Tony's Diary Package — page 462

9 November 2020 The weekend is normallya low reporting time yet we reached LOOK cases Sunday contirming the potential for cases reaching 140-L50K this week - there is no evidence of plateauing--this will lead to 1M cases/week -- cases drive hospitalizations and deaths Cases are distributed throughout age groups but the most rapid rise in cases in thase over 40-69 and over 70 26 States are in the red and orange zone: the highest we have had and as we knew rigingcases lead te rising hospitalizations, inpatient status have surpassed March/April and will surpass the Surrmrer surge rest week Fatalities are rising despite the substantialdelay from cases to fatalities --which is nearly4 weeks -- 0 Fatalities will rise rapidly over the next4 weeks just based onthe number of cases we have now The case fatalivy rates are artificially low at this time due te the rate of rise of cases and the delay in fatalities --this will medulate in 4-4 weeks significantly increasing the CFR espescially for those aver 70. Cases are rapidlyrisingin 50% of all States are red or orange zone- with now rapid increases again in TX, CA, FL, and N¥ and NJ showing early concerning signs Florida igexperiencing a full resurgence as well as Texas, already increasing hospitalizations This is the rest rapid increase of hospitalizations --vwe will reach historic highs in daily hospitalization this week-- acres multiple states and unrelenting increases This week we wall reach 2X the number ot cases of the summer surge which will resultin 2x the hospitalizations and tatalities There is no evidence that any prier surge -- the Spring surge or the Sumner surge is protective in the current Fall surge in any state-- there is no evidenor that 10-15% baseline prior infection in the population leads to change in log phase community spread There is no evidence that "allowing" young people ta become infected and silently spread the virus without diagnosis and isolation tar 10 days is an effective strategy that leads ta anything but widespread silent community spread followed by eecalating: cases, hospitalizations and tatalities in the community. 9 November 2020 continued : actions : the UK with mitigation has plateaued Universities have shown us that itis possible to contrel the silent community spread and change the follow on cascade with mitigation and testing. Ensure the impacttul mitigation efforts and targeted testing for asymptomatic infectianare implemented now to stop the escalating eomirmnuinity spread, increasing hospitalizarions and fatalities. We have a window for aggressive messaging and testing ta change the trapectory but that windew is closing and without aggressive action heépitalewill be uncer threat within 3-4 weeks and continue te escalate for 3-4 weeks after that-- this is why tiring is eritical Expanded strategic use of the Aa tests will be critical to controlling the current surge ; these tests must be used for all individuals in all states with test positive rates over 5% independent of symptoms -- requiring use in symptomatic clients is preventing adequate testing and control of the pandemic. Detection of pre-symptormatic, mild and asymptomatic cases will require bach sentinel surveillance of community populations (eamnunity college students, mapor industries, K-12 teachers ete) as well as surge comunity focused testing af uneber 40 yo te find and isolate these contagious indivichuals, Implementation supporttor agaressive testing of the contagious but asymptomatic population with isolation effectively contained and mitigated spread prior to intection ofthe more vulnerable conmmunity mentbers, Routine testing will be essential in multigenerational households especially in our Tribal Nations. Ore Federal unified consistent messaging about unifarm use af masks, physical distancing and hand washing with profound limitationan indoor gatherings especially with family and friends is essential at this tin: paint -- this is about empeawernent Americans with the knowledge and data for decision making te prevent community spread and sawe lives, University through aggressive testing artd isclation had 97% less infections and isolated 95% less students To change the Future this will require an aggressive data driven balance approach that is not being implemented at the state and local level and will require Federal support and guidance to change this 100/1,300,000; USA -- sure that "every legal vote gets counted". I was surprised that there was not even a hint in Pence's voice that declaring the vaccine successful a few days AFTER the election was a conspiracy of some sort. I have not even heard any of that from the Oval Office. Let us see over the next couple of days. PRESS: CNN with Wolf Blitzer November 10, 2020 - Global - 50,500,000/1,300,000; USA - 10,000,000/238,000