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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Oct 17 • 11 tweets • 4 min read Twitter logo Read on Twitter
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Did you know, you can still access recent national C0VID #wastewater data in the U.S.?

I'll walk you though it.

🧵
1/ Verily national wastewater graph
First, go to Verily's #wastewater website.


Click on the little Line Graph icon on the left side.

2/ data.wastewaterscan.org
Click the line graph icon
When you click on the Line Graph icon, it makes an annoying pop-up.

In the 1st menu, choose SARS-CoV-2.

In the 2nd menu, click *ANY* location. We want national, but they don't include it there. So pick anywhere, and we'll fix it later.

3/ Useless pop-up window
Click the "Get Started" button. Then you'll see something like this. It's the recent wastewater data at whatever rando site you selected.

Again, this is not what we want yet.

4/ Recent wastewater data at one rando site
Now, click to the right of the magnifying glass by "Location(s)" --> then "National" --> then "All Wastewater Sites"

5/ Location pop-up menu
The graph that will come up is overwhelming. No data synthesis. We're getting closer though.

Click the little crossed out eyeball I've circled in red.

6/ Graph of all wastewater data. No national average.
Woo-hoo. We finally have a national average line. I can see why the CDC prefers this over Biobot. 🤣

Click a number on the vertical access and drag up or down (it moves opposite of how I expect). Play around with the start date too. See red circles.

7/ Verily data with national average.
I like to see either the entire pandemic (big picture) or the last 6-7 months (current wave, shown).

8/ Data focused on the current wave
If you zoom out to see the entire pandemic, you'll find a similar picture relative to what you may have been tracking with Biobot, Walgreens, etc.

The waves show up. The estimates of magnitude vary by methodology.

9/
I hope to post an interim Biobot-to-Verily PMC forecast Monday.

I stand by prior forecasts. We'll reach the bottom of the current (very high) valley in 1-2 wks. Cases will pick up noticeably so around mid-November and get very very bad in Dec/Jan.

10/
Point of clarification: Verily data are included in this dashboard, but others have noted Verily does not own the dashboard. The language on their website is ambiguous in this regard, IMO (pic below). It's the first link on Verily's page.

Others report that as CDC Biobot sites come on, they will be included in a Verily-specific dashboard, independent of that above. It seems that rather than harmonizing and unifying data, we are at risk of proliferating more and potentially lower quality dashboards.

11/
 Verily's web page begins by linking to a comprehensive dashboard that they reportedly do not own. Their own limited dashboard follows below on the page.

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More from @michael_hoerger

Mike Hoerger, PhD MSCR MBA Profile picture
Oct 11
Biobot (blue) versus Verily (black) #wastewater data.

You'll see Verily data suggest the most recent wave (#7) has had considerably more transmission than Delta (#3). And that last winter (#6) was similar (or worse!) than the prior winter's BA.1 surge (#4).

Who wins?

1/ Graph of biobot and verily wastewater data. Both show similarly timed waves but vary in magnitude.
Here are the correlations among Biobot levels, Verily levels, & IHME true cases for the 1st of each month from Jan '21 to Apr '23.

Biobot correlates r=.94 (freakish) with IHME. Verily only correlates r=.67.

Either Biobot is much better, or Verily knows something we don't.
2/ Correlation table for biobot, verily, and ihme data
The CDC awarded Biobot's contract to Verily.

Once Verily brings on Biobot's former CDC-contracted wastewater sites, that should help. Case estimation will be easier if they fold in the historic data to more accurately represent the nation.

Forecasting is easy regardless.
3/
Read 5 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Oct 9
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...
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Oct 2
PMC C0VID-19 Tracker, Oct 2, 2023

U.S. #wastewater levels are higher than during 58% of the pandemic:
🔹 1.56% (1 in 64) are infectious
🔹 >745,000 C0VID cases/day
🔹 37,000+ #LongCovid cases/day

Click the full Tweet for more details on each forecast...
1/5

Wastewater levels are up from 505 copies/mL last week to 512 copies/mL this week. Before one screams "SURGE!!!," let's dig into the details. That's about as small an increase as possible, and well within the range of data corrections to real-time reports.

The Real-time model (red line):
It assumes that real-time data reports are accurate. However, real-time data often get corrected. Biobot and the CDC are currently in a transitionary phase of modifying when and which sites report, so I take the real-time data with a grain of salt. If it is accurate, however, the model suggests a rebound in cases, peaking around Oct 11, before bottoming out around Nov 1, before cases begin rising again for the winter wave.

Alt Model #1, Turtle (green line):
The turtle model ignores the most recent week's worth of data from Biobot, treating it as unreliable. Thus, it assumes that rather than a small increase this week, levels are actually continuing to decline and that corrections to real-time reports will later reflect that. It's essentially saying that the bump you're seeing in the real-time model is just noise. Cases will stay almost completely flat the next 6 weeks, with an official low point around Oct 25, before cases begin rising again for the winter wave.

Alt Model #2, Cheetah (orange line):
The cheetah model aims to correct for biases in real-time data reports. If last week's real-time report overestimated levels by 10% upon correction, it assumes this week's real-time report suffers the same bias. Last week's real-time report was quite accurate, so the cheetah model just looks close to the real-time model, same mini-peak, same valley, same rise in November for the winter wave.

Composite Model (black line):
This is the average of the three models. It's what's used for deriving all of the statistics reported. It basically suggests that cases will be mostly level at a high rate the next 6 weeks with minor fluctuations up or down. The composite model's take-home points are 1) continued high cases the next 6 weeks, 2) minimal fluctuation on a day-to-day basis during that time, 3) a low for the remainder of the year around Oct 25, and 4) a winter wave starting to pick up in mid-November.

Next Tweet, let's examine regional variation.
CURRENT ESTIMATES FOR September 27, 2023 Wastewater Levels (copies/mL) 512 New Daily Cases 745,000 % of Population Infectious 1.56% (1 in 64 people) New Daily Long COVID Cases 37,000 to 149,000 4-WEEK FORECAST FOR October 25, 2023 Wastewater Levels (copies/mL) 491 (-4% lower) New Daily Cases 714,000 % of Population Infectious 1.49% (1 in 67 people) New Daily Long COVID Cases 36,000 to 143,000
Regional variation suggests the need to pay attention for an increase unanticipated by the models.

The northeast is still rising steadily, and they are seeing 3-4x more FL 1.5.1 than other regions.

Caveat: this occurs during a time of Biobot/CDC reporting delays/issues.

2/5 Screenshots from Biobot. The northeast cases are still rising, whereas elsewhere, cases are basically flat, very minor uptick or downtick. Subvariant data suggest regional differences.
Zooming out from the 6-month & regional views to the full pandemic, note we're in a steady state of high transmission between the 7th & 8th waves of the U.S. pandemic.

We will likely see at least 1.4% of the population actively infectious every day for the rest of 2023.

3/5 There is more COVID-19 transmission today than during 58.1% of the pandemic. CURRENT ESTIMATES FOR September 27, 2023 Wastewater Levels (copies/mL) 512 New Daily Cases 745,000 % of Population Infectious 1.56% (1 in 64 people) New Daily Long COVID Cases 37,000 to 149,000 WEEKLY ESTIMATES FOR September 27, 2023 New Weekly Cases 5,200,000 New Weekly Long COVID Cases 261,000 to 1,043,000 2023 CUMULATIVE ESTIMATES AS OF September 27, 2023 Total 2023 Cases To Date 220,500,000 Total 2023 Long COVID Cases To Date 11,025,000 to 44,100,000
Read 5 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 25
PMC C0VID-19 Tracker, Sep 20, 2023

U.S. #wastewater levels are higher than during 58% of the pandemic:
🔹 1.55% (1 in 65) are infectious
🔹 >740,000 C0VID cases/day
🔹 37,000+ #LongCovid cases/day

Expect a high trough (600-750K cases/day) until a winter wave.
1/4
 CURRENT ESTIMATES FOR September 20, 2023 Wastewater Levels (copies/mL) 509 New Daily Cases 741,000 % of Population Infectious 1.55% (1 in 65 people) New Daily Long COVID Cases 37,000 to 148,000 4-WEEK FORECAST FOR October 18, 2023 Wastewater Levels (copies/mL) 461 (-9% lower) New Daily Cases 671,000 % of Population Infectious 1.4% (1 in 71 people) New Daily Long COVID Cases 34,000 to 134,000
Let's zoom out from the 6-month view to the full pandemic.

The 7th U.S. C0VID wave has been huge, slightly smaller than Delta, & is now on the decline nationally.

