Mike Hoerger, PhD MSCR MBA Profile picture
Dec 25, 2023 8 tweets 5 min read Read on X
1/
PMC COVID-19 Tracker, Dec 25, 2023 (U.S.)

At peak surge, we will have 2 million U.S. #COVID infections/day.

Nearly 1 in 3 Americans will get infected during the peak 2 months of this winter surge. That’s 105 million infections & >5 million resulting #LongCOVID cases.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	2.1 million/day Percentage of population infectious at peak	4.1% (1 in 24)		3.7% (1 in 27)	4.4% (1 in 23)  CURRENT ESTIMATES FOR December 25, 2023 Wastewater Levels (copies/mL) 1137 New Daily Cases 1,655,000 % of Population Infectious 3.46% (1 in 29 people) New Daily Long COVID Cases  83,000 to 331,000  4-WEEK FORECAST FOR January 22, 2024 Wastewater Levels (copies/mL) 1,293 (14% higher) New Daily Cases 1,8...
2/
Today on Christmas, 3.5% of the U.S. population (1 in 29) is actively infectious with #COVID & rising toward a Jan 10 peak.

COVID transmission is higher than during 94.7% of the pandemic. There's a 50% chance of a COVID exposure if interacting with 20 people today. There is more COVID-19 transmission today        than during 94.7% of the pandemic.  Number of People  |  Chances Anyone is Infectious	 1	3.5% 2	6.8% 3	10.0% 4	13.2% 5	16.2% 6	19.1% 7	21.9% 8	24.6% 9	27.2% 10	29.7% 15	41.1% 20	50.6% 25	58.6% 30	65.3% 35	70.9% 40	75.6% 50	82.8% 75	92.9% 100	97.1% 150	99.5% 200	99.9% 300	>99.9% 400	>99.9% 500	>99.9%
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We posted our first “Christmas Risk” table on October 30, and as you can see, it performed exceedingly well.

These tables should lend confidence in the PMC dashboard, and raise concern about public health leadership and the news media.

Being able to accurately predict within a few percentage points the probability of infectiousness in a room of 20 people, for example, 8 weeks out is very helpful for planning. Moreover, many would estimate *today* that the risk in a room of 20 people is <1 percentage point. We’re talking about potentially magnitudes of difference in risk estimation, and this was highly predictable long ago. It’s not something unanticipated due to a new oddly-behaving sub-variant (there will always be a new sub-variant this time of year when no mitigation) or high rates of air travel (also unsurprising). It was highly predictable, and public health officials should not be given an out. The media will try to frame this as an unanticipated surge, and it simply was not, according to those who know how to forecast.

The formal PMC forecast keeps to 4 weeks, but sometimes a more speculative long-term estimate can help with planning, especially surrounding booking travel plans. People might want to take a wait-and-see approach to booking, purchase travel insurance, or cancel entirely. We characterized the table with appropriate caution, and hopefully it was helpful.

Putting out these forecasts requires putting one’s professional reputation as a scientist on the line. It’s very easy for anonymous and fake-name accounts to make speculative forecasts. The information we provide tends to be highly conservative within a much broader set of analyses, sensitivity analyses, and scenarios considered. Know that we are very cautious about what information we share, post considerable detail on the underlying methodology and assumptions in the online report, and carefully describe how estimates may be more precise or more speculative at times. A published peer-reviewed article will ultimately account for the strengths and limitations in the accuracy of the model.Comparison of the "Christmas Risk" table posted on October 30th versus today. The 8-week predictions were highly accurate. In October, we predicted that interacting with 20 people on Christmas Day would lead to a 47% chance of exposure. Today, we estimate that same risk as 50.6%, a negligible difference and vastly at odds with public expectations concerning risk.
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Christmas infections will seed New Year’s Eve/Day infections, leading to a peak around the 10th.

Around New Year’s, interacting with 15-20 people means a 50% chance of a COVID exposure. In a restaurant or plane, the risk jumps to >98%. Number of People  |  Chances Anyone is Infectious	 1	3.9% 2	7.6% 3	11.2% 4	14.6% 5	17.9% 6	21.1% 7	24.1% 8	27.1% 9	29.9% 10	32.6% 15	44.7% 20	54.6% 25	62.7% 30	69.4% 35	74.9% 40	79.4% 50	86.1% 75	94.8% 100	98.1% 150	99.7% 200	>99.9% 300	>99.9% 400	>99.9% 500	>99.9%
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Zooming out to the full pandemic, we are in the 8th U.S. COVID wave & 2nd biggest all-time.

