Mike Hoerger, PhD MSCR MBA Profile picture
Nov 15, 2022 8 tweets 3 min read Read on X
I've yet to see a well-designed study showing that #COVID #RapidTests are no longer efficacious.

This one is no exception. Why?
5 reasons.

clinicalmicrobiologyandinfection.com/article/S1198-… Image
1. They compare same-day PCR against self-administered/interpreted rapid tests.

For most ppl, that's not reality. It's RAT today or PCR result in 1-3 days (or do both).

A fairer comparison would be a RAT today versus a PCR yesterday (since you'd have to wait for results).
2. They excluded 13% of the sample who were "confirmatory testers" (weird term) -- basically, people who had just tested RAT+ and were coming in for a PCR.

Basically, they excluded the people for whom the test easily worked. Drug trialists pull this stuff all the time.
3. The study excluded ppl with symptoms. Some people use RATs before socializing to reduce risk (hopefully with other Swiss Cheese slices). BUT many use RATs when symptomatic. I don't think the study fairly represents how RATs are being used. Image
4. As RATs became more common, many novices started using them without following instructions well. It would have been helpful if the researchers also administered and interpreted a RAT. I suspect the diminished utility is more "user error" than a property of the test. Fixable.
5. RATs detect most closely the infectious window. A PCR will flip positive a litter earlier & stay positive longer. If a goal is to prevent forward transmission, rather than merely diagnosis, then studies like this are not testing hypotheses with real-world significance.

Mina: Image
Overall, I see RATs as an important piece of mitigation. Even in this anti-RAT study, positive & negative predictive values were 85%-98% across tests (Table S2).

That's about as efficacious an N95 among a novice wearer. All of our shields have holes, so we combine them. Image
RAT efficacy estimates are much higher than many "too good to be true" interventions you see pushed heavily: SSRIs, enovid, nasal sprays. 🤣🤣🤣

The evidence that those protect against COVID is so poor as to harm by distraction. Go buy some bittrex.

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More from @michael_hoerger

Mar 24
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵1/5

🔹3 million new weekly infections in a persistent "lull" of substantial transmission
🔹1 in 107 (0.9%) of the population actively infectious
🔹1 in 3 regions in high/very high transmission (16 states and DC)Heat map of transmission, described in Tweet
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵2/5

We have had a steady state of about a half million infections the past several weeks. That's over 50 million estimated infections so far in 2025.

In a room of 40-50 people, there's a 1-in-3 chance of exposure if no testing/isolation.Current Levels for Mar 24, 2025	 % of the Population Infectious	 0.9% (1 in 107)	 New Daily Infections	 446000	 New Weekly Infections	 3122000	 Resulting Weekly Long COVID Cases	 156,000 to 624,000	 	 Monthly Forecast	 Average % of the Population Infectious	 1.0% (1 in 96)	 Average New Daily Infections	 496566.6667	 New Infections During the Next Month	 14897000	 Resulting Monthly Long COVID Cases	 745,000 to 2,979,000	 	 Running Totals	 Infections Nationwide in 2025	 50757000	 Average Number of Infections	 Per Person All-Time, U.S.	 3.708526284	 	 How Does Risk Increase with More Social Co...
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵3/5

There's a good chance of steady transmission the next month. Often, we'd head into a low lull about now. BUT there are no universal precautions, immunity is waning from the fall & winter 2023-24, & viral evolution looks less 'lucky.'Middle forecast shows 400-600k daily infections.
Read 5 tweets
Mar 11
1) 5-yr Anniversary of the WHO Pandemic Declaration

🔥10 waves
🔥Covid mortality rivals lung cancer
🔥8 infections/person by 2030
🔥Long Covid as catastrophic
🔥Death trajectories becoming complex
🔥"During Covid" as anti-science rhetoric
🔥Serious ppl take Covid seriously
🧵
2) Wastewater-derived estimates of case rates show international consensus 20-26% of populations got Covid during the peak 2 months of the 2023-24 winter wave in the U.S., Canada, and the U.K.
3) The ratio of reported cases versus true cases has remained consistent, demonstrating the validity of wastewater-derived estimates. True cases are 15-30x reported cases, a consistent ratio. There are no examples demonstrating low case rates.
Read 25 tweets
Feb 26
1) Mardi Gras 2020 was 5 years ago today. ⚜️

It was before the pandemic declaration, before the federal government recommended masking.

