Mike Hoerger, PhD MSCR MBA Profile picture
Dec 20, 2023 10 tweets 8 min read Read on X
As a clinical health psychologist, I notice that many people are using psychological defense mechanisms to downplay the risk of COVID.

These are my Top 7 examples:

🧵 Top 7 Psychological Defense Mechanisms Used to Downplay COVID
#1 – Denial – Pretending a problem does not exist to provide artificial relief from anxiety.

Examples:

“During COVID” or “During the pandemic” (past tense)

“The pandemic is over”

“Covid is mild”

“It’s gotten milder”

“Covid is now like a cold or the flu”

“Masks don’t work anyway”

“Covid is NOT airborne”

“Pandemic of the unvaccinated”

“Schools are safe”

“Children don’t transmit COVID”

“Covid is mild in young people”

“Summer flu”

“I’m sick but it’s not Covid”

Taking a rapid test only once

Using self-reported case estimates (25x underestimate) rather than wastewater-derived case estimation

Using hospitalization capacity estimates to enact public health precautions (lagging indicator)

Citing mortality estimates rather than excess mortality estimates. Citing excess mortality without adjusting for survivorship bias.This is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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#2 – Projection – When someone takes what they are feeling and attempts to put it on someone else to artificially reduce their own anxiety.

Examples:

“Stop living in fear.” (the attacker is living in fear)

“You can take your mask off.” (they are insecure about being unmasked themselves)

“When are you going to stop masking?”

“You can’t live in fear forever.”This is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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#3 – Displacement – When someone takes their pandemic anxiety and redirects their discomfort toward someone or something else.

Examples:

Angry, seemingly inexplicable outbursts by co-workers, strangers, or family

White affluent people caring less about the pandemic after learning that it disproportionately affects lower-socioeconomic status people of color

Scapegoating based on vaccination status, masking behavior, etc.

“Pandemic of the unvaccinated”

Vax and relax

“How many of them were vaccinated?” (troll comment on Covid deaths or long Covid)

Redirecting anxiety about mitigating a highly-contagious airborne virus by encouraging people to do simple ineffective mitigation like handwashing

“You do you” (complainers are the problem, not Covid)

Telling people to get vaccinated or take other precautions against the flu or RSV but not mentioning Covid

Parents artificially reducing their own anxiety by placing children in poorly mitigated environments

Clinicians artificially reducing their own anxiety by placing patients in poorly mitigated environments

Housework to distract from stress

Peer pressure not to maskThis is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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#4 – Compartmentalization – Holding two conflicting ideas or behaviors, such as caution and incaution, rather than dealing with the anxiety evoked by considering the incautious behaviors more deeply (hypocrisy)

Hospitals and clinicians claim to value health/safety but then don’t require universal precautions

Public health officials claim to value evidence but then give non-evidence based advice (handwashing over masking), obscure or use low-value data over high-quality data (self-reported case counts over wastewater), etc.

Getting a flu vaccine but not a Covid vaccine

Interviewing long Covid experts who recommend masking in indoor public spaces but then going to Applebee’s

Masking in one potentially risky setting (grocery store) but not masking in another similar or more-risky setting (classroom)

Infectious disease conference where people are unmasked

Long Covid and other patient-advocacy meetings where only half the people mask

In-person only EDI events

Not testing because it’s just family

Mask breaksThis is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
#5 – Reaction formation – expressing artificial positive feelings when actually experiencing anxiety

“It’s good I got my infection out of the way before the holidays”

“I had Covid but it was mild”

Anything quoted in Dr. Jonathan Howard’s book, “We Want Them Infected: How the Failed Quest for Herd Immunity Led Doctors to Embrace Anti-Vaccine Movement”

Herd immunity (infections help)

Hybrid immunity (infections help)

“It’s okay because I was recently vaccinated”

“Omicron is milder”

“Textbook virus”

“Building immunity”This is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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#6 – Rationalization – Artificially reducing Covid anxiety through a weak justification.

Examples:

“I didn’t mask but I used nasal spray”

“I don’t need to mask because I was recently vaccinated”

“It finally got me.”

“You’re going to get Covid again and again and again over your life.”

“It’s not Covid because I don’t have a sore throat.”

“It’s not Covid because I took a rapid test 3 days ago.”

“It’s not Covid because I’m vaccinated.”

“Airplanes have excellent ventilation.”

“I’ve had Covid three times. It’s mild.”

“Verily was cheaper.”

“Nobody else is masking.”

“Nobody else is testing.”

“My roommates don’t take any precautions, so there’s no point in me either.”

“I have a large family, so there’s no point in taking precautions.”

