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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Dec 4, 2023 • 7 tweets • 3 min read • Read on X
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PMC COVID-19 Tracker, Dec 4, 2023
The U.S. surge is worsening faster than anticipated.

Today:
🔹1.2 million daily infections
🔹1 in 38 infectious (2.6%)

In 4 weeks (New Year's Day):
🔹1.8 million daily infections
🔹1 in 26 infectious (3.9%)

1/
 CURRENT ESTIMATES FOR December 4, 2023 Wastewater Levels (copies/mL) 865 New Daily Cases 1,258,000 % of Population Infectious 2.63% (1 in 38 people) New Daily Long COVID Cases 63,000 to 252,000 4-WEEK FORECAST FOR January 1, 2024 Wastewater Levels (copies/mL) 1,284 (49% higher) New Daily Cases 1,869,000 % of Population Infectious 3.91% (1 in 26 people) New Daily Long COVID Cases 93,000 to 374,000
You'll note the diverging forecasts. Biobot #wastewater levels increased more than anticipated this week, and they updated last week's numbers upward too.

The cheetah forecast (yellow) assumes this week's levels will also get revised upward like last week's. The turtle model (green) ignores this week's data as an aberration. The real-time forecast (purple), which assumes all real-time estimates are accurate, is barely visible behind the red line. The red line is the composite average of all 3 forecasts.

You'll notice the blue line (wastewater levels) and red line (forecast) overlap marginally. Biobot reports levels for Nov 29, and we carry them forward in the forecasting model through Dec 4 (today). Transmission is accelerating so much, usually this 5 day lag isn't even visible graphically.

2/
 Zooming in on the forecast. See prior tweet for more detail.
This table shows how additional social contacts increase risk today (Dec 4).

🔥10 people (daycare, team meeting) = about a 1 in 4 chance someone has infectious COVID

🔥🔥30 people (large K-12 class) = over a 50% chance someone has infectious COVID

3/ Number of People | Chances Anyone is Infectious 1 2.6% 2 5.2% 3 7.7% 4 10.1% 5 12.5% 6 14.8% 7 17.0% 8 19.2% 9 21.3% 10 23.4% 15 33.0% 20 41.3% 25 48.7% 30 55.1% 35 60.7% 40 65.6% 50 73.6% 75 86.5% 100 93.1% 150 98.2% 200 99.5% 300 >99.9% 400 >99.9% 500 >99.9%
This table shows how socializing on Christmas will drive the worst of the winter surge. Estimates are revised upward today (Dec 4).

⭐️Large fam gathering (20 people) = over a 50% chance someone's infectious

⭐️⭐️Large restaurant/flight = near-certain someone's infectious

4/ Number of People | Chances Anyone is Infectious 1 3.5% 2 6.8% 3 10.1% 4 13.2% 5 16.2% 6 19.2% 7 22.0% 8 24.7% 9 27.3% 10 29.8% 15 41.2% 20 50.8% 25 58.8% 30 65.5% 35 71.1% 40 75.8% 50 83.0% 75 93.0% 100 97.1% 150 99.5% 200 99.9% 300 >99.9% 400 >99.9% 500 >99.9%
This table shows the risk of socializing on New Year's Day. Finger crossed, the surge should peak around then.

Not a great time to party. 🎉🎉

5/ Number of People | Chances Anyone is Infectious 1 3.9% 2 7.7% 3 11.3% 4 14.7% 5 18.1% 6 21.3% 7 24.4% 8 27.3% 9 30.2% 10 32.9% 15 45.0% 20 55.0% 25 63.1% 30 69.8% 35 75.2% 40 79.7% 50 86.4% 75 95.0% 100 98.1% 150 99.7% 200 >99.9% 300 >99.9% 400 >99.9% 500 >99.9%
Zooming out to the full pandemic shows the harm of the 8th U.S. Covid wave.

🔹More daily infections than 89% of the pandemic
🔹>25x more actual than reported cases
🔹>60,000 #LongCovid cases/day eventually resulting from these infections
🔹Winter peak like last year

6/ There is more COVID-19 transmission today than during 88.9% of the pandemic. CURRENT ESTIMATES FOR December 4, 2023 Wastewater Levels (copies/mL) 865 New Daily Cases 1,258,000 % of Population Infectious 2.63% (1 in 38 people) New Daily Long COVID Cases 63,000 to 252,000 WEEKLY ESTIMATES FOR December 4, 2023 New Weekly Cases 8,800,000 New Weekly Long COVID Cases 440,000 to 1,761,000 2023 CUMULATIVE ESTIMATES AS OF December 4, 2023 Total 2023 Cases To Date 214,388,450 Total 2023 Long COVID Cases To Date 10,719,000 to 42,878,000
Here's the full PMC Dashboard for Dec 4 to Jan 1.

You can read the full report here:

Thank you for your continued questions, suggestions, gratitude, and sharing across other platforms. Please offer any success stories to encourage others.

