Tony's Diary Package — page 481

18 November 2020 All states and major metros now are deteriorating except Hl -- there are 27 states in the red zone and 7 states in orange zone New daily admissions have reached 10,000/day and Inpatient COVID patients reaching historic highs Its fet just the number of cases but the rate of rise - what we are documenting today as new cases are reflective of spread 10-14 days ago - the rate of rapid rise in cases will translate to a proportional rapid rise in hospitalizations and deaths The length of tire te reach peak is significantly longer -- we are seeing improving in El Paso follawing extensive mitigation since 22 October Metros hit hard during the surmmer surge are now surpassing their summer peak We need ta change the rate of rise of cases to change the rapid rise in hospitalizations to preserve hospital capacity -- this s no longer about preventing a crisis -- this is a crisis -- this is about trying to save as many lives as possible within the crisis Europe has shown us that the Fall surge can be contained and hospital capacity sustalned and if we act now we can do the same This will require a comprehensive Federal response with aggressive support to States to include: * Aggressive communication at the WH level masking requirements at all times outside of Immediate household, physically distancing, hand hygiene AND critically limiting of social interactions to the immediate household for the next 60 days while we bridge to the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : this is a short term sacrifice to protect the vulnerable. We need te document precisely the number of vaccine doses available over the next 2 week for pilot rell out to LTCF. 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 natians Expanding frequency of LTCF testing and aligning early vaccination into LTCF Ensuring rapid tiering of those most vulnerable to rapid vaccine immunization access immediately upon EUA (CDC) Short term interventions : in States with demonstrated hospital staffing under threat - restricting indoor dining and limiting areas of congregation without mask (bars, gyms and restricting indoor dining) will be needed as was successful in the USA in the summer and in Europe Without an immediate change we will hit 200,000 cases/day and 1.5M cases/week, and over 100,000 inpatients -- this is unsustainable Over the Last 30 Days Cases have risen from an average of 55,370/ week to now 152,978/week 276% increase New Admissions have risen from 5500/day or 38,500/week to now 10,000/day or 75,000 per week 181% increase Inpatient COVID patients has risen from 42,098 to now 72,057 171% increase Inpatients with COVID currently rising at 17% week over week witha project of 84,306 inpatients next week and 100,000 inpatients the week after assuming the same rate of discharge (if sicker patients are admitted the % increase will become greater week over week) Deaths have risen from 697/day average to now 1206/day average 173% increase