Mike Hoerger, PhD MSCR MBA Profile picture
Oct 30 โ€ข 7 tweets โ€ข 4 min read Twitter logo Read on Twitter
PMC C0VID-19 Tracker, Oct 30, 2023

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

Today's Numbers:
๐Ÿ”น 1.27% (1 in 78) are infectious
๐Ÿ”น >600,000 C0VID cases/day
๐Ÿ”น>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:
๐Ÿ”น 1.76% (1 in 57) are infectious
๐Ÿ”น >800,000 C0VID cases/day
๐Ÿ”น>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. ๐Ÿ˜ท๐Ÿ’‰
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/ Whatโ€™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., Whatโ€™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., Whatโ€™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. ๐Ÿ™

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

Oct 25
New #LongCOVID article out today in one of the top science journals, @Nature.

The most striking finding to me was that more frequent vaccination reduced the risk of yearlong LC from the 4.3-5.2% range (in their sample, which is low) to just 0.38%. That's a >10x reduction.

1/ Trimmed version of Table 1
Their sample is at the low end of #LongCOVID estimates overall, so for a fairer comparison, I could imagine 20% of the under-vaccinated group with LC & about 2% in the more frequently vaxxed group.

We could quibble on the base rates, but the risk reduction is the key stat.

2/
I always advocate for multilayered mitigation because a 0.4-2% chance of a new severe disability is considerable for individuals and populations. Effects are cumulative. Also, vaccines wane, and evading variants emerge unpredictably. Forward transmission is common. Etc.

3/
Read 8 tweets
Oct 23
PMC C0VID-19 Tracker, Oct 23, 2023
"As Good As It Gets"

U.S. #wastewater levels are higher than during 44% of the pandemic:
๐Ÿ”น 1.05% (1 in 95) are infectious
๐Ÿ”น >500,000 C0VID cases/day
๐Ÿ”น>25,000 #LongCovid cases/day

Fall cases bottom out in 2 days or so.
1/
PMC19 Cases and Forecast, 6 month view. We've passed the late-summer wave, are projected to bottom out for the fall on October 25 (or perhaps a little later). Then, every day remaining in 2023 will see worse transmission.
Zooming out from the 6-month view to the full pandemic, note that fall transmission is bottoming out at a high rate.

The U.S. 8th wave this winter will start to pick up soon, at a fast clip, and transmission will accelerate in December.

2/ Graph of C19 wastewater data from Biobot, with case estimates and forecast, full pandemic to date.  There is more COVID-19 transmission today        than during 43.8% of the pandemic.  CURRENT ESTIMATES FOR October 23, 2023 Wastewater Levels (copies/mL) 345 New Daily Cases 502,000 % of Population Infectious 1.05% (1 in 95 people) New Daily Long COVID Cases  25,000 to 100,000   WEEKLY ESTIMATES FOR October 23, 2023 New Weekly Cases 3,500,000 New Weekly Long COVID Cases  176,000 to 703,000   2023 CUMULATIVE ESTIMATES AS OF October 23, 2023 Total 2023 Cases To Date 181,044,020 Total 2023 Long ...
With 1.05% of the U.S. population actively infectious (Oct 23), larger group activities continue to be increasingly risky.

Expect similar numbers the next two weeks. Then, activities will get much more dangerous.

#MaskUp #FitTest #VaxUp (if allowed/available)
3/ Number of People | Chances Anyone is Infectious 1	1.1% 2	2.1% 3	3.1% 4	4.1% 5	5.1% 6	6.1% 7	7.1% 8	8.1% 9	9.1% 10	10.0% 15	14.6% 20	19.0% 25	23.2% 30	27.1% 35	30.9% 40	34.4% 50	41.0% 75	54.7% 100	65.2% 150	79.5% 200	87.9% 300	95.8% 400	98.5% 500	99.5%
Read 9 tweets
Oct 17
Did you know, you can still access recent national C0VID #wastewater data in the U.S.?

I'll walk you though it.

๐Ÿงต
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
Read 11 tweets
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
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/
๐Ÿงต 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 โ€“ 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
Oct 2
PMC C0VID-19 Tracker, Oct 2, 2023

U.S. #wastewater levels are higher than during 58% of the pandemic:
๐Ÿ”น 1.56% (1 in 64) are infectious
๐Ÿ”น >745,000 C0VID cases/day
๐Ÿ”น 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

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