Tony's Diary Package — page 417

1. -- > - 8,200,000/220,400 21 October 2020 This the most diffuse community spread in both urban and rural counties we have experienced and we are 1-2 weeks from these new cases filling hospitals in urban and rural areas making load balancing difficult significantly straining the hospital system and 2-3 weeks from escalating fatalities. It will be criticalto ensure that the North East, CA, TX, FL hold during this surge. We are on the same escalating slope from summer but at a higher baseline 36K vs 21K which will lead to potentially 80K cases/day rapidly. With current case rate expansion we will achieve the greatest number of daily cases since the pandemic began this week. This is not due to increased testing but broad and ever increasing community spread, There are no states, regions, or communities with enough prior COVID infection to provide any substantial protection from new community spread which will lead to hospitalizations and fatalities. This is very evident by the rising cases again across the Sunbelt and moving into the North East. We are now seeing concerning trends in the Sunbelt in states that stopped most of their mitigation efforts 2--3 weeks ago. This sequence of events must stop with the initial silent spread with aggressive sentinel surveillance testing. Aggressive testing in the contagious but asymptomatic population with isolation effectively contained and mitigated prior to infection of the more vulnerable community members. Providing appropriate isolation options for infected individuals from multigeneration households will be key. We have found from careful analysis, modelling and triangulation of all the data that community spread can be controlled without a lockdown as we have done but the time to act is critical and must be with the original detection of the silent spread, ensuring infected individuals know how to limit their infection of others and with messaging on universal masking, physical distancing, and essential limitation of public and private gatherings indoors especially small gatherings with friends and family. Consistent messaging about masks, physical distancing and hand washing with limitation on indoor gatherings especially with family and friends is essential at this time point -- this is about empowerment of Americans with data for decision making. The swing for the next two weeks in packet. In reviewing these states I have included the top county profiles to dernonstrate in most states the diffuse type of spread unlike March/April where it was very metro oriented and this spread is urban and rural. I have included the data from the Europe (slide 4) and a new analysis from CDC (slide 17/18) showing that quarantine can be decreased to 7 days with symptom tracking and COVID19 testing on day 4,5, or 6. This should be ready for guidance in a couple of weeks. Violly Roberts -- "Why Fauci Won't Fauci reportedly quotes 'The Godfather' in response to Trump criticisms By Yaron Steinbuch October 20, 2020 I 7:00am I Updated October 21, 2020 Global - 40,500,000/1,100,000; USA - 8,200,000/220,400 Se. Patrick Leahy (D-VY) called me to encourage me in light of the POTUS attacks on me. His mother's side of the family is Italian and he said to me "Coraggio" or courage, which his grandmother used to tell him when he was a prosecutor in Vermont. PRESS: Article in Washington Post by Molly Roberts - "Why Fauci Won't Quit";