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

Dec 15
PMC COVID Update, Dec 15, 2025 (U.S.)

In the latest CDC data, 15 states have moderate to very high transmission.
🔹1 in 63 estimated actively infectious nationally, rising fastest in the Midwest & Northeast
🔹Very High: Indiana
🔹High: Nebraska, Vermont, Connecticut

🧵1/9 Heat map from CDC data and PMC estimates of 1 in 63 actively infectious and >700,000 new daily infections, based on wastewater derived estimates using models noted in the Technical Appendix at the website listed in the image.
PMC estimates 1 in 26 people in Indiana are infectious and 1 in 39 in Connecticut.

MI, MS, and AR may have higher levels than shown due to poor reporting.

States AL to MS shown.

🧵2/9 Alabama	Moderate	1 in 41 (2.4%) Alaska	Very Low	1 in 220 (0.5%) Arizona	Very Low	1 in 118 (0.8%) Arkansas	Low*	1 in 68 (1.5%) California	Very Low	1 in 382 (0.3%) Colorado	Very Low*	1 in 230 (0.4%) Connecticut	High	1 in 39 (2.6%) Delaware	Very Low	1 in 222 (0.4%) District of Columbia	Very Low	1 in 131 (0.8%) Florida	Very Low	1 in 320 (0.3%) Georgia	Very Low	1 in 275 (0.4%) Guam	Very Low	1 in 426 (0.2%) Hawaii	Very Low	1 in 670 (0.1%) Idaho	Very Low	1 in 108 (0.9%) Illinois	Low	1 in 71 (1.4%) Indiana	Very High	1 in 26 (3.8%) Iowa	Low	1 in 76 (1.3%) Kansas	Moderate	1 in 62 (1.6%) Kentucky	Mode...
PMC estimates 1 in 39 are infectious in both Nebraska and Vermont (coincidence, not typo).

Very few NY sites are reporting to the CDC, so use the NYS website there instead.

States MO to WY shown.

🧵3/9 Missouri	Low	1 in 80 (1.2%) Montana	Very Low	1 in 135 (0.7%) Nebraska	High	1 in 39 (2.5%) Nevada	Very Low	1 in 225 (0.4%) New Hampshire	Moderate	1 in 47 (2.1%) New Jersey	Very Low	1 in 200 (0.5%) New Mexico	Low	1 in 75 (1.3%) New York	Moderate*	1 in 49 (2.1%) North Carolina	Very Low	1 in 226 (0.4%) North Dakota	Low*	1 in 85 (1.2%) Ohio	Moderate	1 in 62 (1.6%) Oklahoma	Moderate*	1 in 47 (2.1%) Oregon	Low	1 in 89 (1.1%) Pennsylvania	Moderate	1 in 55 (1.8%) Rhode Island	Low	1 in 70 (1.4%) South Carolina	Very Low	1 in 215 (0.5%) South Dakota	Low	1 in 86 (1.2%) Tennessee	Moderate	1 in 60 (1.7%) ...
Read 9 tweets
Dec 8
PMC COVlD Update, Dec 8, 2025 (U.S.)
1/9

🔥🔥🔥Very High: Arizona (Yuma)
🔥🔥High: Indiana and Vermont
🔥Moderate: Nebraska and Alabama

Data only go through late November, and levels often increase following Thanksgiving. Heat map and PMC estimates of transmission (1 in 102 actively infectious).
PMC COVlD Update, Dec 8, 2025 (U.S.)
2/9

State-by-state estimates (part 1). Arizona is Very High, but sites were only online in the Yuma area. Indiana remains high.

MI and MS have considerable uncertainty.

DC is exceptionally low. Alabama	Moderate	1 in 47 (2.1%) Alaska	Very Low	1 in 220 (0.5%) Arizona	Very High*	1 in 18 (5.7%) Arkansas	Very Low*	1 in 138 (0.7%) California	Very Low	1 in 574 (0.2%) Colorado	Low	1 in 76 (1.3%) Connecticut	Low	1 in 91 (1.1%) Delaware	Very Low	1 in 307 (0.3%) District of Columbia	Very Low	1 in 5,777 (0.0%) Florida	Very Low	1 in 494 (0.2%) Georgia	Very Low	1 in 180 (0.6%) Guam	Very Low	1 in 289 (0.3%) Hawaii	Very Low	1 in 704 (0.1%) Idaho	Very Low	1 in 121 (0.8%) Illinois	Very Low	1 in 112 (0.9%) Indiana	High	1 in 30 (3.3%) Iowa	Low	1 in 83 (1.2%) Kansas	Low	1 in 105 (1.0%) Kentucky	Very L...
PMC COVlD Update, Dec 8, 2025 (U.S.)
3/9

State-by-state estimates (part 1). Vermont remains High. Tennessee has fallen rapidly from a quick surge.

