Tony's Diary Package — page 431

8. 28 October 2020 We are now seeing both small and large metros in the previous hot spots in the spring and summer beginning to exhibit significant community spread and with cooling this spread could significant accelerate as in CHI and hit new alltime records, There is no evidence that previous experience with significant viral spread is in any manner protective of this fall surge Hospitalizations are rising in all state categories (red, orange, yellow, light green) except for dark green states at this time -- we are seeing record numbers of new admissions with no month over month improvement in thee fatality rate since July Fatality rates in people over 70 remains at 10-11% of all cases. Increased access to novel therapeutics will be needed to change this. Cases will cantinue to hit all time highs week over week as the core mitigation efforts and targeted testing for asymptomatic infection in those under are not occurring. (Last week we were up nearly 9K high over high and with current slope it means we could cross 85 90K the end of this week and 100K/day the end of the next week--- its not the absolute case number but these numbers are an indication of community spread and community spread leads inevitably to infection to those vulnerable to serious complications and deaths) This sequence of events must stop with the initial silent spread with aggressive sentinel surveillance testing. Aggressive testing of the contagious but asymptomatic population with isolation effectively contained and mitigated spread prior to infection of the more vulnerable community members. It is critical ta act now finding the continued source of 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. One unified consistent messaging about masks, physical distancing and hand washing with profound limitation on indoor gatherings especially with family and friends is essential at this time point -- this is about empowerment Americans with the knowledge and data for decision making. States will begin to react with the spring mitigation efforts but this won't control the indoor house spread. . . National Picture NEW CASES PER 100,000 LAST WEER NATIONAL RANKING OF NEW CASES PER 100,000 LAST WEEK a Kew Comes per 130K I in the Laat Weel Halicnal Malicnal ark State anit St NEW CASES PER 100,000 IN THE WEER: OME MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE = BBC PRESS: Marc Siegal "Doctor Radio" Sirius Radio; Interview with Joel Achenbach - Washington Post; JAMA Podcast with Howard Bauchner; BBC