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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
Jan 17
Based on today's CDC & Biobot data, we estimate the following for the week of Jan 19:

🔸1 in 52 people in the U.S. actively infectious
🔸25% chance of exposure in a room of 15 ppl
🔸Nearly 1 million new daily infections
🔸5 cumulative infections per person all-time (avg)
🧵1/5 Heat map from CDC data with PMC estimates. Description of "Very High" states in next post
Transmission estimates have been marginally corrected upward.

11 states have Very High COVlD levels:

🔸PA: 1 in 25 estimated actively infectious
🔸MI: 1 in 23
🔸OH & KY: 1 in 22
🔸SD: 1 in 20
🔸NE & IA: 1 in 18
🔸IL & ME: 1 in 17
🔸IN: 1 in 16
🔸WV: 1 in 11
🧵2/5 Proportion Actively Infectious 1 in 52 (1.9%) New Daily Infections 941,000 Infections the Past Week 6,020,000 Infections in 2026 18,000,000 Cumulative Infections per Person 5.01 Long COVID Long COVID Cases Resulting 47,000 to 188,000 from New Daily Infections Long COVID Cases Resulting 301,000 to 1,200,000 from New Weekly Infections Excess Deaths Excess Deaths Resulting 270 to 450 from New Daily Infections Excess Deaths Resulting ...
We're in the middle of a 12th COVlD wave.

The peak has likely passed, but with students headed back to school, transmission is expected to remain high for at least the next several weeks.

🧵3/5 1) Graph of 12 waves 2) Barometer showing above-average transmission 3) Year over year graph 4) Forecast for transmission to decline and then percolate at high levels
Read 5 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 10
The size of the winter COVlD wave has been revised upward as post-holiday data come in.

We estimated 1 in 55 people in the U.S. are actively infectious.

🔥WV: 1 in 14
🔥IN: 1 in 15
🔥MI & OH: 1 in 21
🔥MO: 1 in 22
🔥CT: 1 in 24
🔥KS: 1 in 25
🔥MA & IL: 1 in 27

Quick 🧵 1/4 Heat map and PMC estimates, 1 in 55 infectious and 892,000 new daily infections for Jan 12. We expedited the report to release it two days early.
Nationally, we are seeing an estimated 892,000 new daily SARS-CoV-2 infections, meaning a 1 in 4 chance of exposure in a room of 15 people. Risk varies considerably by state.

We are approaching an average of 5 infections per person since pandemic onset.
🧵 2/4 Alabama Moderate Alaska Very Low Arizona Very Low Arkansas High* California Very Low Colorado Low Connecticut Very High Delaware Moderate District of Columbia Very Low Florida Very Low Georgia Very Low Guam Very Low Hawaii Very Low Idaho Very Low Illinois Very High Indiana Very High Iowa High Kansas Very High Kentucky Moderate Louisiana Moderate Maine High Maryland High Massachusetts Very High Michigan Very High* Minnesota Moderate Mississippi Low* Missouri Very High* Montana High Nebraska High Nevada Very Low New Hampshire Moderate New Jersey Low New Mexico Moderate New York High* North Ca...
We are in the 12th COVlD wave of the U.S.

Current transmission is higher than 68% of all days since the pandemic onset in 2020.
🧵 3/4 12 waves of COVlD Pandemic barometer: Higher than 88% of the past 100 days, 73% of the past year, 68% of the entire pandemic. Year over year graph Forecast of slowly declining transmission.
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 8
You might not have heard, but the northeastern U.S. is in a COVlD surge.

We use wastewater levels to derive estimates of the proportion of people actively infectious in each state (prevalence), e.g., 1 in 24 people in Connecticut.

Let me walk you through it...

🧵1/8 Colors show CDC levels PMC prevalence estimates noted: -Maine 1 in 38 actively infectious with COVlD -New Hampshire 1 in 35 (limited data) -Vermont 1 in 75 -New York 1 in 44 (limited data) -Pennsylvania 1 in 44 -Massachusetts 1 in 36 -Connecticut 1 in 24 -Rhode Island 1 in 41 -New Jersey 1 in 82
Notice that #Connecticut has excellent SARS-CoV-2 wastewater surveillance. It's "Very High" across much of the state, per CDC.

Based on wastewater levels, we estimate 1 in 24 residents are actively infectious w/COVlD. That's a 66% exposure risk in a room of 25 people.

🧵2/8 Colors show CDC levels PMC estimate of prevalence
The CDC reports "Very High" levels in #Massachusetts.

The surveillance is less robust, but we estimate 1 in 26 residents are actively infectious, similar to our estimate in CT where coverage is better.

In a room of 25 people, that's a 62% chance of an exposure.

🧵3/8 Colors show CDC levels PMC prevalence estimates provided
Read 8 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 8
We're in the middle of a 12th COVlD wave in the U.S., with transmission particularly high in the Midwest and Northeast.

The CDC announced this week that COVlD continues to kill more Americans than breast and prostate cancer combined.

Get boosted & #MaskUp 💉💪😷
1/4🧵 Heat map of CDC data with PMC prevalence estimate
Levels are "Moderate" to "Very High" in 26 states.

However, data reporting is slow, and about 1/3 of states have low-quality data this week due to the holidays and illness.

