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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Dec 18, 2023 • 11 tweets • 5 min read • Read on X
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1/
 PMC COVID-19 Tracker, Dec 18, 2023

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.U.S. Winter 2023-24 COVID Surge Best Estimate Range Rank among COVID waves 2nd 2nd 4th Date of peak Jan 10 Jan 3 Jan 17 Daily infections at peak 2.0 million/day 1.7 million/day 2.2 million/day Percentage of population infectious at peak 4.2% (1 in 24) 3.7% (1 in 27) 4.6% (1 in 22)
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.U.S. Winter 2023-24 COVID Surge Best Estimate Range Rank among COVID waves 2nd 2nd 4th Date of peak Jan 10 Jan 3 Jan 17 Daily infections at peak 2.0 million/day 1.7 million/day 2.2 million/day Percentage of population infectious at peak 4.2% (1 in 24) 3.7% (1 in 27) 4.6% (1 in 22)
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%) CURRENT ESTIMATES FOR December 18, 2023 Wastewater Levels (copies/mL) 950 New Daily Cases 1,382,000 % of Population Infectious 2.89% (1 in 35 people) New Daily Long COVID Cases 69,000 to 276,000 4-WEEK FORECAST FOR January 15, 2024 Wastewater Levels (copies/mL) 1,363 (44% higher) New Daily Cases 1,984,000 % of Population Infectious 4.15% (1 in 24 people) New Daily Long COVID Cases 99,000 to 397,000
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. There is more COVID-19 transmission today than during 90.6% of the pandemic. CURRENT ESTIMATES FOR December 18, 2023 Wastewater Levels (copies/mL) 950 New Daily Cases 1,382,000 % of Population Infectious 2.89% (1 in 35 people) New Daily Long COVID Cases 69,000 to 276,000 WEEKLY ESTIMATES FOR December 18, 2023 New Weekly Cases 9,700,000 New Weekly Long COVID Cases 484,000 to 1,935,000 2023 CUMULATIVE ESTIMATES AS OF December 18, 2023 Total 2023 Cases To Date 230,778,870 Total 2023 Long COVID Cases To Date 11,539,000 to 46,156,000
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.

Experts agree. You do not want Long COVID.


WEEKLY ESTIMATES FOR December 18, 2023 New Weekly Cases 9,700,000 New Weekly Long COVID Cases 484,000 to 1,935,000
6/
 These are the chances of interacting with someone infectious on Dec 18, based on the total number of social contacts.

Interact with 10 people = 25% chance someone is infectious. This helps explain why so many kids are getting sick at school lately. Number of People | Chances Anyone is Infectious 1 2.9% 2 5.7% 3 8.4% 4 11.1% 5 13.6% 6 16.1% 7 18.6% 8 20.9% 9 23.2% 10 25.4% 15 35.6% 20 44.4% 25 52.0% 30 58.5% 35 64.2% 40 69.1% 50 76.9% 75 88.9% 100 94.7% 150 98.8% 200 99.7% 300 >99.9% 400 >99.9% 500 >99.9%
7/
 A small Christmas gathering of 7-10 people means a 25% chance someone has infectious COVID

20 people = 50% chance

Flight or restaurant with 100 people = 97% chance someone has infectious COVID Number of People | Chances Anyone is Infectious 1 3.4% 2 6.7% 3 9.9% 4 13.0% 5 16.0% 6 18.9% 7 21.7% 8 24.4% 9 27.0% 10 29.5% 15 40.8% 20 50.3% 25 58.2% 30 64.9% 35 70.5% 40 75.3% 50 82.6% 75 92.7% 100 97.0% 150 99.5% 200 99.9% 300 >99.9% 400 >99.9% 500 >99.9%
8/
 At a small New Year's Eve party or lunch the next day with 10 people, there's a 1 in 3 chance someone has infectious COVID.

In early January, we will approach peak transmission. Number of People | Chances Anyone is Infectious 1 3.9% 2 7.7% 3 11.3% 4 14.7% 5 18.1% 6 21.2% 7 24.3% 8 27.3% 9 30.1% 10 32.8% 15 45.0% 20 54.9% 25 63.0% 30 69.7% 35 75.2% 40 79.7% 50 86.3% 75 95.0% 100 98.1% 150 99.7% 200 >99.9% 300 >99.9% 400 >99.9% 500 >99.9%
9/
 Here's the full PMC Dashboard for Dec 18 to Jan 15.

You can read the full report here:

Thank you for your continued questions, suggestions, gratitude, and sharing across other platforms. pmc19.com/data/
than during 90.6% of the pandemic. CURRENT ESTIMATES FOR December 18, 2023 Wastewater Levels (copies/mL) 950 New Daily Cases 1,382,000 % of Population Infectious 2.89% (1 in 35 people) New Daily Long COVID Cases 69,000 to 276,000 WEEKLY ESTIMATES FOR December 18, 2023 New Weekly Cases 9,700,000 New Weekly Long COVID Cases 484,000 to 1,935,000 2023 CUMULATIVE ESTIMATES AS OF December 18, 2023 Total 2023 Cases To Date 230,778,870 Total 2023 Long COVID Cases To Date 11,539,000 to 46,156,000 4-WEEK FORECAST FOR January 15, 2024 Wastewater Levels (copies/m...
10/
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More from @michael_hoerger

Mike Hoerger, PhD MSCR MBA Profile picture
Oct 21
PMC COVlD Update, Oct 20, 2025 (U.S.)

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 Graph of the 11 waves, shows current lull.
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 Infections Proportion Actively Infectious 1 in 191 (0.5%) New Daily Infections 255,000 Infections the Past Week 1,800,000 Infections in 2025 191,000,000 Cumulative Infections per Person 4.69 Long COVID Long COVID Cases Resulting 13,000 to 51,000 from New Daily Infections Long COVID Cases Resulting 90,000 to 360,000 from New Weekly Infections Excess Deaths Excess Deaths Resulting 70 to 120 from New Daily Infections Excess Deaths ...
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.

🧵3/11 Number of People Chances Anyone is Infectious 1 0.5% 2 1.0% 3 1.6% 4 2.1% 5 2.6% 10 5.1% 15 7.6% 20 10.0% 25 12.3% 30 14.5% 50 23.1% 75 32.5% 100 40.8% 200 64.9% 300 79.2%
Read 11 tweets
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

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