We're seeing 5 million infections/week nationally, much higher than people realize, so continue with advocacy.
2/4 CURRENT ESTIMATES FOR September 20, 2023 Wastewater Levels (copies/mL) 509 New Daily Cases 741,000 % of Population Infectious 1.55% (1 in 65 people) New Daily Long COVID Cases 37,000 to 148,000 WEEKLY ESTIMATES FOR September 20, 2023 New Weekly Cases 5,200,000 New Weekly Long COVID Cases 259,000 to 1,037,000 2023 CUMULATIVE ESTIMATES AS OF September 20, 2023 Total 2023 Cases To Date 180,900,000 Total 2023 Long COVID Cases To Date 9,045,000 to 36,180,000
1.55% of the U.S. population is actively infectious with C0VID (Sep 20).

Schools and in-person work remain extremely risky.

If in the U.S., schedule a #booster. Go remote. #MaskUp. Read up on and improve indoor air quality. Avoid indoor dining. #RapidTest.
3/4 Number of People | Chances Anyone is Infectious 1 1.6% 2 3.1% 3 4.6% 4 6.1% 5 7.5% 6 8.9% 7 10.4% 8 11.8% 9 13.1% 10 14.5% 15 20.9% 20 26.8% 25 32.3% 30 37.4% 35 42.1% 40 46.5% 50 54.2% 75 69.0% 100 79.0% 150 90.4% 200 95.6% 300 99.1% 400 99.8% 500 >99.9%
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 14
PMC C0VID-19 Tracker, Sep 13, 2023

U.S. #wastewater levels are higher than during 64% of the pandemic:
🔹 1.8% (1 in 57) are infectious
🔹 >800,000 C0VID cases per day
🔹 >40,000 #LongCovid cases per day

Let's look at the good and bad of where we're heading....

The "Good" News:
Peaking. Transmission is slowing down a little and forecasted to decline further over the next month. If the Biobot data hold up against data corrections, the late summer wave peaked on August 30 at approximately 931,000 cases per day. By October 11, we expect to be closer to 700,000 cases per day. Less morbidity and mortality are always good news.

Modeling. Our models generally predicted that the peak would be sometime between Aug 23 and Sep 14, even amid some noisy wastewater data from Biobot. We regularly predicted that wastewater levels would fluctuate between 400-700 copies/mL from August to October, even amid much scolding and taunting from people who believed it would be much better or worse. The current forecasts show much convergence. The composite (black line) forecast is comprised of a real-time forecast (assumes Biobot's real-time wastewater data are accurate), turtle forecast (ignores the most recent week's Biobot data), and cheetah forecast (corrects the most recent week's Biobot data), all of which are quite similar at the moment. At present, this looks like a win for forecasting, with more improvements on the way. Good forecasts can help people make better predictions in an uncertain world.

Dissemination. The final bit of good news is that people are using this data to inform friends, their workplaces, and schools. In this regard, the time to act is NOW. People who do not follow wastewater are watching the anecdotal evidence in their lives pick up (personal reinfection, friends and coworkers infected, more masking, near-misses at schools, etc.). As reality glimmers through denial, now is the time to show people the data that validates what they are subjectively experiencing (still amid much second-guessing and gas-lighting). Anyone "flipped" toward watching the data will be much better prepared for the winter.

The Bad News:
High valley. Although a decline in transmission is always good, we're headed toward what is likely a very high valley in October at 700,000 infections per day, and then the picture will likely get much worse in November, December and January, unless we see an unanticipated level of vaccinations.

Grim Implications. In the "good" times of October, we will still see 1.5% of Americans (1 in 69) actively infectious at any given moment. Our low-end estimate suggests 35,000 new Long C0VID cases from such infections. That's grim.

Media narrative. The psychological dynamics are bleak. Expect the news media to focus on the fact that transmission is going down (the "good" news) instead of the much bigger picture that it's leveling off at very high rates (the very bad news). The over-optimism will likely undermine vaccinations and masking. The narrative should be "plan to take multi-layered precautions like using masks, getting boosters, and using remote options through January," but will more likely be "cases are headed back down."

#VaxUp #MaskUp #Ventilate #HEPA #CorsiRosenthalBox #remotework

1/
 CURRENT ESTIMATES FOR September 13, 2023 Wastewater Levels (copies/mL) 579 New Daily Cases 843,000 % of Population Infectious 1.76% (1 in 57 people) New Daily Long COVID Cases 42,000 to 169,000 4-WEEK FORECAST FOR October 11, 2023 Wastewater Levels (copies/mL) 479 (-17% lower) New Daily Cases 697,000 % of Population Infectious 1.46% (1 in 69 people) New Daily Long COVID Cases 35,000 to 139,000
Let's zoom out from the 6-month view to the full pandemic.

