables (aged). This would require using all of the first supply as the prime (and not withholding half the doses for the boost), thus allowing us to vaccinate more of the high priority group and depend on the integrity of the supply chain to supply the booster doses. His intent is good, but I point out that this would be a PR disaster since we have been saying all along that an independent body (ACIP) would be very much involved in these recommendations. It would be interpreted as sidestepping a established process by political influence. My argument turns the tide to get ACIP involved with us from the beginning. They may agree with us (which is great) or they may not whereby we can say we included them in the process, but we do not accept their recommendation Ron Klain texted me last night after midnight. I was asleep. He sent me video of Joe and Jill giving Thanksgiving message to be careful over Thanksgiving. I will speak with Ron Today. Ron just texted me and said that they decided on Rochelle Walensky for CDC director on my recommendation!! PRESS: Good Morning America (ABC) with George Stephanopoulos; C-SPAN Washington Journal; WINS Radio (NYC); WGN TV (Chicago); Byron Allen and GRIO, an African-American online TV interview; Huffington Post (Jeff Young) - writing a piece on "A Day in the Life of Dr. Fauci"; McClatchy (Mike Wilner) print interview on vaccines; Kaiser News Interview (Lauren Weber); Interview with Scientific American (Charles Schmidt); November. 26, 2020 (Thanksgiving) Global - 59,800,000/1,400,000; 12,700,000/261,300 USA Surge continues Trump not addressing the outbreak at all Consumed with blasting sway at people and pardoning people like Gen. Flynn. Georgia Senate re-run about to occur to determine control of the Senate. Went on walk with Will and Joli to Mall and was "mobbed" by well-wishers who wanted photos with me. Went to the steps of Lincoln Memorial and read the speech of Lincoln on the opposite wall of the Gettysburg Address. Strikingly referable to today: "Men who worship the same God can be so far apart on fundamental issues...." PRESS: U.S. News
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Nov. 25, 2020 / 8:44 PM Fauci, Harris top 'Time' 2020 Person of the Year nominees 10, .-- 12,800,000/263,000 27 November 2020 There are 279 atetes in the red sone and 11 etates if orange zone = 40 etates in full recurgence however cases are increasing e¢roas all etates including the mare populous etates which will significantly increase hoepitalizations and fatalities - data will be unvtable including fatalities due to reperting changes All major metros have or are exceeding the apring and summer aunpe cased except for NYC, Ma, HOU but their rate of rise could drive then ever their priar highs in days Ihave included C4, IL, TX, PA the primary drivers of the large national numbers of cases and fatalities at this time The duration of rising cases and the rate of rise is greater than the spring or summer whech will prolong the high fatalities forthe next 4-6 weeks rapedly reaching over 200,000 American fatalities rapidly (Mov testing willbe the same at Qct) and & mot increasing at the rate of increasing cases, hospitalizations and fatalities We need to make it clear that choices (state and metro policy choices and personal choices} will drive a post Thanksgiving surge because of the underlying high viral load that will be an oversvhelming threat to the health care system. Many states are inadequately mitigating including sunbelt states that mitigated well in the summer. Aggressive mitigation needs tohapgen now to prevent a catechysmic Holiday season forthe hosgitel systems. CFR; population will correlate with bevel of mitigation. The mitigation choices states are making or not making will direct correlate on level of fatalities. The impact of these choices om human life will be very evident. Current improvements are seen im 1-2 states aggressively mitigating and it will be wery evident over the mext G0 days that mitigation saved lives and the lack of mitigation resulted in unnecessary high fatalities - States that did not mitigate in the Fadl surge will end up with population CPR equal to the Spring surge when treatment was subogtimal - WD, $0, M7 -- states must be encouraged to advance policies that mitigation against this Fall viral sunge We found the friends and farnily small gatherings driving hospitalizations during the state visits but we also kncew that those drivers agpeared im the sunbelt after the states fully mitigated in the public spaces -- including significant reducing capacity or closing spaces where masks cannot be vweonn Euroge countries with clear polcies are Improving rapedly with aggressive containment with mitigating policies and clear communication and are carefully reopening There are ow 27 States in the red and orange for hospitalizations of COVID cases -- care deteriorates across all patients with and without OOVID when states enter the red zone -- there are nore states in this category everyday New daiy COVID conflrmed admiisons are over LODO day and inpathent COVID patients reaching histori: haghs BODO linoeading LOKweek), nearly 45%) of all confirmed OOVID admissions ane ower 70 and CFR remains mear 10% for those over 70 and near 1% for those 40-69 - ye will reach historic highs im dally fatalities Although we were beginning to see early signs of decreases iin the rate of rise of hospitalizations I remain deeply wonred about apost Thanksgiving surge that will once propel us towards 450,000 deaths as the Fall surge continues Inte the winter ifwe cant both mitigate in publbc spaces and convince Americans ofthe danger There are state examples of changing the rate of rise of cases to change the ragid rise im hospitalizations to preserve hospital capacity -- this isino kenger about preventing a crists -- this is a crisis -- thits is about trying to save as many lirees as possible within the criss and we have examples of states that are improving 1, The virus is accelerating faster than our response and this requires am even further accelerated and comprehensive Federal response with aggressive support to States te include strong statements that Europe and States with strong mitigation are improving = there is a clear roadmap to contain this virus and preserve the health system: . Continued aggressive communication at the WH level masking requirements at all times outside of immediate household, physically distancing, hand hygiene AND critically limiting of social interactions to the immediate household for the next 60 days while we bridge to the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : this is a short term sacrifice to protect the vulnerable, We must directly confront the myths that many Americans believe . Many Americans believe that masks don't work due to prior tweets, that the epidemic is a hoax, that the figure of 94% of those whe died had co-morbidities meant that they died from something else and we have inflated the fatalities - instead of understanding that the co-morbidities predisposed them to severe COVID ' Clear recommendations to States about the importance of short term mitigation interventions : restricting indoor dining and limiting and/or closing areas of congregation without mask (bars, gyms etc.) this was successful in the USA in the summer and was successful in Europe during their fall surge = states across the country are not mitigating adequately to preserve the health system . Continued critical guidance on the Holiday season to limit indoor unmasking across households if they choose to gather ' Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger community spread in waves =a hand full of states are moving in this direction . Expansion of MAT testing now to ensure colleges can access routine regular cost effective testing in January . Expanding frequency of LICF testing and aligning early vaccination into LTCF . With Moderna's potential of one shot resulting in some protection - aggressive immunization of the elderly could dramatically change hospitalization rates and fatalities in the next 30-35 days . Ensuring rapid tlering of thase most vulnerable to rapid vaccine immunization access immediately upon EWA = this may require implementation support ta the states and full utilization of federal qualified health clinics
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November 27, 2020 - Global - 60, 300,000/1,400,000; USA - 12,800,000/263,000 Now concerned about the post-Thanksgiving surge 2a) New Daily Confirmed COVID-19 Cases in the U.S. 2M FA EE \ Fy od Confirmed a : ps i a Mi qm oy say FF .-- 13,000,000/264,000 TRENDS IN HOSPITAL INPATIENT COVID UTILIZATION DURING THE LAST 8 WEEKS a --. Inpatient bed utilization cubegporien I heed OF ae Pe a a 'ik Hartharr, Markee: in bere Serene. Seeer Sernaehirs I J = ont by _ sap ry PP PPP rebate ee sae Record number of hospitalizations at >80,000
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November 28, 2020 - Global - 61,300,000/1,400,000; USA - 13,000,000/264,000 oy Be Ue Rb pe iad 10. 11. 12. 28 November 2020 There are 29 states inthe red zone and 11 states in orange zone Data is unstable due ta Thankselving but in summary -- testing rates are static compared te October Cases are increasing especially in CA = incredibly high case counts despite Thanksgiving, the NorthEast, the Sunbelt with significant deterioration in AZ Data will be unstable including fatalithes due ta reporting delays -- but haspital new admissions should be real time and I will be tracking those carefully Hospitalizations new admissions and current inpatients with COVID approaching 100,000 but the rate of rise is slowing and next week could plateau There are now 29 States in the red and orange for hospitalizations of COVID cases -- care deteriorates across all patients with and without COVID when states enter the red zone -- there are more states in this category everyday This will allaw us to fully see the impact of Thanksgiving travel and gathering in 2 weeks a5 we should have peaked and should have declined We need to make it clear that choices (state and metre policy choices and personal choices) will drive a post Thanksgiving surge because of the underlying high viral load that will be an overwhelming threat to the health care system. Many states are currently Inadequately mitigating including sunbelt states that mitigated well in the summer. Aggressive mitigation needs to occur now to prevent a cataclysmic Holiday season for the hospital systerns. CFR and deaths/iM population will correlate with level of mitigation. The mitigation choloes states make or don't make will direct correlate with cumulative level of fatalities. It is net te late with the Holidays coming to change. The impact of these cheices on human life will be very evident. Current improvements are seen in 1-2 states aggressively mitigating and it will be very evident aver the next 60 days that mitigation saved lives and the lack af mitigation resulted in unnecessary high fatalities - States that did not mitigate will end up with population CFR equal to the Spring surge when treatment was suboptimal - NG, 50, MT-- states must be encouraged to advance policies that mitigation against this Fall viral surge We found the friends and farnily small gatherings driving hospitalizations during the state visits but we also know that these drivers appeared in the sunbelt after the states fully mitigated in the public spaces --including significant reducing capacity or closing spaces where masks cannot be warn Europe countries With clear policies are improving rapidly with aggressive containment with mitigating policies and clear communication and are carefully reapening Although we were beginning te see early signs of decreases in the rate of rise of hospitalizations I remain deeply worried about a post Thanksgiving surge that will once propel us towards 450,000 deaths as the Fall surge continues inte the winter If we can't both mitigate in public spaces and convince Americans of the danger -- convincing Governors and Mayors naw to mitigate post Thanksgiving and pre-Holidays is essential Reporting of cases will be inaccurate for the next couple of days due to Holiday. However, we can expect a post-Thanksgiving surge. Did filming with Janet Tobias and John Hoffmann for the NatGeo documentary. Went to the old RFK Stadium/Armory complex to view and film the 250,000 white flags put up by artist Susan in memory of those who died from COBID-19. Very reminiscent of the HIV/AIDS Quilt project. The crew filmed Chris and I walking through the acres of small white flags. Also filmed us from above with a drone. Trump bringing his argument before the Supreme Court. He has lost every court case (>30) except for one. The Supreme court issue relates to a lower court rejecting his claim that the Pennsylvania election was rigged. He and his lawyers (led by Rudy Giuliani) are an extreme embarrassment to the GOP and to the country. The rest of the world is looking at what is going on here incredulously. We look like a Banana Republic. I never would have imagined in my wildest dreams that our democracy would be so shook. It is still amazing how the ZGOP leaders do not abandon Trump. They are just afraid of him and what he can do after he leaves the Presidency to their political careers - Profiles in Cowardice. Received Deo et Patriae Award from Regis High School and President George W. Bush sent a letter of congratulations: Letter from President George W ts ant 10/1,400,000; USA -- 29 November 2020 There are 27 etates in the red zone and 11 states in erange rene and C4 included in the packet theugh testing in yellow zone Gata will be unstable including fatalities due to reporting delays -- but hospital mew admissions should be real time and I will be tracking those carefully --although still rising the rate of rise is decreasing. Current inpatients with COVID approaching 100,000 We will fully seo the impact of Thanksgiving travel and gathering in 2 weeks as we should have peaked and should have decline There are now 29 States in the red and orange forhospitalizations of GOVID cases -- care deteriorates