Tony's Diary Package — page 470

aw min 1, 10. 11, 12 November 2020 As shown in slide 3 this is the most rapid rise in cases encompassing all age groups and the most rapid rise in hospitalizations increasingly stressing the systems that will increasingly compromise non COVID care BUT it is clear this can be contained with aggressive effort as the UK is doing aver the past 20 days and can be done over the next 30 days here with real and immediate impact This will require a comprehensive Federal response with aggressive support te 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 ta 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 nations . Expanding frequency of LTCF testing and aligning early vaccination into LTCF if immunogenicity is clear in elderly * Ensuring rapid tiering of those most vulnerable to rapid immunization access immediately upon ELA (CDC) . Short term interventions ; in States with demonstrated hospital staffing under threat - restricting indoor dining and briefly limiting areas of congregation without mask (bars, gyms and restricting indoor dining) will be needed as was successful in the USA in the summer Why is this needed now -it is needed now because cases are in a historic rate of rising spread and the rate of daily hospital admissions are not sustainable But we have the tools can change this now and bridge ta long term effective control through vaccination Even with the Veterans Holiday that interferes with reporting 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 Cases are distributed throughout age groups but the most rapid rise in cases and hospitalizations in those over 40-69 and aver 70 26 States are in the red and orange zone and now over 7000 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 2 November 2020 continued This week we will reach 2X the number of cases of the summer surge which will result in 2X the hospitalizations and fatalities of summer surge There is no evidence that any prior surge --Spring surge or Summer surge is protective in the Fall surge in any state-- there is na evidence that 10-15% baseline prior infection in the population leads ta change in log phase community spread with cooling driving Americans indoors There is no evidence that "allowing" young people te become infected and silently spread the virus without diagnosis and isolation is an effective strategy a5 it leads to widespread silent community spread followed by escalating cases across all age groups, hospitalizations and threats to the health delivery system and fatalities in the cammunity Vaccine quantities despite limited amounts can be used strategically to save the most lives between now and January MAb amounts are also limited and it will be critical to align this limited supply to thase most in need PPE gowns and gloves are limited and we must ask states and hospitals te fully utilize current stocks as relief will be possible after February with vaccinations decreasing hospitalizations Expanded strategic use of the Ag tests is critical ta controlling the current surge : these tests must be used for all individuals in all states with test positive rates aver 5% independent of symptoms =requiring use in symptomatic clients is preventing testing and control of the pandemic. Detection af pre-symptomatic, mild and asymptomatic cases requires both surveillance of community populations (community callege students, majar industries, K-12 teachers etc) and surge community focused testing of under 40 yo ta find and isolate these contagious individuals. Implementation support for aggressive testing of the contagious but asymptomatic population with isolation effectively contained and mitigated spread prior te infection of the more vulnerable community members. Routine testing will be essential in multigenerational households especially in our Tribal Nations, One Federal unified consistent messaging about uniform use of 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 to prevent community spread and save lives, University through aggressive testing and isolation had 97% less infections and isolated 95% less students Ta 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 PRESS: Good Morning America with Robyn Roberts; Vice News with Liz Landers; Chatham House with Emma Ross and David Heymann; American Philosophical Society Fireside Chat with Mark Thompson; VICE TV