Mike Hoerger, PhD MSCR MBA Profile picture
Nov 13, 2022 13 tweets 8 min read Read on X
New article in @JAMANetworkOpen provides critical data on the long-term trajectory of COVID-19 symptoms.

Lots of bad news. 😕
Very bad news for ppl w/cancer or bad acute case of COVID. 😬
Also, a few rays of hope. 🌞
#LongCOVID #COVIDcancer

1/12
jamanetwork.com/journals/jaman… Title and graph, journal ar...
66% of adults had at least 1 symptom during the acute phase (first 2 months) of diagnosis of #COVID-19.

I’ve highlighted the symptoms experienced by at least 10%. Note that some of the less common symptoms are quite debilitating though (e.g., 9% w/lung pain).

2/12 Symptom table. Acute sympto...
If you had a #COVID symptom initially, what are the chances it persists beyond 2 months? See 2nd column, green highlights emphasize those enduring among >10%.

Many of the initial symptoms endure in about 20% of ppl. Russian-roulette like odds.

3/12 Table shows the percentage ...
If you know someone with a new #COVID infection/reinfection who is experiencing symptoms, dive deep into that particular row.

For example, while memory loss is rare (4.3%), it’s the most enduring symptom beyond 2 months (40% persisting).

4/12 Table mark up emphasizes on...
If you had an acute #COVID symptom, what were the chances it would resolve within 1 year?
See authors’ BLACK text.

I’ve also added a column with the chances a symptom persists (ORANGE text). Balanced framing. 🙂

5/12 Table on long-term persiste...
Now, let’s manually combine the acute (<2 month), near-term (>2 month), and long-term (>1yr) #COVID data into one figure. Silly JAMA. 😊

Some symptoms present at 2 months largely fall off. Others persist in >25% (palp, art pain, att/conc, memory, sleep).

6/12 Manually combining data fro...
Overall, the number of #COVID-19 symptoms each person experiences diminishes over time.

Caveats: Initial infections were all pre-vax (call for hope), but also pre-omicron and before many reinfections (call for caution). Note, %s are among those who had an acute symptom.

7/12 Graph: Number of COVID symp...
Older adults, women, and ppl w/>5 acute symptoms were more likely to have persistent #COVID symptoms at 1 year.

A history of #cancer predicted prolonged symptoms. #COVIDcancer

Higher BMI = more persistent symptoms. Bad for the U.S.

8/12 Fully adjusted model examin...
An Appendix figure models the typical time to resolution of a #COVID symptom (crude estimate, varies by symptom & individual).

I added the blue line, which suggest about 5% would experience symptoms at 3 yrs. That's >16 million Americans. Very rough estimate. #recession

9/12 Crude analytic model attemp...
Model of time to COVID-19 symptom resolution by subgroup.

#COVID has persistent effects for those with a history of cancer or who had a bad acute case. Either we have a critical gender health disparity or men are trying to walk off heart palpitations. 🤔

#COVIDcancer
10/12 Subgroup analyses show that...
An average of 10% of adults were experiencing long-term symptoms from #COVID-19.

The authors note that this is a critical public health problem b/c of the high incidence of infection. They are perhaps too optimistic. We have a high incidence of REinfections.

11/12 Authors' conclusions from t...
Limitations: The COVID-19 initial infections were all before the vaccine era, mostly before reinfections, and pre-omicron.

You cannot have long-term data AND up-to-date world events. Stay cautious until the long-term data are optimistic.

12/12
By the way, feel free to share any of this on other platforms (Mastodon, Discord, TikTok, Myspace, or even Facebook) and with family/friends. I tried to annotate the figures in a way that it would be relatable to a general audience. Where I failed, ask questions.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Mike Hoerger, PhD MSCR MBA

Mike Hoerger, PhD MSCR MBA Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @michael_hoerger

Oct 11
PMC COVlD Wave Update (Europe)
11 October 2025 🧵

The PMC website includes an international directory of websites with COVlD wastewater monitoring. It is more up to date than the directories of the EU and WHO.

Let's review what's happening in Europe...

1/ world map, nations with surveillance shown in blue. URL says pmc19.com/global
Data in #Austria show a rising COVlD wave. The x axis (bottom) has infrequent labels, but the data shown go through October 8th.

