Tony's Diary Package — page 464

10 November 2020 1. Although this is the most diffuse, most rapid rise in cases, encompassing all age groups it is clear this can be contained with aggressive effort as the LK is doing over the past 20 days and can be done over the next 30 days here with real and immediate impact 2, This will require a comprehensive Federal response with aggressive support to States to include: . Aggressive communication on not only masking at all times outside of immediate household, physically distancing and hand hygiene but absolute limiting of social interactions ta the immediate household for the next 60 days while we bridge to the rapid vaccination of the vulnerable populations dramatically decreasing hospitalizations and fatalities : this is a short term sacrifice to protect the vulnerable * Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger community spread in waves : ADM Giroir and CDC working with States and Tribal mations * Expanding frequency of LTCF testing and aligning early vaccination into LTCF if immunogenicity is clear in elderly (done) . Ensuring rapid tiering of those most vulnerable to rapid immunization access immediately upon ELA (CDC) * Short term interventions : with demonstrated hospital staffing under threat restricting indoor dining and briefly limiting areas of congregatian without mask (bars) will be needed 3, Why is this needed now =it is needed now because cases are ina historic rate of rising spread and the rate of daily hospital admissians are not sustainable But we have the tools can change this now and bridge to lang term effective control through vaccination Monday night usually reflects an additional day of low reporting but we are trending 30K over last week which will lead to 150K cases/day by the end of the week leading to 1M cases/week = which will overwhelming our hospitals staff as is occurring in the Northern plains All areas of cooling are experiencing log phase community spread and Florida, Texas, Arizona are experiencing a full resurgence There is no evidence of plateauing = this will lead to 1M cases/week = continuing to drive hospitalizations and deaths Cases are distributed throughout age groups but the most rapid rise in cases in those over 40-69 and over 70 26 States are in the red and orange zone and now over 2000 counties are in "high concern" due to cases and speed of rise Fatalities are rising despite the substantial delay from cases to fatalities -- which is nearly 4 weeks = so fatalities will rise rapidly over the next 4 weeks just based on the number of cases we have now 10. The case fatality rates are artificially low at this time due to the rate of rise of cases and the delay in fatalities -- this will modulate in 2-3 weeks significantly increasing the CFR especially far those over 70. * won nin AREA OF CONCERN CONTINUUM Dale: 1azaz0 Area of Concern Continuum by County Sheen ie tier: ial Pain rare - O8NOV2020 sre 7 possible ACC Cassifications based on current and recent history of case and testing data forthe location: (7) LowBurden--conrmiunities with minimal activily (2) Moderate Burden--communties with moderate disease activity (merging Hotepot-- communities with ahigh likelihood to become hotspots. in the next 1-7 days (4)Hotspot-- communities that have reached athreshold of disease activity considered asbeing offhigh burden (Sustained Hotepot--communitias that have had alhigh sustained case burden and may be higher nek for expenencing healincare resource limitations (6) High Burden--Resolving--communites that wererecently identified as hotspots and are nowimpnoving (?)Moderate Burden--Fesohing --communities that have a moderate level of burden, but are demonstrating improvement See Data Sources Methods sides for more information. Mm ardieeed Habit Mag ce RC a BI ~ TH BD Rd BMS MDDS MOOT DMO JOT OGL GO-LL See below the states that are increasing: