Mike Hoerger, PhD MSCR MBA Profile picture
Dec 11, 2023 8 tweets 5 min read Read on X
PMC COVID-19 Tracker, Dec 11, 2023
The surge continues.

Today:
🔹1.2 million daily infections
🔹1 in 41 infectious (2.5%)

In 4 weeks (Jan 8):
🔹1.6 million daily infections
🔹1 in 30 infectious (3.3%)

1/

A few key methodologic updates.
1) Biobot correct levels downward for the past two weeks, so you might notice that this week's estimates seem similar to last week's or marginally lower.

2) Our forecasting model uses a combination of historic data (situation past several years) and current data (past 4 weeks). In the historic model, we switched from using mean-type data to median-type data. This avoids overestimating levels based on the BA.1 surge and allows us to predict accurately a little faster, rather than predicting high and waiting for the current 4-week's data to correct it.

3) The forecasts depend a lot on the most recent week's data. To the extent Biobot is accurate or inaccurate in real-time, this leads to divergent forecasts.CURRENT ESTIMATES FOR December 11, 2023 Wastewater Levels (copies/mL) 807 New Daily Cases 1,174,000 % of Population Infectious 2.46% (1 in 41 people) New Daily Long COVID Cases  59,000 to 235,000   4-WEEK FORECAST FOR January 8, 2024 Wastewater Levels (copies/mL) 1,083 (34% higher) New Daily Cases 1,576,000 % of Population Infectious 3.3% (1 in 30 people) New Daily Long COVID Cases  79,000 to 315,000
You'll see the forecasts differ considerably (1.3 to 1.9 million daily infections) in 4 weeks.

2/

However, they mostly agree on the peak. It could be as early as Jan 1 or as late as Jan 15. It's a moot point. Transmission will be similar across that timespan and the weekly reports lack the precision to say whether it will peak on the 4th or 9th, for example. Early Jan will remain bad.

Details:

The real-time model (purple) anticipates the highest surge levels. This assumes that Biobot real-time reports are accurate, but they were substantially corrected for the past two weeks, and there were some issues with real-time accuracy during the summer wave. The turtle model (green) discount’s the most recent week’s data as an aberration, assumes transmission should be corrected upward a little, and predicts a steady rise with peak around January 1. The cheetah model (yellow) says that because last week’s data were corrected downward, this week’s estimate should be too, so it’s much more conservative on the next several weeks. The average of all models (red) guides forecasted numbers for the next four weeks. A month from now, we will see about 1.6 million new U.S. cases per day (range of 1.3 to 1.9 million across forecasting models), with 3.3% of the U.S. population or 1 in 30 people actively infectious.Zoomed in version of prior tweet
Zooming out, you'll see that we're in a very bad place historically. With the divergent forecasts, it's merely a matter of whether this is the 2nd biggest U.S. COVID surge or 4th biggest.

The #LongCOVID cases resulting from these infections may top 400,000/week.

3/ There is more COVID-19 transmission today        than during 87.2% of the pandemic.  CURRENT ESTIMATES FOR December 11, 2023 Wastewater Levels (copies/mL) 807 New Daily Cases 1,174,000 % of Population Infectious 2.46% (1 in 41 people) New Daily Long COVID Cases 59,000 to 235,000  WEEKLY ESTIMATES FOR December 11, 2023 New Weekly Cases 8,200,000 New Weekly Long COVID Cases 411,000 to 1,644,000  2023 CUMULATIVE ESTIMATES AS OF December 11, 2023 Total 2023 Cases To Date 221,642,490 Total 2023 Long COVID Cases To Date 11,082,000 to 44,328,000
These are the chances of interacting with someone infectious on Dec 11, based on the total number of social contacts.

Interact with 10 people = 22% chance someone is infectious.

This helps explain why so many kids are getting sick at school lately.

4/ 1	2.5% 2	4.9% 3	7.2% 4	9.5% 5	11.7% 6	13.9% 7	16.0% 8	18.0% 9	20.1% 10	22.0% 15	31.1% 20	39.2% 25	46.3% 30	52.6% 35	58.1% 40	63.0% 50	71.2% 75	84.5% 100	91.7% 150	97.6% 200	99.3% 300	>99.9% 400	>99.9% 500	>99.9%
As of Dec 11, these are the updated chances of interacting with someone infectious on Christmas Day, based on the size of gathering(s).

At 6 people, the chances of interacting with someone infectious are the same as rolling a "1" on a die. At 20-25 people, it's a coin toss.
5/ 1	2.8% 2	5.6% 3	8.3% 4	10.9% 5	13.5% 6	15.9% 7	18.3% 8	20.6% 9	22.9% 10	25.1% 15	35.2% 20	43.9% 25	51.5% 30	58.0% 35	63.6% 40	68.5% 50	76.4% 75	88.6% 100	94.4% 150	98.7% 200	99.7% 300	>99.9% 400	>99.9% 500	>99.9%
In the U.S., the current surge will peak sometime between Jan 1 and Jan 15. These are the chances of interacting with someone infectious around New Year's Day, near the peak.

6/ 1	3.1% 2	6.2% 3	9.1% 4	11.9% 5	14.7% 6	17.4% 7	20.0% 8	22.5% 9	24.9% 10	27.2% 15	37.9% 20	47.1% 25	54.8% 30	61.5% 35	67.1% 40	72.0% 50	79.6% 75	90.8% 100	95.8% 150	99.2% 200	99.8% 300	>99.9% 400	>99.9% 500	>99.9%
Here's the full PMC Dashboard for Dec 11 to Jan 8.

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/
       than during 87.2% of the pandemic.	 	 CURRENT ESTIMATES FOR	 December 11, 2023	 Wastewater Levels (copies/mL)	 807	 New Daily Cases	 1,174,000	 % of Population Infectious	 2.46% (1 in 41 people)	 New Daily Long COVID Cases	 59,000 to 235,000	 	 WEEKLY ESTIMATES FOR	 December 11, 2023	 New Weekly Cases	 8,200,000	 New Weekly Long COVID Cases	 411,000 to 1,644,000	 	 2023 CUMULATIVE ESTIMATES AS OF	 December 11, 2023	 Total 2023 Cases To Date	 221,642,490	 Total 2023 Long COVID Cases To Date	 11,082,000 to 44,328,000	 	 4-WEEK FORECAST FOR	 January 8, 2024	 Wastewater Levels (copies/mL...
As a reminder, we have a contest to see who can use these data to help others. Please post success stories on the Tweet below.

8/

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More from @michael_hoerger

Feb 26
1) Mardi Gras 2020 was 5 years ago today. ⚜️

It was before the pandemic declaration, before the federal government recommended masking.

COVlD spread quickly through New Orleans, leading to one of the highest mortality rates per capita in the U.S.... Timeline showing Mardi Gras 2020 just 4 days before the first known reported death of C19 in the U.S.  Note. "Peak" diagnoses refers to the peak of the 1st wave.
2) New Orleans service workers were disproportionately hit by the early pandemic. Many died. Many developed #LongCOVID at the time or have now through repeat infections. Many have switched to other sectors....

3) The sad fact is that many service workers are continuing to get #LongCOVID through repeat infections today because the pandemic is ongoing and many restaurants have high occupant density and horrendous air quality....

Read 4 tweets
Feb 17
1) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

🔥1 in 72 actively infectious
🔥Sustained high transmission
🔥30 states in high/very high transmission (CDC)
🔥3x the transmission of Feb 2021
🔥668,000 daily infections
🔥Only 1 in 28 cases reportedGraph shows 10 waves of the pandemic.  Tables summarized partially in post. Additionally, transmission is higher than during 59% of the pandemic.  How Does Risk Increase with More Social Contacts? Number of People | Chances anyone is infectious 1	1.4% 2	2.8% 3	4.1% 4	5.5% 5	6.8% 6	8.1% 7	9.4% 8	10.6% 9	11.9% 10	13.1% 15	19.0% 20	24.5% 25	29.7% 30	34.4% 35	38.9% 40	43.0% 50	50.5% 75	65.2% 100	75.5% 300	98.5%
2) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

This is a mid-sized wave, meaning substantial transmission. Notice that transmission remains steady at high rates.

Expect steady or slightly declining transmission, unless the real-time data are retroactively corrected.Two graphs, showing year-over-year transmission and the forecast, summarized in the post.
3) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

Notice that 30 states remain in high/very high transmission, per CDC categories.

This is the same as last week. Transmission is 3x higher than in Feb 2021, when people were taking more precautions around masking and testing.Transmission heat map and CDC line graph of regional variation in transmission.
Read 5 tweets
Feb 11
1) A lot of high-risk/aware patients I talk to -- mostly getting cancer treatment -- tend to protect themselves from infection by staying home more.

In the work we do, we help patients to understand that a well-fitting high-quality mask can allow them to attend events safely.
2) These are some tips for finding a well-fitting mask among common options in the U.S. and Canada.

3) Here's a more comprehensive diagram of masks that fit most. Aside from #5, these are widely available.

*#5 (Aegle) was the first N95 widely available during the ongoing pandemic for <$1. Hard to find these days, but I gave some to students.
Read 7 tweets
Jan 28
1) PMC COVID Dashboard for the Week of Jan 27, 2025 (U.S.)

🔹1 in 108 actively infectious
🔹3.1 million weekly infections
🔹>150,000 weekly resulting Long Covid conditions Current Levels for Jan 27, 2025 % of the Population Infectious 0.9% (1 in 108) New Daily Infections 443,000  New Weekly Infections 3,101,000  Resulting Weekly Long COVID Cases 155,000 to 620,000  Monthly Forecast Average % of the Population Infectious 0.9% (1 in 106) Average New Daily Infections 452,933 New Infections During the Next Month 13,588,000 Resulting Monthly Long COVID Cases 679,000 to 2,718,000  Running Totals Infections Nationwide in 2025 18,779,000 Average Number of Infections Per Person All-Time, U.S. 3.60  There is more COVID-19 transmission today than during 41.9% of the pan...
2) We predicted the wave peak would be 0.8 to 1.3 million across various forecasts. We presently have it at 0.9-1.0 million, though retroactive corrections can change that. The WHN also runs an excellent model, with a peak estimated at 1.3 million.
whn.global/estimation-of-…
3) Approx 1 million daily infections is quite serious. This is a far cry from the various #nothingburger predictions, and the Monday morning quarterbacks who in hindsight minimize U.S. infections, Long Covid, & disability.

Perhaps they have social media revenue COIs. I don't.
Read 9 tweets
Jan 20
1) PMC COVID-19 Forecast for Jan 20, 2025 (U.S.)

If we are lucky, the 10th wave has peaked, likely in the 0.9-1.1 million daily infections range, barring significant retroactive corrections.

Over the next month, we should still see about 14 million infections, resulting in 700K to 2.8 million new conditions and enduring symptoms under the umbrella of #LongCOVID. This is simply your reminder than transmission remains high on the back on of a wave.

Regarding the peak, there were huge retroactive downward corrections, especially in Oregon. The CDC data originally showed one of the largest waves there all-time, and then corrected it to say a complete lull the whole time. Once the Biobot data get updated, we may see the peak date change by a week, or jump a bit higher than what you see in the main figure.

What you see in the far end of the forecast is unlikely to be a "high lull," but rather an average between a low lull versus a sustained post-peak haunch of lingering transmission. So, keep an eye on the data. If you're putting off a non-urgent medical appointment, we could get into relatively lower transmission in the next 4-8 weeks. What has me concerned is a sneak-peek of @jlerollblues's long-term forecast indicating a clear possibility of an earlier "mid-year" wave than usual, perhaps even in April. We're still getting pretty lucky on the viral evolution front, but the longer that persists, in absent of major policy change, the bigger the wave we could get. It's a very important time to stay tuned.

Caveats: No data from Biobot in weeks (20% model weight). The California wildfires and pending severe storms in the Deep South are wildcards for transmission. School-based transmission could pick up, but to get a higher peak, transmission would need to pick up much faster in the South and West than in the Midwest and North (unlikely).

In the report, I note that PMC will persist even if the CDC drops or scales back their surveillance program. Also, the most two recent "odd" waves have helped clarify how to handle historical data, and a minor update to the model should help with future atypical waves. If time permits, we will fine-tune those changes further, but there are always more battles on the Covid front than we're able to fight. We also provide a link and light commentary on our recent pre-print showing what our current case estimation model for estimating present/prior daily infections has performed well, and why a lot of other models (BNO, JP, CDC) are underestimates.

Info for new readers:

For those unfamiliar with the PMC model, find full weekly reports for the past 1.5 years at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks.

Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, NBC, and CNN. See pgs 11-13 at the above link.

#MaskUp #VaxUp #CleanTheAir #RapidTestCurrent Levels for Jan 20, 2025 % of the Population Infectious 1.1% (1 in 87) New Daily Infections 547,000  New Weekly Infections 3,829,000  Resulting Weekly Long COVID Cases 191,000 to 766,000  Monthly Forecast Average % of the Population Infectious 1.0% (1 in 102) Average New Daily Infections 466,700 New Infections During the Next Month 14,001,000 Resulting Monthly Long COVID Cases 700,000 to 2,800,000  Running Totals Infections Nationwide in 2025 15,281,000 Average Number of Infections Per Person All-Time, U.S. 3.59  How Does Risk Increase with More Social Contacts? Number of People | Ch...
2) Here is the issue of Oregon I noted, with the "disappearing surge" in the CDC data. By that, I don't mean a surge that declined quickly. I mean, the CDC saying there was a huge surge in OR and then saying it was a lull the whole time. Baffling.

