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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Dec 15, 2022 • 5 tweets • 4 min read • Read on X
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Our #pandemic global strategy:
"If I paint a rosy picture, will you promise not to cry?"


1/5 ascopubs.org/doi/full/10.12…
Image
Written a decade ago, the article was about how clinicians too often falsely reassured patients w/terminal #cancer that treatment was working just fine.

There are many parallels b/w cancer cancer, the pandemic, & climate change.

Mortality salience elicits #denial.
2/5 ImageImage
Don't believe me?

Look back at the 1960s. Only 12% of patients were even told they had #cancer.

Society will tolerate BS for a long time to avoid immediate discomfort. So too w/the pandemic. Hardly a mask in sight & reinfections mount.

jamanetwork.com/journals/jama/…
3/5 Image
In the U.S., the "rosy picture" differs by political ideology.

Today in the NEJM: The conservative rosy picture is that COVID is like a cold or the flu. The liberal rosy picture is that leaders are doing just fine by pushing vax-and-relax.

nejm.org/doi/full/10.10…
4/5 Image
The "rosy picture" strategy almost always fails, and if we settle for rosy on COVID, we're going to need a lot more roses.

5/5 Image

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More from @michael_hoerger

Mike Hoerger, PhD MSCR MBA Profile picture
Apr 29
PMC COVID-19 Forecast, April 29, 2024 (U.S.)

Transmission continues to decline. About 1 in 161 people in the U.S. are infectious, the lowest levels since July 1. Transmission levels are higher than during 27% of the pandemic, but a good time to catch up on delayed care.
1/4 There is more COVID-19 transmission today than during 27.7% of the pandemic. CURRENT ESTIMATES FOR April 29, 2024 Wastewater Levels (copies/mL) 203 New Daily Cases 296,000 % of Population Infectious 0.62% (1 in 161 people) New Daily Long COVID Cases 15,000 to 59,000 WEEKLY ESTIMATES FOR April 29, 2024 New Weekly Cases 2,100,000 New Weekly Long COVID Cases 104,000 to 414,000 2024 CUMULATIVE ESTIMATES AS OF April 29, 2024 Total 2024 Cases To Date 105,544,710 Total 2024 Long COVID Cases To Date 5,277,000 to 21,109,000 4-WEEK FORECAST FOR May 27, 2024 Wa...
I have some concerns about Biobot's real-time data quality at the moment. Their real-time data have over-reported levels the past 8 weeks (11% last week, previously 6%, 10%, 7%, 5%, 9%, 4%, 5%) relative to later corrections. Huge bias!
2/4
Qualitatively, the over-reporting in real-time data lead me to believe there's a 50-50 chance we see a May "wavelet" versus continued decline for a couple months. Some of the county-level Biobot data seem implausible (e.g., levels of "3" in Mason County, WA, but others too).
3/4 Mason County, WA Levels of 3 copies/mL, per Biobot. About 1 in 10,000 actively infectious, if accurate.
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Mar 1
31 Reasons Why the New 1-Day COVID Isolation Policy is Wrong

#1
Experts in modeling and testing know that people are infectious with COVID for an average of 7 days, with substantial variability around that average.

"31 Reasons Why the New 1-Day COVID Isolation Policy is Wrong"
#2
People use defense mechanisms to temporarily avoid the death anxiety evoked by thinking of COVID. The too-short 5-day iso was an example of this (see final example).

Such defenses provide temporary relief and are almost always harmful long-term.
#3
Dropping isolation policies to 1 day will predominantly harm people in poor-ventilation environments.

Restaurants have 35-50x less ventilation than the ASHRAE standards, so this will harm the service industry and unsuspecting “brunch class.”
Read 31 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Feb 29
PMC COVID-19 Forecast, Week of Feb 26, 2024
1 of 5 🧵

Forecast for the next month
Over the next month, we should see transmission fall from 790,000 infections/day toward more like a range of 200,000-450,000 infections per day, depending on better or worse scenarios.

That's "good" news in the relative sense for those putting off medical appointments the past 6 months, though still extremely high transmission in any objective sense.

See the online report for details on the models.

Surge in Context
At this point in the surge, it is clear that the peak transmission day was around December 27 (1.92 million/day), and the midpoint of “surging” infections (>1 million/day) was around January 9.

We are estimated to have had 85 total days with >1 million infections per day (November 28 through February 20) during the surge, though these numbers may still fluctuate with corrections the next few weeks.

The low-point leading into the surge was October 18 at 547,000 infections/day. Infections have been at “wave” levels (>500,000 infections/day or higher) since the onset of the late summer wave surpassed that milestone on July 27. We are estimated to dip below 500,000 infections/day around March 6.

This is very unfortunate timing because the medical facilities that enacted universal masking may end policies on March 1. Many were hoping for a period of lower transmission before such policies ended. As of today, the estimated low point for transmission is March 27 (348,000 infections/day), but the level and date are subject to much uncertainty.CURRENT ESTIMATES FOR February 26, 2024 Wastewater Levels (copies/mL) 546 New Daily Cases 794,000 % of Population Infectious 1.66% (1 in 60 people) New Daily Long COVID Cases 40,000 to 159,000 4-WEEK FORECAST FOR March 25, 2024 Wastewater Levels (copies/mL) 242 (-56% lower) New Daily Cases 353,000 % of Population Infectious 0.74% (1 in 135 people) New Daily Long COVID Cases 18,000 to 71,000
PMC COVID-19 Forecast, Week of Feb 26, 2024
2 of 5 🧵

Current State of the Pandemic
🔹73 million infections in the U.S. in 2024 (so far)
🔹790,000 daily infections
🔹1.66% (1 in 60) actively infectious
🔹40,000+ resulting #LongCOVID cases/day

Deeper Dive
Transmission is finally starting to decline again, and expect major declines the next four week.

