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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Dec 23, 2022 • 15 tweets • 11 min read • Read on X
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In an Invited Editorial in @JAMAOnc today, my colleagues & I call for health systems to develop “Comprehensive #Pandemic Support Programs” for their most vulnerable patients.

These are our Top 10 Tips!

THREAD 🧵
jamanetwork.com/journals/jamao… JAMA Oncology article, "Variability in COVID-19 Vaccine
Tip #1: Health systems should explain to all patients that #COVIDisAirborne and is best avoided through multi-layered mitigation. Swiss Cheese model of COVID mitigation
Tip #2: Health systems should prioritize getting the most vulnerable patients vaccinated & boosted.

Offer #vaccines on-site w/the SAFEST options.

Vulnerable patients want highly-ventilated or outdoor options & high-quality (e.g., N95) masks for safety. Make it happen. Vaccination given while clinician wears an N95 outdoors
Tip #3: Health systems should test whether vulnerable patients have a good #antibody response to #vaccines (cutoffs of 5,000 or 11,500 U/mL for anti-S antibodies) to inform risk.

Consider pre-exposure prophylactics, based on the patient & the variant(s) circulating. Figures from Lee et al., discussed in our editorial. Cut offFigures from Lee et al., discussed in our editorial. Cut off
Tip #4: Health systems should help patients to sample and correctly wear free high-quality #masks (N95, KN95, KF94, FFP3).

Community-based programs have proven successful. Health systems should step up to support their most vulnerable patients.

Tip #5: Health systems should help vulnerable patients to understand the benefits & limitations of COVID testing, when to time testing, precautions to take after exposures/symptoms, and how to access #RAT and #PCR testing.

Make getting #Paxlovid easier. Headline: Paxlovid is underused. Especially in my part of
Tip #6: Health systems should help vulnerable patients understand indoor air quality (#IAQ).

#Ventilation & filtration remove viral-laden aerosols to reduce COVID risk.

Health systems should offer concrete help w/purchasing #HEPA filters for home.

cleanairstars.com/filters/ Clean Air Stars, website
Tip #7: Health systems should be leaders in explaining to vulnerable patients how to reduce in-home spread when someone tests positive for #COVID.

Too few health systems advise on reducing in-home transmission.

BUT we have the tools!
healthyheating.com/2021.COVID.Res… Example image of tactics for reducing in-home spread of COVI
Tip #8: Health systems should support vulnerable patients by developing #LongCOVID assessment & treatment programs.

Such programs exist: survivorcorps.com/pccc

They are both underutilized & overbooked. We need more programs & less medical #gaslighting about Long COVID.
Tip #9: Health systems should support vulnerable patients by keeping a list of local businesses offering remote & #COVIDsafe options.

Many of us are doing so on the #Discord app.

Vulnerable patients want health systems to use their credibility & resources to do this. Screen shot of a Discord list of local recommendations. He
Tip #10: Health systems should support vulnerable patients in solving the problems they face living in a confrontational, too-often #ableist world.

We offer concrete tips, such as reminding ppl masking is a healthy choice, not a political one.

While our tips focus on how health systems can help patients, our rhetorical strategy was to create tension.

If health systems get vulnerable patients into well-fitting N95s, that should foster #CognitiveDissonance when clinicians poorly mask.

Foot-in-the-door technique. "Foot in the door technique." Please read our arti
People w/#cancer are more vulnerable to COVID & long COVID, even when (wisely) vaccinated, per our article & others.

Patients w/ #hematologic cancers, late-stage cancers, or on systemic therapy (e.g., chemo) are quite vulnerable.

Today, JAMA Oncology shows that patients w/#hemocologic #cancer are among the MOST vulnerable.

It is not "virtue signaling" to mask correctly to protect the most vulnerable individuals. Photo of a hematology conference. Today, JAMA Oncology's l
Finally, in our Invited Editorial in JAMA Oncology today, we note that "vulnerability" to COVID too often remains uncertain.

#Vulnerability is also dynamic, as an initial infection can increase vulnerability. Universal precautions remain key.

jamanetwork.com/journals/jamao… Paragraph from the article. Link in Tweet.

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Mike Hoerger, PhD MSCR MBA Profile picture
Sep 16
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵1/7

COVlD-19 levels are "Very High" or "High" in the majority of states, per the CDC.

This includes 27 states & D.C.

🔥🔥Very High:
Alaska, Hawai'i, California, Nevada, Idaho, Utah, S. Dakota, Nebraska, Texas, Louisiana, Indiana, Kentucky, Tennessee, Florida, S. Carolina, N. Carolina, D.C., Maryland, and Connecticut.

🔥High:
Washington state, Oregon, Montana, probably N. Dakota (imputed), Arkansas, Alabama, Virginia, Delaware, Rhode Island, and Massachusetts.

PMC estimates 1 in 38 people (2.7%) are actively infectious. Wastewater-derived case estimates suggest 1.3 million new daily infections.Heat map using CDC levels. Key findings summarized in the post.
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵2/7

Transmission is peaking nationally, but regional variation is common. Know what's happening in your state, and get the word out.

