Mike Hoerger, PhD MSCR MBA Profile picture
Sep 1, 2023 5 tweets 5 min read Read on X
PMC C0VID-19 Tracker, Aug 30, 2023

U.S. #wastewater levels are higher than during the majority (63.1%) of the pandemic:

🔹1.69% (1 in 59 people) are infectious
🔹800,000 new daily COVID-19 cases
🔹Causing 40-160K #LongCOVID cases per day

Technical details follow...
1/
What’s the Current State of the Pandemic?

We are near the peak (hopefully) of a 7th U.S. C0VID wave.

Transmission remains very high. The U.S. has seen >165 million infections this year, leading to at least 8 million #LongCOVID cases.

2/
How Well are the PMC Models Performing?

Deep dive:

3/

When our models are supplied with accurate real-time data, they are extremely accurate forecasting (e.g., R^2 = 96% for 1-week predictions).

Unfortunately, the Biobot real-time wastewater reports are often corrected substantially. If we had been supplied with the “correct” wastewater levels last week, we would have accurately predicted this week’s wastewater levels for the first time with 0% error (predicted: 554 copies/mL, actual: 554 copies/mL).

The PMC models place a huge emphasis on recent reports, so if recent reports are bad, this throws off the models. Indeed, prior Biobot data suggested the summer wave had peaked recently, and now it seems about 2 weeks away (if no surge).

These are actually quite marginal errors -- hopefully. Predicting the exact day of a “peak” amid a wide plateau is hard and of marginal relevance to decision making. It's like predicting the hottest day of the summer when it's about 100 degrees F for two months straight.

But even with these rough data, the overall pattern and levels remain close to predictions and historical averages.

The pandemic is not “over.”

When describing the current wave to people, it’s useful to characterize as “we’re somewhere between 2/3 Delta and Delta at present.” Avoid understating or overstating, as it will undermine credibility.

The point is to get the models as accurate as possible, even while the broader story remains unchanged (bad situation like Delta, worse than much of the past 6 months, hopefully peaking soon, better October, then 3 very bad months).

Given the issues with the real-time Biobot data, we’re updating the models in a few ways:

1) offering a few models and a composite
2) incorporating models that work around potential issues with the real-time reports (described next), and
3) adding additional external data (future models, which may incorporate air travel data, weather data, and more).
What’s the C0VID Forecast for the Next Month?

If there’s no immune-evading surge, there should be a rise in cases and then decline to the current levels. Historically, October sees a large drop, and we’d expect the same if no immune-evading surge.

4/

Details...

You’ll see several different forecasting models that have different peaks but the same overall pattern.

The models:
-General update:
All models incorporate historical data and recent data. Previously, we used historical data on monthly variation in levels and recent data on levels the past 4 weeks. Current models have two updates. One, they include the year (2020, 2021, 2022, 2023), though this improves precision quite marginally. Two, instead of monthly variation, they use half-month variation (imagine each year chopped into 24 “half months,” with annualized averages across the pandemic, e.g., a 2nd-half of September estimate). This is very important. Historically, September has lower levels than August. BUT levels in early September are much higher than late September (think school transmission). If this specification had been incorporated sooner, we’d have expected a slower decline in the late-summer wave. Instead of a gradual decline in September, imagine a plateau from mid-Aug to mid-Sep, following by a steeper decline.

-Real-time model: ⌚️
This is the standard model. It assume biobot’s real-time wastewater levels are accurate.

-Turtle model (slow, conservative): 🐢
This model ignores the most recent week of biobot data, essentially deeming it useless. You will notice the real-time (red) and turtle (green) forecasts overlap exactly. This is because the turtle model ignoring this week’s data predicted it exactly accurately based on last week’s data. Expect more divergence in the future. This was a weird fluke.

-Cheetah model (fast, aggressive): 🐆
This model aims to get ahead of biobot real-time mistakes. If biobot’s real-time reports were underestimates by 15% last week, it assumes the current week’s reports are an underestimate of 15%. Think more aggressive models. We presented this previously as an alternative model, then dismissed it, and now have brought it back.

-Composite model: ⌚️🐢🐆
It’s the arithmetic average of the three models, used for generating the other statistics.
As of Aug 30, What’s the Risk in an Office or in a Classroom?

The office and classroom risks remain quite bad.
🔥🔥🔥

5/

Details...

In a group of 10 people (daycare, team meeting, etc.), there’s a >15% chance someone will have infectious COVID. In a group of 20-25 people (e.g., K-12 classroom, department meeting, busy hospital waiting room, etc.), there’s about a 30% chance someone would have infectious COVID. In a university classroom of 40 people, it should be assumed someone has infectious COVID. This is quite troubling for instructors or students who mix time with multiple groups of classmates each week.

Not all classrooms and meetings are the same. Virtual meetings reduce risk close to zero. Outdoor meetings are often safer than indoors. Testing reduces risk, as do policies that encourage people to stay home when symptomatic. High-quality, well-fitting masks greatly reduce risk. Air quality monitoring and improved air cleaning reduce risk. Recent boosters reduce risk. It remains troubling that elected leaders and public health officials choose to model poor mitigation when ongoing risk is so high.

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More from @michael_hoerger

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
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
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
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
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
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

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