2/4🧵 National estimates: Number of People Chances Anyone is Infectious 1 1.5% 2 3.0% 3 4.5% 4 6.0% 5 7.4% 10 14.3% 15 20.7% 20 26.5% 25 32.0% 30 37.0% 50 53.8% 75 68.6% 100 78.6% 200 95.4% 300 99.0%
Barometer: Higher transmission than 90 of the past 100 days (perhaps higher still, due to low data reporting quality)
State CDC Level Actively Infectious Alabama Moderate 1 in 48 (2.1%) Alaska Very Low 1 in 152 (0.7%) Arizona Very Low 1 in 201 (0.5%) Arkansas High* 1 in 36 (2.8%) California Very Low 1 in 484 (0.2%) Colorado Moderate 1 in 49 (2.0%) Connecticut Very High 1 in 24 (4.2%) Delaware Low* 1 in 70 (1.4%) District of Columbia Very Low 1 in 5,835 (0.0%) Florida Very Low 1 in 284 (0.4%) Georgia Low 1 in 90 (1.1%) Guam Very Low 1 in 687 (0.1%) Hawaii Very Low 1 in 874 (0.1%) Idaho Very Low 1 in 169 (0.6%) Illinois Moderate* 1 in 56 (1.8%) Indiana High* 1 in 34 (2.9%) Iowa Moderate 1 in 41 (2.4%) Kansas...
State CDC Level Actively Infectious Missouri Moderate* 1 in 42 (2.4%) Montana High 1 in 34 (2.9%) Nebraska Very High 1 in 26 (3.9%) Nevada Very Low 1 in 138 (0.7%) New Hampshire High* 1 in 35 (2.9%) New Jersey Low 1 in 82 (1.2%) New Mexico Low 1 in 87 (1.2%) New York Moderate* 1 in 44 (2.3%) North Carolina Low 1 in 82 (1.2%) North Dakota High* 1 in 34 (3.0%) Ohio Very High 1 in 27 (3.7%) Oklahoma Moderate* 1 in 62 (1.6%) Oregon Very Low 1 in 170 (0.6%) Pennsylvania Moderate 1 in 44 (2.3%) Rhode Island Moderate 1 in 41 (2.4%) South Carolina Moderate 1 in 54 (1.9%) South Dakota Very High 1 in...
If like years 1-4 of the pandemic, the winter wave has peaked. If like last year, we could hover near peak levels for a month.

Forecasting quality is low with 1/3 of states having data issues. Hopefully, we'll know a lot more in a few days.

3/4🧵 12 waves
Proportion Actively Infectious 1 in 65 (1.5%) New Daily Infections 749,000 Infections the Past Week 5,390,000 Infections in 2026 3,000,000 Cumulative Infections per Person 4.88 Long COVID Long COVID Cases Resulting 37,000 to 150,000 from New Daily Infections Long COVID Cases Resulting 270,000 to 1,080,000 from New Weekly Infections Excess Deaths Excess Deaths Resulting 220 to 370 from New Daily Infections Excess Deaths Resulting ...
year over year graph
forecast
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 5
We told you that 109,000-175,000 Americans would died of COVID (excess deaths) in 2025.

Today, the CDC estimates 101,000 deaths/year (flat from Oct 2022 to Sep 2024), and likely higher when considering more nebulous non-acute excess deaths (heart attack 6 months later).
1/5
The CDC estimates are actually higher than I would have guessed, given their methodology, which models estimates based on easily countable factors in healthcare and expert input on multiplier values. It lends credence to the PMC upper bound of excess deaths of 175,000/yr.
2/5
What's troubling is the CDC has annual mortality flat. My expectation based on mortality displacement and Swiss Re data is that it should be declining. If is stays flat, we're running on something like breast+prostate cancer or lung cancer deaths per year in perpetuity.
3/5
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Dec 31, 2025
PMC COVlD Update, Week of Dec 29, 2025
🧵1/10

Happy New Year's Eve! #nye

Based on today's CDC data, we estimate 1 in 51 Americans are actively infectious with COVlD. That's nearly 1 million new daily infections.

Be wise. Vax up, mask up. #oneofthetwo Heat map from CDC data and PMC estimates.
🧵2/10

Many states are surging presently. True levels are higher than shown in most places due to state-level reporting lags. Alabama Moderate 1 in 46 (2.2%) Alaska Low 1 in 93 (1.1%) Arizona Very Low 1 in 201 (0.5%) Arkansas High* 1 in 32 (3.1%) California Very Low 1 in 351 (0.3%) Colorado Low 1 in 71 (1.4%) Connecticut High 1 in 33 (3.1%) Delaware Low 1 in 90 (1.1%) District of Columbia Very Low 1 in 300 (0.3%) Florida Very Low 1 in 282 (0.4%) Georgia Very Low 1 in 125 (0.8%) Guam Very Low 1 in 585 (0.2%) Hawaii Very Low 1 in 855 (0.1%) Idaho Very Low 1 in 221 (0.5%) Illinois Moderate 1 in 41 (2.5%) Indiana Very High 1 in 14 (6.9%) Iowa Low 1 in 69 (1.4%) Kansas Moderate 1 in 46 (2.2%) Kentucky High 1 in 34 (2.9...
🧵3/10

Although many states are surging, do not feel false security in "low" level states. For example, NY has terrible reporting quality with the CDC currently. Missouri Moderate* 1 in 56 (1.8%) Montana Low 1 in 76 (1.3%) Nebraska Very High 1 in 18 (5.5%) Nevada Very Low 1 in 122 (0.8%) New Hampshire Moderate* 1 in 42 (2.4%) New Jersey Very Low 1 in 113 (0.9%) New Mexico Moderate 1 in 62 (1.6%) New York Very Low* 1 in 127 (0.8%) North Carolina Very Low 1 in 125 (0.8%) North Dakota Moderate* 1 in 43 (2.3%) Ohio High 1 in 28 (3.6%) Oklahoma Very High 1 in 25 (4.0%) Oregon Very Low 1 in 170 (0.6%) Pennsylvania Moderate 1 in 45 (2.2%) Rhode Island Moderate 1 in 41 (2.4%) South Carolina Low 1 in 84 (1.2%) South Dakota High 1 in 33 (3.0%) Tennessee Moder...
Read 10 tweets

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