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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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More from @michael_hoerger

Mike Hoerger, PhD MSCR MBA Profile picture
Jul 29
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵1/12

PMC estimates 400,000 new daily infections. 1 in 118 people actively infectious.

Weekly stats:
🔹2.8 million infections (>40x reported cases)
🔹>140,000 resulting #LongCOVID cases
🔹>1,000 resulting excess deaths Heat map Very High: Louisiana, Guam High: Hawai'i, Florida
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵2/12

Please excuse any typos and delays. Any time Mimal's boot turns deep red, we're doing local outreach in addition to dashboard work, etc.

If you don't know Mimal yet, you won't be able to unsee them.
es.wikipedia.org/wiki/MIMALDeep red boot = Louisiana
Minnesota (M), Iowa (I), Missouri (M), Arkansas (A), Louisiana (L) = Mimal Louisiana is the boot. Sometimes depicted with Kentucky fried chicken on a Tennessee pan.
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵3/12

It's HOT COVID SUMMER in the Deep South. No geographic/political prejudices, see next.

Covid is burning through Guam, Louisiana, Florida, and Texas (underestimate due to sites down). Louisiana: 1 in 32, Very High (CDC)
Texas: 1 in 98, Moderate (underestimate, CDC)
Guam: 1 in 25, Very High (CDC)
Florida: 1 in 59, High (CDC)
Read 12 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jul 25
U.S. CDC numbers just released. Good news (for those not in Louisiana). "Only" a 5% national increase.

2025 has closely tracked with summer 2023 transmission. A 12-13% increase would have been expected based on those numbers. That said... Up: Midwest, Northeast Down: West, South
real-time data have been prone to retroactive corrections. This is frustrating, of course, because it leaves people making decisions based on data that are only of good quality when 2 weeks old.

If we saw a 12% increase this week, I'd say look at 2023 for a glimpse...
at the future. Instead, I would consider these plausible scenarios:
🔹Wave still similar to 2023
🔹Later wave with schools more implicated
🔹Something temporarily much better

Of course, temporarily better often means...
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jul 21
1. PMC COVlD Dashboard, July 21, 2025 (U.S.)

COVlD is surging in 7 states, according to the CDC.
🔹Hawai'i (Very High)
🔹California (High)
🔹Nevada (High)
🔹Texas (High)
🔹Louisiana (High)
🔹Florida (High)
🔹South Carolina (High) Heat map, summarized in post
2. PMC COVlD Dashboard, July 21, 2025 (U.S.)

Western surge:
🔹California: 1 in 63 actively infectious, much higher in LA & Bay areas
🔹Hawai'i: 1 in 35 actively infectious
🔹Nevada: 1 in 63 actively infectious

These are wastewater derived estimates, not from individual tests CA map with stat summarized in post
NV map with stat summarized in post
HI map with stat summarized in post
3. PMC COVlD Dashboard, July 21, 2025 (U.S.)

Southern surge:

🔹Texas: 1 in 56
🔹Louisiana (New Orleans): 1 in 65
🔹Florida: 1 in 66
🔹South Carolina: 1 in 71

Again, wastewater estimates (wise indicator), not individual testing (low-quality data). SC map and stat noted in post
LA map and stat noted in post
FL map and stat noted in post
TX map and stat noted in post
Read 12 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jul 15
1) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

We estimate 1 in 148 Americans are actively infectious. This equates to 2.3 million infections/week, expected to result in >100,000 new #LongCOVID conditions & >800 deaths.

A room of 100 people is a coin toss of an exposure. Figure shows each wave of the pandemic. Tables: Current Levels for Jul 14, 2025 % of the Population Infectious 0.7% (1 in 148) New Daily Infections 324000 New Weekly Infections 2268000 Resulting Weekly Long COVID Cases 113,000 to 454,000 Resulting Weekly Excess Deaths 800 to 1,300 Monthly Forecast Average % of the Population Infectious 1.3% (1 in 80) Average New Daily Infections 598766.6667 New Infections During the Next Month 17963000 Resulting Monthly Long COVID Cases 898,000 to 3,593,000 Resulting Monthly Excess Deaths 6,400 to 10,700 Running Totals Infection...
2) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

Transmission (red) is closely tracking the path of 2 years ago (yellow). However, the incoming data are spotty. >20% of CDC states have limited/no data, & Biobot hasn't reported in weeks.

Could be MUCH worse or slightly better. Graph of year over year transmission. The current year (red) is tracking the path of two years ago (yellow) extremely closely. Two years ago, the peak was around September 1, at about 1 million daily estimated infections, and significantly higher than the Delta wave (blue).
3) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

Our model formalizes the mathematical assumptions in those predictions. If transmission follows what we know in terms of how waves grow or slow generally and historical patterns, this is what we'd expect.

