Tony's Diary Package — page 382

4 October 2020 1.The overall picture continues to deteriorate raising concerns across the United States [beyond the improvements across the South that are currently holding) the abselute numbers and the concerning trendlines across the upper North West and Mid West and now the North East -- although some of these changes are subtle when you triangulate them and take into account the changing weather conditions in these areas small clusters can rapidly and silently spread to large outbreaks : highest alert states alert counties are in your packet and several NE counites are now in the alert packet 2. The silent spread among the asymptomatic individuals leads to silent community spread that then spreads te the mare cautious group including the vulnerable members of households : the way to prevent this is to ensure personal mitigation through masks, physical distancing and personal hygiene combine with early identification of community spread to ensure communities have clear information so they can actively participate in preventing further spread and protecting the vulnerable individuals in their household, 3. These data driven laser focused Interventions will be essential as we move inte the fall: there needs ta be a clear recognition of in household, small gatherings among neighbors and family events are active spreading events when there is even one asymptomatic COVID positive individual -- although outdoors are safer both the level of the viral load and claseness of contact can lead to increasing spread 4. Tribal Nations from these regions will drive substantial hospitalizations and fatalities 5. The overarching concern relates to the balance of personal mitigation behaviors and the weather driving more activities indoors with the lower humidity increasing the K value (dispersion factor) with lower humidity the droplets partially evaporate allowing for longer suspension in the air and together -- poor personal mitigation and cooling weather with heating will increase the R value 6.Any baseline immunity in the population (ranging from <1-10%5) in all states except LA, N¥, NJ (where mortality was 3-4X all other states) can be offset and overcame by this weather element and increased indoor activities -- this is the concern about continued spread in states where the weather is changing (cooling) and the need for Immediate mitigation actions by the leadership and the public collectively : conversely the improved weather across the south with movement outdoors from air conditioning will lower both Bl and decrease dispersian (K)-- 7 There also needs to be careful proactive attention to the NE -- cases rising in NYC and Boston 8. Will be key to increase testing in the communities and states where test positivity is rising to prevent further community spread to prevent increases in hospitalizations and fatalities 4. This first several tranches of BINAX to states should be prioritized to states with high community spread 7,400,000/2 10,000 to waiting 10 days. I told them that this would create a firestorm of pushback from the press since it would be breaking all the CDC guidelines. I suggested that they might use the 2 negative PCRs over 24 hours as opposed to the 10 day from onset of sxs rule. Sean said that they gave the POTUS dexamethasone since his O2 level dropped into the 80s, but he bounced back quickly with O2 administration. They started dex just as a precaution. White House comms (including Alyssa) as well as Sean giving confusing messages to the public about the POTUS health. Mark Meadows was honest and said that his situation was precarious requiring O2 on Friday night and the POTUS got angry with Mark sine he did not show a happy face. Sean was obviously intimidated by POTUS and so he sugar-coated the briefing. Bottom line is that POTUS is doing rather well. He had a limo drive him up and down Rockville Pike waving to the crowds of supporters. He wore a cloth mask instead of a N95 and press criticized him for endangering the Secret Service who were in the car. October 5, 2020 - Global - 35,100,000/1,000,000; USA - 7,400,000/210,000 1. The overall picture continues to deteriorate raising concerns across the United States (beyond the improvements across the South that are currently holding) the absolute numbers and the concerning trendlines across the upper North West and Mid West and now the North East - although some of these changes