7/ pmc19.com/data/
There is more COVID-19 transmission today than during 88.9% of the pandemic. CURRENT ESTIMATES FOR December 4, 2023 Wastewater Levels (copies/mL) 865 New Daily Cases 1,258,000 % of Population Infectious 2.63% (1 in 38 people) New Daily Long COVID Cases 63,000 to 252,000 WEEKLY ESTIMATES FOR December 4, 2023 New Weekly Cases 8,800,000 New Weekly Long COVID Cases 440,000 to 1,761,000 2023 CUMULATIVE ESTIMATES AS OF December 4, 2023 Total 2023 Cases To Date 214,388,450 Total 2023 Long COVID Cases To Date 10,719,000 to 42,878,000 4-WEEK FORECAST FOR Janua...

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More from @michael_hoerger

Mike Hoerger, PhD MSCR MBA Profile picture
Oct 11
PMC COVlD Wave Update (Europe)
11 October 2025 🧵

The PMC website includes an international directory of websites with COVlD wastewater monitoring. It is more up to date than the directories of the EU and WHO.

Let's review what's happening in Europe...

1/ world map, nations with surveillance shown in blue. URL says pmc19.com/global
Data in #Austria show a rising COVlD wave. The x axis (bottom) has infrequent labels, but the data shown go through October 8th.

Find more here:

2/ pmc19.com/austrialongitudinal graph
COVlD levels have been percolating in #Belgium, with "moderate" levels overall.

The transmission pattern is similar across regions. Plants at Namur-Brumagne and Oostende report "high" levels.



3/ pmc19.com/belgiumheat map and longitudinal graph
Read 20 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Oct 5
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵1/9

An estimated 1 in 81 people are actively infectious during the ongoing 11th wave.

The "shutdown" has created a blackout at the state level.

Transmission is half that of the peak one month ago, and we anticipate a relative national "lull" in early-to-mid November, albeit still at dangerous levels.

Our model uses a combination of CDC and Biobot data, so we are able to estimate national statistics despite the CDC data going offline. On the map, note that Puerto Rico continues to update; they use a CDC-style system but were dropped by the CDC long ago. For full methodology, review the technical appendix on the website.Heat map, grayed out. 1 in 81 estimated actively infectious, or 602,000 new daily infections, per wastewater-derived estimates.
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵2/9

#DuringCOVID is today. We estimate >600,000 new daily infections. This is about half the peak on September 6.

Notice current levels are similar to the estimated peaks of the first 3 waves. 11 wave graph
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵3/9

Weekly estimates:
🔹4.5 million infections
🔹>200,000 resulting long-term health conditions
🔹>1,300 resulting excess deaths Infections Oct 6, 2025 pmc19.com/data Proportion Actively Infectious 1 in 81 (1.2%) New Daily Infections 602,000 Infections the Past Week 4,540,000 Infections in 2025 189,000,000 Cumulative Infections per Person 4.69 Long COVID Long COVID Cases Resulting 30,000 to 120,000 from New Daily Infections Long COVID Cases Resulting 227,000 to 910,000 from New Weekly Infections Excess Deaths Excess Deaths Resulting 170 to 280 from New Daily Infe...
Read 9 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Oct 3
BREAKING: 3 State Pharmacy Boards Still Block COVlD Boosters without a Prescription

ACIP voted against prescriptions for boosters & 47 states + DC follow that guidance.

Georgia, Missouri, & Louisiana require prescriptions.

Key points in my letter to the pharmacy boards. 🧵1/7 Map shows only Missouri, Louisiana, and Georgia are blocking residents from routing COVlD boosters unless they have a prescription.
Georgia law indicates that the pharmacy board is to follow ACIP. They do not dictate further nuance. Georgia continues to require prescriptions, going against the spirit of the law, ACIP, and 47 other states.

🧵2/7 Georgia: State law does NOT require a prescription if it is a “vaccine that is included on the adult immunization schedule recommended by the Advisory Committee on Immunization Practices (ACIP)”1 ACIP voted against prescriptions, and 47 states have accepted that schedule. The law does not mention a CDC Director sign-off, which may be delayed months. Act now to save lives. 1. https://law.justia.com/codes/georgia/title-43/chapter-34/article-2/section-43-34-26-1/
Louisiana law tells the pharmacy board to follow ACIP. ACIP says do not require a prescription, and 47 other states agree.

The Louisiana pharmacy board continues to require a prescription.

🧵3/7 Louisiana: State law does NOT require a prescription if the “vaccine is administered in conformance with the most current immunization administration protocol as set forth by the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practice.” 2 ACIP voted against prescriptions, and 47 states have accepted that protocol. The law does not mention a CDC Director sign-off, which may be delayed months. Act now to save lives. 2. https://law.justia.com/codes/louisiana/revised-statutes/title-37/rs-37-1218-1/
Read 7 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Oct 1
I remember when they said kids don't transmit COVlD much because they are short, small, and have tiny lungs. They lied.
I remember when they said COVlD doesn't transmit in schools. They lied.
I remember when they said COVlD is mild in kids without understanding post-acute sequelae. They lied.
Read 25 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 30
PMC COVlD Update, Sep 29, 2025 (U.S.)

