Tony's Diary Package — page 402

14 October 2020 Many states in the heartland and upper MidWest and MT, WY, ND, SD, ID, UT are reaching all time highs in case numbers with rising hospitalizations (fatalities are rising but being offset by declines in the Sunbelt keeping rates at 700-800 daily ave). Please review the WH DAILY REPORT -- week of week hospitalizations are rising significantly in thase over 40 yo and over 70. Community spread is expanding to CO, IL, IN,QH MAN, NM and nearly every states has increasing cases and deeply concerning trends. I have included the most concerning 28 states. NO, MMT, W¥ all have populations size similar to VT, MH, and Maine and had test positivity rates equal to the these North East States 2 months ago and are now in full log spread -- this could move in the same way in VT, NH, ME. Low population densities and small metros are not protection from viral spread in the community which will lead to increased hospitalizations and deaths. Small clusters are rapidly and silently spreading to ever larger community outbreaks -- this spread is preventable with aggressive mitigation including aggressive sentinel surveillance testing to find the silent spread and immediately isolate asymptomatic cases : this is not about shut downs or lock downs but using the clear evidence based mitigation that has worked -- which requires behavioral changes both in publle and private. The Sunbelt continues to contribute significant daily deaths showing the significant delay between improvement in the pandemic picture and continued fatalities. Fatalities will begin to rise across the US in the next 1-2 weeks and will not be offset by declines in the sunbelt. There is an absolute necessity of the Administration to use this moment of the WH outbreaks to ask the American people to wear masks, physical distance and avoid gatherings in both public and private spaces .