Surgical masks (they are actual “procedure masks,” by the way)

Various pseudo-scientific treatments used by the left and right

Handwashing as the primary Covid public health recommendation

Droplet transmission as a thing

Public health guidance that begins with “data shows” (sic)

Risk maps that never turn deep red

5 expired rapid tests

“Masks recommended” instead of universal precautions

“Seasonal”This is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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#7 – Intellectualization – using extensive cognitive arguments to artificially circumvent Covid anxiety

Examples:

Unending threads to justify indoor dining

Data-rich public health dashboards that use low-quality metrics and/or don’t change public health recommendations as risk increases

The entire justification for “off-ramps”

Oster, Wen, Prasad

Schools denying air cleaners because it “could make children anxious”

Schools not rapid testing this surge because it “could make children anxious”

The mental gymnastics underlying the rationales for who can get vaccinated, how frequently, or with what brand

Service workers told not to mask because it could make clients uncomfortable

“What comorbidities did they have?”

“The vulnerable will fall by the wayside”

Musicians and others holding large indoor events

5-day isolation periodsThis is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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Here's a link to the full book, a newer edition than what I own. The information on defense mechanisms begins on textbook page 100.

Please let me know if there's a more accessible alt-text solution that you would prefer so I can do better next time.
isotis.files.wordpress.com/2016/07/mcwill…

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More from @michael_hoerger

Jul 29
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵1/12

PMC estimates 400,000 new daily infections. 1 in 118 people actively infectious.

Weekly stats:
🔹2.8 million infections (>40x reported cases)
🔹>140,000 resulting #LongCOVID cases
🔹>1,000 resulting excess deaths Heat map Very High: Louisiana, Guam High: Hawai'i, Florida
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵2/12

Please excuse any typos and delays. Any time Mimal's boot turns deep red, we're doing local outreach in addition to dashboard work, etc.

If you don't know Mimal yet, you won't be able to unsee them.
es.wikipedia.org/wiki/MIMALDeep red boot = Louisiana
Minnesota (M), Iowa (I), Missouri (M), Arkansas (A), Louisiana (L) = Mimal  Louisiana is the boot.   Sometimes depicted with Kentucky fried chicken on a Tennessee pan.
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵3/12

It's HOT COVID SUMMER in the Deep South. No geographic/political prejudices, see next.

Covid is burning through Guam, Louisiana, Florida, and Texas (underestimate due to sites down). Louisiana: 1 in 32, Very High (CDC)
Texas: 1 in 98, Moderate (underestimate, CDC)
Guam: 1 in 25, Very High (CDC)
Florida: 1 in 59, High (CDC)
Read 12 tweets
Jul 25
U.S. CDC numbers just released. Good news (for those not in Louisiana). "Only" a 5% national increase.

2025 has closely tracked with summer 2023 transmission. A 12-13% increase would have been expected based on those numbers. That said... Up: Midwest, Northeast Down: West, South
real-time data have been prone to retroactive corrections. This is frustrating, of course, because it leaves people making decisions based on data that are only of good quality when 2 weeks old.

If we saw a 12% increase this week, I'd say look at 2023 for a glimpse...
at the future. Instead, I would consider these plausible scenarios:
🔹Wave still similar to 2023
🔹Later wave with schools more implicated
🔹Something temporarily much better

Of course, temporarily better often means...
Read 6 tweets
Jul 21
1. PMC COVlD Dashboard, July 21, 2025 (U.S.)

COVlD is surging in 7 states, according to the CDC.
🔹Hawai'i (Very High)
🔹California (High)
🔹Nevada (High)
🔹Texas (High)
🔹Louisiana (High)
🔹Florida (High)
🔹South Carolina (High) Heat map, summarized in post
2. PMC COVlD Dashboard, July 21, 2025 (U.S.)

Western surge:
🔹California: 1 in 63 actively infectious, much higher in LA & Bay areas
🔹Hawai'i: 1 in 35 actively infectious
🔹Nevada: 1 in 63 actively infectious

These are wastewater derived estimates, not from individual tests CA map with stat summarized in post
NV  map with stat summarized in post
HI  map with stat summarized in post
3. PMC COVlD Dashboard, July 21, 2025 (U.S.)

Southern surge:

🔹Texas: 1 in 56
🔹Louisiana (New Orleans): 1 in 65
🔹Florida: 1 in 66
🔹South Carolina: 1 in 71

Again, wastewater estimates (wise indicator), not individual testing (low-quality data). SC map and stat noted in post
LA map and stat noted in post
FL map and stat noted in post
TX map and stat noted in post
Read 12 tweets
Jul 15
1) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

We estimate 1 in 148 Americans are actively infectious. This equates to 2.3 million infections/week, expected to result in >100,000 new #LongCOVID conditions & >800 deaths.

A room of 100 people is a coin toss of an exposure. Figure shows each wave of the pandemic.   Tables: Current Levels for Jul 14, 2025	 % of the Population Infectious	 0.7% (1 in 148)	 New Daily Infections	 324000	 New Weekly Infections	 2268000	 Resulting Weekly Long COVID Cases	 113,000 to 454,000	 Resulting Weekly Excess Deaths	 800 to 1,300	 	 Monthly Forecast	 Average % of the Population Infectious	 1.3% (1 in 80)	 Average New Daily Infections	 598766.6667	 New Infections During the Next Month	 17963000	 Resulting Monthly Long COVID Cases	 898,000 to 3,593,000	 Resulting Monthly Excess Deaths	 6,400 to 10,700	 	 Running Totals	 Infection...
2) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

Transmission (red) is closely tracking the path of 2 years ago (yellow). However, the incoming data are spotty. >20% of CDC states have limited/no data, & Biobot hasn't reported in weeks.