COVlD spread quickly through New Orleans, leading to one of the highest mortality rates per capita in the U.S.... Timeline showing Mardi Gras 2020 just 4 days before the first known reported death of C19 in the U.S.  Note. "Peak" diagnoses refers to the peak of the 1st wave.
2) New Orleans service workers were disproportionately hit by the early pandemic. Many died. Many developed #LongCOVID at the time or have now through repeat infections. Many have switched to other sectors....

3) The sad fact is that many service workers are continuing to get #LongCOVID through repeat infections today because the pandemic is ongoing and many restaurants have high occupant density and horrendous air quality....

Read 4 tweets
Feb 17
1) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

🔥1 in 72 actively infectious
🔥Sustained high transmission
🔥30 states in high/very high transmission (CDC)
🔥3x the transmission of Feb 2021
🔥668,000 daily infections
🔥Only 1 in 28 cases reportedGraph shows 10 waves of the pandemic.  Tables summarized partially in post. Additionally, transmission is higher than during 59% of the pandemic.  How Does Risk Increase with More Social Contacts? Number of People | Chances anyone is infectious 1	1.4% 2	2.8% 3	4.1% 4	5.5% 5	6.8% 6	8.1% 7	9.4% 8	10.6% 9	11.9% 10	13.1% 15	19.0% 20	24.5% 25	29.7% 30	34.4% 35	38.9% 40	43.0% 50	50.5% 75	65.2% 100	75.5% 300	98.5%
2) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

This is a mid-sized wave, meaning substantial transmission. Notice that transmission remains steady at high rates.

Expect steady or slightly declining transmission, unless the real-time data are retroactively corrected.Two graphs, showing year-over-year transmission and the forecast, summarized in the post.
3) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

Notice that 30 states remain in high/very high transmission, per CDC categories.

This is the same as last week. Transmission is 3x higher than in Feb 2021, when people were taking more precautions around masking and testing.Transmission heat map and CDC line graph of regional variation in transmission.
Read 5 tweets
Feb 11
1) A lot of high-risk/aware patients I talk to -- mostly getting cancer treatment -- tend to protect themselves from infection by staying home more.

In the work we do, we help patients to understand that a well-fitting high-quality mask can allow them to attend events safely.
2) These are some tips for finding a well-fitting mask among common options in the U.S. and Canada.

3) Here's a more comprehensive diagram of masks that fit most. Aside from #5, these are widely available.

*#5 (Aegle) was the first N95 widely available during the ongoing pandemic for <$1. Hard to find these days, but I gave some to students.
Read 7 tweets
Jan 28
1) PMC COVID Dashboard for the Week of Jan 27, 2025 (U.S.)

🔹1 in 108 actively infectious
🔹3.1 million weekly infections
🔹>150,000 weekly resulting Long Covid conditions Current Levels for Jan 27, 2025 % of the Population Infectious 0.9% (1 in 108) New Daily Infections 443,000  New Weekly Infections 3,101,000  Resulting Weekly Long COVID Cases 155,000 to 620,000  Monthly Forecast Average % of the Population Infectious 0.9% (1 in 106) Average New Daily Infections 452,933 New Infections During the Next Month 13,588,000 Resulting Monthly Long COVID Cases 679,000 to 2,718,000  Running Totals Infections Nationwide in 2025 18,779,000 Average Number of Infections Per Person All-Time, U.S. 3.60  There is more COVID-19 transmission today than during 41.9% of the pan...
2) We predicted the wave peak would be 0.8 to 1.3 million across various forecasts. We presently have it at 0.9-1.0 million, though retroactive corrections can change that. The WHN also runs an excellent model, with a peak estimated at 1.3 million.
whn.global/estimation-of-…
3) Approx 1 million daily infections is quite serious. This is a far cry from the various #nothingburger predictions, and the Monday morning quarterbacks who in hindsight minimize U.S. infections, Long Covid, & disability.

Perhaps they have social media revenue COIs. I don't.
Read 9 tweets

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