Find more here:

2/ pmc19.com/austrialongitudinal graph
COVlD levels have been percolating in #Belgium, with "moderate" levels overall.

The transmission pattern is similar across regions. Plants at Namur-Brumagne and Oostende report "high" levels.



3/ pmc19.com/belgiumheat map and longitudinal graph
Read 20 tweets
Oct 5
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵1/9

An estimated 1 in 81 people are actively infectious during the ongoing 11th wave.

The "shutdown" has created a blackout at the state level.

Transmission is half that of the peak one month ago, and we anticipate a relative national "lull" in early-to-mid November, albeit still at dangerous levels.

Our model uses a combination of CDC and Biobot data, so we are able to estimate national statistics despite the CDC data going offline. On the map, note that Puerto Rico continues to update; they use a CDC-style system but were dropped by the CDC long ago. For full methodology, review the technical appendix on the website.Heat map, grayed out. 1 in 81 estimated actively infectious, or 602,000 new daily infections, per wastewater-derived estimates.
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵2/9

#DuringCOVID is today. We estimate >600,000 new daily infections. This is about half the peak on September 6.

Notice current levels are similar to the estimated peaks of the first 3 waves. 11 wave graph
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵3/9

Weekly estimates:
🔹4.5 million infections
🔹>200,000 resulting long-term health conditions
🔹>1,300 resulting excess deaths Infections						Oct 6, 2025				pmc19.com/data Proportion Actively Infectious										1 in 81 (1.2%) New Daily Infections										 602,000  Infections the Past Week										 4,540,000  Infections in 2025										 189,000,000  Cumulative Infections per Person										 4.69  										 Long COVID										 Long COVID Cases Resulting								30,000 to 120,000		   from New Daily Infections										 Long COVID Cases Resulting								227,000 to 910,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									170 to 280	   from New Daily Infe...
Read 9 tweets
Oct 3
BREAKING: 3 State Pharmacy Boards Still Block COVlD Boosters without a Prescription

ACIP voted against prescriptions for boosters & 47 states + DC follow that guidance.

Georgia, Missouri, & Louisiana require prescriptions.

Key points in my letter to the pharmacy boards. 🧵1/7 Map shows only Missouri, Louisiana, and Georgia are blocking residents from routing COVlD boosters unless they have a prescription.
Georgia law indicates that the pharmacy board is to follow ACIP. They do not dictate further nuance. Georgia continues to require prescriptions, going against the spirit of the law, ACIP, and 47 other states.

🧵2/7 Georgia:  State law does NOT require a prescription if it is a “vaccine that is included on the adult immunization schedule recommended by the Advisory Committee on Immunization Practices (ACIP)”1 ACIP voted against prescriptions, and 47 states have accepted that schedule.  The law does not mention a CDC Director sign-off, which may be delayed months. Act now to save lives.  1. https://law.justia.com/codes/georgia/title-43/chapter-34/article-2/section-43-34-26-1/
Louisiana law tells the pharmacy board to follow ACIP. ACIP says do not require a prescription, and 47 other states agree.

The Louisiana pharmacy board continues to require a prescription.

🧵3/7 Louisiana:  State law does NOT require a prescription if the “vaccine is administered in conformance with the most current immunization administration protocol as set forth by the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practice.” 2 ACIP voted against prescriptions, and 47 states have accepted that protocol.  The law does not mention a CDC Director sign-off, which may be delayed months. Act now to save lives.  2. https://law.justia.com/codes/louisiana/revised-statutes/title-37/rs-37-1218-1/
Read 7 tweets
Oct 1
I remember when they said kids don't transmit COVlD much because they are short, small, and have tiny lungs. They lied.
I remember when they said COVlD doesn't transmit in schools. They lied.
I remember when they said COVlD is mild in kids without understanding post-acute sequelae. They lied.
Read 25 tweets
Sep 30
PMC COVlD Update, Sep 29, 2025 (U.S.)

Summary: COVlD is everywhere.

On the back end of this unprecedented 11th wave, "times they are a-changin." In particular, COVlD levels are shifting north and east.

Notice that few states are in the highest and lowest categories. Much of the south and west have considerable transmission post-peak. Many places in the north and east are seeing steady or increasing transmission after relatively lower levels.

Overall, levels are lower than the past few weeks, but transmission remains considerable. Those relying on anecdata (friends, coworkers, and family infected) may increasingly realize we are in a wave.

