Mike Hoerger, PhD MSCR MBA Profile picture
Oct 9, 2023 9 tweets 4 min read Read on X
Our new article is out documenting the burden of the #pandemic on food service workers.

What it boils down to is fighting an #AIRBORNE virus with droplet dogma.

I will walk you through some of the more shocking highlights.
1/
🧵 Background As an illustrative example of COVID-19 pandemic community-based participatory research (CBPR), we describe a community-academic partnership to prioritize future research most important to people experiencing high occupational exposure to COVID-19 – food service workers. Food service workers face key challenges surrounding (1) health and safety precautions, (2) stress and mental health, and (3) the long-term pandemic impact.  Method Using CBPR methodologies, academic scientists partnered with community stakeholders to develop the research aims, methods, and measures, and interpret...
During the BA.1 Omicron wave, for example, food service workers could often get free #HandSanitizer.

Yet, free high-quality masks (e.g., #N95) were hard to come by.

N95s prevent people from inhaling airborne virus into their lungs. Hand sanitizer does not.

2/ Survey Result, Statistic  Free hand sanitizer, well stocked 17 (73.9%) Encouraged to stay home when sick 16 (69.6%) Free soap, well stocked 15 (65.2%) Free gloves 13 (56.5%) HVAC (heating/air conditioning) system is well-maintained 10 (43.5%) Health insurance 9 (39.1%) Free cloth masks 9 (39.1%) Free surgical masks 9 (39.1%) Free COVID-19 testing 7 (30.4%) Paid sick leave 5 (21.7%) Free high-quality masks, e.g., N95, N99, N100, KN95, KF94 5 (21.7%) Dental insurance 4 (17.4%) Vision insurance 3 (13.0%) Mental health services/counseling 2 (8.7%) HEPA filters are provided in areas with many pe...
With a lack of #PublicHealth guidance, many in the food service industry have faced decision fatigue in handling C0VID-related issues.

Participants said co-workers struggle with what to do if sick (87%), when to return to work (83%), or whether to get a booster (61%).
3/ Estimate, whether any co-workers experience decision fatigue by area, No. (%)  What to do if possibly sick with COVID-19 20 (87.0%) What to do if a family member is diagnosed with COVID-19 19 (82.6%) How to interact with customers about showing proof of vaccination 19 (82.6%) When to return to work after COVID-19 19 (82.6%) What to do if a family member may have COVID-19 18 (78.3%) What to do if diagnosed with COVID-19 17 (73.9%) How to interact with customers who dislike vaccines 17 (73.9%) How to interact with customers who dislike masks 16 (69.6%) When a child should return to school aft...
Food service workers have expressed that C0VID has had a big impact on co-workers' #MentalHealth.

Anxiety, depression, and substance use lead the way. However, many respondents also noted a co-worker dealing with #bereavement, suicidal ideation, or violence (17-36%).
4/ Anxiety and worry 22 (95.7%) Depression and sadness 18 (78.3%) Substance use 16 (69.6%) Loneliness 11 (47.8%) Anger 11 (47.8%) Bereavement 6 (26.1%) Suicidal thoughts 4 (17.4%) Violence and abuse 4 (17.4%)
Shortly after the BA.1 Omicron surge, many in the food service industry were aware of a co-worker dealing with #LongCOVID.

"Fatigue" (often EXHAUSTION) led the way. Many knew a co-worker with prolonged loss of taste or smell, which are huge to that occupation.
5/ Awareness of someone personally in the food service industry dealing with a symptom or side effect > 3 months after getting COVID19 that the participant attributed to the virus (i.e., Long COVID symptoms)   Fatigue or overtired 15 (65.2%) Anxiety 13 (56.5%) Depression 12 (52.2%) Loss of taste 11 (47.8%) Difficulty sleeping 11 (47.8%) Headache 9 (39.1%) Attention difficulties 9 (39.1%) Loss of smell 7 (30.4%) Cough 7 (30.4%) Joint pain 6 (26.1%) Sick to one’s stomach 6 (26.1%) Pain 5 (21.7%) Difficulty breathing 5 (21.7%) Digestive problems 4 (17.4%) Weakened lung capacity 4 (17.4%) Weight l...
In the more recent days of the pandemic, food service workers emphasized that a key priority was reducing in-home spread of C0VID.

Experts you know from Twitter provided their guidance on reducing in-home spread. Here's a link to another resource.

6/ cleanaircrew.org/someone-in-my-…
COVID-19 Mitigation Professionals In-home mitigation Masks Wear N95 respirators (masks) or P100/N100 elastomerics if finances permit. Filtration Use HEPA filters or do-it-yourself (DIY) air cleaners called Corsi-Rosenthal boxes or SAFE air purifiers. Ventilation Open windows. Use fans to blow clean air in. Use fans to blow infected air out of isolation rooms. Isolation Create an isolation room at home. Family members testing negative stay outside as much as possible. The person who is ill should eat outside if possible. Testing and Treatment Testing Get PCR testing if possible. Use at-home ...
When explaining to other scientists that #CovidIsAirborne, I have found it helpful to quote Jha.


7/
Jha - C19 is "purely airborne"
Too often, restaurants continue to be superspreaders of C0VID and other airborne illnesses.

#ASHRAE indicates that they should be cleaning the air 28-40 times per hour. Instead, many are doing more like 0.8
8/ The new standards indicate that restaurants and similar establishments should clean the air approximately 28–40 times per hour, depending on occupancy level (more precisely, 40 cubic feet per minute per person [cfm/person] or 20 L per second per person [l/s/person]) to reduce airborne illness transmission, approximately double the historic standard of 15 air changes per hour in U.S. operating rooms. To put in context, many restaurants, bars, and similar establishments clean the air 0.8 times per hour [43], 35–50 times lower than the current ASHRAE air cleaning standards.
In fact, we clean fish tanks better than we clean the air in many dangerous settings like restaurants.
@sri_srikrishna
9/ As the engineer Devabhaktuni Srikrishna frequently notes, even fish get 4–6 full water exchanges per hour in properly running fish tanks [44]. Essentially, food service venues are among the highest-risk settings and have the lowest mitigation. The ASHRAE standards are a firm indication of the occupational hazards of food service work.

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More from @michael_hoerger

Apr 22
🧵1 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

🌤️Only 1 in 5 days of the pandemic have seen transmission as low as today
🌤️1 in 196 actively infectious
⚡️BUT still 1.7 million weekly infections, resulting in >85,000 LC cases and up to 1,000 deaths

I'll walk you through it... Current Levels for Apr 21, 2025	 % of the Population Infectious	 0.5% (1 in 196)	 New Daily Infections	 244000	 New Weekly Infections	 1708000	 Resulting Weekly Long COVID Cases	 85,000 to 342,000	 Resulting Weekly Excess Deaths	 600 to 1,000	 	 Monthly Forecast	 Average % of the Population Infectious	 0.7% (1 in 147)	 Average New Daily Infections	 324800	 New Infections During the Next Month	 9744000	 Resulting Monthly Long COVID Cases	 487,000 to 1,949,000	 Resulting Monthly Excess Deaths	 3,500 to 5,800	 	 Running Totals	 Infections Nationwide in 2025	 62331000	 Average Number of Infecti...
🧵2 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

We're in the 6th year. See the small red line, bottom left. Notice how closely it tracks the median (gray), year 4 (yellow), & year 5 (orange).

Acknowledging caveats, those are plausible gist-level scenarios for months ahead. year over year graph, summarized in post
🧵3 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

Expect steady transmission bouncing up and down around the current national lull-level estimate the next several weeks. 200-350k daily infections nationally.

This is about as low as lulls bottom out anymore. Past 12 months and forecast, summarized in post
Read 8 tweets
Apr 14
🧵1/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

🔹2.2 million weekly infections
🔹1 in 149 actively infectious
🔹>100,000 LC cases resulting from the week's infections
🔹>800 deaths resulting from the week's infections
🔹"Lull" transmission steady/slightly decliningCurrent Levels for Apr 14, 2025	 % of the Population Infectious	 0.7% (1 in 149)	 New Daily Infections	 320000	 New Weekly Infections	 2240000	 Resulting Weekly Long COVID Cases	 112,000 to 448,000	 Resulting Weekly Excess Deaths	 800 to 1,300	 	 Monthly Forecast	 Average % of the Population Infectious	 0.7% (1 in 138)	 Average New Daily Infections	 345366.6667	 New Infections During the Next Month	 10361000	 Resulting Monthly Long COVID Cases	 518,000 to 2,072,000	 Resulting Monthly Excess Deaths	 3,700 to 6,200	 	 Running Totals	 Infections Nationwide in 2025	 60891000	 Average Number of ...
🧵2/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

Year-over-year transmission (red line, lower left) is tracking the median (grey), year 4 (yellow), and year 5 (orange) closely.

