Nov 16, 2020
Tony's Diary Package, p.744 · fauci_diary:entry:00555
Page text: p.744 · original PDF
- Date
- 2020-11-16 00:00 (day precision)
- Type
- diary entry · diary
- author
- Anthony S. Fauci
Nov 16, 2020
In context
A single line often inverts meaning once you see what it answers, so neighbouring messages are always shown.
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Nov 14, 2020 Feb 24,2021
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November 15, 2020 - Surge continues. 244,000 deaths (1300 yesterday); 10,900,000 infections, 167,000 cases yesterday. Big issue now is the logistics of distribution of the vaccine. Locals are saying that the USG has not given them enough money (bullions instead of hundreds of millions) to be able to distribute the vaccine. Crazy Scott Atlas is out there urging people of Michigan to "rise up" against the restrictions put on by the Michigan Governor Gretchen Whitmer to quell the outbreak. WH Comms still lets him out despite the fact that Alyssa tells me she thinks he is destructive. Clearly someone (POTUS, Meadows) wants him out there:
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November 16, 2020 - Global - 54,300,000/1,300,000; USA - 11,000,000/246,000 Continual surge: 138,000 new infections yesterday. POTUS has no interest at all in the Pandemic. He is focusing on blocking Biden from being POTUS. He is embarrassing the USA. However, 72,000,000 voted for him. Difficult to understand. Craziness has overtaken part of our country (1/2). Jared Kushner did call me up right before the press briefing related to the Moderna vaccine announcement (see below) 16 November 2020 1. All states and major metros now are deteriorating except Hl -- there are 27 states inthe red zane and? states inerange zane-- major high populous states are now significantly deteriorating from MIL IL, IN, GH, PA, to MJ, M4 and western NY, CA-- this surge must be flattened 2. Cempared te last week cates ip 50%, hospitalizations up18% and deaths 26% - this rate of increase will crush the hespitals 3. Ta be erystal clear -- its not just the number of cases but the rate of rise - what we are decumenting today as new cases are reflective of spread 10-14 days age - the rate of rapid rise in cases will tranélate to a proportional rapid rise in hospitalizations and deaths 4, We need to change the rate of rise of cases to change the rapid rise in hospitalizations to preserve haspital capacity--this is no longer about preventing a crisis -- this is a crisis -- thisis about tryina te save as many lives as possible within the crisis 5. Europe hat shown os that the Fall surge can be cantained and hospital capacity sustainedand ifwe act mow we can da the came 6. Thisvaill require a comprehensive Federal response with agaressive support to States bo include: ' Aggressive communication at the WH level masking requirements at all tirnes outside of immediate househeld, physically distancing, hand hygiene AND critically limiting of social interactions te 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 tern sacrifice to protect the vulnerable. We need to decurnent precisely the number of vaccine doses availabh: over the nest ? week fer pilot reall out to LCE, . Aggressive re-alignment of 4g testing towards finding and preventing unrelenting silent spread that cantinues be trigger community spread inwaves > SOM Giroir and COC working with States and Tribal nations . Expanding frequency of LTC testing and aligning early vacelnation late LTCF * Ensuring rapid tiering of those most vulnerable to rapid vaccine immunization access imnovediately upean EUG (COC) . Short term interventions : in States with demonstrated haspitalstaffing under threat - restricting indoor dining and briefly limiting areas of congregation without mask (bars, gyms and restricting indoor dining} will be needed as was successful in the USA in the Summer 7. Withoutanimmediate change we will hit 200,000 cases/day and LSM casesfweek, and over 100,000 inpatients --this is unsustainable Date: 11 s20e0 I New Cases per 100K NEW CASES PER 100,000 IM THE WEEH: I National Picture 'OWE MONTH BEFORE TWO MONTHS BEFORE a eee a re Cases per 100K $20 Comin ast 14 Dury Mobs swe {9 10 to 50 (9 F1b 1h ® (107 te 198 Ee 200 me a08 (£00 of More All states are now showing