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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
Dec 15
PMC COVID Update, Dec 15, 2025 (U.S.)

In the latest CDC data, 15 states have moderate to very high transmission.
🔹1 in 63 estimated actively infectious nationally, rising fastest in the Midwest & Northeast
🔹Very High: Indiana
🔹High: Nebraska, Vermont, Connecticut

🧵1/9 Heat map from CDC data and PMC estimates of 1 in 63 actively infectious and >700,000 new daily infections, based on wastewater derived estimates using models noted in the Technical Appendix at the website listed in the image.
PMC estimates 1 in 26 people in Indiana are infectious and 1 in 39 in Connecticut.

MI, MS, and AR may have higher levels than shown due to poor reporting.

States AL to MS shown.

🧵2/9 Alabama Moderate 1 in 41 (2.4%) Alaska Very Low 1 in 220 (0.5%) Arizona Very Low 1 in 118 (0.8%) Arkansas Low* 1 in 68 (1.5%) California Very Low 1 in 382 (0.3%) Colorado Very Low* 1 in 230 (0.4%) Connecticut High 1 in 39 (2.6%) Delaware Very Low 1 in 222 (0.4%) District of Columbia Very Low 1 in 131 (0.8%) Florida Very Low 1 in 320 (0.3%) Georgia Very Low 1 in 275 (0.4%) Guam Very Low 1 in 426 (0.2%) Hawaii Very Low 1 in 670 (0.1%) Idaho Very Low 1 in 108 (0.9%) Illinois Low 1 in 71 (1.4%) Indiana Very High 1 in 26 (3.8%) Iowa Low 1 in 76 (1.3%) Kansas Moderate 1 in 62 (1.6%) Kentucky Mode...
PMC estimates 1 in 39 are infectious in both Nebraska and Vermont (coincidence, not typo).

Very few NY sites are reporting to the CDC, so use the NYS website there instead.

States MO to WY shown.

🧵3/9 Missouri Low 1 in 80 (1.2%) Montana Very Low 1 in 135 (0.7%) Nebraska High 1 in 39 (2.5%) Nevada Very Low 1 in 225 (0.4%) New Hampshire Moderate 1 in 47 (2.1%) New Jersey Very Low 1 in 200 (0.5%) New Mexico Low 1 in 75 (1.3%) New York Moderate* 1 in 49 (2.1%) North Carolina Very Low 1 in 226 (0.4%) North Dakota Low* 1 in 85 (1.2%) Ohio Moderate 1 in 62 (1.6%) Oklahoma Moderate* 1 in 47 (2.1%) Oregon Low 1 in 89 (1.1%) Pennsylvania Moderate 1 in 55 (1.8%) Rhode Island Low 1 in 70 (1.4%) South Carolina Very Low 1 in 215 (0.5%) South Dakota Low 1 in 86 (1.2%) Tennessee Moderate 1 in 60 (1.7%) ...
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Dec 8
PMC COVlD Update, Dec 8, 2025 (U.S.)
1/9
🔥🔥🔥Very High: Arizona (Yuma)
🔥🔥High: Indiana and Vermont
🔥Moderate: Nebraska and Alabama

Data only go through late November, and levels often increase following Thanksgiving. Heat map and PMC estimates of transmission (1 in 102 actively infectious).
PMC COVlD Update, Dec 8, 2025 (U.S.)
2/9
State-by-state estimates (part 1). Arizona is Very High, but sites were only online in the Yuma area. Indiana remains high.

MI and MS have considerable uncertainty.

DC is exceptionally low. Alabama Moderate 1 in 47 (2.1%) Alaska Very Low 1 in 220 (0.5%) Arizona Very High* 1 in 18 (5.7%) Arkansas Very Low* 1 in 138 (0.7%) California Very Low 1 in 574 (0.2%) Colorado Low 1 in 76 (1.3%) Connecticut Low 1 in 91 (1.1%) Delaware Very Low 1 in 307 (0.3%) District of Columbia Very Low 1 in 5,777 (0.0%) Florida Very Low 1 in 494 (0.2%) Georgia Very Low 1 in 180 (0.6%) Guam Very Low 1 in 289 (0.3%) Hawaii Very Low 1 in 704 (0.1%) Idaho Very Low 1 in 121 (0.8%) Illinois Very Low 1 in 112 (0.9%) Indiana High 1 in 30 (3.3%) Iowa Low 1 in 83 (1.2%) Kansas Low 1 in 105 (1.0%) Kentucky Very L...
PMC COVlD Update, Dec 8, 2025 (U.S.)
3/9
State-by-state estimates (part 1). Vermont remains High. Tennessee has fallen rapidly from a quick surge.

Data quality are low in NY. Missouri Very Low 1 in 176 (0.6%) Montana Very Low 1 in 136 (0.7%) Nebraska Moderate 1 in 45 (2.2%) Nevada Very Low 1 in 372 (0.3%) New Hampshire Very Low 1 in 109 (0.9%) New Jersey Very Low 1 in 217 (0.5%) New Mexico Very Low 1 in 118 (0.8%) New York Very Low* 1 in 260 (0.4%) North Carolina Very Low 1 in 233 (0.4%) North Dakota Low* 1 in 101 (1.0%) Ohio Low 1 in 70 (1.4%) Oklahoma Low* 1 in 68 (1.5%) Oregon Very Low 1 in 150 (0.7%) Pennsylvania Low 1 in 89 (1.1%) Rhode Island Very Low 1 in 187 (0.5%) South Carolina Very Low 1 in 144 (0.7%) South Dakota Low 1 in 82 (1.2%) Tennessee Very Low...
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Nov 23
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵1/10

With CDC data operational again, the transmission map is back. The data are always a week old, so transmission is likely worse than depicted.