If that trend continues, expect steady yet bumpy transmission the next couple months, until June/July.line graphs, described in tweet
🧵3/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

The heat map shows only 4 states in the CDC 'high' level and none in the 'very' high level.

Check local data. Those timing activities to lulls may see a clear opportunity.heat map, described in tweet
Read 6 tweets
Apr 9
The NIH Clinical Center drops universal masking after 5 months of protecting patients, family, & staff.

Wastewater-derived estimates indicate 2.79 million Americans are getting Covid per week AND top actuaries suggest an American dies of Covid every 3 minutes.

🧵1/5 Masks are optional beginning April 11. Staff will mask on request.
These are the current wastewater-derived estimates of transmission.

2.79 million Covid infections/week in the U.S. in the current high "lull."
🧵2/5
This thread with video explains in exquisite detail how every 3 minutes in 2025 an American dies of Covid.

🧵3/5
Read 5 tweets
Apr 7
1) PMC COVlD Dashboard, April 7, 2025 (U.S.)

🔹1 in 120 actively infectious
🔹1 in 3 chance of exposure in a room of 50
🔹2.8 million weekly infections
🔹>140,000 resulting LC cases from the week's infections
🔹>1,000 deaths resulting from the week's infections Current Levels for Apr 7, 2025	 % of the Population Infectious	 0.8% (1 in 120)	 New Daily Infections	 399000	 New Weekly Infections	 2793000	 Resulting Weekly Long COVID Cases	 140,000 to 559,000	 Resulting Weekly Excess Deaths	 1,000 to 1,700	 	 Monthly Forecast	 Average % of the Population Infectious	 1.0% (1 in 105)	 Average New Daily Infections	 455766.6667	 New Infections During the Next Month	 13673000	 Resulting Monthly Long COVID Cases	 684,000 to 2,735,000	 Resulting Monthly Excess Deaths	 4,900 to 8,100	 	 Running Totals	 Infections Nationwide in 2025	 55591000	 Average Number of...
2) Watch this video to understand how we use excess death data from one of the world's largest reinsurers to estimate how this week's infections will result in >1,000 deaths.
3) Transmission is steady or declining across much of the nation, but remains high in 11 states and DC, per the CDC.

Other sources, such as WastewaterSCAN, show a near doubling of transmission in the Northeast the past few weeks, so remain cautious.
Read 4 tweets
Mar 31
🧵1 of 5
PMC Dashboard, March 31, 2025 (U.S.)

🔹800-1,400 deaths expected to result from this week's infections (new stat, see video next Tweet)
🔹100,000+ Long Covid conditions to result from this week's infections
🔹1 in 142 actively infectious todayCurrent Levels for Mar 31, 2025	 % of the Population Infectious	 0.7% (1 in 142)	 New Daily Infections	 337000	 New Weekly Infections	 2359000	 Resulting Weekly Long COVID Cases	 118,000 to 472,000	 Resulting Weekly Excess Deaths	 800 to 1,400	 	 Monthly Forecast	 Average % of the Population Infectious	 0.8% (1 in 120)	 Average New Daily Infections	 397233.3333	 New Infections During the Next Month	 11917000	 Resulting Monthly Long COVID Cases	 596,000 to 2,383,000	 Resulting Monthly Excess Deaths	 4,300 to 7,100	 	 Running Totals	 Infections Nationwide in 2025	 52303000	 Average Number of ...
🧵2 of 5
PMC Dashboard, March 31, 2025 (U.S.)

This video explains U.S. COVID excess death statistics, which we have incorporated into the dashboard.

🧵3 of 5
PMC Dashboard, March 31, 2025 (U.S.)

The transmission forecast suggests 300-500k daily infections the next month. If the data get retroactively corrected downward, we could dip to 200k.

Check local dashboards, and time events accordingly.Forecast graph, described in post
Read 5 tweets
Mar 31
PMC Update on #ExcessDeaths

🔥109,000-175,000 people in the U.S. are expected to die as a result of COVID in 2025, based on estimates derived from Swiss Re
🔥COVID deaths expected to be on par with lung cancer in the U.S. in 2025
🔥Death data added to the dashboard
2) Full video links to learn more about COVID #ExcessDeaths in the U.S.

Dashboard page (presently featured): pmc19.com/data
Downloadable file: pmc19.com/data/deaths033…
Veed platform: veed.io/view/558039f4-…
3) The new #ExcessDeath statistics build on what we described in the 5-year pandemic anniversary video.

Watch from 12:14-20:00 to see how simplistic models underestimate COVID deaths. The Swiss Re model solves that problem. PMC extends that work.
Read 6 tweets

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