Mike Hoerger, PhD MSCR MBA Profile picture
Oct 30, 2023 7 tweets 4 min read Read on X
PMC C0VID-19 Tracker, Oct 30, 2023

We're at the onset of an 8th U.S. pandemic wave.

Today's Numbers:
🔹 1.27% (1 in 78) are infectious
🔹 >600,000 C0VID cases/day
🔹>30,000 #LongCovid cases/day

We will pass the late-summer wave's peak in just over a month.

1/
CURRENT ESTIMATES FOR October 30, 2023 Wastewater Levels (copies/mL) 418 New Daily Cases 609,000 % of Population Infectious 1.27% (1 in 78 people) New Daily Long COVID Cases  30,000 to 122,000   4-WEEK FORECAST FOR November 27, 2023 Wastewater Levels (copies/mL) 579 (38% higher) New Daily Cases 842,000 % of Population Infectious 1.76% (1 in 57 people) New Daily Long COVID Cases  42,000 to 168,000
The different forecasting models reach a strikingly similar conclusion about where we'll be in a month: very bad.

November 27 by the Numbers:
🔹 1.76% (1 in 57) are infectious
🔹 >800,000 C0VID cases/day
🔹>40,000 #LongCovid cases/day

2/

Forecasting nuance:

Alt Model #1 (turtle) thinks the current real-time numbers are an underestimate, and it ignores the most recent week's data. Alt Model #2 (cheetah) accounts for recent errors in the real-time numbers; with low error, it maps on very closely to the real-time (red) line. The black line shows the composite used for reporting estimates. Note, everything converges in 4 weeks.
4-WEEK FORECAST FOR November 27, 2023 Wastewater Levels (copies/mL) 579 (38% higher) New Daily Cases 842,000 % of Population Infectious 1.76% (1 in 57 people) New Daily Long COVID Cases  42,000 to 168,000
Zooming out to the full pandemic, you can see that we are entering the 8th wave.

Today, there is more transmission than during 50.6% of pandemic days. It's a coin toss as to whether any particular day of the pandemic has had more or less transmission than today. 😷💉
3/ There is more COVID-19 transmission today        than during 50.6% of the pandemic.  CURRENT ESTIMATES FOR October 30, 2023 Wastewater Levels (copies/mL) 418 New Daily Cases 609,000 % of Population Infectious 1.27% (1 in 78 people) New Daily Long COVID Cases  30,000 to 122,000   WEEKLY ESTIMATES FOR October 30, 2023 New Weekly Cases 4,300,000 New Weekly Long COVID Cases  213,000 to 853,000   2023 CUMULATIVE ESTIMATES AS OF October 30, 2023 Total 2023 Cases To Date 185,317,950 Total 2023 Long COVID Cases To Date  9,266,000 to 37,064,000
Although we're about to exit the valley between the 7th & 8th waves, transmission is still very high. Large groups amplify transmission.

For example, in a group of 20-25, there's about a 25% chance someone would have infectious C19. In a large lecture hall, it's assumed.

4/ What’s the COVID Risk in an Office or in a Classroom?  Number of people  |  chances anyone is infectious  1	1.3% 2	2.5% 3	3.8% 4	5.0% 5	6.2% 6	7.4% 7	8.6% 8	9.8% 9	10.9% 10	12.0% 15	17.5% 20	22.6% 25	27.4% 30	31.9% 35	36.2% 40	40.1% 50	47.3% 75	61.8% 100	72.3% 150	85.4% 200	92.3% 300	97.9% 400	99.4% 500	99.8%
Here's the danger of a Thanksgiving gathering in the U.S. (Nov 23). Many people are finalizing holiday plans now.

In a large family gathering of 15-20 people, there's about a 25% chance someone would be infectious.

I am quite confident in these numbers.

5/ In the U.S., What’s the COVID Risk for Thanksgiving?  Number of people  |  Chances anyone is infectious  1	1.6% 2	3.3% 3	4.9% 4	6.4% 5	8.0% 6	9.5% 7	11.0% 8	12.4% 9	13.9% 10	15.3% 15	22.0% 20	28.2% 25	33.9% 30	39.2% 35	44.0% 40	48.5% 50	56.4% 75	71.2% 100	81.0% 150	91.7% 200	96.4% 300	99.3% 400	99.9% 500	>99.9%
Here's the possible danger of a Christmas gathering in the U.S. (Dec 25).

