Tony's Diary Package — page 365

26 September 2020 1.Cases continue to increase in the Heartland and the upper Midwest and Northwest without any evidence of containment --no state outside of MN, WI, ND is adequately mitigating their community spread -- hospitalizations are rising across these states and fatalities will continue to increase across these regions 2.Hospital admissions for confirmed cases are rising at the National level driven by the Heartland and the North West -- ND, SD, MT, UT (significant increase in Tribal Nation infections in MT which will drive mortality and must be mitigated. Call with MT on Thursday was more directed at Administration rather than aggressive public health mitigation of community spread in Billings and among the Tribal Nations -- we need to try to get to UT (Provo) and MT 3,Most concerning is the rising confirmed hospitalizations in over 70 yo the most at risk for poor outcomes largely driven by community spread several weeks ago when we experience the large decline in testing and inability to see the early spread among younger groups and ability to contain the community spread before impacting the elderly. 4.\t will be key to return to the Heartland, WI, MN as well as UT and MT when possible to do a deep dive into the data and provide clear mitigation recommendations 5.1 have included the ILI data as requested. Slides 4-6. Because much of ILI is modelled a seen here it is insensitive as an early indicator, insensitive to rising hospitalizations or predictive of rising mortality. For the last surge where 100K person succumbed the entire time the country was under the threshold (slide 4) and states were at minimal to low levels through most of the surge in the summer --currently only IA is moderate but & states are equal to worse than IA related to hospitalization and deaths TRENDS IN CASE INCIDENCE DURING THE LAST 8 WEEKS Aare el . Hatherr Martens ines wero ee harigpre a: Ainge Hin Mortara orth Deed: Bieteicie Piece Whoo Richdgee Fee Terk Bode told MalGnttrsiern 7" I he a fll laa mel ce! I ema Rate per 109,000 Hareb Orage nah med teen aioe it bebana on Paeraypiena ad Hew Heid CoH population categories (based on bast 7 days} ie Det Na Laat ml ial bt cc! mm) sme! tc = Figure depict: average (iiiaesat se and en et te Lie wae I en B-week period of 7/30I I] Il Iv vy a soainiia seiamaiie Winnie Habeas O24. Vertical esis ranges a fram fo 450 eases per 100.000 progiulestigry (7 cley mo --_-- i. A Regions