morces all patients with and without COVID when states enter the red zone -- there are mone states in this category everyday We need to make it clear that choices (state and metro poboy choices and personal choices) will drive a post Thanksgiving sume because of the gerlying high viral Koad that will be an overwhelming Cheat 00 the health care system, Many states are currently madequatety mitigating mcluding sunbelt states that mitigated well in the summer, Aggressive mitigation meeds to occur mow to prevent 4 cataclemic Holiday season for the hoapital syitems, CFR and desthe/1M population wil correlate with level of mitigation. The mitigation choices stated make yall correlate with level of fatalities. Iti wat to late with the Holla coming to change. The impact of these choices on humec lite will be very evident. Current imGryemenis ane seen in 1-2 states agerestively mitipaling and it will be very evident over the newt 60 daws That mitigation saved fives and lack Of ralgation resulted in uinecessary high lateliies - Sates not mitipeting will ach population OFA equal to the Sprig sunk when lreelment wad suboptinial - WO, $0, MT -- sleles must be ercouraped to advance polices Cheat malggation ageing his Fall viral sure We Found the friends and farily small gatherings driving hospitalizations during the state visits hut those drivers agpeaned in the Sunbelt after the states Fully niitigated inthe public spaces -- including significant reducing cagacity or chosing spams where masks cannest be wenn Furope countries with clear policies are improving rapidty with aggressive containment with mitigating policies and clear oomenunécationm and are concfully reogening We were beginning to smo signs of decreases in the cate of rise of hospitalizations but a post Thanksgiving surge ontop ofaearly 100,00 inpatients will prone us towards 450,000 deaths as the Fall surge mows into winter ifwe can't both mitigate in public spaces and convinee Americans of the danger = convincing Governors and Mayors now to mitigate gost Thanksgiving and pre-Holidays is essential Got call from Ron Klain tonight at 5:15 PM. He wanted to fill me in on recent appointments (not announced yet) to make sure that I am OK with them: Josh Sharfstein (FDA), Vivek Murthy (Surgeon General), Rochelle Walensky (CDC), Jeff Zients (COVID-19 Czar), Gina Raimondo (Secretary of HHS). Ron said that Biden wanted to call me soon but he did not want to compromise me with the Trump people. They will clear with Meadows that the transition team can start getting in place and then Biden will call me. Got call last night from Mark Ghaly (Deputy Director for Community Health for the LA County Dept of Health Services). He has called me several times for advice. Frantic call saying that they are surging in LA County and very soon hospital beds will be overrun. He wants to do a 3 weeks shutdown of the city to "stop the surge" and wants my support since there is a large pushback to locking down. I agreed to support him.
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2020-11-29 00:00
Anthony S. Fauci
November 29, 2020 - Global - 61,900,000/1,400,000; USA - 13,100,000/266,000 Now at end of Thanksgiving weekend. Expect further surges (Birx's daily report): 1. The summer surge post Memorial day-- USA baseline cases were at 25K day now >L60K/day, inpatients were <30K and now =90K -- we are ina very dangerous place fora further resurgence 2, The virus continues te accelerate faster than our response and this requires an even further accelerated and comprehensive Federal response with aggressive support te States to include strang statements that Europe and States with strong mitigation are impraying-- thereisa clear roadmap tecontainthis virus and preserve the health system: * Continued aggressive communication at the WH level masking requirements at all times outside of immediate household, physically distancing, hand hygiene AND critically limiting of social interactions to the immediate household for the next 60 days while we bridge to the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : thisis a short term sacrifice to protect the vulnerable, We must directly confront the myths that many Americans believe Americans believe that masks don't work, that the epidemic is a hoax, that the figure of !1% of those who died had camorbidities meant that they died trom something else and we have inflated the tatalities --instead af understanding that the co-morbidities predisposed them to severe COVID and deaths have been underreported Clear recommendations to States about the Importance of short term mitigation Interventlons ; restricting indoordining and limiting and/or closing areas of congregation without mask (bars, gyms ebc.) this was successful in the USA in the summer and was successfulin Europe during their tall surge - states across the country are not mitigating adequately to preserve the health System Continued critical guidance an the Holiday season to limitindoorunmasking across households it they choose to gather Aggressive re-allgnment of Ag testing towards tinding and preventing unrelenting silent spread that continues to trigger community spread in waves = a hand full of states are moving in this direction Expansionaf WAT testing now to ensure colleges and K-12 teachers can access routine regulartesting inJanuary Expanding frequency of LTC testing and aligning early vaccination Inte LICE With Medera's potential of one shot resulting In some protectbon - aggressive innnunization of the vulnerable and the elderly could dramatically change hospitalization rates and fatalities In the mext 30-35 days Ensuring rapid tiering of those most vulnerable to rapldvaccine Inmunization access Immediately uponEWaA--this may require implementationsupport to the states and full utilization of federal qualified health clinics Date Milestone Dec 1 Covid-19 illness documented (unpublicized Nov 17*) Jan 10 SARS-CoV-2 virus sequenced Jan 15 NIH designs mRNA vaccine in collaboration with Moderna Mar 16 Moderna Phase 112 trial begins May 2 Pfizer/BioNTech Phase 112 trial begins July 14 Moderna Phase 112 trial published in NEJM July 27, 28 Moderna and Pfizer/BioNTech Phase 3 trial begins Aug 12 Pfizer/BioNTech Phase 112 published in Nature October 22,27. Enrollment in both Phase 3 trials complete; >74,000 participants Nov 9 Pfizer/BioNTech announces interim analysis efficacy > 90% Nov 16 Moderna announces interim analysis efficacy 94.5% Nov 18 Pfizer/BioNTech announces 95% efficacy as final result Nov 20 1st EUA submitted by Pfizer/BioNTech Nov 27 Distribution of vaccine by UAL charter flights throughout US Dec 10 FDA External review of Pfizer/BioNTech EUA Dec 11 Phase 1a Vaccination begins for health care professionals* *Provisional on positive external review Photos below of Fauci making rounds with Clinical Center inpatient and Clinic Staff - from October 2020 - 13,300,000/266, 100 Fauci makeing rounds with Clinica PRESS: NBC Meet the Press with Chuck Todd; ABC This Week with Martha Raddatz
