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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
Oct 21
PMC COVlD Update, Oct 20, 2025 (U.S.)

SARS-CoV-2 transmission has fallen.
🔹1 in 191 (0.5%) actively infectious
🔹"Lull" levels at 20% of the summer peak
🔹255,000 new daily infections (still concerning)

Many will knock out higher-risk activities the next 2-4 weeks.
🧵1/11 Graph of the 11 waves, shows current lull.
PMC COVlD Update, Oct 20, 2025 (U.S.)

"Lull" transmission remains dangerous:
🔹1.8 million estimated new weekly infections
🔹>90,000 estimated new #LongCOVID conditions from this week's infections
🔹>500 excess deaths to result from this week's infections

🧵2/11 Infections Proportion Actively Infectious 1 in 191 (0.5%) New Daily Infections 255,000 Infections the Past Week 1,800,000 Infections in 2025 191,000,000 Cumulative Infections per Person 4.69 Long COVID Long COVID Cases Resulting 13,000 to 51,000 from New Daily Infections Long COVID Cases Resulting 90,000 to 360,000 from New Weekly Infections Excess Deaths Excess Deaths Resulting 70 to 120 from New Daily Infections Excess Deaths ...
PMC COVlD Update, Oct 20, 2025 (U.S.)

Exposure risk during "lull" transmission remains high when engaging in many social interactions.

Interacting with 25 people yields a 12% chance of exposure. 100 people? 41% chance of exposure, assuming no testing/isolation.

🧵3/11 Number of People Chances Anyone is Infectious 1 0.5% 2 1.0% 3 1.6% 4 2.1% 5 2.6% 10 5.1% 15 7.6% 20 10.0% 25 12.3% 30 14.5% 50 23.1% 75 32.5% 100 40.8% 200 64.9% 300 79.2%
Read 11 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
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
Mike Hoerger, PhD MSCR MBA Profile picture
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
Mike Hoerger, PhD MSCR MBA Profile picture
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
Mike Hoerger, PhD MSCR MBA Profile picture
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
Mike Hoerger, PhD MSCR MBA Profile picture
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

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