Tony's Diary Package — page 518

6 December 2020 The improvementsin the Northern Plains, Rocky MountainStates and Heartland is being directly offset by the surging cases and hespitalization on the West Coast, Sunbelt, MidAtlantic and NE -- these more populousstates will drive this over the next 2-3 weeks and when combined with a pending full Thanksgiving surge will represent the greatest threat to hospital systems and general inpatient care-- this is not about ventilators and PPE this time -- this will be about the statf capacityto care for this volume of patients with and without cOVID 33 States are inthe COVID red zone for cases and test positivity and 9 states are in the orange zone for test + and red for cases There are now 34 Statesin the red (24) and orange (10) zone for hospitalizations of COVID cases -- general medical care deteriorates when states enter the red 2one-- there are riore states in this categery everyday decision by COC en wha i inmunined first will determine the future stability af the hospital system and hospitalization rates - current plan will net change the pandemic dynamics impact on hospitals Alltrends show that this escalation was occurring even before the transmission trom Thanksgiving -- we should begin ta see the full impact of Thanksaiving starting this week and as warned thls Winter surge will be bigger, broader, and more deadly. It will bring teaether both the Spring and Summer surge inte one overwhelming threat dramatically increasing hospitalizations and deaths: even with the innovations this will be catastrophic withoutincreased mitigation mow -- states without adequate publle pollcbes will have the highest fatallty rates per pepulations equal te the Spring rates despite Imprevernents In care due te the lack of mitigation --death rates In ND and SD and approaching N¥/MJ #5 We do not have enough vaccine for vulnerable Americans to change hospitalization and fatalities trendsin Dec-Feb-- we need to be clear to the Qmerican people vaccines will haw: animpact inthe Spring but NOT over the next 3 months, Behavior change and proactive testing te find both the asymptomatic and symptomatic transmitters are our only interventions and states are still net testing correctly to find kath The movernent of the surge into populous states especially without adequate policies or without individual Americans mitigating will drive fatalities and nvost of these states do not have adequate mitigation policies and fatalities will continue averagingover 2500/day 17 Kiweek, TOK /nvonth at amininun reaching over 330K by New Years and 450K by the end of February without calls for action at the Federal, State, and Local level and using PSs to combat the myths related to COVID throughout the country twill be very evident over the next 30 days that mitigation policies saves lives and the lack of mitigation results in preventable deaths on for They also want to announce on Tuesday the important role that I will have to be the Chief medical Advisor for the Administration. They will send me the wording to make sure that I am OK with it. Gov. Cuomo called me today (1:30 PM) - He wanted to touch bases with me in anticipation for the fact that I will be joining him tomorrow on a press conference for the state of MY. He wanted to brief me on what he was going to say. He and I have a growing and strong relationship. Received a call (3:00 PM) from Olivia Dalton from the Biden Transition team asking me to participate in an event (I asked to do it virtually) in Wilmington where Biden will announce his "health team" including me. We discussed my virtual remarks and other issues. Deb Birx on MTP pleading (as I have been doing) with the public to abide by public health mitigation methods. Example of state by state increases in deaths and cases: