Tony's Diary Package — page 383

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 - this spread is preventable with aggressive mitigation : this is not about shutting down but using the clear evidence based mitigation that has worked - attached both states of concern and the stable southern state 2. The silent spread among the asymptomatic individuals leads to silent community spread that then spreads to the more 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 and protecting the vulnerable individuals in their household. 3. These data driven laser focused interventions will be essential as we move into the fall : there needs to 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 closeness of contact can lead to increasing spread 4. 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 and the clear evidence of aerosol contribution 5. Any baseline immunity in the population (ranging from <1-10%) in all states except LA, NY, NJ (where mortality was 3-4X all other states) can be offset and overcome 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 R1 and decrease dispersion (K) - 6. There also needs to be careful proactive attention to the NE - cases rising in NYC and Boston 7. 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 8. This first several tranches of BINAX to states should be prioritized to states with high community spread White House people continue to get infected - latest is