Tony's Diary Package — page 503

30 November 2020 There are 26 states in the red zone and 10 states in orange zone -- data is extremely unstable due to the long Holiday break There aré two different regional dynamics in the pandemic. The Northern Plains and mast of the Heartland except OK is finally stabilizing after 8 weeks of unrelenting rise but from IN to OH to PA, the mid Atlantic, the NE region and the West Coast, TX and AZ continue to deteriorate which will drive up cases, hospitalizations and deaths. Currenth new admissions are stabilizing and the key will be whether Thanksgiving drives a super surge There are now 29 States in the red and orange for hospitalizations of COVID cases -- care deteriorates across all patients with and without COVID when states enter the red zone -- there are mare states in this category everyday -- decision by CDC on who [s immunized first will determine the future stability of the hospital system. Gee and Jan will be the key months for pressure on the hospital system and without prioritizing thase most like to require hospitalization and death could result in over all failure of critical care for all Americans independent of COVID status itis clear that choices (state and metro policy chobces and personal chelces) will drive a post Thanksgiving surge because of the underlying high viral load that will be an overwhelming threat to the health care system. Many states are currently inadequately mitigating Including sunbelt states that mitigated well in the summer. Aggressive mitigation needs to occur mow to prevent a cataclysmic Holiday season for the hospital systems. CFR and deaths/i1M population will correlate with level of mitigation. The mitigation cholces states make or don't make will direct correlate with curnulative level of fatalities, itis not to late with the Holidays coming to change. The impact of these choices on human life will be very evident. it will be very evident aver the next 60 days that mitigation saved lives and the lack of mitigation resulted in unnecessary high fatalities - States that did not mitigate will end up with population CFR equal te the Spring surge when treatment was suboptimal - ND, 5D, MT -- states must be encouraged to advance policies that mitigation against this Fall viral surge We found the friends and family small gatherings driving hospitalizations during the state visits but we also know that those drivers appeared in the sunbelt after the states fully mitigated im the public spaces -- including significant reducing capacity or closing spaces where masks cannot be worn Europe countries with clear policies are improving rapidly with aggressive containment with mitigating policies and clear communication and are carefully reopening Although we were beginning ta see decreases in the rate of rise of hospitalizations I remain deeply worried about a post Thanksgiving surge that could propel us towards 450,000 deaths as the Fall surge continues into the winter through Jan and Feb and if we can't both mitigate in public spaces and convince Americans of the danger --convincing Governors and Mayors now to mitigate past Thanksgiving and pre-Holidays is essential 1. Toprevent 4 post Thanksgiving surge a comprehensive Federal response with aggressive support to States to include strang statements that Europe and States with strong mitigation are improving -- there ls 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 who died had co-morbidities meant that they died fram 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, gyrns 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 te limit indoor unmasking across households if they choose ta 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 NAT testing now to ensure colleges and K-12 teachers can access routine regular testing in January ' Expanding frequency of LTCF testing and aligning early vaccination into LTCF ' With Moderna's potential of one shot resulting in some protection - aggressive immunization of the vulnerable and the elderly could dramatically change hospitalization rates and fatalitiesin the next 30-35 days * Ensuring rapid tiering of those most vulnerable to rapid vaccine Immunization access immediately upon EUA = this may require implementation support to the states and full utilization of federal qualified health clinics