Mike Hoerger, PhD MSCR MBA Profile picture
Nov 13, 2023 8 tweets 5 min read Read on X
PMC C0VID-19 Tracker, Nov 13, 2023

We're entering the 8th pandemic wave, likely surging to >2% infectious (>1 million cases/day) in a month.

Today's numbers:
🔹 1.41% (1 in 71) are infectious
🔹 >670,000 C0VID cases/day
🔹>34,000 #LongCovid cases/day

1/
CURRENT ESTIMATES FOR  November 13, 2023  Wastewater Levels (copies/mL)  462  New Daily Cases  672,000  % of Population Infectious  1.41% (1 in 71 people)  New Daily Long COVID Cases   34,000 to 134,000    4-WEEK FORECAST FOR  December 11, 2023  Wastewater Levels (copies/mL)  739 (60% higher)  New Daily Cases  1,076,000  % of Population Infectious  2.25% (1 in 44 people)  New Daily Long COVID Cases   54,000 to 215,000
Note that the different forecasting models show high convergence.

December 11 by the Numbers:
🔹 2.25% (1 in 44) likely to be infectious
🔹 >1 million anticipated C0VID cases/day
🔹>50,000 resulting #LongCovid cases/day

2/ 4-WEEK FORECAST FOR  December 11, 2023  Wastewater Levels (copies/mL)  739 (60% higher)  New Daily Cases  1,076,000  % of Population Infectious  2.25% (1 in 44 people)  New Daily Long COVID Cases   54,000 to 215,000
Zooming out to the full #pandemic, there is no debate we're in an 8th U.S. C0VID wave, likely entering a "surge" in my view. That's not a word I take lightly.

There's more transmission than during 54% of pandemic days.
#MaskUp #VaxUp 😷💉

3/ There is more COVID-19 transmission today        than during 54.1% of the pandemic.  CURRENT ESTIMATES FOR November 13, 2023 Wastewater Levels (copies/mL) 462 New Daily Cases 672,000 % of Population Infectious 1.41% (1 in 71 people) New Daily Long COVID Cases 34,000 to 134,000  WEEKLY ESTIMATES FOR November 13, 2023 New Weekly Cases 4,700,000 New Weekly Long COVID Cases 235,000 to 941,000  2023 CUMULATIVE ESTIMATES AS OF November 13, 2023 Total 2023 Cases To Date 194,286,130 Total 2023 Long COVID Cases To Date 9,714,000 to 38,857,000
How Does the Oncoming 8th Wave Compare with Prior Waves?

I suspect we’re headed somewhere between the magnitude of Wave 2 (winter 20-21) & Wave 6 (last winter). If so, I would characterize us as heading into a surge. I do not use the word “surge” lightly.

More...
4/

In comparing waves, I see a qualitative distinction at about 1 million daily infections (wastewater levels of 750 copies/mL).

Waves 1, 2, 3, and 7 all hovered around that mark. I refer to these as waves, not surges.

Wave 4, 5, and 6 all had sustained time periods of weeks with over 1 million infections per day. The “area under the curve” is substantially higher, and I refer to these as “surges.”

If one ventures to use this distinction, will Wave 8 be a wave like Waves 1, 2, 3, and 7, or more of a surge with sustained daily infections of >1 million per day?

Remember, the model uses a combination of historical data plus what is happening during the preceding 4 weeks. This means we will know best when a couple weeks out. Beyond 4 weeks, the model is relying heavily on historical data, and the three prior winters (Waves 2, 4, and 6) are very different. Wave 4 is an outlier among the waves, obviously. Wave 2 was more typical of a non-winter wave. Wave 6 (surge) piggybacked on Wave 5 (surge) and may have been unique in that regard due to any fleeting population-level immunity. My model suggests we’re headed toward a surge slightly bigger than last year, and I could see that, because any fleeting immunity from Wave 7 is likely less than that derived from Wave 5, and people are not up-to-date on vaccinations. Other behavioral precautions are similar for this versus last winter: mostly non-existent. However, the model does not capture any of that. It’s predicting worse (more infections) than last year because it’s influenced by the BA.1 wave.

Acknowledging that, I suspect we will peak slightly lower than Wave 6, perhaps around the 1.5 million infections/day rate. Anything between Wave 2 and a 20% bigger version of Wave 6, I would consider a reasonable estimate at this point.
Full view of the pandemic waves with line drawn to compare "surges" with extended weeks of >1 million cases/day versus the other (also very terrible but not quite as terrible) waves.
Although only at the start of the 8th wave, transmission is already high on Nov 13.

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

5/ What’s the COVID Risk in an Office or in a Classroom?	 Number of People  |  Chances Anyone is Infectious	 1	1.4% 2	2.8% 3	4.2% 4	5.5% 5	6.8% 6	8.1% 7	9.4% 8	10.7% 9	12.0% 10	13.2% 15	19.1% 20	24.7% 25	29.8% 30	34.6% 35	39.1% 40	43.2% 50	50.7% 75	65.4% 100	75.7% 150	88.0% 200	94.1% 300	98.6% 400	99.7% 500	>99.9%
Here's an update on the danger of a #Thanksgiving gathering in the U.S. (Nov 23).