significant increase in cases, this is the time sequence over the last 6 months. We have not seen a surge in testing in the last 30 days but are seeing deterioration across the country. Confirmed Cases [Thousancs) Lim New Dally Confirmed COVID-19 Cases In the U.S. ae ee) " ee # Fg Q = » Ce. ee vo FF ¥ fetsegesr eg tse evs rt eve 'iin ty ca a Day eee Day Mowing Avarage 00/1,300,000; USA -- ----_--<$--$==$=--$=$<--= thy "ig, *******The administration (POTUS, Pence, Meadows, etc) keep emphasizing that we have never been as well prepared to respond to this pandemic. They refer to hospital beds, ventilators, PPE, etc. They are missing the fact that the pandemic is raging and they are really doing NOTHING to stop its spread. They have essentially given up (see comments above from Mark Meadows) in stopping it and concentrating on having enough supplies to address the cases as they come in. In fact, smaller states (southwest, northwest) are rapidly running out of ICU beds and personnel. They are wrong on both accounts. Freddy Ford (George W. Bush's Chief of Staff) emails me and mentions that W. wants to receive vaccine publicly to indicate his support for vaccines, and could I help out. Sir Elton John and husband David Furnish call me up and want to talk about how we can link the interest in COVID-19with sustained interested in ending the COVID pandemic. Great conversation; they are very "proud of me". I suggest linking testing for COVID to getting tested for HIV and getting people on PrEP. They loved the idea. PRESS: NBC Today Show with Savannah Guthrie; CBS with Jon LaPook; WTOP Radio; Press briefing by Francis Collins, me, Stephane Bancel, Matt Hepburn; Stephen Hoge, John Mascola related to Moderna announcement
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Nov 16, 2020 Feb 24,2071 May?, 2071 Source: Johns Hopkins University CSS--E COVID-19 Data cc ey Ph Feb4,.2020 --> <) May 2, 2021 New Daily Confirmed COVID-19 Cases In the U.S. a0 Z : 200 i z 150 E E on mom yo tm Dal foo oa oom Cal a. = am Mm ot y apy ok toe em gs SRST SS SV SSSR SSCS SSR T ESS SSG SEES E ae Re eRe ees aera es 2020/2021 a4 az aie aja asl ue 4s 4fii India is exploding: Good number today for the USA: The share of daily COVID-19 tests that are positive Shown is the rolling 7-day average. The number of confirmed cases divided by the number of tests, expressed as a percentage. Tests may refer to the number of tests performed or the number of people tested - depending on which is reported by the particular country. Cunear ] toc 30% 25% 20% 15% 10% 5% United States --- Israel 0% United Kingdom Mar 1,2020 Apr 30,2020 Jun19,2020 Aug 8, 2020 Sep 27,2020 Jan5,2021 Feb 24,2021
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Nov 16, 2020
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Nov 16, 2020
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November 17, 2020 - Global - 54,800,000/1,300,000; USA - 11,100,000/246,200 17 November 2020 Task Force All states and major metros now are deteriorating except Hl -- there are 27 states in the red sone ane 7 states in orange zone Nev daily admissions reaching 10,000/day and inpatient COVID patients reaching historic highs Its not just the number of coses but the rate ofrise - what we are documenting today as mew cases are reflective of spread 10-14 days ago - the rate of rapid rise in cases will translate to a proportional rapid rise in hospitalizations and deaths The length of time to reach peak is significantly honger -- wee are seeing improving im El) Pasa following extensive mitigation since 220ctoher Metriod hit hard during the summer surge are mow passing Their summer peal We need to change the rate of rise of cases to change the taped rise in hospitalizations to preserve hogpital capacity -- this Gono longer about preventing a criss --the i a omnis -- Chit abou trying lo dave ad mieny lives as posible within the onnis Europe has shown us that the Fadl sunge can be contained and hospital capacity sustained and if we act mow we can do the same This will require a comprehensive Federal response with aggressive support to States to include: ' Aggressive communication at tha WH lavad masking requirements ot all times outside ofimmsdiate heuscheld, physically distancing, hand hygiene AND orttically limiting of social interactions