I am exceedingly cautious on posting long-range forecasts. They are speculative and do not account for the highly-valuable near-term fluctuations that can occur, particularly if there's an immune-evasive variant. Take these as my best point estimates nearly two months out, for illustrative purposes just so people get an idea of how bad things may be. Many people are booking trips now, so these rough estimates may be useful.

In a small gathering of 9-10 people, there's about a 25% chance someone is infectious. Once you start looking at large family or multi-family gatherings that span 20-25 people, you basically begin to assume someone has infectious C19.

6/
In the U.S., What’s the COVID Risk for Christmas Day?  Number of People  |  Chances anyone is infectious 1	3.1% 2	6.2% 3	9.1% 4	11.9% 5	14.7% 6	17.4% 7	19.9% 8	22.5% 9	24.9% 10	27.2% 15	37.9% 20	47.0% 25	54.8% 30	61.5% 35	67.1% 40	72.0% 50	79.6% 75	90.8% 100	95.8% 150	99.1% 200	99.8% 300	>99.9% 400	>99.9% 500	>99.9%
Here's the full PMC Dashboard for Oct 30.

You can read the full report at

Please share across other social media platforms. Much appreciated. 🙏

7/pmc19.com/data

There is more COVID-19 transmission today        than during 50.6% of the pandemic.  CURRENT ESTIMATES FOR October 30, 2023 Wastewater Levels (copies/mL) 418 New Daily Cases 609,000 % of Population Infectious 1.27% (1 in 78 people) New Daily Long COVID Cases  30,000 to 122,000   WEEKLY ESTIMATES FOR October 30, 2023 New Weekly Cases 4,300,000 New Weekly Long COVID Cases  213,000 to 853,000   2023 CUMULATIVE ESTIMATES AS OF October 30, 2023 Total 2023 Cases To Date 185,317,950 Total 2023 Long COVID Cases To Date  9,266,000 to 37,064,000   4-WEEK FORECAST FOR November 27, 2023 Wastewater Leve...

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More from @michael_hoerger

Jan 25
During this 12th COVlD wave, the CDC reports 1-in-3 states have "High" or "Very High" levels.

PMC estimates the proportion of residents actively infectious (prevalence):
◾️USA: 1 in 67
◾️IA: 1 in 27
◾️MI: 1 in 25
◾️IN & CT: 1 in 23
◾️ME: 1 in 21
◾️OK & SD: 1 in 17

🧵1/ Heat map using CDC data. National PMC prevalence estimate noted; estimated incidence of 732,000 new daily infections.
On average, Americans have have 5.0 cumulative SARS-CoV-2 infections.

This week's infections are expected to result in 1/4 to 1 million new #LongCOVID conditions and ≈2,000 excess deaths.
🧵2/ Column 1: Table of state-level prevalence estimates. Highest estimates noted in the thread text.  Column 2:  Proportion Actively Infectious										1 in 67 (1.5%) New Daily Infections										 732,000  Infections the Past Week										 5,220,000  Infections in 2026										 24,000,000  Cumulative Infections per Person										 5.04  										 Long COVID										 Long COVID Cases Resulting								37,000 to 146,000		   from New Daily Infections										 Long COVID Cases Resulting								261,000 to 1,040,000		   from New Weekly Infections										 										 Excess Deaths										 Ex...
The wave peak is now estimated >10% higher than last week at 1.2 million new daily infections, nearly double the Delta wave.

We expect sustained high transmission (≈600,000 to 750,000 new daily infections) the next few weeks as COVlD circulates through schools/families.
🧵3/ Fig 1: Graph of 12 waves  Fig 2: "Barometer" showing above average transmission  Fig 3: Year-over-year graph, which informs the analytic forecast  Fig 4: Forecast described in post
Read 4 tweets
Jan 17
Based on today's CDC & Biobot data, we estimate the following for the week of Jan 19:

🔸1 in 52 people in the U.S. actively infectious
🔸25% chance of exposure in a room of 15 ppl
🔸Nearly 1 million new daily infections
🔸5 cumulative infections per person all-time (avg)
🧵1/5 Heat map from CDC data with PMC estimates. Description of "Very High" states in next post
Transmission estimates have been marginally corrected upward.