In a large gathering of 15-20 people, there's about a 25% chance someone would be infectious. I remain quite confident in these numbers, virtually identical to last week's forecast.

6/ In the U.S., What’s the COVID Risk for Thanksgiving?	 Number of People  |  Chances Anyone is Infectious	 1	1.6% 2	3.2% 3	4.7% 4	6.2% 5	7.7% 6	9.2% 7	10.7% 8	12.1% 9	13.5% 10	14.9% 15	21.5% 20	27.6% 25	33.2% 30	38.3% 35	43.1% 40	47.5% 50	55.3% 75	70.1% 100	80.0% 150	91.1% 200	96.0% 300	99.2% 400	99.8% 500	>99.9%
Here's an updated estimate on the possible danger of a #Christmas gathering in the U.S. (Dec 25).

I am exceedingly cautious on posting long-range forecasts.

7/

More...

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. These estimates are virtually identical to those in the forecast from last week.

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.
In the U.S., What’s the COVID Risk for Christmas Day?	 Number of People  |  Chances Anyone is Infectious	 1	3.1% 2	6.1% 3	9.1% 4	11.9% 5	14.7% 6	17.3% 7	19.9% 8	22.4% 9	24.8% 10	27.2% 15	37.9% 20	47.0% 25	54.8% 30	61.4% 35	67.1% 40	71.9% 50	79.5% 75	90.7% 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 Nov 13.

You can read the full report at

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

8/ pmc19.com/data
There is more COVID-19 transmission today	        than during 54.1% of the pandemic.	 	 CURRENT ESTIMATES FOR	 November 13, 2023	 Wastewater Levels (copies/mL)	 462	 New Daily Cases	 672,000	 % of Population Infectious	 1.41% (1 in 71 people)	 New Daily Long COVID Cases	 34,000 to 134,000	 	 WEEKLY ESTIMATES FOR	 November 13, 2023	 New Weekly Cases	 4,700,000	 New Weekly Long COVID Cases	 235,000 to 941,000	 	 2023 CUMULATIVE ESTIMATES AS OF	 November 13, 2023	 Total 2023 Cases To Date	 194,286,130	 Total 2023 Long COVID Cases To Date	 9,714,000 to 38,857,000	 	 4-WEEK FORECAST FOR	 Decembe...

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More from @michael_hoerger

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
Dec 31, 2025
PMC COVlD Update, Week of Dec 29, 2025
🧵1/10

Happy New Year's Eve! #nye

Based on today's CDC data, we estimate 1 in 51 Americans are actively infectious with COVlD. That's nearly 1 million new daily infections.

Be wise. Vax up, mask up. #oneofthetwo Heat map from CDC data and PMC estimates.
🧵2/10

Many states are surging presently. True levels are higher than shown in most places due to state-level reporting lags. Alabama	Moderate	1 in 46 (2.2%) Alaska	Low	1 in 93 (1.1%) Arizona	Very Low	1 in 201 (0.5%) Arkansas	High*	1 in 32 (3.1%) California	Very Low	1 in 351 (0.3%) Colorado	Low	1 in 71 (1.4%) Connecticut	High	1 in 33 (3.1%) Delaware	Low	1 in 90 (1.1%) District of Columbia	Very Low	1 in 300 (0.3%) Florida	Very Low	1 in 282 (0.4%) Georgia	Very Low	1 in 125 (0.8%) Guam	Very Low	1 in 585 (0.2%) Hawaii	Very Low	1 in 855 (0.1%) Idaho	Very Low	1 in 221 (0.5%) Illinois	Moderate	1 in 41 (2.5%) Indiana	Very High	1 in 14 (6.9%) Iowa	Low	1 in 69 (1.4%) Kansas	Moderate	1 in 46 (2.2%) Kentucky	High	1 in 34 (2.9...
🧵3/10

Although many states are surging, do not feel false security in "low" level states. For example, NY has terrible reporting quality with the CDC currently. Missouri	Moderate*	1 in 56 (1.8%) Montana	Low	1 in 76 (1.3%) Nebraska	Very High	1 in 18 (5.5%) Nevada	Very Low	1 in 122 (0.8%) New Hampshire	Moderate*	1 in 42 (2.4%) New Jersey	Very Low	1 in 113 (0.9%) New Mexico	Moderate	1 in 62 (1.6%) New York	Very Low*	1 in 127 (0.8%) North Carolina	Very Low	1 in 125 (0.8%) North Dakota	Moderate*	1 in 43 (2.3%) Ohio	High	1 in 28 (3.6%) Oklahoma	Very High	1 in 25 (4.0%) Oregon	Very Low	1 in 170 (0.6%) Pennsylvania	Moderate	1 in 45 (2.2%) Rhode Island	Moderate	1 in 41 (2.4%) South Carolina	Low	1 in 84 (1.2%) South Dakota	High	1 in 33 (3.0%) Tennessee	Moder...
Read 10 tweets
Dec 15, 2025
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, 2025
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

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