Could be MUCH worse or slightly better. Graph of year over year transmission. The current year (red) is tracking the path of two years ago (yellow) extremely closely. Two years ago, the peak was around September 1, at about 1 million daily estimated infections, and significantly higher than the Delta wave (blue).
3) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

Our model formalizes the mathematical assumptions in those predictions. If transmission follows what we know in terms of how waves grow or slow generally and historical patterns, this is what we'd expect.

The spottiness of the current real-time data reduce precision substantially. Retroactive corrections can make the forecast jump around from better to worse from one week to the next. Expect the worst. Hope for the best.Graph shows national transmission expected to increase the next several weeks.
Read 11 tweets
Jul 2
🌍Want to track COVID transmission accurately worldwide?

This PMC thread walks you through leading dashboards with information more up to date than WHO & EU directories.

🧵 1/ World map, countries with high-quality up-to-date surveillance systems shown in blue.
The Pandemic Mitigation Collaborative (PMC) Dashboard provides weekly COVID updates for the U.S., using wastewater surveillance derived case estimation models and analytic forecasting.

We have added a list of international dashboards:
🧵 2/
pmc19.com/data/index.php…Australia: NSW Health Australia Department of Health, Western Australia Austria: Federal Government of Austria City of Vienna - Regional Coron-A Consortium Austria Czech Republic: State Health Institute Czech Republic Belgium: Belgian Institute for Health Canada: Government of Canada Andrew Young's Canada Visualization C19 Resources Canada * World Health Network (WHN) Canada **
Denmark: Statens Serum Institut Denmark Europe (multi-national): EU Wastewater Observatory Finland: National Institute for Health and Welfare Finland WHN Finland ** France: French Republic Data Airborne Risk Reduction Association (ARRA) France Zan Armstrong's France Visualization COVID Weather App France (Android, IOS, or Web) Thomas Delattre's France Visualization Germany: Infection Radar Germany Bay-VOC Bavaria Region Berlin Waterworks WHN Germany **
Hong Kong: Centre for Health Protection, Hong Kong Hungary: National Center for Public Health and Pharmacy of Hungary India: Pune Knowledge Cluster of India Gujarat Biotechnology Research Centre of India Ireland: Health Protection Surveillance Centre Ireland Japan: Japan Institute for Health Security Latvia: Institute of Food Safety, Animal Health and Environment Latvia Lithuania: National Public Health Centre of Luthuania Luxembourg: Microbs Luxembourg Netherlands: National Institute for Public Health and the Environment Netherlands WHN Netherlands ** New Zealand: New Zealand Institute for...
Slovenia: National Institute of Public Health Slovenia Spain: Government of Catalonia - Regional South Africa: National Institute for Communicable Diseases of South Africa South Korea: Korea Disease Control and Prevention Agency Sweden: Pathogens Sweden Switzerland: Swiss Confederation Federal Office of Public Health ETH Zurich Switzerland WISE Dashboard U.K.: Public Health Scotland Buckinghamshire Disability Service (BuDS) U.K.  *See the numbers 1-21 along the lower left. Click on 3-6 for national and regional data. ** Click on the dropdown menu. May need to try a different web browser.
Our international directory includes official government dashboards & those developed by citizen scientists.

We exclude countries that have stopped reporting in the past 2-12 months even if on EU or WHO lists. We also exclude low-quality data from opt-in testing programs.
🧵 3/
Read 43 tweets
Jun 24
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

🔥Biggest uptick since Jan
🔥1 in 167 actively infectious
🔥>2 million weekly infections
🔥700-1,200 resulting excess deaths from weekly infections

Track transmission closer to home w/our new state & international resources 👇

🧵1/6
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

🔹With >90% probability, we have entered the 11th COVlD wave.
🔹In a room of 50 people, there is already a 1 in 4 chance of an exposure.
🔹We expect nearly 15 million infections in the next month, and rising.

🧵2/6Current Levels for Jun 23, 2025	 % of the Population Infectious	 0.6% (1 in 167)	 New Daily Infections	 287000	 New Weekly Infections	 2009000	 Resulting Weekly Long COVID Cases	 100,000 to 402,000	 Resulting Weekly Excess Deaths	 700 to 1,200	 	 Monthly Forecast	 Average % of the Population Infectious	 1.0% (1 in 97)	 Average New Daily Infections	 493300	 New Infections During the Next Month	 14799000	 Resulting Monthly Long COVID Cases	 740,000 to 2,960,000	 Resulting Monthly Excess Deaths	 5,300 to 8,800	 	 Running Totals	 Infections Nationwide in 2025	 74869000	 Average Number of Infect...
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

We continue to expect transmission to break 500,000 daily infections in the U.S. around July 9th.

This is the same prediction as last week, as the forecast was dead on. Yet, there is considerably uncertainty around this timing.

🧵3/6Longitudinal transmission, past 12 months and 1-month forecast
Read 6 tweets

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