Tony's Diary Package — page 488

1. 21 November 2020 All states and major metros now are fully deteriorating except Hl -- there are 29 states in the red zone and 9 states in orange zone -- the duration of rising cases and the rate of rie greater than the spring or summer which will prolong the high fatalities for the next 4-6 weeks rapidly reaching over 300,000 There are suggestions of early stabllization in test positivity and cases inthe Northern Plains and Heartland as they experienced a break Inthe weather a couple of weeks ago but is has cooled again and with college students returning and the potential of multiple frlends and familly gatherings we could experience another rapid roe Concerning is the rapid rise in cases inthe next set of states which are much more populous and willdrive even higher hospitalizations and fatalities There is no evidence that any prior infections at the population level is changing the above relationship or providing any significant blunting to the significant fatalities that will continue tose rapidly. Finally by not detecting the silent spread in young people continues to drive ever expanding cases, hospitalizations and deaths As predicted we hit 200,000 cases/day (195,000) and LSM cases!week, and over 100,000 inpatients --this is unsustainable states without mitigation will have the highest fatalities rate: states that are aggressively mitigating will flatten their curves more quickly and preserve their hospital systems New dally COVID confirmed admissions are over 10,000,/day and inpatient COVID patients reaching historic highs -- there are not significant new improvements in treatment to further improve CFR which will remain near LO for those over 70 and near 1% for those 40-69 - we will reach historic highs in dally fatalities Last week 130K confirmed and suspected COVID cases were admitted --these drive PPE use and staff neecds-- Its not just the number of cases but the rate of ree - today's cases are reflective of spread 10-14 days ago - the rate of rapid rise in cases will translate to a proportional rapid rise in hoepital izations and deaths : but there ls clear evidence that aggressive mitigation works -- Europe is stabilizing We need to change the rate of rise of cases to change the rapid rise in hospitalizations to preserve hospital capacity-- this is mo longer about preventing a crisis -- this is a crisis -- this is about trying to save as many lives as possible within the erisis This will require a comprehensive Federal response with aggressive support te States ta Include: * Continued aggressive communication at the WH lewel masking requirements at all tines outside of rimediate household, physically distancing, hand hygiene AND critically limiting of social interactions te the immediate household for the next 60 days while we bridge ta the rapid vaccination of the vulnerable populations decreasing heepitalzations and fatalities : this is a shart tenm sacrifice ta protect the vulnerable. ' Conthvued critical guidance on Thanksglving ta limitindoor unmasking across households ' Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger cormnuntty spread in waves ' Expanding frequency of LTCF testing and aligning early vaccination inte LICE ' Ensuring rapid tiering of thoee rest vulnerable ta rapid vaccie immunization access immediately upon EUA (COC) ' Short term mitigation interventions: restricting indoor dining and limiting and/or closing areas of congregation without mask (bars, gyms ard restricting indoor dining) will be needed as was successful inthe USA inthe surmimner and in Europe Had Zoom with NIH people (Francis Collins, John Mascola, Kim Taylor, Gary Gibbons, Eliseo Perez-Stable, Cliff Lane) and with the Janssen people (Paul Stoffels, Mathai Mammen, Stacey Hargraves, Peter Ronco, Macaya Douoguih, et al) to review the status of the Janssen trial and to encourage getting greater diversity in the trial. Got call from Larry Horowitz tonight telling me that Peter Marks told him that Trump called up Steve Hahn today and told him that Alex Azar said that Steve lost the POTUS the election by holding up the news about the Pfizer vaccine. Trump was cursing Steve on the phone and then hung up. Steve did not know if he was going to get fired and told this to Peter who called up Larry. Still not sure what is going to happen.