U.S. wastewater levels indicate that COVID transmission is higher than during 58.4% of the days of the pandemic (down from 85.9% a week ago). Transmission is lower than 41.6% of the pandemic.

As we noted the past two weeks, we believed the post-peak hill was itself peaking on around February 7th and that last week’s slightly higher values might get retroactively corrected downward. That was, in fact, the case (the peak was the 7th), and transmission has fallen further since.

We are still at very high “wave” levels, but no longer “surging” at over a million infections/day. The big picture remains very bad, but this is good news for people putting off medical appointments for months.There is more COVID-19 transmission today than during 58.4% of the pandemic. CURRENT ESTIMATES FOR February 26, 2024 Wastewater Levels (copies/mL) 546 New Daily Cases 794,000 % of Population Infectious 1.66% (1 in 60 people) New Daily Long COVID Cases 40,000 to 159,000 WEEKLY ESTIMATES FOR February 26, 2024 New Weekly Cases 5,600,000 New Weekly Long COVID Cases 278,000 to 1,112,000 2024 CUMULATIVE ESTIMATES AS OF February 26, 2024 Total 2024 Cases To Date 73,585,610 Total 2024 Long COVID Cases To Date 3,679,000 to 14,717,000
PMC COVID-19 Forecast, Week of Feb 26, 2024
3 of 5 🧵

Risks in Group Settings
Although transmission is falling, it's easy to get distracted by the relative changes and ignore that the absolute risk remains high, especially in large groups with limited or no mitigation.

In a group of 10, there's a 15% at least one person is actively infectious. In a group of 30, it's a 40% chance, and so forth. Almost nobody would take those chances of a serious illness if informed and capable of grappling with the seriousness of that risk without becoming defensive. Unfortunately, a lot of institutions are pushing minimizer narratives if not directly forcing students and workers into more dangerous settings.How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1 1.7% 2 3.3% 3 4.9% 4 6.5% 5 8.0% 6 9.6% 7 11.1% 8 12.5% 9 14.0% 10 15.4% 15 22.2% 20 28.5% 25 34.2% 30 39.5% 35 44.4% 40 48.8% 50 56.7% 75 71.5% 100 81.3% 150 91.9% 200 96.5% 300 99.3% 400 99.9% 500 >99.9%
Read 5 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Feb 8
New book about to drop.

1/4
Ralph Nader's "Unsafe at Any Speed: The designed-in dangers of the American automobile," cover modified to "COVID-19 Unsafe as we breathe: The designed-in dangers of the California 1-day isolation policy"
Dr. Moriarty & other modelers know people are infectious for an average of about 7 days, per high-quality studies. Many for much longer.

Dr. Mina's pinned Tweet lays out a sample timeline.

Sending kids to school on Day 2 positive will essentially maximize infections.
2/4 Pinned tweet from Michael Mina showing a heuristic infection timeline for an individual patient. Sending someone to school 1 day after positive basically means they're being sent to school right at peak infectiousness.
The consequence of the California 1-day isolation policy is that many parents and grandparents will develop serious health conditions and too often die prematurely.

Bad for families. Good for inspiring the next generation of bereavement workers.

3/4
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Feb 5
1 / 6 🧵
PMC COVID-19 Forecast, Week of Feb 5, 2024

We are seeing escalating transmission in a post-peak hill.
🔹2.8% (1 in 36) actively infectious
🔹1.3 million infections/day
🔹Hill peaks in 2 days 🤞
🔹>65,000 resulting #LongCOVID cases/dayCURRENT ESTIMATES FOR February 5, 2024 Wastewater Levels (copies/mL) 909 New Daily Cases 1,323,000 % of Population Infectious 2.77% (1 in 36 people) New Daily Long COVID Cases 66,000 to 265,000 4-WEEK FORECAST FOR March 4, 2024 Wastewater Levels (copies/mL) 520 (-43% lower) New Daily Cases 757,000 % of Population Infectious 1.58% (1 in 63 people) New Daily Long COVID Cases 38,000 to 151,000
2 / 6 🧵
PMC COVID-19 Forecast, Week of Feb 5, 2024

We began to see evidence of a post-peak hill 3 weeks ago. I was skeptical. The real-time data now bear this out. Hopefully we are not in a Terminator-style scenario where the technology outsmarts the maker. 🤣Visual shows line graphs for today and each of the past 3 weeks. The post-peak hill becomes more pronounced over time, as the model gains more precision.
3 / 6 🧵
PMC COVID-19 Forecast, Week of Feb 5, 2024

Zooming out to the full pandemic, we see transmission higher than a week ago, and higher than 87.8% of the pandemic.

Nearly 10 million infections/week. >50 million estimated infections so far in 2024 in the U.S. alone.There is more COVID-19 transmission today than during 87.8% of the pandemic. CURRENT ESTIMATES FOR February 5, 2024 Wastewater Levels (copies/mL) 909 New Daily Cases 1,323,000 % of Population Infectious 2.77% (1 in 36 people) New Daily Long COVID Cases 66,000 to 265,000 WEEKLY ESTIMATES FOR February 5, 2024 New Weekly Cases 9,300,000 New Weekly Long COVID Cases 463,000 to 1,852,000 2024 CUMULATIVE ESTIMATES AS OF February 5, 2024 Total 2024 Cases To Date 50,401,800 Total 2024 Long COVID Cases To Date 2,520,000 to 10,080,000
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Feb 4
The poor drainage infrastructure in #NewOrleans is a detriment to housing justice, quality of life, and productivity.

A thread of videos in and around the area.
🧵
Read 22 tweets

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