We estimate nearly 750,000 new daily infections nationwide, meaning approximately 1 in 66 people or 1.5% are actively infectious.

These estimates are derived by linking wastewater levels to IHME true case estimates using methodology commonly employed worldwide, detailed on the website, noted in a pre-print. Many publications in leading medical journals link wastewater data to key metrics that matter, noted in the online technical appendix.

In this week's report, we note adding North Dakota and Puerto Rico to the heat map in support of health equity. We have been imputing ND levels since the launch of PMC 3.0 using data from neighboring states. PR continues to report qualitative levels using the CDC format but is not longer included on the CDC website.

1/8 🧵heat map based on CDC data, and PMC case estimates
PMC COVlD Update, Sep 29, 2025 (U.S.)

State-level prevalence estimates, AL to MS. The levels use CDC labels, which tend to have an optimistic portrayal of risk. For example, CO is listed at "low" (by our estimate 1.5% infectious).

#MaskUp at 1.5% if having lapsed.

2/8 🧵 Alabama	High	1 in 33 (3.0%) Alaska	Low	1 in 69 (1.5%) Arizona	Moderate*	1 in 42 (2.4%) Arkansas	High	1 in 38 (2.7%) California	High	1 in 36 (2.8%) Colorado	Low	1 in 69 (1.5%) Connecticut	Very High	1 in 18 (5.6%) Delaware	Very High	1 in 24 (4.1%) District of Columbia	Low	1 in 81 (1.2%) Florida	Low	1 in 62 (1.6%) Georgia	Low	1 in 101 (1.0%) Guam	Very Low	1 in 130 (0.8%) Hawaii	Moderate	1 in 53 (1.9%) Idaho	Low	1 in 62 (1.6%) Illinois	Moderate	1 in 60 (1.7%) Indiana	High	1 in 27 (3.8%) Iowa	Moderate	1 in 58 (1.7%) Kansas	Low	1 in 78 (1.3%) Kentucky	Moderate	1 in 39 (2.6%) Louisiana	High	1 in 3...
PMC COVlD Update, Sep 29, 2025 (U.S.)

State-level prevalence estimates, Missouri to Wyoming.

New York had *huge* retroactive upward corrections, and is now "High," as many residents hypothesized.

Note, Puerto Rico only provides CDC qualitative levels, so no data.

3/8 🧵 Missouri	Very Low	1 in 156 (0.6%) Montana	High	1 in 37 (2.7%) Nebraska	High	1 in 27 (3.8%) Nevada	Very High	1 in 15 (6.6%) New Hampshire	Moderate	1 in 59 (1.7%) New Jersey	Low	1 in 82 (1.2%) New Mexico	Low	1 in 102 (1.0%) New York	High	1 in 35 (2.8%) North Carolina	High	1 in 35 (2.9%) North Dakota	High*	1 in 34 (3.0%) Ohio	Moderate	1 in 58 (1.7%) Oklahoma	Low*	1 in 81 (1.2%) Oregon	High	1 in 32 (3.1%) Pennsylvania	Low	1 in 61 (1.6%) Rhode Island	High	1 in 33 (3.1%) South Carolina	Moderate	1 in 40 (2.5%) South Dakota	High	1 in 28 (3.5%) Tennessee	Low	1 in 75 (1.3%) Texas	Moderate	1 in 48 (2....
Read 8 tweets
Sep 27
BREAKING: COVlD transmission surges across the Northeast amid 11th wave.

CDC levels & PMC prevalence estimates:
🔹CT: Very High (1 in 18 people actively infectious)
🔹RI: High (1 in 33)
🔹NY: High (1 in 35)
🔹MA: High (1 in 37)

Quick thread 🧵 1/7 Heat map from CDC data with PMC prevalence estimates noted in post
#NewYork has "High" transmission statewide & many counties are seeing "Very High" transmission, per CDC.

PMC estimates 1 in 35 people are actively infectious statewide.

A lot of sites are offline, but notice the overall coverage remains strong. Bad picture statewide.
🧵 2/7 Heat map with prevalence estimate, noted in post
In #Connecticut, we estimate 1 in 18 people are actively infectious. The CDC indicates "Very High" levels.

Statewide coverage is good. Assume it's very high risk everywhere.
🧵 3/7 Heat map and pmc estimate
Read 7 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(