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November 30, 2020 - Global - 62,400,000/1,500,000; USA - 13,300,000/266,100 We will see in the next few weeks whether the travel associated with Thanksgiving leads to a surge upon a surge. 95,000 people are currently hospitalized with COVID-19 - new record for this outbreak. Biden putting together his team. Very diversified with women and people of color. Trump still flailing about challenging without any hint of evidence that various states were won by him. He still has his Greek Chorus of people backing him although little by little they are being less vocal and explicit about backing him. The GOP is in a crisis in that many have lost credibility by not explicitly condemning Trump. They are all afraid since he does have almost 1⁄2 the country with him. He will definitely run in 2024 and they are afraid that they will lose his support if they come out against him. Terrible situation for democracy. Got call from Gov. JB Pritzker (D-IL) praising me for what I have been doing and asking for my backing for him to keep stringent public health measures (short of lock down). He is getting pushback from bars and restaurants and even from hard core people who do not want to wear masks. He said that I am so credible and respected that he would like to quote what I have said as backup for himself. He liked my statement on Sunday shows of "Close the bars; open the schools". He is very frustrated with people not wearing masks and told me he would like to just say: "Wear a fucking mask!" 30 November 2020 There are 26 states in the red zone and 10 states in orange zone -- data is extremely unstable due to the long Holiday break There aré two different regional dynamics in the pandemic. The Northern Plains and mast of the Heartland except OK is finally stabilizing after 8 weeks of unrelenting rise but from IN to OH to PA, the mid Atlantic, the NE region and the West Coast, TX and AZ continue to deteriorate which will drive up cases, hospitalizations and deaths. Currenth new admissions are stabilizing and the key will be whether Thanksgiving drives a super surge There are now 29 States in the red and orange for hospitalizations of COVID cases -- care deteriorates across all patients with and without COVID when states enter the red zone -- there are mare states in this category everyday -- decision by CDC on who [s immunized first will determine the future stability of the hospital system. Gee and Jan will be the key months for pressure on the hospital system and without prioritizing thase most like to require hospitalization and death could result in over all failure of critical care for all Americans independent of COVID status itis clear that choices (state and metro policy chobces and personal chelces) will drive a post Thanksgiving surge because of the underlying high viral load that will be an overwhelming threat to the health care system. Many states are currently inadequately mitigating Including sunbelt states that mitigated well in the summer. Aggressive mitigation needs to occur mow to prevent a cataclysmic Holiday season for the hospital systems. CFR and deaths/i1M population will correlate with level of mitigation. The mitigation cholces states make or don't make will direct correlate with curnulative level of fatalities, itis not to late with the Holidays coming to change. The impact of these choices on human life will be very evident. it will be very evident aver the next 60 days that mitigation saved lives and the lack of mitigation resulted in unnecessary high fatalities - States that did not mitigate will end up with population CFR equal te the Spring surge when treatment was suboptimal - ND, 5D, MT -- states must be encouraged to advance policies that mitigation against this Fall viral surge We found the friends and family small gatherings driving hospitalizations during the state visits but we also know that those drivers appeared in the sunbelt after the states fully mitigated im the public spaces -- including significant reducing capacity or closing spaces where masks cannot be worn Europe countries with clear policies are improving rapidly with aggressive containment with mitigating policies and clear communication and are carefully reopening Although we were beginning ta see decreases in the rate of rise of hospitalizations I remain deeply worried about a post Thanksgiving surge that could propel us towards 450,000 deaths as the Fall surge continues into the winter through Jan and Feb and if we can't both mitigate in public spaces and convince Americans of the danger --convincing Governors and Mayors now to mitigate past Thanksgiving and pre-Holidays is essential 1. Toprevent 4 post Thanksgiving surge a comprehensive Federal response with aggressive support to States to include strang statements that Europe and States with strong mitigation are improving -- there ls a clear roadmap to contain this virus and preserve the health system: * Continued aggressive communication at the WH level masking requirements at all times outside of immediate household, physically distancing, hand hygiene AND critically limiting of social interactions to the immediate household for the next 60 days while we bridge to the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : this is a short term sacrifice to protect the vulnerable. We must directly confront the myths that many Americans believe * Many Americans believe that masks don't work due to prior tweets, that the epidemic is a hoax, that the figure of 94%) of those who died had co-morbidities meant that they died fram something else and we have inflated the fatalities -- instead of understanding that the co-morbidities predisposed them to severe COVID ' Clear recommendations to States about the importance of short term mitigation interventions : restricting indoor dining and limiting and/or closing areas of congregation without mask (bars, gyrns etc.) this was successful in the USA in the summer and was successful in Europe during their fall surge -- states across the country are not mitigating adequately to preserve the health system ' Continued critical guidance on the Holiday season te limit indoor unmasking across households if they choose ta gather ' Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger community spread in waves -- a hand full of states are moving in this direction ' Expansion of NAT testing now to ensure colleges and K-12 teachers can access routine regular testing in January ' Expanding frequency of LTCF testing and aligning early vaccination into LTCF ' With Moderna's potential of one shot resulting in some protection - aggressive immunization of the vulnerable and the elderly could dramatically change hospitalization rates and fatalitiesin the next 30-35 days * Ensuring rapid tiering of those most vulnerable to rapid vaccine Immunization access immediately upon EUA = this may require implementation support to the states and full utilization of federal qualified health clinics NATIONAL TIME Percent Test Positivity New Casen -- TOwy owing Aesrage Mi Chandy Tent Ponitiwity: -- 7-Day Aoeng cea i aly Cac Hew Hospital