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

Dec 15
PMC COVID Update, Dec 15, 2025 (U.S.)

In the latest CDC data, 15 states have moderate to very high transmission.
🔹1 in 63 estimated actively infectious nationally, rising fastest in the Midwest & Northeast
🔹Very High: Indiana
🔹High: Nebraska, Vermont, Connecticut

🧵1/9 Heat map from CDC data and PMC estimates of 1 in 63 actively infectious and >700,000 new daily infections, based on wastewater derived estimates using models noted in the Technical Appendix at the website listed in the image.
PMC estimates 1 in 26 people in Indiana are infectious and 1 in 39 in Connecticut.

MI, MS, and AR may have higher levels than shown due to poor reporting.

States AL to MS shown.

🧵2/9 Alabama	Moderate	1 in 41 (2.4%) Alaska	Very Low	1 in 220 (0.5%) Arizona	Very Low	1 in 118 (0.8%) Arkansas	Low*	1 in 68 (1.5%) California	Very Low	1 in 382 (0.3%) Colorado	Very Low*	1 in 230 (0.4%) Connecticut	High	1 in 39 (2.6%) Delaware	Very Low	1 in 222 (0.4%) District of Columbia	Very Low	1 in 131 (0.8%) Florida	Very Low	1 in 320 (0.3%) Georgia	Very Low	1 in 275 (0.4%) Guam	Very Low	1 in 426 (0.2%) Hawaii	Very Low	1 in 670 (0.1%) Idaho	Very Low	1 in 108 (0.9%) Illinois	Low	1 in 71 (1.4%) Indiana	Very High	1 in 26 (3.8%) Iowa	Low	1 in 76 (1.3%) Kansas	Moderate	1 in 62 (1.6%) Kentucky	Mode...
PMC estimates 1 in 39 are infectious in both Nebraska and Vermont (coincidence, not typo).

Very few NY sites are reporting to the CDC, so use the NYS website there instead.

States MO to WY shown.

🧵3/9 Missouri	Low	1 in 80 (1.2%) Montana	Very Low	1 in 135 (0.7%) Nebraska	High	1 in 39 (2.5%) Nevada	Very Low	1 in 225 (0.4%) New Hampshire	Moderate	1 in 47 (2.1%) New Jersey	Very Low	1 in 200 (0.5%) New Mexico	Low	1 in 75 (1.3%) New York	Moderate*	1 in 49 (2.1%) North Carolina	Very Low	1 in 226 (0.4%) North Dakota	Low*	1 in 85 (1.2%) Ohio	Moderate	1 in 62 (1.6%) Oklahoma	Moderate*	1 in 47 (2.1%) Oregon	Low	1 in 89 (1.1%) Pennsylvania	Moderate	1 in 55 (1.8%) Rhode Island	Low	1 in 70 (1.4%) South Carolina	Very Low	1 in 215 (0.5%) South Dakota	Low	1 in 86 (1.2%) Tennessee	Moderate	1 in 60 (1.7%) ...
Read 9 tweets
Dec 8
PMC COVlD Update, Dec 8, 2025 (U.S.)
1/9

🔥🔥🔥Very High: Arizona (Yuma)
🔥🔥High: Indiana and Vermont
🔥Moderate: Nebraska and Alabama

Data only go through late November, and levels often increase following Thanksgiving. Heat map and PMC estimates of transmission (1 in 102 actively infectious).
PMC COVlD Update, Dec 8, 2025 (U.S.)
2/9

State-by-state estimates (part 1). Arizona is Very High, but sites were only online in the Yuma area. Indiana remains high.

MI and MS have considerable uncertainty.

DC is exceptionally low. Alabama	Moderate	1 in 47 (2.1%) Alaska	Very Low	1 in 220 (0.5%) Arizona	Very High*	1 in 18 (5.7%) Arkansas	Very Low*	1 in 138 (0.7%) California	Very Low	1 in 574 (0.2%) Colorado	Low	1 in 76 (1.3%) Connecticut	Low	1 in 91 (1.1%) Delaware	Very Low	1 in 307 (0.3%) District of Columbia	Very Low	1 in 5,777 (0.0%) Florida	Very Low	1 in 494 (0.2%) Georgia	Very Low	1 in 180 (0.6%) Guam	Very Low	1 in 289 (0.3%) Hawaii	Very Low	1 in 704 (0.1%) Idaho	Very Low	1 in 121 (0.8%) Illinois	Very Low	1 in 112 (0.9%) Indiana	High	1 in 30 (3.3%) Iowa	Low	1 in 83 (1.2%) Kansas	Low	1 in 105 (1.0%) Kentucky	Very L...
PMC COVlD Update, Dec 8, 2025 (U.S.)
3/9

State-by-state estimates (part 1). Vermont remains High. Tennessee has fallen rapidly from a quick surge.