Note that the levels CDC calls "low" are still quite alarming.State | CDC Level | PMC Estimate, % Actively Infectious Alabama High 1 in 30 (3.4%) Alaska Very High 1 in 22 (4.6%) Arizona Moderate 1 in 40 (2.5%) Arkansas High 1 in 28 (3.6%) California Very High 1 in 21 (4.8%) Colorado Moderate 1 in 50 (2.0%) Connecticut Very High 1 in 19 (5.3%) Delaware High 1 in 33 (3.0%) District of Columbia Very High 1 in 17 (6.0%) Florida Very High 1 in 24 (4.2%) Georgia Moderate 1 in 46 (2.2%) Guam Low 1 in 64 (1.6%) Hawaii Very High 1 in 26 (3.8%) Idaho Very High 1 in 14 (7.3%) Illinois Moderate 1 in 44 (2.3%) Indiana Very High 1 in 16 (6.1%) Iowa Moderate 1 in 40...
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵3/7

Note that transmission is increasingly spreading from the South & West toward other areas. Know your state-level risk.

Transmission remains alarming even in areas CDC labels "Very Low" (e.g., Missouri, estimated 1 in 109). State | CDC Level | PMC Estimate, % Actively Infectious Missouri Very Low 1 in 109 (0.9%) Montana High 1 in 36 (2.8%) Nebraska Very High 1 in 18 (5.5%) Nevada Very High 1 in 17 (5.9%) New Hampshire Low 1 in 64 (1.6%) New Jersey Moderate 1 in 56 (1.8%) New Mexico Very Low 1 in 106 (0.9%) New York Low 1 in 73 (1.4%) North Carolina Very High 1 in 17 (5.8%) North Dakota High* 1 in 32 (3.2%) Ohio Moderate 1 in 47 (2.1%) Oklahoma Moderate* 1 in 44 (2.3%) Oregon High 1 in 31 (3.2%) Pennsylvania Moderate 1 in 44 (2.3%) Rhode Island High 1 in 30 (3.3%) South Carolina Very High 1 in 15 (6.6%) South D...
Read 7 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 13
California COVlD Surge Rages Higher

🔸CDC SARS-CoV-2 wastewater levels "Very High," and up from last week
🔸1 in 21 estimated actively infectious
🔸>250,000 estimated new daily infections statewide

Four figures...
1/4🧵 CDC: Very High: PMC Estimate: 1 in 21 actively infectious
CDC wastewater data in California show COVlD cases increasing from the already "Very High" levels last week.

2/4🧵 Line graph of the past 6 months showing the surge in wastewater viral levels
With an estimated 1 in 21 (or 4.8%) of California residents actively infectious of COVlD, risk increases dramatically in larger and more frequent social gatherings.

Interact with 25 people of average risk of being positive, and that's a >70% chance of exposure.
3/4🧵 How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1 4.8% 2 9.4% 3 13.7% 4 17.9% 5 21.8% 6 25.6% 7 29.1% 8 32.5% 9 35.8% 10 38.9% 15 52.2% 20 62.6% 25 70.8% 30 77.1% 35 82.1% 40 86.0% 50 91.5% 75 97.5% 100 99.3% 300 99.9%
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 10
Let's say you're a dairy farmer. You have 100 cows. Each year, about 5 cows die, and another 5 cows are born. Then, along comes a virus. Let's call it "cowvid"...
1/
Let's say "cowvid" wipes out about half the cows over the course of a couple years. Now, you're down to 50 cows....
2/
The local mayor declares "cowvid" to be over. This surprises you as a farmer because 5 of your cows keep dying annually. 5 of 50 instead of 5 out of 100. Seems like more, but you're not a city slicker...
3/
Read 12 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 7
#DuringCOVID is today.

Image pack 1 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
1 million New Daily Infections.

Today!

Image pack 2 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Where are the free vaccines, N95s, and tests?

Image pack 3 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 3
PMC Dashboard Update (U.S.) 🧵1 of 8

The 11th wave is still rising.
🔥23 states/territories High/Very High
🔥Very High: Alabama, DC, Guam, Hawai'i, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah
🔥1 in 56 estimated actively infectious
🔥876,000 new daily infections CDC heat map, very high states noted in post. PMC estimate of 1 in 56 actively infectious nationwide
PMC Dashboard Update (U.S.) 🧵2 of 8

Note that the CDC has modified 📉 how transmission levels correspond to the categorical bins.

Take California. We estimate 1 in 30 actively infectious statewide. This would have previously been "Very High," now just "High."
#NewNormal CDC heatmap, with PMC estimate of 1 in 30
PMC Dashboard Update (U.S.) 🧵3 of 8

Here are the prevalence estimates for the first half of states/territories.

Notice how high the levels are in some of the "Moderate" states. State CDC Level Alabama Very High Alaska High Arizona High Arkansas Moderate California High Colorado Moderate Connecticut High Delaware High District of Columbia Very High Florida High Georgia Moderate Guam Very High Hawaii Very High Idaho High Illinois Very Low Indiana Moderate* Iowa Low Kansas Low Kentucky High Louisiana Very High Maine Low Maryland Moderate Massachusetts Moderate Michigan Very Low Minnesota Moderate Mississippi High*
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Aug 21
During times like these when COVlD transmission heats up in the U.S., expect to see a lot more angry outbursts for three central reasons.

First, "displacement," or people trying to deny the reality of their anxiety by taking it out on other people....
Second, a lot of people can sustain a strong denial of reality about the ongoing pandemic during lulls. They suppress the existence of COVlD waves and excess deaths, disability, and retirements.

During waves, those defenses burst. Loss of control = anger...
Third, a lot of people (many reading this) understand COVlD correctly & experience righteous indignation during COVlD waves. We quite reasonably do not like all of the unjust and gratuitous suffering.

I find it helpful to channel that intensity into helping other people....
Read 6 tweets

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