3) It's an important time to reflect that we have never had a federal Covid response commensurate with the magnitude of this $14-billion problem in the U.S.

3/11/20-1/19/21 = 290K infections/day (91 million total)

1/20/21-1/19/25 = 759K infections/day (1.1 billion total)

10 waves and >1 billion estimated infections in 5 years.

We have never had a well-conceived multi-layered mitigation strategy, and the strategy we have had has often underachieved due to insufficient operational management.

This places society at greater systemic risk from repeat-infection Long COVID. The approach is unreasonable to people with primary immunodeficiencies, cancer, organ transplants, kidney disease, type 1 and 2 diabetes, Long COVID, pregnancy, and many other conditions. Upwards of 2 million older adults in the U.S. are in early retirement, with the labor participation rate still well below pre-pandemic levels, and older adults almost wholly accounting for that presently. The children that were pretended to be magically shielded from Covid are not doing well on the cumulative infection front either.

I do not see that changing. I hope the many scientists and public health officials biting their tongues the past 4 years now feel liberated to speak up on Covid. Note that state and regional organizations and individuals were a big reason why transmission was better under control in year 1 of the pandemic.

Note that our statistics are estimated "true" cases based on the PMC model, not reported cases, which are vast undercounts (ascertainment bias). See the first Tweet for info on our model, including our website, which contains hundreds of pages of reports (pmc19.com/data), or read our recent pre-print showing the high accuracy of our case estimation model, to the extent that is ascertainable (researchsquare.com/article/rs-578…). To believe the true infection estimates are lower than these figures, one would have to suspend cognitive reasoning and merely assume transmission happens at vastly lower rates in the U.S. than those documented through the most-rigorous testing-based program in Europe.figure showing the 10 Covid waves (U.S.)
Read 5 tweets
Jan 6
1) PMC COVID-19 Dashboard, Jan 6, 2025 (U.S.)

📈1 in 49 people actively infectious
🔥Nearly 1 million daily infections
🎲About a 50-50 chance someone has COVID in a large class if typical risk and no testing/isolating
🏥300,000+ new Long Covid conditions per week

The infections are likely minor underestimates. AZ and OR did not report this week. They were surging, so the lack of data brings down the average. As well, the model gives 80% weight to CDC wastewater data and 20% weight to Biobot, but Biobot took the week off, so this is dependent on observed changes in the CDC data.

It would be wise to add multiple imputation into the model to account for all the non-random missingness during surges, but I won't likely get to that anytime soon.

The peak is looking more and more like 1.4 million daily infections, but I wouldn't be surprised if it's earlier than shown and more like 1.3 million, based on the pattern of retroactive data corrections last winter. If the real-time data really stink, it could come in closer to 1.0-1.1 million. To top 1.6 million, we would probably need some serious immune escape that at present I just don't see happening. However, in past winters, transmission was declining nationally in early/mid January, and back-to-school is a wild card.

Info for new readers:

For those unfamiliar with the PMC model, find full weekly reports for the past 1.5 years at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks. Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, NBC, and CNN. See pgs 11-13 at the above link.

We will have a pre-print out in the next week or so documenting very compelling evidence for the validity of using wastewater to estimate case rates. Forecasting is challenging in the context of the current viral evolution, but the real-time estimates of cases are impressively accurate to the best we can evaluate it.

#MaskUp #VaxUp #CleanTheAir #RapidTestCurrent Levels for Jan 6, 2025 % of the Population Infectious 2.1% (1 in 49) New Daily Infections 980,000  New Weekly Infections 6,860,000  Resulting Weekly Long COVID Cases 343,000 to 1,372,000  Monthly Forecast Average % of the Population Infectious 2.7% (1 in 38) Average New Daily Infections 1,272,833 New Infections During the Next Month 38,185,000 Resulting Monthly Long COVID Cases 1,909,000 to 7,637,000  Running Totals Infections Nationwide in 2025 5,468,000 Average Number of Infections Per Person All-Time, U.S. 3.55  How Does Risk Increase with More Social Contacts? Number of people |...
2) PMC COVID-19 Dashboard, Jan 6, 2025 (U.S.)

We're in the 10th wave of the pandemic (1st graph), and transmission this year has picked up atypically late, while coming on strong (2nd graph).Two graphs, summarized in tweet
3) PMC COVID-19 Dashboard, Jan 6, 2025 (U.S.)

Note that sputtering in the West's rise is likely an aberration, as surging OR and AZ did not provide data this week.

Read 5 tweets

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