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

Sep 13
California COVlD Surge Rages Higher

🔸CDC SARS-CoV-2 wastewater levels "Very High," and up from last week
🔸1 in 21 estimated actively infectious
🔸>250,000 estimated new daily infections statewide

Four figures...
1/4🧵 CDC: Very High: PMC Estimate: 1 in 21 actively infectious
CDC wastewater data in California show COVlD cases increasing from the already "Very High" levels last week.

2/4🧵 Line graph of the past 6 months showing the surge in wastewater viral levels
With an estimated 1 in 21 (or 4.8%) of California residents actively infectious of COVlD, risk increases dramatically in larger and more frequent social gatherings.

Interact with 25 people of average risk of being positive, and that's a >70% chance of exposure.
3/4🧵 How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1	4.8% 2	9.4% 3	13.7% 4	17.9% 5	21.8% 6	25.6% 7	29.1% 8	32.5% 9	35.8% 10	38.9% 15	52.2% 20	62.6% 25	70.8% 30	77.1% 35	82.1% 40	86.0% 50	91.5% 75	97.5% 100	99.3% 300	99.9%
Read 4 tweets
Sep 10
Let's say you're a dairy farmer. You have 100 cows. Each year, about 5 cows die, and another 5 cows are born. Then, along comes a virus. Let's call it "cowvid"...
1/
Let's say "cowvid" wipes out about half the cows over the course of a couple years. Now, you're down to 50 cows....
2/
The local mayor declares "cowvid" to be over. This surprises you as a farmer because 5 of your cows keep dying annually. 5 of 50 instead of 5 out of 100. Seems like more, but you're not a city slicker...
3/
Read 12 tweets
Sep 7
#DuringCOVID is today.

Image pack 1 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
1 million New Daily Infections.

Today!

Image pack 2 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Where are the free vaccines, N95s, and tests?

Image pack 3 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Read 9 tweets
Sep 3
PMC Dashboard Update (U.S.) 🧵1 of 8

The 11th wave is still rising.
🔥23 states/territories High/Very High
🔥Very High: Alabama, DC, Guam, Hawai'i, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah
🔥1 in 56 estimated actively infectious
🔥876,000 new daily infections CDC heat map, very high states noted in post. PMC estimate of 1 in 56 actively infectious nationwide
PMC Dashboard Update (U.S.) 🧵2 of 8

Note that the CDC has modified 📉 how transmission levels correspond to the categorical bins.

Take California. We estimate 1 in 30 actively infectious statewide. This would have previously been "Very High," now just "High."
#NewNormal CDC heatmap, with PMC estimate of 1 in 30
PMC Dashboard Update (U.S.) 🧵3 of 8

Here are the prevalence estimates for the first half of states/territories.

Notice how high the levels are in some of the "Moderate" states. State	CDC Level Alabama	Very High Alaska	High Arizona	High Arkansas	Moderate California	High Colorado	Moderate Connecticut	High Delaware	High District of Columbia	Very High Florida	High Georgia	Moderate Guam	Very High Hawaii	Very High Idaho	High Illinois	Very Low Indiana	Moderate* Iowa	Low Kansas	Low Kentucky	High Louisiana	Very High Maine	Low Maryland	Moderate Massachusetts	Moderate Michigan	Very Low Minnesota	Moderate Mississippi	High*
Read 9 tweets
Aug 21
During times like these when COVlD transmission heats up in the U.S., expect to see a lot more angry outbursts for three central reasons.

First, "displacement," or people trying to deny the reality of their anxiety by taking it out on other people....
Second, a lot of people can sustain a strong denial of reality about the ongoing pandemic during lulls. They suppress the existence of COVlD waves and excess deaths, disability, and retirements.

During waves, those defenses burst. Loss of control = anger...
Third, a lot of people (many reading this) understand COVlD correctly & experience righteous indignation during COVlD waves. We quite reasonably do not like all of the unjust and gratuitous suffering.

I find it helpful to channel that intensity into helping other people....
Read 6 tweets
Aug 19
I submitted my comment to endorse universal high-quality masks (respirators) in healthcare. Today is the final day.

Alt text continues in the following posts. RE: Z94.4, Selection, use, and care of respirators (New Edition)  Dear Colleagues,  As the director of a population science program at a major U.S. cancer center, I strongly endorse this draft proposal to increase the use of high-quality well-fitting masks (respirators) in medical settings. I will comment on the relevance of this proposal mainly for cancer care. In the U.S., cancer care is commonly more organized than other specialty care and, thus, often leads the way on policy initiatives, which then translate to other elements of care over time.  1. COVID-19 continues to cause excess dea...
They put forth projections, with the most granular detail for the U.S. and U.K., suggesting excess deaths will persist through at least 2033. Their projections do not show excess deaths stopping in 2033; that is simply the final year of their current analysis. Moreover, while they provide the most data for the U.S. and U.K., their analysis suggests a more general trend throughout the globe. The COVID-19-associated excess deaths are commonly identified as cardiovascular and cancer causes of death.   Swiss Re Institute. (2024). The future of excess mortality after COVID-19. https://www.swissr...
Alt text continued 2. The SARS-CoV-2 virus that causes COVID-19 continues to transmit at high rates worldwide. Overall, 28 nations continue to use wastewater surveillance to monitor SARS-CoV-2 levels. A directory is available at the dashboard that I oversee (pmc19.com/data). In the U.S., we are currently experiencing our 11th wave of transmission. Many nations are experiencing annual or twice annual waves of transmission.
Alt text continued 3. International consensus standards identify a broad range of patients at known high-risk of severe outcomes of COVID-19. The largest group at known high risk of severe outcomes is patients with cancer. Other diagnoses associated with above average risk include people undergoing transplants or receiving dialysis, and patients with any of these diagnoses: immunodeficiencies, renal disease, systemic-immune mediated or single-site immune-mediated inflammatory conditions, asplenia, anatomical barrier defects, pregnancy, and diabetes. These findings underscore the importance of standards in hea...
Read 7 tweets

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