Summary: COVlD is everywhere.

On the back end of this unprecedented 11th wave, "times they are a-changin." In particular, COVlD levels are shifting north and east.

Notice that few states are in the highest and lowest categories. Much of the south and west have considerable transmission post-peak. Many places in the north and east are seeing steady or increasing transmission after relatively lower levels.

Overall, levels are lower than the past few weeks, but transmission remains considerable. Those relying on anecdata (friends, coworkers, and family infected) may increasingly realize we are in a wave.

We estimate nearly 750,000 new daily infections nationwide, meaning approximately 1 in 66 people or 1.5% are actively infectious.

These estimates are derived by linking wastewater levels to IHME true case estimates using methodology commonly employed worldwide, detailed on the website, noted in a pre-print. Many publications in leading medical journals link wastewater data to key metrics that matter, noted in the online technical appendix.

In this week's report, we note adding North Dakota and Puerto Rico to the heat map in support of health equity. We have been imputing ND levels since the launch of PMC 3.0 using data from neighboring states. PR continues to report qualitative levels using the CDC format but is not longer included on the CDC website.

1/8 🧵heat map based on CDC data, and PMC case estimates
PMC COVlD Update, Sep 29, 2025 (U.S.)

State-level prevalence estimates, AL to MS. The levels use CDC labels, which tend to have an optimistic portrayal of risk. For example, CO is listed at "low" (by our estimate 1.5% infectious).

#MaskUp at 1.5% if having lapsed.

2/8 🧵 Alabama High 1 in 33 (3.0%) Alaska Low 1 in 69 (1.5%) Arizona Moderate* 1 in 42 (2.4%) Arkansas High 1 in 38 (2.7%) California High 1 in 36 (2.8%) Colorado Low 1 in 69 (1.5%) Connecticut Very High 1 in 18 (5.6%) Delaware Very High 1 in 24 (4.1%) District of Columbia Low 1 in 81 (1.2%) Florida Low 1 in 62 (1.6%) Georgia Low 1 in 101 (1.0%) Guam Very Low 1 in 130 (0.8%) Hawaii Moderate 1 in 53 (1.9%) Idaho Low 1 in 62 (1.6%) Illinois Moderate 1 in 60 (1.7%) Indiana High 1 in 27 (3.8%) Iowa Moderate 1 in 58 (1.7%) Kansas Low 1 in 78 (1.3%) Kentucky Moderate 1 in 39 (2.6%) Louisiana High 1 in 3...
PMC COVlD Update, Sep 29, 2025 (U.S.)

State-level prevalence estimates, Missouri to Wyoming.

New York had *huge* retroactive upward corrections, and is now "High," as many residents hypothesized.

Note, Puerto Rico only provides CDC qualitative levels, so no data.

3/8 🧵 Missouri Very Low 1 in 156 (0.6%) Montana High 1 in 37 (2.7%) Nebraska High 1 in 27 (3.8%) Nevada Very High 1 in 15 (6.6%) New Hampshire Moderate 1 in 59 (1.7%) New Jersey Low 1 in 82 (1.2%) New Mexico Low 1 in 102 (1.0%) New York High 1 in 35 (2.8%) North Carolina High 1 in 35 (2.9%) North Dakota High* 1 in 34 (3.0%) Ohio Moderate 1 in 58 (1.7%) Oklahoma Low* 1 in 81 (1.2%) Oregon High 1 in 32 (3.1%) Pennsylvania Low 1 in 61 (1.6%) Rhode Island High 1 in 33 (3.1%) South Carolina Moderate 1 in 40 (2.5%) South Dakota High 1 in 28 (3.5%) Tennessee Low 1 in 75 (1.3%) Texas Moderate 1 in 48 (2....
Read 8 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Sep 27
BREAKING: COVlD transmission surges across the Northeast amid 11th wave.

CDC levels & PMC prevalence estimates:
🔹CT: Very High (1 in 18 people actively infectious)
🔹RI: High (1 in 33)
🔹NY: High (1 in 35)
🔹MA: High (1 in 37)

Quick thread 🧵 1/7 Heat map from CDC data with PMC prevalence estimates noted in post
#NewYork has "High" transmission statewide & many counties are seeing "Very High" transmission, per CDC.

PMC estimates 1 in 35 people are actively infectious statewide.

A lot of sites are offline, but notice the overall coverage remains strong. Bad picture statewide.
🧵 2/7 Heat map with prevalence estimate, noted in post
In #Connecticut, we estimate 1 in 18 people are actively infectious. The CDC indicates "Very High" levels.

Statewide coverage is good. Assume it's very high risk everywhere.
🧵 3/7 Heat map and pmc estimate
Read 7 tweets

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