Mike Hoerger, PhD MSCR MBA Profile picture
Nov 20, 2023 β€’ 9 tweets β€’ 4 min read β€’ Read on X
PMC COVID-19 Tracker, Nov 20, 2023

We're headed into a winter surge!

Today:
πŸ”Ή762,000 daily cases
πŸ”Ή1 in 63 infectious (1.6%)

In 4 weeks:
πŸ”Ή1,265,000 daily cases
πŸ”Ή1 in 38 infectious (2.7%)

1/
CURRENT ESTIMATES FOR  November 20, 2023  Wastewater Levels (copies/mL)  523  New Daily Cases  762,000  % of Population Infectious  1.59% (1 in 63 people)  New Daily Long COVID Cases   38,000 to 152,000     4-WEEK FORECAST FOR  December 18, 2023  Wastewater Levels (copies/mL)  869 (66% higher)  New Daily Cases  1,265,000  % of Population Infectious  2.65% (1 in 38 people)  New Daily Long COVID Cases   63,000 to 253,000
Zooming out to the full pandemic, we're clearly in the 8th U.S. COVID wave, which I would characterize as a #surge.
🌊🌊🌊🌊🌊🌊🌊🌊

There's already more virus circulating today than during 60% of the days of the pandemic.
2/ There is more COVID-19 transmission today        than during 60.7% of the pandemic.  CURRENT ESTIMATES FOR November 20, 2023 Wastewater Levels (copies/mL) 523 New Daily Cases 762,000 % of Population Infectious 1.59% (1 in 63 people) New Daily Long COVID Cases 38,000 to 152,000  WEEKLY ESTIMATES FOR November 20, 2023 New Weekly Cases 5,300,000 New Weekly Long COVID Cases 267,000 to 1,067,000  2023 CUMULATIVE ESTIMATES AS OF November 20, 2023 Total 2023 Cases To Date 199,496,320 Total 2023 Long COVID Cases To Date 9,975,000 to 39,899,000
BNO & popular news outlets focus on *reported* cases. Actual cases derived from the true levels of virus in wastewater indicate 25x more infections.

By undercounting, they are grossly underestimating the number of resulting #LongCOVID cases.


3/
WEEKLY ESTIMATES FOR November 20, 2023 New Weekly Cases 5,300,000 New Weekly Long COVID Cases 267,000 to 1,067,000
Contact reduction (spending time in-person with fewer people) is an extremely smart method of avoiding infection. You'll see this in the next two tables. One focuses on schools/meetings. The other is more generic. Let's see which one gets shared more.
4/
This table shows how the risk of interacting with someone with COVID increases as the size of a classroom or meeting increases, as of Nov 20.

With 10 people, there's a 15% chance someone has COVID. With 50 people, there's a 55% chance someone has COVID.

5/ 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	10.6% 8	12.1% 9	13.5% 10	14.8% 15	21.4% 20	27.5% 25	33.1% 30	38.3% 35	43.0% 40	47.4% 50	55.2% 75	70.0% 100	80.0% 150	91.0% 200	96.0% 300	99.2% 400	99.8% 500	>99.9%
This table has the same data but a more generic title. It should help people think about the typical number of people they interact with in a day.

In interacting with 10 people, there's a 15% chance someone has COVID. 50 people = 55% chance. Plane, restaurant, or theater with 100 people = 80% chance someone there has COVID.

Again, same table as Tweet #5, just framed with a different title.

6/
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	10.6% 8	12.1% 9	13.5% 10	14.8% 15	21.4% 20	27.5% 25	33.1% 30	38.3% 35	43.0% 40	47.4% 50	55.2% 75	70.0% 100	80.0% 150	91.0% 200	96.0% 300	99.2% 400	99.8% 500	>99.9%
Many families will gather for Thanksgiving in 3 days (Nov 23). Here's how COVID risk increases with the number of social interactions.

In a family gathering of 5, there's an 8% chance someone has COVID. A big gathering of 10 = 16% chance. Two family dinners each with 10 people (approx 20 people total) = 29% chance someone has COVID. Packed restaurant of 100 = 82% chance someone has COVID. Flight of 200 = 97% chance someone has COVID.

7/
Number of People  |  Chances Anyone is Infectious	 1	1.7% 2	3.3% 3	4.9% 4	6.5% 5	8.1% 6	9.6% 7	11.1% 8	12.6% 9	14.1% 10	15.5% 15	22.3% 20	28.6% 25	34.4% 30	39.7% 35	44.5% 40	49.0% 50	56.9% 75	71.7% 100	81.5% 150	92.0% 200	96.6% 300	99.4% 400	99.9% 500	>99.9%
Many families will gather for Christmas and other celebrations next month. Here's how COVID risk increases with the number of social interactions.

In a family gathering of 5, there's an 15% chance someone has COVID. A big gathering of 10 = 27% chance. Two family dinners each with 10 people (approx 20 people total) = 47% chance someone has COVID. Packed restaurant of 100 = 96% chance someone has COVID. Flight of 200 = 99.8% chance someone has COVID.

These numbers are speculative at 1-month out. The model will refine estimates as we get closer and closer. Stay tuned.

8/
Number of People  |  Chances Anyone is Infectious	 1	3.1% 2	6.2% 3	9.1% 4	12.0% 5	14.7% 6	17.4% 7	20.0% 8	22.5% 9	24.9% 10	27.3% 15	38.0% 20	47.1% 25	54.9% 30	61.6% 35	67.2% 40	72.0% 50	79.7% 75	90.8% 100	95.9% 150	99.2% 200	99.8% 300	>99.9% 400	>99.9% 500	>99.9%
Here's the full PMC Dashboard for Nov 20.

You can read the full report here:

Thanks everybody for sharing across platforms and your feedback on things like axis labels, making the percentages meaningful, etc. Much appreciated. The "C" in PMC is for collaborative.

9/pmc19.com/data/

There is more COVID-19 transmission today	        than during 60.7% of the pandemic.	 	 CURRENT ESTIMATES FOR	 November 20, 2023	 Wastewater Levels (copies/mL)	 523	 New Daily Cases	 762,000	 % of Population Infectious	 1.59% (1 in 63 people)	 New Daily Long COVID Cases	 38,000 to 152,000	 	 WEEKLY ESTIMATES FOR	 November 20, 2023	 New Weekly Cases	 5,300,000	 New Weekly Long COVID Cases	 267,000 to 1,067,000	 	 2023 CUMULATIVE ESTIMATES AS OF	 November 20, 2023	 Total 2023 Cases To Date	 199,496,320	 Total 2023 Long COVID Cases To Date	 9,975,000 to 39,899,000	 	 4-WEEK FORECAST FOR	 Decem...

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More from @michael_hoerger

Sep 13
California COVlD Surge Rages Higher

πŸ”ΈCDC SARS-CoV-2 wastewater levels "Very High," and up from last week
πŸ”Έ1 in 21 estimated actively infectious
πŸ”Έ>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.
πŸ”₯23 states/territories High/Very High
πŸ”₯Very High: Alabama, DC, Guam, Hawai'i, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah
πŸ”₯1 in 56 estimated actively infectious
πŸ”₯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 πŸ“‰ 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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