Tony's Diary Package — page 320

26 August 2020 Continued improvement in most of the original red states but increases upinta OK, AR, MO, KS, 1A, NE, IL, ND, 5D More than 50% of deaths coming from 4 states: GA, CA, TX, FL (slide 4] Continued week over improvement in cases, hospitalizations and deaths (slides 6-7) Cases are rising in France and Spain and across Europe but cases have not exceeded their Spring Phase (slide5) Hospitalizations declining and week mortality declining and continue to decline if gains across the Sunbelt can be maintained and Heartland stabilizes Continued improvement in mortality rates in all age groups including those over 7O Ordered the states by the 4 states with red zone test positivity and cases/100,000 Tx, ID, M5, $C then the 17 states with only red zane cases but yellow zone test positivity -- this is a mix of improving states with falling cases (NV, FL,LA, CA, NC} with states with increasing cases (14, 4R, 5D, ND, KS, OK, MO, IL) Test positivity and cases rising in MO, K5, OK, IL movement of increasingly high test + in Heartland : will meed continued worked with the Heartland with rising cases, test + and large land grant universities returning without adequate testing to define depth of outbreaks and prevention of spread into the local communities with vulnerable residents Will need strong Labor Day messaging to prevent another Memorial Day spreading event that has taken 2 months to begin to control -- approx 40% of the deaths have occurred post the Memorial Day triggered super spreading week that seeded the South. Most of the Heartland most likely seeded from residents vacationing in the beach areas with high community spread • Big shit show today about the change in CDC testing guidelines where they said if you are exposed to a documented case of COVID-19 you need not get tested if you are asymptomatic. This version was circulated at a TF meeting a couple of weeks ago and we were asked to look at it and sign on. I did so cursorily, made a change but did not grasp the implications of this change that means we put no emphasis on symptomatic spread. The guidelines were further discussed at a Aug 20 TF meeting when I was under general anesthesia for vocal cord surgery. When the shit hit the fan and the public health community went nuts at these changes, Brett Giroir said at a press conference that the TF, explicitly mentioning me, approved this, it got me vey upset. Clearly at the Aug 20 meeting, Deb Birx did not agree (she told me so). Also, I did not give it a lot of attention and I was not in the room for the final discussion when Deb objected. Sanjay Gupta (CNN) reported the disconnect between me and Brett which caused a bit of a media storm. Behind these changes was Scott Gottlieb • Telephone conversation between Peter Marks, Steve Hahn, Francis Collins, Cliff Lane, Mike Lauer, Dean Follmann, and Rich Forshee (FDA) about the basis of their declaring an EUA on CP. We (NIH) feel that FDA clearly caved to the White House and we were trying to examine the data that was the basis for their decision. Clearly Hahn was very defensive and Peter was "hurt" because he thought that the NIH was attacking the FDA. We settled it, but it is becoming clear that Steve is a bit more political than we are. Seems to be star struck about being around the White House and likely caved to Meadows. Who is looking for good news before the election.