We are headed into potentially the 2nd largest COVID surge all-time in the U.S.
If #wastewater levels follow historic trends, we will reach 2 million infections/day at peak surge with 4.2% of the population actively infectious on Jan 10.
2/ The winter peak should arrive between Jan 3 and Jan 17. The model estimates a peak of 1.7 to 2.2 million infections per day.
If unlucky, 1 in 20 people will be infectious, and it will be the 2nd largest wave. If lucky, more like 1 in 30, and the 4th largest wave.
Consider optimistic and pessimistic scenarios not captured by these models.
Optimism:
A rosy scenario would be that the peak occurs a week earlier at a slightly lower level (1.6-1.7 infections/day like last winter or the preceding summer). The level of acceleration in transmission argues against that, in favor of a higher peak, but Biobot is reporting some unusual regional variation (much lower transmission in the U.S. South and West). Moreover, historical patterns of how transmission should or should not accelerate cannot account for existing variation on population-level immunity due to variation in prior exposure history, recency of vaccination, and how well the current vaccine matches disseminating subvariants relative to prior vaccines. Finally, Biobot wastewater sites could be overreporting, and levels could get corrected downward. Each of these factors is highly plausible, but the “rosy” scenario remains quite bleak and suggests the pandemic remains far from “over.”
Pessimism:
Also, consider more pessimistic scenarios. Current vaccination rates remain extremely low, and several other countries are reporting atypically high acceleration via wastewater data. Placing plausible hypothetical values in the model, it is difficult to imagine a scenario where the U.S. reaches 2.5 million infections/day. Sometimes, people draw graphs showing a continued acceleration like BA.1, but such models seem to reflect imagination rather than data. The data do not suggest an evidence for a BA.1-level surge.
3/ COVID transmission is already very bad in the U.S. and getting worse.
Today:
🔹1.4 million daily infections
🔹1 in 35 infectious (2.9%)
In 4 weeks (Jan 15):
🔹1.9 million daily infections
🔹1 in 24 infectious (4.2%)
4/ Zooming out to the entire pandemic, we're in the 8th wave. It's likely to be the 2nd-4th biggest all-time and about 1/4 to 1/3 the peak of the horrendous BA.1 surge.
#Wastewater shows that transmission today is worse than during 90% of the entire pandemic.
5/ We are at nearly 10 million U.S. COVID infections per week. Conservatively, such infections alone would result in nearly a half-million #LongCOVID cases.
The relative "lull" in SARS-CoV-2 transmission is unlikely to go much lower.
✨1 in 209 people are estimated actively infectious, likely the lowest levels of 2025 nationwide.
Get boosted. Stock up on masks, tests, & filters.
PMC COVlD Update, Nov 3, 2025 (U.S.)
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No data presently suggest the rise of a winter wave any earlier than "usual."
If following historical trends, transmission will pick up Nov 15-29. Last year's rise was atypically late.
PMC COVlD Update, Nov 3, 2025 (U.S.)
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Expect rising misinformation/disinformation as transmission heats up:
🔹Abuse of community notes, particularly surrounding wastewater methodology
🔹Paid bot army attacks, especially about boosters & masks
Transmission typically accelerates in mid-November.
We are currently in a relative 'lull.' We estimate about a quarter-million new daily infections with 1 in 185 people actively infectious. Still bad, likely to get worse.
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PMC COVlD Update, Oct 27, 2025 (US)
Our forecast through November 8 calls for flat transmission.
Nothing yet indicates the onset of a winter wave, but it would also be atypical for the lull to last much longer than another 2-3 weeks.
2/9 🧵
PMC COVlD Update, Oct 27, 2025 (US)
We estimate 264,000 new daily infections during this 'lull' period.
Biobot data have returned. Our substitute data from WWS last week correlated r=.97 (near perfect) with that, but Biobot did retroactively increase recent estimates.
SARS-CoV-2 transmission has fallen.
🔹1 in 191 (0.5%) actively infectious
🔹"Lull" levels at 20% of the summer peak
🔹255,000 new daily infections (still concerning)
Many will knock out higher-risk activities the next 2-4 weeks.
🧵1/11
PMC COVlD Update, Oct 20, 2025 (U.S.)
"Lull" transmission remains dangerous:
🔹1.8 million estimated new weekly infections
🔹>90,000 estimated new #LongCOVID conditions from this week's infections
🔹>500 excess deaths to result from this week's infections
🧵2/11
PMC COVlD Update, Oct 20, 2025 (U.S.)
Exposure risk during "lull" transmission remains high when engaging in many social interactions.
Interacting with 25 people yields a 12% chance of exposure. 100 people? 41% chance of exposure, assuming no testing/isolation.
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/
Data in #Austria show a rising COVlD wave. The x axis (bottom) has infrequent labels, but the data shown go through October 8th.
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.
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
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#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.
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
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Weekly estimates:
🔹4.5 million infections
🔹>200,000 resulting long-term health conditions
🔹>1,300 resulting excess deaths
Key points in my letter to the pharmacy boards. 🧵1/7
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.
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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.