That assumes no major wastewater corrections.

We've surpassed the 1st wave, winter of 2020-21, Delta, & 2023 summer wave. Claims that “COVID is over” are harmful misinformation. There is more COVID-19 transmission today        than during 94.7% of the pandemic.  CURRENT ESTIMATES FOR December 25, 2023 Wastewater Levels (copies/mL) 1137 New Daily Cases 1,655,000 % of Population Infectious 3.46% (1 in 29 people) New Daily Long COVID Cases 83,000 to 331,000  WEEKLY ESTIMATES FOR December 25, 2023 New Weekly Cases 11,600,000 New Weekly Long COVID Cases 579,000 to 2,317,000  2023 CUMULATIVE ESTIMATES AS OF December 25, 2023 Total 2023 Cases To Date 241,674,380 Total 2023 Long COVID Cases To Date 12,084,000 to 48,335,000
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Hospitals & clinicians should require universal masking. Public health officials should warn of the surge & recommend multi-layered mitigation.

Anything less is grounded in politics, short-term revenue, or defensiveness against COVID anxiety.
7/
Here's the full PMC Dashboard for Dec 25 to Jan 22.

You can read the full report here:

Thank you for your continued questions, suggestions, gratitude, infographics, videos, & sharing across other platforms. pmc19.com/data/
There is more COVID-19 transmission today	        than during 94.7% of the pandemic.	 	 CURRENT ESTIMATES FOR	 December 25, 2023	 Wastewater Levels (copies/mL)	 1137	 New Daily Cases	 1,655,000	 % of Population Infectious	 3.46% (1 in 29 people)	 New Daily Long COVID Cases	 83,000 to 331,000	 	 WEEKLY ESTIMATES FOR	 December 25, 2023	 New Weekly Cases	 11,600,000	 New Weekly Long COVID Cases	 579,000 to 2,317,000	 	 2023 CUMULATIVE ESTIMATES AS OF	 December 25, 2023	 Total 2023 Cases To Date	 241,674,380	 Total 2023 Long COVID Cases To Date	 12,084,000 to 48,335,000	 	 4-WEEK FORECAST FOR	 ...
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If you're using the PMC dashboard to help others, please post your success stories, infographics, photos, videos, and more in the following Tweet.

We will make awards at the end of the year. The examples are inspirational.

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More from @michael_hoerger

Jan 25
During this 12th COVlD wave, the CDC reports 1-in-3 states have "High" or "Very High" levels.

PMC estimates the proportion of residents actively infectious (prevalence):
◾️USA: 1 in 67
◾️IA: 1 in 27
◾️MI: 1 in 25
◾️IN & CT: 1 in 23
◾️ME: 1 in 21
◾️OK & SD: 1 in 17

🧵1/ Heat map using CDC data. National PMC prevalence estimate noted; estimated incidence of 732,000 new daily infections.
On average, Americans have have 5.0 cumulative SARS-CoV-2 infections.

This week's infections are expected to result in 1/4 to 1 million new #LongCOVID conditions and ≈2,000 excess deaths.
🧵2/ Column 1: Table of state-level prevalence estimates. Highest estimates noted in the thread text.  Column 2:  Proportion Actively Infectious										1 in 67 (1.5%) New Daily Infections										 732,000  Infections the Past Week										 5,220,000  Infections in 2026										 24,000,000  Cumulative Infections per Person										 5.04  										 Long COVID										 Long COVID Cases Resulting								37,000 to 146,000		   from New Daily Infections										 Long COVID Cases Resulting								261,000 to 1,040,000		   from New Weekly Infections										 										 Excess Deaths										 Ex...
The wave peak is now estimated >10% higher than last week at 1.2 million new daily infections, nearly double the Delta wave.

We expect sustained high transmission (≈600,000 to 750,000 new daily infections) the next few weeks as COVlD circulates through schools/families.
🧵3/ Fig 1: Graph of 12 waves  Fig 2: "Barometer" showing above average transmission  Fig 3: Year-over-year graph, which informs the analytic forecast  Fig 4: Forecast described in post
Read 4 tweets
Jan 17
Based on today's CDC & Biobot data, we estimate the following for the week of Jan 19:

🔸1 in 52 people in the U.S. actively infectious
🔸25% chance of exposure in a room of 15 ppl
🔸Nearly 1 million new daily infections
🔸5 cumulative infections per person all-time (avg)
🧵1/5 Heat map from CDC data with PMC estimates. Description of "Very High" states in next post
Transmission estimates have been marginally corrected upward.