Admixsians Hew Deaths ' ah ah at ah ah = ch ab qi nh e 'at ah oh es qh ES a * ge ei i E ah ot at at ak a * a Ea |f= * "< a " -- Tay Binning Aerie Me Daily Conbirined Ad cca Ge Daily Suspected Anise = T-Dey Bowing deere Me Oaty Deaths Date Source COC Aggregate Data, Viniied Testing Datase, Unified HospitalDateset NOT FOR DISTRIBUTION // FOR OFFICIAL USE AND PLANNING PURPOSESONLY Sen. Rand Paul continues to act like an idiot: Rand Paul says Fauci owes parents and students an apology over pandemic measures BY DOMINICK MASTRANGELO - 11/30/20 12:01 PM EST 488 Sen. Rand Paul (R-Ky.) scolded Dr. Anthony Fauci in a tweet on Sunday, suggesting the nation's leading infectious disease expert apologize for his warnings about the danger coronavirus poses to school-aged children. "Dr. Fauci owes [Rand Paul] an apology," one of Paul's Twitter followers said. Paul responded: "No, he owes one to every single parent and school-age child in America. I told him this multiple times this summer." Fauci and Paul have clashed several times since the pandemic began, with the Kentucky Republican accusing Fauci of fear-mongering rhetoric and what he says is incorrect praise of so-called lockdown measures implemented to stem the spread of the virus. "Dr. Fauci, every day we seem to hear from you things we can't do. But when you're asked, 'Can we go back to school?' I don't hear much certitude at all. 'Well, maybe.' 'It depends.' Guess what? It's rare for kids to transmit this. I don't hear that coming from you. All I hear is, 'We can't do this, we can't do that, we can't play baseball,'" Paul said while demanding schools reopen during a Senate hearing in late June. "It's important to realize that if society meekly submits to an expert and that expert is wrong, a great deal of harm may occur when we allow one man's policy or one group of small men and women to be foisted on an entire nation." Fauci responded to Paul at the hearing, saying he feels "very strongly we need to do whatever we can to get the children back to school." During the early days of the pandemic, Fauci and other public health officials urged local school districts to consider all factors before deciding if it was safe to have children and teachers return to classrooms. On Sunday, Fauci clarified his position on school closures amid a nationwide spike in coronavirus cases this fall. "The default position should be to try as best as possible, within reason, to keep the children in school, to get them back to school," Fauci said on ABC's "This Week." "If you look at the data, the spread among children and from children is not very big at all, not like one would have suspected. So let's try to get the kids back. But let's try to mitigate the things that maintain and push the kind of community spread we are trying to avoid. And those are the things you know well. The bars, the restaurants ... those are the things that drive the community spread. Not the schools." • Did weekly Governor's call today led by VP Pence. • Moderna applied to FDA for an EUA for their mRNA vaccine. Their final data were very impressive. 94% efficacy and 30 severe outcomes, all in placebo, none in vaccine. Pfizer did this submission last week (Nov. 20) • Fireside chat with American Society of Hematology - 13,400,000/267,300 progress President Trump has done, • Did a nice 60 minute Facebook Live with Mark Zuckerberg PRESS: WUSA TV interview (Gabe Cohen); WTOP Radio; Yahoo News and Sports; iheart Radio; Cheddar TV; WedMD Magazine interview (I will be one of their public health "heroes"; Facebook Live with Mark Zuckerberg; BBC World News Radio;
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December 1, 2020 - Global - 62,700,000/1,500,000; USA - 13,400,000/267,300 Many GOP (such as Roy Blount) still supporting Trump who is becoming more and more unhinged. He is losing every court case that he appeals to overthrow the vote in a number of states. He rales that it is all a stolen election and that he won by a landslide. Very embarrassing. Blount refuses to call Biden the President -Elect. Scott Atlas resigns! I imagine that is because everything that is happening now with the surges has finally proven him to be incorrect on virtually everything that he has said. The one area where he was correct was in saying that school children are not the drivers of the outbreak. However, he was dead wrong in saying that mitigation does nothing and that when states peak and come down, it is because they have reached herd immunity. Yet, now we are seeing states and cities that peaked high months ago and now are peaking even higher. So much for heard immunity. Rand Paul still coming after me saying that I should shut everything down. The press is contradicting him by showing quotes from me to the contrary. What a jerk! I am staying above the fray. Alex Azar is becoming more sycophantic towards Trump as we get to the end of the administration. See below: Azar Touts Swift Progress On COVID-19 Vaccine Development. Fox News (11/30, Nelson, 27.59M) reports that on Monday, HHS Secretary Alex Azar said progress on the COVID-19 has been unprecedented. He told Fox News, "Think about this: 10 months into this pandemic hitting our shores, thanks to what President Trump has done, we believe we're going to have people getting vaccinated, millions of people, before Christmas this year. It's just unheard of in the history of public health, this accomplishment." He added that "the vaccine will be 'shipped' within 24 hours of FDA approval and then it would be up to 'nursing homes, hospitals, and pharmacies to get that dispensed.'" day the He was explaining to me why he California Governor: State At "Tipping Point" Of Pandemic. Reuters (11/30, Whitcomb, Caspani) reports California Gov. Gavin Newsom (D) "said on Monday the state was at a 'tipping point' in the COVID-19 pandemic that would soon overwhelm hospitals as political leaders nationwide turn to increasingly aggressive measures to hold back the latest • Had important call with Gov Cuomo who called me up. He was explaining to me why he had an independent panel look at the COVID-19 vaccines. He said that the skepticism about the FDA already existed (i.e. their doing an EUA for Hydroxychloroquine) and he was trying to ameliorate it. He also was concerned about managing expectations about how quickly the vaccines will make a big and broad difference. He and I agree that the difference will not be until mid to late summer. He told me about his conversations with Trump and how Trump wants to mend the fences with Cuomo despite the fact that he has been trashing him. He wants to change his residence back to NYC saying that it would be good for NYC. Cuomo pushed back and told him that he did not agree that it would be good for NYC. Also, Trump apologized for calling Chris Cuomo "Fredo". Cuomo believes that Trump is a psychopath and an evil man who just wants to manipulate for his future, which he knows is bleak. Cuomo also expressed disdain for Azar saying that he is a sycophant to Trump and does not understand that black and brown people will not get fair access to vaccines with the paltry amount of money that the USG is giving to the states for the implementation of the vaccine distribution. USG gave $200 million to NY, when they really need $1 billion. Cuomo told me the best thing that could happen for my legacy would be for Trump to fire me and then have Biden re-hire me. • Had call with Rob Manfred, Commissioner of MLB - He needed advice about the timing of Spring Training (February for pitchers) vis-à-vis the roll out of vaccines and when there would be enough people vaccinated so that he can both get his players vaccinated and have a degree of herd immunity present so that he can have spectators in the stands. I told him that by April there could be massive vaccinations IF people uptake the vaccine. We could have most people vaccinated by early summer which means they can start with half full stadiums and then by the World Series they could conceivably have packed stadiums. He might delay start of Spring Training from February to March. Also, he wants to offer stadiums and parking lots for massive vaccination programs. I told him that would be a CDC/local public health department issue. • Had Miami Mayors call. - The mayor of Miami-Dade County - Daniella Levine Cava now has COVID-19. Former Mayor Jimenez has COVID-19. Still remaining issue that Governor DeSantis is blocking the mayors attempts to mitigate. For example, he will not allow closing the bars and indoor restaurants. • Had call with Gary Bettman (NHL) about the coming hockey season • Task Force call - The VP still extracts "happy talk" out of a very sober report from Birx about the surge and the fact that we are perilously close to having our health care system 1 December 2020 Data is unstable but when cases nse despite the Holidays are they are across the West Coast, TX, Iid-Atlantic and ME it races more red flags There are 26 states in the red zane and 10 states in orange zone -- date & extremely unstable due ta the long Holiday break Thereare two different regione! dynamics in the panderic. L The Northern Plains. and mastof the Heartland except 8 is fimalhestabd ang after 2 weeks of uneelerting rise, Thess states will aliwus to secthe Thankegiving surge and beable to estimate the impact of theupooming Holidays and the messaging needed bo prevent a lanuanyand Febuary surge From iNito GH te, the mad Atientic, the ME region and the West Goes, TS and 42 continue to debenoratewhich will driveup cases, hos petalizations and deaths toeven high ttes.due to population sie and it will be difficult to estirnate the post Thankaaiving impact. Bo The current pecture could combine the Spong and Sumner surge states together inboa Winter sunge resulting inven higher hospetalaationsand deaths 4. Fach surge Spnng (100% fatalities), Summer [100k fatalitees:), Fall Surge I 100K fatalities) combening Spang and Summer could lead toa 200K Fatalities There are now 29 States in the red and orange fer hosgitalizatiens of COVID cages --gereral medical care deteriorates when slates enter Lie red gone --There are more states in this category eseryday = decision by COC on whe is emimuneced first will determine: the future stabelty of the hospital system. Dec and Jan willbe Lhe Rey months for pressure on the hosgital systemand wilhoul provritizing those Geely to require hospitalization and heghest rise of death could recult rower all fadure af critical care for all Amencans independent af OOWiD status Lwillbe wery evident over the mext 30 days thal mitigation saved lives and the lackal mitigation resulted in unnecessary high fatalities - Staves that did mat motgete will end up with population CFR equal ta the Spreng surge whentreatment was suboptimal W0, 50, MT states must be encouraged ta aceance policies Chak nabigabion against this Fall viral surge Europe: countrns with clear policies aire improving ranidhy with aggressive containment with motwating policies and clear camimunication and art carefully MOeTINg Although we were boginning to seo decmasas inthe rate of nse of hospetalcations a past Thanksgiving sumge thet could propel ws towards 450,000 deaths as the Fall sunge continues into the winter through Jan and Feb and if we cant bath mitigate in public spaces and convince Americans of the danger -- canwincing Gowamars and Mayors now to mitigate past Thanksgiving and pro-Holidays & espantial 1. To prevent a post Thanksgiving surge a comprehensive Federal response with agressive support to States to include strong Statements that Europe and States with strong mitigation are improving-- there is a clear roadmap to contain this virus and preserve the health system -- ensuring the identification of silent spread and early Dx and Tx and those at risk for serious De: Continued aggressive communication at the WH level rnasking requirementsat all tires outside of immediate household, physically distancing, hand hygiene AND critically limiting of social interactions te the immediate househeld fer the neat 60 days while we bridge te the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : thisis ashort tern sacrifice to protect the vulnerable. We must directly confront the myths that many Americans believe * Many Americans believe that masks don't work due te prior tweets, thatthe epidemicis a hoax, that the figure ef 44 of those who died had eo-morbidities meant that they died from something ele and we have inflated the fatalities -instead of understanding that the co-rnerkidities precdipesed thern te severe COVID ' Clear recommendations to States about the importance of short term mitigation interventions © restricting indenr dining and limiting andor chasing areas of congregation without mask (bars, gyre ete.) this vas successful in the USA in the surnimner and was successful in Purope during their fall surge -- states across the country are net mitigating adequately ta preserve the health system ' Cantinutd critical guidane: on the Meliday seasen be limit indenr unmasking acres households if they choose ta Bathoet * Aggressive re-alignment of 4p testing towards finding and preventing unrelenting silent spread that carntinues te tigger community spread inwavwes --a hand fullof states are moving in this direction Exparcsionol MAT testing mow to ensure colleges and K-12 teachers can access routine: regular testing in lanuary * Expanding frequency of LTCF testing arcd aligning early vaccination into LTCF * With Moderna's potential of one shot resulting in some protection - aggressive immunization of the vulnerable and the elderly could dramatically change hospitalization rates and fatalitiesin the next 30-35 days * Ensuring rapid tiering of those mast vulnerable to rapid vaccine immunization access immediately upom ELM -- this may require implementation support tothe states and full utilization of federal qualified health clinics over-run by the surge upon the surge. He and the Greek Chorus of the TF just cannot accept that we are in serious trouble. Very frustrating Some states starting to plateau while others continue to surge. See below: Danger of hospitals being overrun and lack of