Data quality are low in NY. Missouri	Very Low	1 in 176 (0.6%) Montana	Very Low	1 in 136 (0.7%) Nebraska	Moderate	1 in 45 (2.2%) Nevada	Very Low	1 in 372 (0.3%) New Hampshire	Very Low	1 in 109 (0.9%) New Jersey	Very Low	1 in 217 (0.5%) New Mexico	Very Low	1 in 118 (0.8%) New York	Very Low*	1 in 260 (0.4%) North Carolina	Very Low	1 in 233 (0.4%) North Dakota	Low*	1 in 101 (1.0%) Ohio	Low	1 in 70 (1.4%) Oklahoma	Low*	1 in 68 (1.5%) Oregon	Very Low	1 in 150 (0.7%) Pennsylvania	Low	1 in 89 (1.1%) Rhode Island	Very Low	1 in 187 (0.5%) South Carolina	Very Low	1 in 144 (0.7%) South Dakota	Low	1 in 82 (1.2%) Tennessee	Very Low...
Read 9 tweets
Nov 23
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵1/10

With CDC data operational again, the transmission map is back. The data are always a week old, so transmission is likely worse than depicted.

We estimate 1 in 116 people actively infectious and 422,000 new daily infections. Heat map: Indiana and Arkansas with "moderate" transmission. All others, "low" or "very low" (CDC categories).
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵2/10

State level estimates are back. Note, the CDC changed their data processing approach in August, which tends to downplay transmission.

Does 1 in 45 in Indiana seem "moderate"?

Levels in MI may be mod/high (poor reporting). Alabama	Very Low	1 in 153 (0.7%) Alaska	Very Low	1 in 272 (0.4%) Arizona	Low	1 in 63 (1.6%) Arkansas	Moderate*	1 in 47 (2.1%) California	Very Low	1 in 365 (0.3%) Colorado	Very Low	1 in 137 (0.7%) Connecticut	Low	1 in 103 (1.0%) Delaware	Very Low	1 in 262 (0.4%) District of Columbia	Very Low	1 in 418 (0.2%) Florida	Very Low	1 in 408 (0.2%) Georgia	Very Low	1 in 292 (0.3%) Guam	Very Low	1 in 887 (0.1%) Hawaii	Very Low	1 in 426 (0.2%) Idaho	Very Low	1 in 116 (0.9%) Illinois	Very Low	1 in 116 (0.9%) Indiana	Moderate	1 in 45 (2.2%) Iowa	Very Low	1 in 108 (0.9%) Kansas	Very Low	1 in 109 (0.9%) Ke...
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵3/10

State-level estimates (continued).

Current levels may be much higher than noted here. Note that CDC data are always at least a week old. The 2nd half of November is a time period historically of accelerating transmission. Missouri	Very Low	1 in 202 (0.5%) Montana	Very Low*	1 in 114 (0.9%) Nebraska	Low	1 in 95 (1.1%) Nevada	Very Low	1 in 228 (0.4%) New Hampshire	Low	1 in 78 (1.3%) New Jersey	Very Low	1 in 192 (0.5%) New Mexico	Very Low	1 in 151 (0.7%) New York	Very Low	1 in 212 (0.5%) North Carolina	Very Low	1 in 212 (0.5%) North Dakota	Very Low*	1 in 116 (0.9%) Ohio	Very Low	1 in 109 (0.9%) Oklahoma	Low*	1 in 70 (1.4%) Oregon	Very Low	1 in 194 (0.5%) Pennsylvania	Very Low	1 in 111 (0.9%) Rhode Island	Very Low	1 in 167 (0.6%) South Carolina	Very Low	1 in 112 (0.9%) South Dakota	Very Low	1 in 127 (0.8%) Tennes...
Read 10 tweets
Nov 8
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
1/6🧵

🔹301,000 new daily infections based on wastewater-derived models
🔹1 in 162 people (0.6%) actively infectious
🔹Levels the past 2 months corrected upward by Biobot
🔹"Lull point" estimated between Nov 5-21. Rising soon. Year over year graph, emphasizing that levels commonly rise in mid November
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
2/6🧵

The central estimate of the forecast suggests we will surpass 500,000 new daily infections on Nov 22.

There's a 25% chance of a prolonged lull like last year. More likely, we are in wave territory by the end of the month. Close up of the most recent 3 months of data, including the forecast.
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
3/6🧵

We are presently in a lull between the 11th and 12th wave. Now is the time to get boosted and stock up on N95 masks, tests, and air purifier filters.

Do a DIY fit test if you've been putting it off. Graph of the 11 waves
Read 6 tweets
Nov 3
PMC COVlD Update, Nov 3, 2025 (U.S.)
1 of 9 🧵

The relative "lull" in SARS-CoV-2 transmission is unlikely to go much lower.

✨1 in 209 people are estimated actively infectious, likely the lowest levels of 2025 nationwide.

Get boosted. Stock up on masks, tests, & filters. Year-over-year graph
PMC COVlD Update, Nov 3, 2025 (U.S.)
2 of 9 🧵

No data presently suggest the rise of a winter wave any earlier than "usual."

If following historical trends, transmission will pick up Nov 15-29. Last year's rise was atypically late. Forecasted transmission
PMC COVlD Update, Nov 3, 2025 (U.S.)
3 of 9 🧵

Expect rising misinformation/disinformation as transmission heats up:
🔹Abuse of community notes, particularly surrounding wastewater methodology
🔹Paid bot army attacks, especially about boosters & masks
Read 9 tweets
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

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