11 states have Very High COVlD levels:

🔸PA: 1 in 25 estimated actively infectious
🔸MI: 1 in 23
🔸OH & KY: 1 in 22
🔸SD: 1 in 20
🔸NE & IA: 1 in 18
🔸IL & ME: 1 in 17
🔸IN: 1 in 16
🔸WV: 1 in 11
🧵2/5 Proportion Actively Infectious										1 in 52 (1.9%) New Daily Infections										 941,000  Infections the Past Week										 6,020,000  Infections in 2026										 18,000,000  Cumulative Infections per Person										 5.01  										 Long COVID										 Long COVID Cases Resulting								47,000 to 188,000		   from New Daily Infections										 Long COVID Cases Resulting								301,000 to 1,200,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									270 to 450	   from New Daily Infections										 Excess Deaths Resulting 				...
We're in the middle of a 12th COVlD wave.

The peak has likely passed, but with students headed back to school, transmission is expected to remain high for at least the next several weeks.

🧵3/5 1) Graph of 12 waves 2) Barometer showing above-average transmission 3) Year over year graph 4) Forecast for transmission to decline and then percolate at high levels
Read 5 tweets
Jan 10
The size of the winter COVlD wave has been revised upward as post-holiday data come in.

We estimated 1 in 55 people in the U.S. are actively infectious.

🔥WV: 1 in 14
🔥IN: 1 in 15
🔥MI & OH: 1 in 21
🔥MO: 1 in 22
🔥CT: 1 in 24
🔥KS: 1 in 25
🔥MA & IL: 1 in 27

Quick 🧵 1/4 Heat map and PMC estimates, 1 in 55 infectious and 892,000 new daily infections for Jan 12.  We expedited the report to release it two days early.
Nationally, we are seeing an estimated 892,000 new daily SARS-CoV-2 infections, meaning a 1 in 4 chance of exposure in a room of 15 people. Risk varies considerably by state.

We are approaching an average of 5 infections per person since pandemic onset.
🧵 2/4 Alabama	Moderate Alaska	Very Low Arizona	Very Low Arkansas	High* California	Very Low Colorado	Low Connecticut	Very High Delaware	Moderate District of Columbia	Very Low Florida	Very Low Georgia	Very Low Guam	Very Low Hawaii	Very Low Idaho	Very Low Illinois	Very High Indiana	Very High Iowa	High Kansas	Very High Kentucky	Moderate Louisiana	Moderate Maine	High Maryland	High Massachusetts	Very High Michigan	Very High* Minnesota	Moderate Mississippi	Low* Missouri	Very High* Montana	High Nebraska	High Nevada	Very Low New Hampshire	Moderate New Jersey	Low New Mexico	Moderate New York	High* North Ca...
We are in the 12th COVlD wave of the U.S.

Current transmission is higher than 68% of all days since the pandemic onset in 2020.
🧵 3/4 12 waves of COVlD  Pandemic barometer: Higher than 88% of the past 100 days, 73% of the past year, 68% of the entire pandemic.  Year over year graph  Forecast of slowly declining transmission.
Read 4 tweets
Jan 8
You might not have heard, but the northeastern U.S. is in a COVlD surge.

We use wastewater levels to derive estimates of the proportion of people actively infectious in each state (prevalence), e.g., 1 in 24 people in Connecticut.

Let me walk you through it...

🧵1/8 Colors show CDC levels PMC prevalence estimates noted: -Maine 1 in 38 actively infectious with COVlD -New Hampshire 1 in 35 (limited data) -Vermont 1 in 75 -New York 1 in 44 (limited data) -Pennsylvania 1 in 44 -Massachusetts 1 in 36 -Connecticut 1 in 24 -Rhode Island 1 in 41 -New Jersey 1 in 82
Notice that #Connecticut has excellent SARS-CoV-2 wastewater surveillance. It's "Very High" across much of the state, per CDC.

Based on wastewater levels, we estimate 1 in 24 residents are actively infectious w/COVlD. That's a 66% exposure risk in a room of 25 people.