adequate staffing (see graphs below): DRAFT - PRE-DECISIONAL & DELIBERATIVE Leveraging CDC Areas of Concern Continuum Data Areas of ConcernClassifications: 1. Sustained Hotspot - communities that have had a high sustainedcase burden and may be higher risk for experiencing healthcare resource limitations 2. Hotspot - communities that have reached a threshold of disease activity considered as being of high burden 3. Emerging Hotspot - communities witha high likelihood to become hotspotsin the next 1-7 days 4. High Burden - Resolving - communities that were recently identified as hotspotsand are now improving ModerateBurden - communities with moderate disease activity 6. Moderate Burden - Resolving - communitiesthat have a moderate level of burden, but are demonstrating Improvement 7, Low Burden - communities with minimal activity Sources: COCs Areas of Concern Continuum -85% of hospitals and -90% of LTCFs are located in 'hotspot' counties Number of hospitals in countiesby AQC classification 3,654 (75.2%) (10.4%) el y (11.4%) me 3S) 0.78) 28) (0.28) Humber of LTCFs in counties by AOC classification 11,963 (80.9%) 1,074 (9.8%) 5.355) one (7.3%) on sai Sustained Hotspot Emerging High Moderate Moderate Law Hotspot Hotspot Burden Burden Burden Burden Resolving ing DRAFT » PRE-DECISIONAL& DELIBERATIVE Using CDC's Areas of Concerns classification & hospital-reported supply status--prioritize Distributors efforts Priorities for outreach * RI, LA, WI, UT, MN, MI, NM, OK, TN, MU li & a0 - I a=] I States nat digolayed g + WT (14% in hetspet, 25% . = reported PPE iqaue) Rie a 60) = ME (38%, 29%) = = Hi (69%, 28%) = » GA (TA, 15%) c @ : : = = 2 40 NH Law MN = = AL Tx c Wil @ MT 6c e®Ho aw eo IL usag| °AK = Py ow © lhUuNE . a (23.4%) @SD AR Mo A oc Ml ¢ AZ Fa by MA gs @ © ° =, "2. oH vA mOR BKY @ID CONC wy FL Bh DE = As ; ie pst ® States in top three quartiles % of population in a 'hotspot' county based on "Areas of Concern" classification (95.63%) = In data quality @ States in bottom quartile In data quality • Received Lifetime Achievement Award together with Henrietta Fore (Director of UNICEF) and David Beasley at elegant "virtual" gala. Praised by Barbara Bush in an interview and several celebrities • Heated discussion at TF meeting regarding the NIH Guidelines not being specific enough in its recommendations for mAb and CP. Typical Deb Birx wanting to push therapies more than the data justify. In the discussion, Pence was convinced by Deb and others - 13,600,000/270,000 (with no medical background) chimed in that saying "no evidence for or against the use of ......." Had long conversations with Cliff tonight and he is very reluctant to change the wording. VP was insistent that we indicate more strongly that the drugs work since Deb says that the clinicians are not using the drugs since they do not see a strong indication in the guidelines that the drugs work. Trying to work with Cliff who is adamant PRESS: Did Press Conference with Gov. Jared Polis (D-CO); WNBC NY TV;
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December 2, 2020 - Global - 63,400,000/1,500,000; USA - 13,600,000/270,000 Situation remains tenuous. Note from Deb Birx associated with her daily slide set: The situation we find ourselves is deteriorating beyond words. Please help me convey to senior leaders that is the worse combination of factors that we have seen since the beginning of the pandemic. Combining the Spring and Summer surge into a winter surge is what is deeply concerning. Despite my warnings there are OVP staff that undermine this message everyday and have greater access to the VP. I know its hard to see it coming, I know its hard to fathom, but it is coming even independent of the Thanksgiving potential due to the movement into populous states and nearly 50% of the country still believes this is being over blown, that it's a hoax, that masks don't work and I think the most damaging there is a set curve independent of mitigation - ie it doesn't matter what you do it will look the same. Yes there is an epidemic curve to both mitigated and unmitigated surges BUT the peak is higher and the duration of the surge is 2X longer without mitigation. Yes when hospitals get overwhelmed people do take more precautions and flatten the curve but that results in nearly 2X the fatalities as a mitigated response. Inadequately mitigated is nearly 2X the area under the curve as mitigated - 2X the hospitalizations and potentially 2X the deaths. Finally unlike the spring the asymptomatic group under 35 will not mitigate in the same way and will continue to drive infections and that is why more precautions must be implemented now - both state level mitigation policies and personal mitigation efforts. Deb 2600+ Deaths today. Worse since the NYC surge in early Spring (CURRENTLY HOSPITALIZED PER MILLION BY STATE Dec 01 I Hospitalized Per Million Peak - 968 in New York, April 13 uaa Under 100 100 - 250 250 - 500 Over 500 Source: The COVID Tracking Project ~ Under100 ©100-250 8250-500 WM Over 500 @ 2 December 2020 1. Data remains unstable (test positivity, cases, deaths as they come from the state reporting) but when cases rise despite the decreased reporting as there are across the West Coast, TX, Mid-Atlantic and NE it raises red flags 2. New admissions and inpatient census data comes directly and daily from the hospitals so that reporting is more reliable and although at record highs were stabilizing -- BUT as noted yesterday the improvements in the Northern Plains, Rocky Mountain States and Heartland is being offset by the surging hospitalization on the West Coast, Sunbelt, MidAtlantic and NE--these more populous states will drive this over the next 2-3 weeks independent of a post Thanksgiving surge as they reflect transmission before Thanksgiving 3. There are now 31 States in the red (23) and orange (&) zone for hospitalizations af COVID cases -- general medical care deteriorates when states enter the red zone -- there are more states in this category everyday -- decision by CDC on who is immunized first will determine the future stability of the hospital system. Dec and Jan will be the key months for pressure on the hospital system and without prioritizing thease likely to require hospitalization and highest risk of death could result in aver all failure of critical care for all Americans Independent of COVID status = UK is immunizing HCWs, LTCF and everyone over $0. Our hospitalizations and fatalities mirror this except in USA its over 70. 4. Please review slide 3-- as raised a couple of weeks ago-- the movement of the surge into populous states especially without adequate policies or without individual Americans mitigating will drive fatalities -- states with >100 yesterday -- TM (237), MI (195), PA (170), IL (146), IN (141), CA, MO, OH, WI -- bald states do nat have adequate mitigation policies -- the others are due to personal decisions 5. There aré two different regional dynamics in the pandemic. 