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

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
Mar 24
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵1/5

🔹3 million new weekly infections in a persistent "lull" of substantial transmission
🔹1 in 107 (0.9%) of the population actively infectious
🔹1 in 3 regions in high/very high transmission (16 states and DC)Heat map of transmission, described in Tweet
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵2/5

We have had a steady state of about a half million infections the past several weeks. That's over 50 million estimated infections so far in 2025.

In a room of 40-50 people, there's a 1-in-3 chance of exposure if no testing/isolation.Current Levels for Mar 24, 2025	 % of the Population Infectious	 0.9% (1 in 107)	 New Daily Infections	 446000	 New Weekly Infections	 3122000	 Resulting Weekly Long COVID Cases	 156,000 to 624,000	 	 Monthly Forecast	 Average % of the Population Infectious	 1.0% (1 in 96)	 Average New Daily Infections	 496566.6667	 New Infections During the Next Month	 14897000	 Resulting Monthly Long COVID Cases	 745,000 to 2,979,000	 	 Running Totals	 Infections Nationwide in 2025	 50757000	 Average Number of Infections	 Per Person All-Time, U.S.	 3.708526284	 	 How Does Risk Increase with More Social Co...
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵3/5

There's a good chance of steady transmission the next month. Often, we'd head into a low lull about now. BUT there are no universal precautions, immunity is waning from the fall & winter 2023-24, & viral evolution looks less 'lucky.'Middle forecast shows 400-600k daily infections.
Read 5 tweets
Mar 11
1) 5-yr Anniversary of the WHO Pandemic Declaration

🔥10 waves
🔥Covid mortality rivals lung cancer
🔥8 infections/person by 2030
🔥Long Covid as catastrophic
🔥Death trajectories becoming complex
🔥"During Covid" as anti-science rhetoric
🔥Serious ppl take Covid seriously
🧵
2) Wastewater-derived estimates of case rates show international consensus 20-26% of populations got Covid during the peak 2 months of the 2023-24 winter wave in the U.S., Canada, and the U.K.
3) The ratio of reported cases versus true cases has remained consistent, demonstrating the validity of wastewater-derived estimates. True cases are 15-30x reported cases, a consistent ratio. There are no examples demonstrating low case rates.
Read 25 tweets
Feb 26
1) Mardi Gras 2020 was 5 years ago today. ⚜️

It was before the pandemic declaration, before the federal government recommended masking.

COVlD spread quickly through New Orleans, leading to one of the highest mortality rates per capita in the U.S.... Timeline showing Mardi Gras 2020 just 4 days before the first known reported death of C19 in the U.S.  Note. "Peak" diagnoses refers to the peak of the 1st wave.
2) New Orleans service workers were disproportionately hit by the early pandemic. Many died. Many developed #LongCOVID at the time or have now through repeat infections. Many have switched to other sectors....

3) The sad fact is that many service workers are continuing to get #LongCOVID through repeat infections today because the pandemic is ongoing and many restaurants have high occupant density and horrendous air quality....

Read 4 tweets
Feb 17
1) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

🔥1 in 72 actively infectious
🔥Sustained high transmission
🔥30 states in high/very high transmission (CDC)
🔥3x the transmission of Feb 2021
🔥668,000 daily infections
🔥Only 1 in 28 cases reportedGraph shows 10 waves of the pandemic.  Tables summarized partially in post. Additionally, transmission is higher than during 59% of the pandemic.  How Does Risk Increase with More Social Contacts? Number of People | Chances anyone is infectious 1	1.4% 2	2.8% 3	4.1% 4	5.5% 5	6.8% 6	8.1% 7	9.4% 8	10.6% 9	11.9% 10	13.1% 15	19.0% 20	24.5% 25	29.7% 30	34.4% 35	38.9% 40	43.0% 50	50.5% 75	65.2% 100	75.5% 300	98.5%
2) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

This is a mid-sized wave, meaning substantial transmission. Notice that transmission remains steady at high rates.

Expect steady or slightly declining transmission, unless the real-time data are retroactively corrected.Two graphs, showing year-over-year transmission and the forecast, summarized in the post.
3) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

Notice that 30 states remain in high/very high transmission, per CDC categories.

This is the same as last week. Transmission is 3x higher than in Feb 2021, when people were taking more precautions around masking and testing.Transmission heat map and CDC line graph of regional variation in transmission.
Read 5 tweets

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