We estimate 1 in 116 people actively infectious and 422,000 new daily infections. Heat map: Indiana and Arkansas with "moderate" transmission. All others, "low" or "very low" (CDC categories).
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵2/10

State level estimates are back. Note, the CDC changed their data processing approach in August, which tends to downplay transmission.

Does 1 in 45 in Indiana seem "moderate"?

Levels in MI may be mod/high (poor reporting). Alabama Very Low 1 in 153 (0.7%) Alaska Very Low 1 in 272 (0.4%) Arizona Low 1 in 63 (1.6%) Arkansas Moderate* 1 in 47 (2.1%) California Very Low 1 in 365 (0.3%) Colorado Very Low 1 in 137 (0.7%) Connecticut Low 1 in 103 (1.0%) Delaware Very Low 1 in 262 (0.4%) District of Columbia Very Low 1 in 418 (0.2%) Florida Very Low 1 in 408 (0.2%) Georgia Very Low 1 in 292 (0.3%) Guam Very Low 1 in 887 (0.1%) Hawaii Very Low 1 in 426 (0.2%) Idaho Very Low 1 in 116 (0.9%) Illinois Very Low 1 in 116 (0.9%) Indiana Moderate 1 in 45 (2.2%) Iowa Very Low 1 in 108 (0.9%) Kansas Very Low 1 in 109 (0.9%) Ke...
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵3/10

State-level estimates (continued).

Current levels may be much higher than noted here. Note that CDC data are always at least a week old. The 2nd half of November is a time period historically of accelerating transmission. Missouri Very Low 1 in 202 (0.5%) Montana Very Low* 1 in 114 (0.9%) Nebraska Low 1 in 95 (1.1%) Nevada Very Low 1 in 228 (0.4%) New Hampshire Low 1 in 78 (1.3%) New Jersey Very Low 1 in 192 (0.5%) New Mexico Very Low 1 in 151 (0.7%) New York Very Low 1 in 212 (0.5%) North Carolina Very Low 1 in 212 (0.5%) North Dakota Very Low* 1 in 116 (0.9%) Ohio Very Low 1 in 109 (0.9%) Oklahoma Low* 1 in 70 (1.4%) Oregon Very Low 1 in 194 (0.5%) Pennsylvania Very Low 1 in 111 (0.9%) Rhode Island Very Low 1 in 167 (0.6%) South Carolina Very Low 1 in 112 (0.9%) South Dakota Very Low 1 in 127 (0.8%) Tennes...
Read 10 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Nov 8
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
1/6🧵

🔹301,000 new daily infections based on wastewater-derived models
🔹1 in 162 people (0.6%) actively infectious
🔹Levels the past 2 months corrected upward by Biobot
🔹"Lull point" estimated between Nov 5-21. Rising soon. Year over year graph, emphasizing that levels commonly rise in mid November
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
2/6🧵

The central estimate of the forecast suggests we will surpass 500,000 new daily infections on Nov 22.

There's a 25% chance of a prolonged lull like last year. More likely, we are in wave territory by the end of the month. Close up of the most recent 3 months of data, including the forecast.
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
3/6🧵

We are presently in a lull between the 11th and 12th wave. Now is the time to get boosted and stock up on N95 masks, tests, and air purifier filters.

Do a DIY fit test if you've been putting it off. Graph of the 11 waves
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Nov 3
PMC COVlD Update, Nov 3, 2025 (U.S.)
1 of 9 🧵

The relative "lull" in SARS-CoV-2 transmission is unlikely to go much lower.

✨1 in 209 people are estimated actively infectious, likely the lowest levels of 2025 nationwide.

Get boosted. Stock up on masks, tests, & filters. Year-over-year graph
PMC COVlD Update, Nov 3, 2025 (U.S.)
2 of 9 🧵

No data presently suggest the rise of a winter wave any earlier than "usual."

If following historical trends, transmission will pick up Nov 15-29. Last year's rise was atypically late. Forecasted transmission
PMC COVlD Update, Nov 3, 2025 (U.S.)
3 of 9 🧵

Expect rising misinformation/disinformation as transmission heats up:
🔹Abuse of community notes, particularly surrounding wastewater methodology
🔹Paid bot army attacks, especially about boosters & masks
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Oct 28
PMC COVlD Update, Oct 27, 2025 (US)

Transmission typically accelerates in mid-November.

We are currently in a relative 'lull.' We estimate about a quarter-million new daily infections with 1 in 185 people actively infectious. Still bad, likely to get worse.

1/9 🧵 year over year graph
PMC COVlD Update, Oct 27, 2025 (US)

Our forecast through November 8 calls for flat transmission.

Nothing yet indicates the onset of a winter wave, but it would also be atypical for the lull to last much longer than another 2-3 weeks.

2/9 🧵 Graph of recent transmission and current forecast
PMC COVlD Update, Oct 27, 2025 (US)

We estimate 264,000 new daily infections during this 'lull' period.

Biobot data have returned. Our substitute data from WWS last week correlated r=.97 (near perfect) with that, but Biobot did retroactively increase recent estimates.

3/9 🧵 Graph of the 11 waves of the pandemic
Read 9 tweets

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