Data quality are low in NY. Missouri	Very Low	1 in 176 (0.6%) Montana	Very Low	1 in 136 (0.7%) Nebraska	Moderate	1 in 45 (2.2%) Nevada	Very Low	1 in 372 (0.3%) New Hampshire	Very Low	1 in 109 (0.9%) New Jersey	Very Low	1 in 217 (0.5%) New Mexico	Very Low	1 in 118 (0.8%) New York	Very Low*	1 in 260 (0.4%) North Carolina	Very Low	1 in 233 (0.4%) North Dakota	Low*	1 in 101 (1.0%) Ohio	Low	1 in 70 (1.4%) Oklahoma	Low*	1 in 68 (1.5%) Oregon	Very Low	1 in 150 (0.7%) Pennsylvania	Low	1 in 89 (1.1%) Rhode Island	Very Low	1 in 187 (0.5%) South Carolina	Very Low	1 in 144 (0.7%) South Dakota	Low	1 in 82 (1.2%) Tennessee	Very Low...
Read 9 tweets
Nov 23
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵1/10

With CDC data operational again, the transmission map is back. The data are always a week old, so transmission is likely worse than depicted.

We estimate 1 in 116 people actively infectious and 422,000 new daily infections. Heat map: Indiana and Arkansas with "moderate" transmission. All others, "low" or "very low" (CDC categories).
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵2/10

State level estimates are back. Note, the CDC changed their data processing approach in August, which tends to downplay transmission.

Does 1 in 45 in Indiana seem "moderate"?

Levels in MI may be mod/high (poor reporting). Alabama	Very Low	1 in 153 (0.7%) Alaska	Very Low	1 in 272 (0.4%) Arizona	Low	1 in 63 (1.6%) Arkansas	Moderate*	1 in 47 (2.1%) California	Very Low	1 in 365 (0.3%) Colorado	Very Low	1 in 137 (0.7%) Connecticut	Low	1 in 103 (1.0%) Delaware	Very Low	1 in 262 (0.4%) District of Columbia	Very Low	1 in 418 (0.2%) Florida	Very Low	1 in 408 (0.2%) Georgia	Very Low	1 in 292 (0.3%) Guam	Very Low	1 in 887 (0.1%) Hawaii	Very Low	1 in 426 (0.2%) Idaho	Very Low	1 in 116 (0.9%) Illinois	Very Low	1 in 116 (0.9%) Indiana	Moderate	1 in 45 (2.2%) Iowa	Very Low	1 in 108 (0.9%) Kansas	Very Low	1 in 109 (0.9%) Ke...
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵3/10

State-level estimates (continued).

Current levels may be much higher than noted here. Note that CDC data are always at least a week old. The 2nd half of November is a time period historically of accelerating transmission. Missouri	Very Low	1 in 202 (0.5%) Montana	Very Low*	1 in 114 (0.9%) Nebraska	Low	1 in 95 (1.1%) Nevada	Very Low	1 in 228 (0.4%) New Hampshire	Low	1 in 78 (1.3%) New Jersey	Very Low	1 in 192 (0.5%) New Mexico	Very Low	1 in 151 (0.7%) New York	Very Low	1 in 212 (0.5%) North Carolina	Very Low	1 in 212 (0.5%) North Dakota	Very Low*	1 in 116 (0.9%) Ohio	Very Low	1 in 109 (0.9%) Oklahoma	Low*	1 in 70 (1.4%) Oregon	Very Low	1 in 194 (0.5%) Pennsylvania	Very Low	1 in 111 (0.9%) Rhode Island	Very Low	1 in 167 (0.6%) South Carolina	Very Low	1 in 112 (0.9%) South Dakota	Very Low	1 in 127 (0.8%) Tennes...
Read 10 tweets
Nov 8
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
1/6🧵

🔹301,000 new daily infections based on wastewater-derived models
🔹1 in 162 people (0.6%) actively infectious
🔹Levels the past 2 months corrected upward by Biobot
🔹"Lull point" estimated between Nov 5-21. Rising soon. Year over year graph, emphasizing that levels commonly rise in mid November
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
2/6🧵

The central estimate of the forecast suggests we will surpass 500,000 new daily infections on Nov 22.

There's a 25% chance of a prolonged lull like last year. More likely, we are in wave territory by the end of the month. Close up of the most recent 3 months of data, including the forecast.
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
3/6🧵

We are presently in a lull between the 11th and 12th wave. Now is the time to get boosted and stock up on N95 masks, tests, and air purifier filters.

Do a DIY fit test if you've been putting it off. Graph of the 11 waves
Read 6 tweets
Nov 3
PMC COVlD Update, Nov 3, 2025 (U.S.)
1 of 9 🧵

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. Year-over-year graph
PMC COVlD Update, Nov 3, 2025 (U.S.)
2 of 9 🧵

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. Forecasted transmission
PMC COVlD Update, Nov 3, 2025 (U.S.)
3 of 9 🧵

Expect rising misinformation/disinformation as transmission heats up:
🔹Abuse of community notes, particularly surrounding wastewater methodology
🔹Paid bot army attacks, especially about boosters & masks
Read 9 tweets
Oct 28
PMC COVlD Update, Oct 27, 2025 (US)

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.

1/9 🧵 year over year graph
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 🧵 Graph of recent transmission and current forecast
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.

3/9 🧵 Graph of the 11 waves of the pandemic
Read 9 tweets

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