Tony's Diary Package — page 508

1 December 2020 Data is unstable but when cases nse despite the Holidays are they are across the West Coast, TX, Iid-Atlantic and ME it races more red flags There are 26 states in the red zane and 10 states in orange zone -- date & extremely unstable due ta the long Holiday break Thereare two different regione! dynamics in the panderic. L The Northern Plains. and mastof the Heartland except 8 is fimalhestabd ang after 2 weeks of uneelerting rise, Thess states will aliwus to secthe Thankegiving surge and beable to estimate the impact of theupooming Holidays and the messaging needed bo prevent a lanuanyand Febuary surge From iNito GH te, the mad Atientic, the ME region and the West Goes, TS and 42 continue to debenoratewhich will driveup cases, hos petalizations and deaths toeven high ttes.due to population sie and it will be difficult to estirnate the post Thankaaiving impact. Bo The current pecture could combine the Spong and Sumner surge states together inboa Winter sunge resulting inven higher hospetalaationsand deaths 4. Fach surge Spnng (100% fatalities), Summer [100k fatalitees:), Fall Surge I 100K fatalities) combening Spang and Summer could lead toa 200K Fatalities There are now 29 States in the red and orange fer hosgitalizatiens of COVID cages --gereral medical care deteriorates when slates enter Lie red gone --There are more states in this category eseryday = decision by COC on whe is emimuneced first will determine: the future stabelty of the hospital system. Dec and Jan willbe Lhe Rey months for pressure on the hosgital systemand wilhoul provritizing those Geely to require hospitalization and heghest rise of death could recult rower all fadure af critical care for all Amencans independent af OOWiD status Lwillbe wery evident over the mext 30 days thal mitigation saved lives and the lackal mitigation resulted in unnecessary high fatalities - Staves that did mat motgete will end up with population CFR equal ta the Spreng surge whentreatment was suboptimal W0, 50, MT states must be encouraged ta aceance policies Chak nabigabion against this Fall viral surge Europe: countrns with clear policies aire improving ranidhy with aggressive containment with motwating policies and clear camimunication and art carefully MOeTINg Although we were boginning to seo decmasas inthe rate of nse of hospetalcations a past Thanksgiving sumge thet could propel ws towards 450,000 deaths as the Fall sunge continues into the winter through Jan and Feb and if we cant bath mitigate in public spaces and convince Americans of the danger -- canwincing Gowamars and Mayors now to mitigate past Thanksgiving and pro-Holidays & espantial 1. To prevent a post Thanksgiving surge a comprehensive Federal response with agressive support to States to 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 -- ensuring the identification of silent spread and early Dx and Tx and those at risk for serious De: Continued aggressive communication at the WH level rnasking requirementsat all tires outside of immediate household, physically distancing, hand hygiene AND critically limiting of social interactions te the immediate househeld fer the neat 60 days while we bridge te the rapid vaccination of the vulnerable populations decreasing hospitalizations and fatalities : thisis ashort tern sacrifice to protect the vulnerable. We must directly confront the myths that many Americans believe * Many Americans believe that masks don't work due te prior tweets, thatthe epidemicis a hoax, that the figure ef 44 of those who died had eo-morbidities meant that they died from something ele and we have inflated the fatalities -instead of understanding that the co-rnerkidities precdipesed thern te severe COVID ' Clear recommendations to States about the importance of short term mitigation interventions © restricting indenr dining and limiting andor chasing areas of congregation without mask (bars, gyre ete.) this vas successful in the USA in the surnimner and was successful in Purope during their fall surge -- states across the country are net mitigating adequately ta preserve the health system ' Cantinutd critical guidane: on the Meliday seasen be limit indenr unmasking acres households if they choose ta Bathoet * Aggressive re-alignment of 4p testing towards finding and preventing unrelenting silent spread that carntinues te tigger community spread inwavwes --a hand fullof states are moving in this direction Exparcsionol MAT testing mow to ensure colleges and K-12 teachers can access routine: regular testing in lanuary * Expanding frequency of LTCF testing arcd 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 mast vulnerable to rapid vaccine immunization access immediately upom ELM -- this may require implementation support tothe states and full utilization of federal qualified health clinics over-run by the surge upon the surge. He and the Greek Chorus of the TF just cannot accept that we are in serious trouble. Very frustrating Some states starting to plateau while others continue to surge. See below: Danger of hospitals being overrun and lack of adequate staffing (see graphs below):