to the Immvediata household for tha ment 60 days while we bridge to the ragid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : this isa short term sacrifice: to protect the vulnerable. We need to document precisehy the number ofvaccine doses available over the next 2 work for pilot roll outta LTC. . Aggressive re-alignment of ig testing bowaerds finding and preventing unrelenting silent spread that continues bo bragger conmimunity spread in waves ADM Girdir and COC working with States and Tribal nations * Expanding frequency of LTCF testing and aligning, earty vaccination into LTCF * Ensuring rapad tering of those most vulnerable te rapid vaccine immunization access immediately wpom ELA (CoC) * Short term interventions ;in States with demonstrated hospital staffing under threat - restricting indoor dining and limiting areas of congeegation without mask bars, gyms and restricting Indoor dining) will be needed as was successful im the US4 in the sunimer and im Europe Without an immediate change we will hit 200,000 casesfday avd 15M cases/week, and over TODD inpatients -- this i unsustainable The surge continues. ICU beds in Montana are running out.. Recent (Nov. 13) NPR interview of ICU nurse in Billings MT: RIHA: We are currently at a critical level of patients in our ICU. So as you mentioned, we're the largest hospital operating system in Montana. And under normal operating circumstances, we have a 24-bed ICU in our hospital. When I left last night at the end of my shift, we currently had 44 ICU patients that were under the care of our service with a very, very full emergency room and likely more ICU patients coming in. In Task Force meeting today, Deb, I (by virtual), Bob sounded the alarm. Mark Meadows blurted out and objected to our call for a consistent message about masks and testing asymptomatics. He feels that no matter how much you test, you still will have outbreak. He got tested every day and he claims to have been infected while wearing a mask - NONSENSE. He was not wearing a mask before he got infected. He has bought into Scott Atlas. This is disgraceful. Deb suggested that we have a doctor White House press conference once per week. I pointed out that we must have a consistent message from the White House. I was not so subtly referring to Scott Atlas saying that masks do not work. Daily New Cases in the United States Daily New Cases Cases per Day Data as of 000 CMT et 200k = ua c=] = uw i=] = Newel Corcravines Daily Cases = =I New Cases per 100K 11/07 /2020-11/13/2020 rf I Cases per 100K 220 Cases im Last 14 Daye _ I Mow, I I Msn 4) tos "tags I OE S10 P| MD 101 to 100 I BB 200 an9 ar Mere New York Times "Dealbook" 10/1,300,000; USA -- PRESS: NPR Morning Edition; New York Times "Dealbook"
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November 18, 2020 - Global - 55,100,000/1,300,000; USA - 11,300,000/248,000 Still very much out of control. Trump is absent when it comes to outbreak. He recently fired a civil servant Christopher Kreb, cybersecurity official. This is having press speculate that he might fire me. 18 November 2020 All states and major metros now are deteriorating except Hl -- there are 27 states in the red zone and 7 states in orange zone New daily admissions have reached 10,000/day and Inpatient COVID patients reaching historic highs Its fet just the number of cases but the rate of rise - what we are documenting today as new cases are reflective of spread 10-14 days ago - the rate of rapid rise in cases will translate to a proportional rapid rise in hospitalizations and deaths The length of tire te reach peak is significantly longer -- we are seeing improving in El Paso follawing extensive mitigation since 22 October Metros hit hard during the surmmer surge are now surpassing their summer peak We need ta change the rate of rise of cases to change the rapid rise in hospitalizations to preserve hospital capacity -- this s no longer about preventing a crisis -- this is a crisis -- this is about trying to save as many lives as possible within the crisis Europe has shown us that the Fall surge can be contained and hospital capacity sustalned and if we act now we can do the same This will require a comprehensive Federal response with aggressive support to States to include: * 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 need te document precisely the number of vaccine doses available over the next 2 week for pilot rell out to LTCF. Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger community spread in waves : ADM Giroir and CDC working with States and Tribal natians Expanding frequency of LTCF testing and aligning early vaccination into LTCF Ensuring rapid tiering of those most vulnerable to rapid vaccine immunization access immediately upon EUA (CDC) Short term interventions : in States with demonstrated hospital staffing under threat - restricting indoor dining and limiting areas of congregation without mask (bars, gyms and restricting indoor dining) will be needed as was successful in the USA in the summer and in Europe Without an immediate change we will hit 200,000 cases/day and 1.5M cases/week, and over 100,000 inpatients -- this is unsustainable Over the Last 30 Days Cases have risen from an average of 55,370/ week to now 152,978/week 276% increase New Admissions have risen from 5500/day or 38,500/week to now 10,000/day or 75,000 per week 181% increase Inpatient COVID patients has risen from 42,098 to now 72,057 171% increase Inpatients with COVID currently rising at 17% week over week witha project of 84,306 inpatients next week and 100,000 inpatients the week after assuming the same rate of discharge (if sicker patients are admitted the % increase will become greater week over week) Deaths have risen from 697/day average to now 1206/day average 173% increase The Fall Surge is Different than the Summer or Spring Surge The depth of uncontrolled community spread is measured not only the absolute number of cases and new hospital admissions but the rate of rise of those cases and new admissions. This is the greatest rate of rise we have seen -- we have not increased testing significantly since summer to explain this rate of rise (testing up 10% - cases up 278%). SLIDE 4 and5 The breadth of community spread is measured by the number of rural and urban counties with high and rising cases now 2000/3107, the number of LTCF with + staff moving up each week from 30% to now over 70% in many states, and the number of major metros with significant increases in cases. This is the greatest breadth of infection we have seen. SLIDE 6 The duration of the current surge is measured by the length of time in rapid slope acceleration which predicts both duration of rising hospitalizations and fatalities. The current duration of rapid rise is now entering week 8 across the Northern Plains which is twice the duration to peak in the prior spring and summer surges (4-5 weeks). SLIDE 7 Depth of Fall Surge Daily New Cases in the United States Daily New Cases Cases per Day Data as of 0:00 GMT+0 200k Vi re i 150k ] ra I = a y " = Ok = I ne 1} S A ue I iy = 50k WE in I ! Es I PN at ! fl I I Hill TT ses fl T || I I Pa tel = Vaal 1) ij Al WT wa o a PA h I TURRET TTT ETE EE rh. a & A A £ *. " . Jot ah hy PP ef ah sh Rd es > Pot ae ae pot Pah sk» qe g@ BP a a Po a pf Qf oF a? a eo a wo ee eee ee oe dk a at © Daily Cases (I "+ 7-day moving average Exponential spread: Global USA PRESS: BBC World News TV; Elizabeth Rosenthal Kaiser Health Podcast (NY Times); USA Today Editorial Board Interview; USA Today interview Adrianna Rodriguez
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November 19, 2020 - Global USA 164,000 cases yesterday; 1900 deaths Did Miami Mayors call. New Mayor of Miami-Dade - Daniella Levine Cava, replaced Mayor Carlos Gimenez who has been elected to Congress. Mayor Francis Suarez is Mayor of Miami City. Real problem is that the Mayors want to do the correct thing, but the Governor has ordered that bars and restaurants open at full capacity. The best that he will give the Mayors is a 2 hour curfew, i.e. close bars at 10:00 PM. He is a Trumper and a real problem. Screw people dying; save the economy. Major staff shortages in hospitals in Midwest and other areas. This completely belies the stunning denial that Mark Meadows, POTUS, even the VP, certainly Scott Atlas are manifesting. They believe that the increase in cases is due to increases in testing. They just deny that hospitalizations and deaths are increased greatly. Amazing that even in regions where the virus is surging and hospitals are overflowing, the people in the