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

Jan 6
1) PMC COVID-19 Dashboard, Jan 6, 2025 (U.S.)

📈1 in 49 people actively infectious
🔥Nearly 1 million daily infections
🎲About a 50-50 chance someone has COVID in a large class if typical risk and no testing/isolating
🏥300,000+ new Long Covid conditions per week

The infections are likely minor underestimates. AZ and OR did not report this week. They were surging, so the lack of data brings down the average. As well, the model gives 80% weight to CDC wastewater data and 20% weight to Biobot, but Biobot took the week off, so this is dependent on observed changes in the CDC data.

It would be wise to add multiple imputation into the model to account for all the non-random missingness during surges, but I won't likely get to that anytime soon.

The peak is looking more and more like 1.4 million daily infections, but I wouldn't be surprised if it's earlier than shown and more like 1.3 million, based on the pattern of retroactive data corrections last winter. If the real-time data really stink, it could come in closer to 1.0-1.1 million. To top 1.6 million, we would probably need some serious immune escape that at present I just don't see happening. However, in past winters, transmission was declining nationally in early/mid January, and back-to-school is a wild card.

Info for new readers:

For those unfamiliar with the PMC model, find full weekly reports for the past 1.5 years at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks. Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, NBC, and CNN. See pgs 11-13 at the above link.

We will have a pre-print out in the next week or so documenting very compelling evidence for the validity of using wastewater to estimate case rates. Forecasting is challenging in the context of the current viral evolution, but the real-time estimates of cases are impressively accurate to the best we can evaluate it.

#MaskUp #VaxUp #CleanTheAir #RapidTestCurrent Levels for Jan 6, 2025 % of the Population Infectious 2.1% (1 in 49) New Daily Infections 980,000  New Weekly Infections 6,860,000  Resulting Weekly Long COVID Cases 343,000 to 1,372,000  Monthly Forecast Average % of the Population Infectious 2.7% (1 in 38) Average New Daily Infections 1,272,833 New Infections During the Next Month 38,185,000 Resulting Monthly Long COVID Cases 1,909,000 to 7,637,000  Running Totals Infections Nationwide in 2025 5,468,000 Average Number of Infections Per Person All-Time, U.S. 3.55  How Does Risk Increase with More Social Contacts? Number of people |...
2) PMC COVID-19 Dashboard, Jan 6, 2025 (U.S.)

We're in the 10th wave of the pandemic (1st graph), and transmission this year has picked up atypically late, while coming on strong (2nd graph).Two graphs, summarized in tweet
3) PMC COVID-19 Dashboard, Jan 6, 2025 (U.S.)

Note that sputtering in the West's rise is likely an aberration, as surging OR and AZ did not provide data this week.

Read 5 tweets
Jan 3
📢Clean Air Advocates📢

I recently learned of a new strategy to get more clean indoor air to people's homes. I don't believe I've heard anyone mention this on here, but please add if you have made inroads.
1/
Last August, I was surprised to learn that Entergy, our regional energy company, was giving away free HEPA filters to customers.

This was surprising to me. Why would an energy company do this?
2/
Apparently, most jurisdictions in the U.S. have regulations that require a portion of consumers' energy payments to go toward an energy efficiency fund.

These are often used for discounts on thermostats but occasionally for Energy Star appliances.
3/
Read 4 tweets
Dec 20, 2024
2) This is one of the better scenarios I noted, with national levels coming in at about 3.33. Unfortunately, the rise was a little lower than anticipated only because transmission slowed in the west. Not uniform, so lots of uncertainty.

3) Transmission remains much higher than people realize. Many will get caught off guard by a seemingly #SilentSurge. This is in part because the CDC spent the past month downplaying numbers in misleading graphs.

Read 8 tweets
Dec 16, 2024
PMC COVID-19 Dashboard, Dec 16, 2024
🧵1 of 8

🔹1 in 64 (1.6%) actively infectious in the U.S.
🔹750,000 new daily infections and rising
🔹Highest % increase in transmission in nearly 3 years
🔹10th wave is the "silent surge," coming on late out of nowhere

The video will walk you through each of the graphs on the dashboard and covered in this thread.

Info for new readers:

For those unfamiliar with the PMC model, find full weekly reports for the past 14+ months at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks.

Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, and NBC. See pgs 11-13 at the above link.

We will have a pre-print out in the next month documenting very compelling evidence for the validity of using wastewater to estimate case rates. Forecasting is challenging in the context of the current viral evolution, but the real-time estimates of cases are impressively accurate to the best we can evaluate it.
PMC COVID-19 Dashboard, Dec 16, 2024
🧵2 of 8

🔹10th wave taking off (U.S.)
🔹5 million infections expected this week
🔹>250,000 post-infection conditions (#LongCovid) expected to develop from this week's infections
🔹Higher transmission than 73% of the pandemic

Info for new readers (as noted in Tweet 1):

For those unfamiliar with the PMC model, find full weekly reports for the past 14+ months at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks.

Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, and NBC. See pgs 11-13 at the above link.

We will have a pre-print out in the next month documenting very compelling evidence for the validity of using wastewater to estimate case rates. Forecasting is challenging in the context of the current viral evolution, but the real-time estimates of cases are impressively accurate to the best we can evaluate it.Current Levels for Dec 16, 2024 % of the Population Infectious 1.6% (1 in 64) New Daily Infections 748,000  New Weekly Infections 5,236,000  Resulting Weekly Long COVID Cases 262,000 to 1,047,000  Monthly Forecast Average % of the Population Infectious 2.5% (1 in 41) Average New Daily Infections 1,178,167 New Infections During the Next Month 35,345,000 Resulting Monthly Long COVID Cases 1,767,000 to 7,069,000  Running Totals Infections Nationwide in 2024 242,424,000 Average Number of Infections Per Person All-Time, U.S. 3.50  There is more COVID-19 transmission today than during 73.3% of th...
PMC COVID-19 Dashboard, Dec 16, 2024
🧵3 of 8

Areas of the U.S. depicted in darker red have higher transmission, as of 9 days ago. The map uses CDC data and is simply the CDC "cool blue" map recolored in more traditional red, which is best practices.

The line graph shows transmission increasing by region.

CDC map:
cdc.gov/nwss/rv/COVID1…

CDC regional graph:
cdc.gov/nwss/rv/COVID1…

Info for new readers (as noted in Tweet 1):

For those unfamiliar with the PMC model, find full weekly reports for the past 14+ months at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks.

Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, and NBC. See pgs 11-13 at the above link.

We will have a pre-print out in the next month documenting very compelling evidence for the validity of using wastewater to estimate case rates. Forecasting is challenging in the context of the current viral evolution, but the real-time estimates of cases are impressively accurate to the best we can evaluate it.Map shows highest transmission in Arizona, New Mexico, Minnesota, and Massachusetts.  Estimated Percentage Actively Infectious  	PMC Model		Raw CDC Data (9 days old) National	1.6% (1 in 64)		0.9% (1 in 113) Northeast	0.8% (1 in 132)		0.4% (1 in 234) Midwest	2.4% (1 in 41)		1.4% (1 in 73) South	1.3% (1 in 74)		0.8% (1 in 132) West	1.5% (1 in 66)		0.9% (1 in 118)
Read 8 tweets
Oct 22, 2024
PMC COVID-19 Forecasting Model, Oct 21, 2024
🧵1 of 4

Every indication is that the 10th U.S. Covid wave is on the way. Within 2 weeks, expect transmission to be meaningfully higher.

Current estimates from PMC:
🔹1 in 115 actively infectious
🔹Higher transmission than during 43% of the pandemic
🔹Nearly 3 million weekly infections

These estimates are high in the absolute sense, but low relative to the recent summer wave and likely winter surge.

The CDC data show transmission increasing in the Northeast, and a slowing of the decline in transmission elsewhere. Biobot data also show flattening transmission. The raw CDC and Biobot wastewater data are delayed >1 week. Walgreens shows positive cases, testing, and positivity ratios flattening and is delayed only 1 day.

For those unfamiliar with the model, find full weekly reports for the past 14+ months at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical (median) levels for that date and recent patterns of changes in transmission the past 4 weeks.

Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, and NBC. See pgs 10-11 at the above link.GRAPH Shows forecasted entry into a 10th Covid wave.  TABLES Current Levels for Oct 21, 2024 % of the Population Infectious 0.9% (1 in 115) New Daily Infections 414,000  New Weekly Infections 2,898,000  Resulting Weekly Long COVID Cases 145,000 to 580,000  Monthly Forecast Average % of the Population Infectious 1.3% (1 in 76) Average New Daily Infections 627,600 New Infections During the Next Month 18,828,000 Resulting Monthly Long COVID Cases 941,000 to 3,766,000  Running Totals Infections Nationwide in 2024 225,097,000 Average Number of Infections Per Person All-Time, U.S. 3.46  How Does ...
PMC COVID-19 Forecasting Model, Oct 21, 2024
🧵2 of 4

These graphs show the forecast for changes in transmission over the next month.

The first graph shows year-over-year transmission. The 2nd focuses on the most recent year. Within a month, expect to see 0.7 to 1.0 million daily infections, if the assumptions of the model hold.

If lucky, we could get a slightly longer "lull" than what the model shows. The model likely underestimates the true value for the recent summer peak because many children were infected while going back to school, in fact, the highest peak at that time period all-time. Wastewater underestimates child infections ("contributions" correlate highly with body weight, so it takes four ill 50 lb kids to show up as one ill 200 lb adult). In underestimating the peak, transmission also fell more rapidly than anticipated post-peak. To the extent we underestimated the magnitude of the peak, there may be fewer than anticipated infections the next two weeks and a longer lull.

If you look at the first graph, however, you will see a clear patterns of escalating transmission in November, so it's more a matter of how quickly the situation will worsen than whether it will worsen.

During this relative "lull," it's an excellent time to stock up on high-quality masks, get vaccinated, upgrade the quality and quantity of air cleaners, re-stock on rapid tests, and encourage others to do the same.Two graphs, described in Tweet.
PMC COVID-19 Forecasting Model, Oct 21, 2024
🧵3 of 4

Regional differences suggest that the NE may already be rebounding in transmission. Transmission declines are slowing elsewhere.

We compare the PMC map in standard red against the CDC map using the same data in cool blue.Estimated Percentage Actively Infectious* National	0.9% (1 in 115) Northeast	1.0% (1 in 101) Midwest	0.9% (1 in 114) South	0.8% (1 in 130) West	0.9% (1 in 106)
Read 4 tweets
Oct 7, 2024
PMC COVID-19 Forecasting Model, Oct 7, 2024
🧵 1/4

540,000 daily infections during the "lull" between the 9th & 10th U.S. Covid waves.

🔹1.1% (1 in 88) actively infectious
🔹19 million anticipated infections the next month
🔹Higher transmission than half the pandemicGraph: 10 waves of the pandemic  Tables/stats: Current Levels for Oct 7, 2024 % of the Population Infectious 1.1% (1 in 88) New Daily Infections 541,000  New Weekly Infections 3,787,000  Resulting Weekly Long COVID Cases 189,000 to 757,000  Monthly Forecast Average % of the Population Infectious 1.3% (1 in 74) Average New Daily Infections 643,433 New Infections During the Next Month 19,303,000 Resulting Monthly Long COVID Cases 965,000 to 3,861,000  Running Totals Infections Nationwide in 2024 220,311,000 Average Number of Infections Per Person All-Time, U.S. 3.44  How Does Risk Increase wi...
PMC COVID-19 Forecasting Model, Oct 7, 2024
🧵 2/4

Year-over-year, we have seen the steepest drop in transmission all-time on the back end of a summer/fall wave.

Similar transmission the next month, a very high lull. Expect transmission to accelerate in mid-Nov.Two graphs  Year-over-year transmission. A very high late-summer wave, the highest all-time during Aug/Sep, followed by the steepest decline on the back of a summer wave, all-time.   Forecast. Note similar transmission over the next month, 40-60% of the summer wave's peak. Expect transmission to pick up considerably in mid-Nov in anticipation of a winter surge peaking around New Year's Eve
PMC COVID-19 Forecasting Model, Oct 7, 2024
🧵 3/4

Relative to the Northeast, transmission is 2x higher in the Midwest/South & 2.5x higher in the West region.

However, the CDC regions mask extreme variation within region. The 7 highest-transmission states are far north.Map: Transmission highest in Washington state, Oregon, Montana, Minnesota, Vermont, New Hampshire, and Maine.   Line Graph: Shows the regional statistics summarized in tweet.
Read 4 tweets

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