11 states have Very High COVlD levels:

🔸PA: 1 in 25 estimated actively infectious
🔸MI: 1 in 23
🔸OH & KY: 1 in 22
🔸SD: 1 in 20
🔸NE & IA: 1 in 18
🔸IL & ME: 1 in 17
🔸IN: 1 in 16
🔸WV: 1 in 11
🧵2/5 Proportion Actively Infectious										1 in 52 (1.9%) New Daily Infections										 941,000  Infections the Past Week										 6,020,000  Infections in 2026										 18,000,000  Cumulative Infections per Person										 5.01  										 Long COVID										 Long COVID Cases Resulting								47,000 to 188,000		   from New Daily Infections										 Long COVID Cases Resulting								301,000 to 1,200,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									270 to 450	   from New Daily Infections										 Excess Deaths Resulting 				...
We're in the middle of a 12th COVlD wave.

The peak has likely passed, but with students headed back to school, transmission is expected to remain high for at least the next several weeks.

🧵3/5 1) Graph of 12 waves 2) Barometer showing above-average transmission 3) Year over year graph 4) Forecast for transmission to decline and then percolate at high levels
Read 5 tweets
Jan 10
The size of the winter COVlD wave has been revised upward as post-holiday data come in.

We estimated 1 in 55 people in the U.S. are actively infectious.

🔥WV: 1 in 14
🔥IN: 1 in 15
🔥MI & OH: 1 in 21
🔥MO: 1 in 22
🔥CT: 1 in 24
🔥KS: 1 in 25
🔥MA & IL: 1 in 27

Quick 🧵 1/4 Heat map and PMC estimates, 1 in 55 infectious and 892,000 new daily infections for Jan 12.  We expedited the report to release it two days early.
Nationally, we are seeing an estimated 892,000 new daily SARS-CoV-2 infections, meaning a 1 in 4 chance of exposure in a room of 15 people. Risk varies considerably by state.

We are approaching an average of 5 infections per person since pandemic onset.
🧵 2/4 Alabama	Moderate Alaska	Very Low Arizona	Very Low Arkansas	High* California	Very Low Colorado	Low Connecticut	Very High Delaware	Moderate District of Columbia	Very Low Florida	Very Low Georgia	Very Low Guam	Very Low Hawaii	Very Low Idaho	Very Low Illinois	Very High Indiana	Very High Iowa	High Kansas	Very High Kentucky	Moderate Louisiana	Moderate Maine	High Maryland	High Massachusetts	Very High Michigan	Very High* Minnesota	Moderate Mississippi	Low* Missouri	Very High* Montana	High Nebraska	High Nevada	Very Low New Hampshire	Moderate New Jersey	Low New Mexico	Moderate New York	High* North Ca...
We are in the 12th COVlD wave of the U.S.

Current transmission is higher than 68% of all days since the pandemic onset in 2020.
🧵 3/4 12 waves of COVlD  Pandemic barometer: Higher than 88% of the past 100 days, 73% of the past year, 68% of the entire pandemic.  Year over year graph  Forecast of slowly declining transmission.
Read 4 tweets
Jan 8
You might not have heard, but the northeastern U.S. is in a COVlD surge.

We use wastewater levels to derive estimates of the proportion of people actively infectious in each state (prevalence), e.g., 1 in 24 people in Connecticut.

Let me walk you through it...

🧵1/8 Colors show CDC levels PMC prevalence estimates noted: -Maine 1 in 38 actively infectious with COVlD -New Hampshire 1 in 35 (limited data) -Vermont 1 in 75 -New York 1 in 44 (limited data) -Pennsylvania 1 in 44 -Massachusetts 1 in 36 -Connecticut 1 in 24 -Rhode Island 1 in 41 -New Jersey 1 in 82
Notice that #Connecticut has excellent SARS-CoV-2 wastewater surveillance. It's "Very High" across much of the state, per CDC.

Based on wastewater levels, we estimate 1 in 24 residents are actively infectious w/COVlD. That's a 66% exposure risk in a room of 25 people.

🧵2/8 Colors show CDC levels PMC estimate of prevalence
The CDC reports "Very High" levels in #Massachusetts.

The surveillance is less robust, but we estimate 1 in 26 residents are actively infectious, similar to our estimate in CT where coverage is better.

In a room of 25 people, that's a 62% chance of an exposure.

🧵3/8 Colors show CDC levels PMC prevalence estimates provided
Read 8 tweets
Jan 8
We're in the middle of a 12th COVlD wave in the U.S., with transmission particularly high in the Midwest and Northeast.