region are calling it "fake news" OWS (General Perna) briefs VPOTUS on vaccine distribution. He is promising a lot. Did nice podcast fireside chat with The Hastings Center ut ke mm 10, 19 November 2020 All states and major metros now are deteriorating except HI = there are 29 states in the red zone and 9 states in orange zane BUT there is early evidence that strong early mitigation is impacting the rate of rise as specific states start to show a slowing of their cases New daily COVID confirmed admissions have reached 10,000/day and inpatient COVID patients reaching historic highs Last week 130% confirmed and suspected COVID cases were admitted = these drive PPE use = please review the daily data report =slide 5 Its not just the number of cases but the rate of rise - today's cases are reflective of spread 10-14 days ago - the rate of rapid rise in cases will translate toa proportional rapid rise in hospitalizations and deaths : but there is clear evidence that aggressive mitigation works We are now seeing the impact of the mitigation efforts put in place 2? weeks agoin the more populous states and suggestions of plateauing in these states see slide 6 -- this is very encouraging and we should reinforce these positive trends related to strang mitigation This joins the European data =slide 7 =that this Fall surge can be rapidly contained with mitigation We need ta change the rate of rise of cases to change the rapid rise in hospitalizations to preserve hospital capacity -- this is no longer about preventing a crisis = this is a crisis = this is about trying to save as many lives as possible within the crisis This will require a comprehensive Federal response with aggressive support to States to include: . 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 isa short term sacrifice to protect the vulnerable. We need to document precisely the number of vaccine doses available over the next 2 week for pilot roll out to LTCF. * Aggressive re-alignment of 4g testing towards finding and preventing unrelenting silent spread that continues to trigger community spread in waves : ADM Giroir and CDC working with States and Tribal nations . Expanding frequency of LTCF testing and aligning early vaccination into LTCF . Ensuring rapid tiering of those most vulnerable to rapid vaccine immunization access immediately upon EUA (CDC) . Short term Interventions : in States with demonstrated haspital staffing under threat - restricting indoor dining and limiting areas of congregation without mask (bars, gyms and restricting indoor dining) will be needed as was successful in the USA in the summer and in Europe Without an immediate change we will hit 200,000 cases/day and 15M cases/week, and over 100,000 inpatients -- this Is unsustainable in our hospital system Over the Last 30 Days * Cases have risen from an average of 503,783/ week to now 1,129,789/week 224% increase * New COVID confirmed admissions have risen from 5500/day to 10,500/day 91% increase * New COVID confirmed and suspected admissions have increased from 89,708/week to 130,695/week 46% increase * Inpatient COVID patients has risen from 47,204 to now 77,518 64% increase * Inpatients with COVID currently rising at 17% week over week witha project of 84,306 inpatients next week and 100,000 inpatients the week after assuming the same rate of discharge (if sicker patients are admitted the % increase will become greater week over week) * Deaths have risen from 5623/week to now 8244/week average 47% increase CASE INCIDENCE IN LAST 7 DAYS AND COMPARISON TOTHE PREVIOUS 7 DAYS openbaar ha Cases per 100K by County Del: HEE Percent Change in Cases per 100K by County -- in the Week TNOV2020-17NOV2020 a in the Week 11NOV2020-17NOV2020 NOT FOR DISTRIBUTION // FOR OFFICIAL USE AND PLANNING PURPOSESONLY 10/1,400,000; USA --- Sharon Stone, Dr. Anthony Fauci to be Honored During Virtual Research in Action Awards Sharon Stone and her good friend Dr. Anthony Fauci are among the honorees at Treatment Action Group's virtual Research in Action Awards PRESS: Nexstar TV; White House Press conference (discussed vaccines and public health measures. Pence ran it and did not allow questions after the presentations. The reporters in the audience (Kaitlan Collins, Jon Karl and others) went nuts with anger; CNN with Chris Cuomo;