Tony's Diary Package — page 497

10, .-- 12,800,000/263,000 27 November 2020 There are 279 atetes in the red sone and 11 etates if orange zone = 40 etates in full recurgence however cases are increasing e¢roas all etates including the mare populous etates which will significantly increase hoepitalizations and fatalities - data will be unvtable including fatalities due to reperting changes All major metros have or are exceeding the apring and summer aunpe cased except for NYC, Ma, HOU but their rate of rise could drive then ever their priar highs in days Ihave included C4, IL, TX, PA the primary drivers of the large national numbers of cases and fatalities at this time The duration of rising cases and the rate of rise is greater than the spring or summer whech will prolong the high fatalities forthe next 4-6 weeks rapedly reaching over 200,000 American fatalities rapidly (Mov testing willbe the same at Qct) and & mot increasing at the rate of increasing cases, hospitalizations and fatalities We need to make it clear that choices (state and metro policy choices and personal choices} will drive a post Thanksgiving surge because of the underlying high viral load that will be an oversvhelming threat to the health care system. Many states are inadequately mitigating including sunbelt states that mitigated well in the summer. Aggressive mitigation needs tohapgen now to prevent a catechysmic Holiday season forthe hosgitel systems. CFR; population will correlate with bevel of mitigation. The mitigation choices states are making or not making will direct correlate on level of fatalities. The impact of these choices om human life will be very evident. Current improvements are seen im 1-2 states aggressively mitigating and it will be wery evident over the mext G0 days that mitigation saved lives and the lack of mitigation resulted in unnecessary high fatalities - States that did not mitigate in the Fadl surge will end up with population CPR equal to the Spring surge when treatment was subogtimal - WD, $0, M7 -- states must be encouraged to advance policies that mitigation against this Fall viral sunge We found the friends and farnily small gatherings driving hospitalizations during the state visits but we also kncew that those drivers agpeared im the sunbelt after the states fully mitigated in the public spaces -- including significant reducing capacity or closing spaces where masks cannot be vweonn Euroge countries with clear polcies are Improving rapedly with aggressive containment with mitigating policies and clear communication and are carefully reopening There are ow 27 States in the red and orange for hospitalizations of COVID cases -- care deteriorates across all patients with and without OOVID when states enter the red zone -- there are nore states in this category everyday New daiy COVID conflrmed admiisons are over LODO day and inpathent COVID patients reaching histori: haghs BODO linoeading LOKweek), nearly 45%) of all confirmed OOVID admissions ane ower 70 and CFR remains mear 10% for those over 70 and near 1% for those 40-69 - ye will reach historic highs im dally fatalities Although we were beginning to see early signs of decreases iin the rate of rise of hospitalizations I remain deeply wonred about apost Thanksgiving surge that will once propel us towards 450,000 deaths as the Fall surge continues Inte the winter ifwe cant both mitigate in publbc spaces and convince Americans ofthe danger There are state examples of changing the rate of rise of cases to change the ragid rise im hospitalizations to preserve hospital capacity -- this isino kenger about preventing a crists -- this is a crisis -- thits is about trying to save as many lirees as possible within the criss and we have examples of states that are improving 1, The virus is accelerating faster than our response and this requires am even further accelerated and comprehensive Federal response with aggressive support to States te include strong statements that Europe and States with strong mitigation are improving = there is a clear roadmap to contain this virus and preserve the health system: . Continued 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 must directly confront the myths that many Americans believe . Many Americans believe that masks don't work due to prior tweets, that the epidemic is a hoax, that the figure of 94% of those whe died had co-morbidities meant that they died from something else and we have inflated the fatalities - instead of understanding that the co-morbidities predisposed them to severe COVID ' Clear recommendations to States about the importance of short term mitigation interventions : restricting indoor dining and limiting and/or closing areas of congregation without mask (bars, gyms etc.) this was successful in the USA in the summer and was successful in Europe during their fall surge = states across the country are not mitigating adequately to preserve the health system . Continued critical guidance on the Holiday season to limit indoor unmasking across households if they choose to gather ' Aggressive re-alignment of Ag testing towards finding and preventing unrelenting silent spread that continues to trigger community spread in waves =a hand full of states are moving in this direction . Expansion of MAT testing now to ensure colleges can access routine regular cost effective testing in January . Expanding frequency of LICF testing and aligning early vaccination into LTCF . With Moderna's potential of one shot resulting in some protection - aggressive immunization of the elderly could dramatically change hospitalization rates and fatalities in the next 30-35 days . Ensuring rapid tlering of thase most vulnerable to rapid vaccine immunization access immediately upon EWA = this may require implementation support ta the states and full utilization of federal qualified health clinics November 27, 2020 - Global - 60, 300,000/1,400,000; USA - 12,800,000/263,000 Now concerned about the post-Thanksgiving surge