The CDC announced this week that COVlD continues to kill more Americans than breast and prostate cancer combined.

Get boosted & #MaskUp 💉💪😷
1/4🧵 Heat map of CDC data with PMC prevalence estimate
Levels are "Moderate" to "Very High" in 26 states.

However, data reporting is slow, and about 1/3 of states have low-quality data this week due to the holidays and illness.

2/4🧵 National estimates: Number of People		Chances Anyone is Infectious			 1				1.5%	 2				3.0%	 3				4.5%	 4				6.0%	 5				7.4%	 10				14.3%	 15				20.7%	 20				26.5%	 25				32.0%	 30				37.0%	 50				53.8%	 75				68.6%	 100				78.6%	 200				95.4%	 300				99.0%
Barometer: Higher transmission than 90 of the past 100 days (perhaps higher still, due to low data reporting quality)
State	CDC Level	Actively Infectious Alabama	Moderate	1 in 48 (2.1%) Alaska	Very Low	1 in 152 (0.7%) Arizona	Very Low	1 in 201 (0.5%) Arkansas	High*	1 in 36 (2.8%) California	Very Low	1 in 484 (0.2%) Colorado	Moderate	1 in 49 (2.0%) Connecticut	Very High	1 in 24 (4.2%) Delaware	Low*	1 in 70 (1.4%) District of Columbia	Very Low	1 in 5,835 (0.0%) Florida	Very Low	1 in 284 (0.4%) Georgia	Low	1 in 90 (1.1%) Guam	Very Low	1 in 687 (0.1%) Hawaii	Very Low	1 in 874 (0.1%) Idaho	Very Low	1 in 169 (0.6%) Illinois	Moderate*	1 in 56 (1.8%) Indiana	High*	1 in 34 (2.9%) Iowa	Moderate	1 in 41 (2.4%) Kansas...
State	CDC Level	Actively Infectious Missouri	Moderate*	1 in 42 (2.4%) Montana	High	1 in 34 (2.9%) Nebraska	Very High	1 in 26 (3.9%) Nevada	Very Low	1 in 138 (0.7%) New Hampshire	High*	1 in 35 (2.9%) New Jersey	Low	1 in 82 (1.2%) New Mexico	Low	1 in 87 (1.2%) New York	Moderate*	1 in 44 (2.3%) North Carolina	Low	1 in 82 (1.2%) North Dakota	High*	1 in 34 (3.0%) Ohio	Very High	1 in 27 (3.7%) Oklahoma	Moderate*	1 in 62 (1.6%) Oregon	Very Low	1 in 170 (0.6%) Pennsylvania	Moderate	1 in 44 (2.3%) Rhode Island	Moderate	1 in 41 (2.4%) South Carolina	Moderate	1 in 54 (1.9%) South Dakota	Very High	1 in...
If like years 1-4 of the pandemic, the winter wave has peaked. If like last year, we could hover near peak levels for a month.

Forecasting quality is low with 1/3 of states having data issues. Hopefully, we'll know a lot more in a few days.

3/4🧵 12 waves
Proportion Actively Infectious										1 in 65 (1.5%) New Daily Infections										 749,000  Infections the Past Week										 5,390,000  Infections in 2026										 3,000,000  Cumulative Infections per Person										 4.88  										 Long COVID										 Long COVID Cases Resulting								37,000 to 150,000		   from New Daily Infections										 Long COVID Cases Resulting								270,000 to 1,080,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									220 to 370	   from New Daily Infections										 Excess Deaths Resulting 					...
year over year graph
forecast
Read 4 tweets
Jan 5
We told you that 109,000-175,000 Americans would died of COVID (excess deaths) in 2025.

Today, the CDC estimates 101,000 deaths/year (flat from Oct 2022 to Sep 2024), and likely higher when considering more nebulous non-acute excess deaths (heart attack 6 months later).
1/5
The CDC estimates are actually higher than I would have guessed, given their methodology, which models estimates based on easily countable factors in healthcare and expert input on multiplier values. It lends credence to the PMC upper bound of excess deaths of 175,000/yr.
2/5
What's troubling is the CDC has annual mortality flat. My expectation based on mortality displacement and Swiss Re data is that it should be declining. If is stays flat, we're running on something like breast+prostate cancer or lung cancer deaths per year in perpetuity.
3/5
Read 6 tweets

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