The spottiness of the current real-time data reduce precision substantially. Retroactive corrections can make the forecast jump around from better to worse from one week to the next. Expect the worst. Hope for the best.Graph shows national transmission expected to increase the next several weeks.
Read 11 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jul 2
🌍Want to track COVID transmission accurately worldwide?

This PMC thread walks you through leading dashboards with information more up to date than WHO & EU directories.

🧵 1/ World map, countries with high-quality up-to-date surveillance systems shown in blue.
The Pandemic Mitigation Collaborative (PMC) Dashboard provides weekly COVID updates for the U.S., using wastewater surveillance derived case estimation models and analytic forecasting.

We have added a list of international dashboards:
🧵 2/
pmc19.com/data/index.php…Australia: NSW Health Australia Department of Health, Western Australia Austria: Federal Government of Austria City of Vienna - Regional Coron-A Consortium Austria Czech Republic: State Health Institute Czech Republic Belgium: Belgian Institute for Health Canada: Government of Canada Andrew Young's Canada Visualization C19 Resources Canada * World Health Network (WHN) Canada **
Denmark: Statens Serum Institut Denmark Europe (multi-national): EU Wastewater Observatory Finland: National Institute for Health and Welfare Finland WHN Finland ** France: French Republic Data Airborne Risk Reduction Association (ARRA) France Zan Armstrong's France Visualization COVID Weather App France (Android, IOS, or Web) Thomas Delattre's France Visualization Germany: Infection Radar Germany Bay-VOC Bavaria Region Berlin Waterworks WHN Germany **
Hong Kong: Centre for Health Protection, Hong Kong Hungary: National Center for Public Health and Pharmacy of Hungary India: Pune Knowledge Cluster of India Gujarat Biotechnology Research Centre of India Ireland: Health Protection Surveillance Centre Ireland Japan: Japan Institute for Health Security Latvia: Institute of Food Safety, Animal Health and Environment Latvia Lithuania: National Public Health Centre of Luthuania Luxembourg: Microbs Luxembourg Netherlands: National Institute for Public Health and the Environment Netherlands WHN Netherlands ** New Zealand: New Zealand Institute for...
Slovenia: National Institute of Public Health Slovenia Spain: Government of Catalonia - Regional South Africa: National Institute for Communicable Diseases of South Africa South Korea: Korea Disease Control and Prevention Agency Sweden: Pathogens Sweden Switzerland: Swiss Confederation Federal Office of Public Health ETH Zurich Switzerland WISE Dashboard U.K.: Public Health Scotland Buckinghamshire Disability Service (BuDS) U.K. *See the numbers 1-21 along the lower left. Click on 3-6 for national and regional data. ** Click on the dropdown menu. May need to try a different web browser.
Our international directory includes official government dashboards & those developed by citizen scientists.

We exclude countries that have stopped reporting in the past 2-12 months even if on EU or WHO lists. We also exclude low-quality data from opt-in testing programs.
🧵 3/
Read 43 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jun 24
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

🔥Biggest uptick since Jan
🔥1 in 167 actively infectious
🔥>2 million weekly infections
🔥700-1,200 resulting excess deaths from weekly infections

Track transmission closer to home w/our new state & international resources 👇

🧵1/6
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

🔹With >90% probability, we have entered the 11th COVlD wave.
🔹In a room of 50 people, there is already a 1 in 4 chance of an exposure.
🔹We expect nearly 15 million infections in the next month, and rising.

🧵2/6Current Levels for Jun 23, 2025 % of the Population Infectious 0.6% (1 in 167) New Daily Infections 287000 New Weekly Infections 2009000 Resulting Weekly Long COVID Cases 100,000 to 402,000 Resulting Weekly Excess Deaths 700 to 1,200 Monthly Forecast Average % of the Population Infectious 1.0% (1 in 97) Average New Daily Infections 493300 New Infections During the Next Month 14799000 Resulting Monthly Long COVID Cases 740,000 to 2,960,000 Resulting Monthly Excess Deaths 5,300 to 8,800 Running Totals Infections Nationwide in 2025 74869000 Average Number of Infect...
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

We continue to expect transmission to break 500,000 daily infections in the U.S. around July 9th.

This is the same prediction as last week, as the forecast was dead on. Yet, there is considerably uncertainty around this timing.

🧵3/6Longitudinal transmission, past 12 months and 1-month forecast
Read 6 tweets

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