If things holds, the 7th U.S. C0VID wave appears to have leveled off as slightly smaller than Delta, still a huge wave. 🌊

We're seeing about 6 million infections/week in the U.S., much higher than people realize.

2/ There is more COVID-19 transmission today than during 63.5% of the pandemic. CURRENT ESTIMATES FOR September 13, 2023 Wastewater Levels (copies/mL) 579 New Daily Cases 843,000 % of Population Infectious 1.76% (1 in 57 people) New Daily Long COVID Cases 42,000 to 169,000 WEEKLY ESTIMATES FOR September 13, 2023 New Weekly Cases 5,900,000 New Weekly Long COVID Cases 295,000 to 1,180,000 2023 CUMULATIVE ESTIMATES AS OF September 13, 2023 Total 2023 Cases To Date 175,200,000 Total 2023 Long COVID Cases To Date 8,760,000 to 35,040,000
Nearly 2% of the U.S. population is actively infectious with C0VID (Sep 13).

Schools and in-person work remain extremely risky.

If in the U.S., schedule a #booster. Go remote. #MaskUp. Read up on and improve indoor air quality. Avoid indoor dining. #RapidTest.

3/ What's the COVID Risk in an Office or in a Classroom? Number of People | Chances Anyone is Infectious 1 1.8% 2 3.5% 3 5.2% 4 6.9% 5 8.5% 6 10.1% 7 11.7% 8 13.3% 9 14.8% 10 16.3% 15 23.4% 20 29.9% 25 35.9% 30 41.4% 35 46.4% 40 50.9% 50 58.9% 75 73.7% 100 83.1% 150 93.1% 200 97.2% 300 99.5% 400 >99.9% 500 >99.9%
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 11
If your county has Biobot #wastewater data, here's information on how to estimate the percentage of people in your area who are actively infectious.

Quick guide. 🧵

Here are a few examples to start.
1/
County, Biobot Wastewater Level (copies/mL), % Infectious Middlesex, MA (near Boston) 1296 3.9% Orange, FL (Orlando) 1100 3.3% Honolulu, HI 1030 3.1% Washington, DC 821 2.5% Shelby, TN (Memphis) 794 2.4% Dallas, TX 611 1.9% Nassau, NY (near NYC) 547 1.7% Palm Beach, FL (near Miami) 478 1.5% Los Angeles, CA 474 1.4% Clark, NV (Las Vegas) 422 1.3% San Diego, CA 350 1.1% Montgomery, PA (near Philadelphia) 350 1.1%
If you're not mathematically inclined, use this table. Look up your county's #wastewater levels (on Biobot only, not other sites), and simply convert it to the % infectious estimate.

If wastewater levels are 1000 copies/mL, 3% of the county is infectious with C0VID.
2/ Biobot Wastewater Level (copies/mL), % Infectious 100 0.3% 200 0.6% 300 0.9% 400 1.2% 500 1.5% 600 1.8% 700 2.1% 800 2.4% 900 2.7% 1000 3.0% 1100 3.3% 1200 3.7% 1300 4.0% 1400 4.3% 1500 4.6% 2000 6.1% 2500 7.6% 3000 9.1% 4000 12.2% 5000 15.2%
To precisely convert Biobot #wastewater levels to the % infectious, just take the Biobot levels and divide by 328. You'll get a percentage.

For example, national levels are at 641 copies/mL. 641/328 = 1.95. So, 1.95% of the U.S. is infectious.
3/ Formula (Long Version) Biobot Wastewater Level (copies/mL) 641 Biobot Wastewater to Cases Multiplier 1455 Multiplier for Biobot to IHME case estimate conversions (uses a trimmed mean, most estimate in the 1000-1600 range) Average Infectious Window 7 https://doi.org/10.1016/S2213-2600(22)00226-0 Decimal to Percentage Multiplier 100 Turns decimals to percents U.S. Population, April 1, 2023 334,565,848 Final day of IHME data, source from https://www.census.gov/popclock/ Local Percent Infectious 1.95 % =B2*B3*B4*B5/B6 Formula (Easy Version) Biobot Wastewater Level (copies/mL...
Read 4 tweets

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