1. The Northern Plains and most of the Heartland except OK is finally stabilizing after 8 weeks of unrelenting rise. These states will allow us to see the Thanksgiving surge and be able to estimate the impact of the upooming Holidays and the messaging needed to prevent a January and February surge 2. From IN te OH to PA, the mid Atlantic, the NE region and the West Coast, TX and AZ continue to deteriorate which will drive up cases, hospitalizations and deaths te even high rates due to population size and it will be difficult to estimate the post Thanksgiving impact. 3. The current picture could combine the Spring and Summer surge states together inte a Winter surge resulting in even higher hospitalizations and deaths 4. Each surge Spring (100K fatalities], Summer (100K fatalities), Fall Surge (100K fatalities) combining Spring and Summer could lead to 200K fatalities 6. ft will be very evident aver the next 30 days that mitigation policies saved lives and the lack of mitigation resulted in unnecessary high fatalities • Call from Mark Meadows saying that it was OK to do press conference with Gov. Cuomo. Also, he really wanted a reality check on the fact that the MHRA of the UK has given their equivalent of an EUA to the Pfizer vaccine. He wanted to know if our FDA was dragging their feet. I totally supported the FDA, Peter Marks, and Steve Hahn and said that the UK were "hot-dogging" it and that even the EMA were blasting the UK for hot dogging. It seemed that Mark was on the brink of firing Hahn. Hope I blocked that together with George -- 13,800,000/273,000 To prevent as many fatalities as possible a comprehensive Federal response with aggressive support to States to include strang statements that Europe with strong mitigation are improving -- there is a clear roadmap ta contain this virus and preserve the health system -- ensuring the identification of silent spread and early Ox and Tx and those at risk for serious Dz: Reinstate aggressive communication at the WH level: masking requirements at all times outside of immediate household, physically distancing, hand hygiene AND critically limiting of social interactions to the immediate household for the next 60 days while we bridge to the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : this is a short term sacrifice to protect the vulnerable. We must directly confront the myths that many Americans believe ' Many Americans believe that masks don't work dué to prior tweets, that the epidemic is a hoax, that the figure of 94% of those who died had co-morbidities meant that they died from something else and we have inflated the fatalities -- instead of understanding that the co-morbidities predisposed them to severe COVID Clear recommendations to States about the importance of short term mitigation interventions : restricting indoor dining and limiting and/or closing areas of congregation without mask (bars, gyrns etc.) this was successful in the USA in the summer and was successful in Europe during their fall surge -- states across the country are not mitigating adequately to preserve the health system --even those states that mitigated In the surmmer are failing to mitigate now Continued critical guidance on the Holiday season to limit all indoor gatherings to Immediate household only Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger community spread In waves -- a hand full of states are moving in this direction Expansion of NAT testing now to ensure colleges and K-12 teachers can access routine regular testing in January Expanding frequency of LTCF testing and aligning early vaccination into LTCF With Moderna's potential of one shot resulting in some protection - aggressive immunization of the vulnerable and the elderly in the community in addition to the Pfizer priority to HCWs and LTCF could dramatically change hospitalization rates and fatalities in the next 30-35 days led • Got call from Jeff Zients in preparation of my briefing the Biden "landing team" tomorrow. Jeff wanted to alert me that Biden will be calling me right after the briefing. • Received the Eleanor Roosevelt Prize for Global Human Rights Advancement from the American Bar Association Center for Human Rights • PEOPLE Magazine names me 2020 Person of the Year together with George Clooney, Selena Gomez and Regina King PRESS: CNN: Elton John honors Anthony Fauci on World AIDS Day; CNN Heroes with Anderson Cooper; KTVQ TV - Billings, MT; ABC News PRIME (Online); Fox TV News; Frank Bruni writes in the NY Times: Anthony Fauci is the steely superhero of my deep state, and he's flanked and fortified by all the government health officials who also pushed back against the quackery of Scott Atlas, the Trump-flattering pandemic adviser who resigned on Monday
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December 3, 2020 - Global - 64,000,000/1,500,000; USA - 13,800,000/273,000 Records being broken: 3000 deaths yesterday; >100,000 hospitalizations; >200,000 new infections. With gauntlet of Today I met with President elect Biden's landing team. It was a good meeting that was led by Jeff Zientz, Vivek Murthy, and included David Kessler, John Auerbach, Tom Inglesby, at their process of the approval of the among others. We went on to discuss the challenges associated with the rollout of the vaccination campaign. In addition, I gave them my advice on what the most effective communication strategy would be for the upcoming administration. In addition, they wanted might take on what the challenges with be in the coming months of January, February, march, and beyond. It was an excellent conversation in which they all expressed their gratitude and respect for me for the work that I have been doing over the past several months. At exactly 3:00 PM, 1 hour as to the beginning of the meeting there was a prearranged call with President elect Joe Biden together with chief of staff Ron Klain. President-Elect Biden was very glad to chat with me and immediately stated that he wanted me to continue in my position as director, NIAID. In addition, he wanted me to be his chief medical adviser. Then, Ron and President elect Biden asked me a series of questions concerning some of the decisions that they would likely have to make in the coming months. Mayor Bill De Blasio called me up asking for advice about the surges that are occurring in NYC and how much of a lock down he should implement. He wanted to keep things mostly open until after the holidays and then shut down. I told him that this was a big mistake since by that time, the damage will have been done and he will have precipitated a major surge. I urged him to close the bars and restaurants and subsidize the establishments so that they do not go under. If he does that and discourages private, large gatherings, he could get away with keeping the shopping areas open. I apologize to the UK on BBC radio for implying that their process of the approval of the vaccine was rushed and sloppy PRESS: CBS News "The Takeout" with Major Garrett; Sky News UK TV; MSNBC with Andrea Mitchell; New York Times interview with Tara Pope Parker; KQED NPR Radio, San Francisco; BBC World News; New Zealand Herald (Dick Brass) print media; Bloomberg: - 14,000,000/276,000