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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
Mar 23
PMC #COVID Update, March 23, 2026 (U.S.)

Transmission levels have plummeted nationally as we shift from the 12th wave toward a relative "lull."

Over half the states have "Very Low" relative transmission, per the CDC.

🧵THREAD 1 of 8 Heat map using CDC levels and PMC estimate of prevalence (1 in 147 actively infectious nationwide).
Transmission varies considerably by state.

Highest
🔥Mississippi: 1 in 31 estimated actively infectious
🔥Michigan: 1 in 41
*Both states w/limited data though

Rates are quite low in relative terms in California, AZ, FL, HI, ID, MA, NV, NY, OR, RI, UT, WI

🧵THREAD 2 of 8 Alabama Very Low Alaska Very Low Arizona Very Low Arkansas Low* California Very Low Colorado Very Low Connecticut Low Delaware Moderate District of Columbia Low Florida Very Low Georgia Very Low Guam Very Low Hawaii Very Low Idaho Very Low Illinois Very Low Indiana Low Iowa Moderate Kansas Low Kentucky Moderate Louisiana Low Maine Very Low Maryland Moderate Massachusetts Very Low Michigan High* Minnesota Moderate Mississippi High* Missouri Low Montana Very Low Nebraska Low Nevada Very Low New Hampshire Low* New Jersey Low New Mexico Very Low New York Very Low North Carolina Low North Dakota...
The 6th anniversary of the WHO's pandemic declaration was March 11.

Bots, minimizers, & individuals' psychological defense mechanisms will downplay that.

Yet, the U.S. just had a 12th wave. We estimate >5 cumulative infections/person & ongoing health harms.

🧵THREAD 3 of 8 Graph of the 12 waves of the pandemic (U.S.)
Read 8 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Mar 14
As of today, the COVID-19 pandemic is now longer than WWII.
If you have been living in denial the past 6 years, know that the U.S. is winding down from a 12th wave of infections presently.
Denial is but one of several obvious defense mechanisms people use to try to block their awareness of the ongoing toll of COVID-19. There are many others.

Short-term capital also plays a role, but even that requires a large dose of defense mechanisms.

Read 7 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 25
During this 12th COVlD wave, the CDC reports 1-in-3 states have "High" or "Very High" levels.

PMC estimates the proportion of residents actively infectious (prevalence):
◾️USA: 1 in 67
◾️IA: 1 in 27
◾️MI: 1 in 25
◾️IN & CT: 1 in 23
◾️ME: 1 in 21
◾️OK & SD: 1 in 17

🧵1/ Heat map using CDC data. National PMC prevalence estimate noted; estimated incidence of 732,000 new daily infections.
On average, Americans have have 5.0 cumulative SARS-CoV-2 infections.

This week's infections are expected to result in 1/4 to 1 million new #LongCOVID conditions and ≈2,000 excess deaths.
🧵2/ Column 1: Table of state-level prevalence estimates. Highest estimates noted in the thread text. Column 2: Proportion Actively Infectious 1 in 67 (1.5%) New Daily Infections 732,000 Infections the Past Week 5,220,000 Infections in 2026 24,000,000 Cumulative Infections per Person 5.04 Long COVID Long COVID Cases Resulting 37,000 to 146,000 from New Daily Infections Long COVID Cases Resulting 261,000 to 1,040,000 from New Weekly Infections Excess Deaths Ex...
The wave peak is now estimated >10% higher than last week at 1.2 million new daily infections, nearly double the Delta wave.

We expect sustained high transmission (≈600,000 to 750,000 new daily infections) the next few weeks as COVlD circulates through schools/families.
🧵3/ Fig 1: Graph of 12 waves Fig 2: "Barometer" showing above average transmission Fig 3: Year-over-year graph, which informs the analytic forecast Fig 4: Forecast described in post
Read 4 tweets
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

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