🧵2/8 Colors show CDC levels PMC estimate of prevalence
The CDC reports "Very High" levels in #Massachusetts.

The surveillance is less robust, but we estimate 1 in 26 residents are actively infectious, similar to our estimate in CT where coverage is better.

In a room of 25 people, that's a 62% chance of an exposure.

🧵3/8 Colors show CDC levels PMC prevalence estimates provided
Read 8 tweets
Jan 8
We're in the middle of a 12th COVlD wave in the U.S., with transmission particularly high in the Midwest and Northeast.

The CDC announced this week that COVlD continues to kill more Americans than breast and prostate cancer combined.

Get boosted & #MaskUp 💉💪😷
1/4🧵 Heat map of CDC data with PMC prevalence estimate
Levels are "Moderate" to "Very High" in 26 states.

However, data reporting is slow, and about 1/3 of states have low-quality data this week due to the holidays and illness.

2/4🧵 National estimates: Number of People		Chances Anyone is Infectious			 1				1.5%	 2				3.0%	 3				4.5%	 4				6.0%	 5				7.4%	 10				14.3%	 15				20.7%	 20				26.5%	 25				32.0%	 30				37.0%	 50				53.8%	 75				68.6%	 100				78.6%	 200				95.4%	 300				99.0%
Barometer: Higher transmission than 90 of the past 100 days (perhaps higher still, due to low data reporting quality)
State	CDC Level	Actively Infectious Alabama	Moderate	1 in 48 (2.1%) Alaska	Very Low	1 in 152 (0.7%) Arizona	Very Low	1 in 201 (0.5%) Arkansas	High*	1 in 36 (2.8%) California	Very Low	1 in 484 (0.2%) Colorado	Moderate	1 in 49 (2.0%) Connecticut	Very High	1 in 24 (4.2%) Delaware	Low*	1 in 70 (1.4%) District of Columbia	Very Low	1 in 5,835 (0.0%) Florida	Very Low	1 in 284 (0.4%) Georgia	Low	1 in 90 (1.1%) Guam	Very Low	1 in 687 (0.1%) Hawaii	Very Low	1 in 874 (0.1%) Idaho	Very Low	1 in 169 (0.6%) Illinois	Moderate*	1 in 56 (1.8%) Indiana	High*	1 in 34 (2.9%) Iowa	Moderate	1 in 41 (2.4%) Kansas...
State	CDC Level	Actively Infectious Missouri	Moderate*	1 in 42 (2.4%) Montana	High	1 in 34 (2.9%) Nebraska	Very High	1 in 26 (3.9%) Nevada	Very Low	1 in 138 (0.7%) New Hampshire	High*	1 in 35 (2.9%) New Jersey	Low	1 in 82 (1.2%) New Mexico	Low	1 in 87 (1.2%) New York	Moderate*	1 in 44 (2.3%) North Carolina	Low	1 in 82 (1.2%) North Dakota	High*	1 in 34 (3.0%) Ohio	Very High	1 in 27 (3.7%) Oklahoma	Moderate*	1 in 62 (1.6%) Oregon	Very Low	1 in 170 (0.6%) Pennsylvania	Moderate	1 in 44 (2.3%) Rhode Island	Moderate	1 in 41 (2.4%) South Carolina	Moderate	1 in 54 (1.9%) South Dakota	Very High	1 in...
If like years 1-4 of the pandemic, the winter wave has peaked. If like last year, we could hover near peak levels for a month.

Forecasting quality is low with 1/3 of states having data issues. Hopefully, we'll know a lot more in a few days.

3/4🧵 12 waves
Proportion Actively Infectious										1 in 65 (1.5%) New Daily Infections										 749,000  Infections the Past Week										 5,390,000  Infections in 2026										 3,000,000  Cumulative Infections per Person										 4.88  										 Long COVID										 Long COVID Cases Resulting								37,000 to 150,000		   from New Daily Infections										 Long COVID Cases Resulting								270,000 to 1,080,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									220 to 370	   from New Daily Infections										 Excess Deaths Resulting 					...
year over year graph
forecast
Read 4 tweets
Jan 5
We told you that 109,000-175,000 Americans would died of COVID (excess deaths) in 2025.

Today, the CDC estimates 101,000 deaths/year (flat from Oct 2022 to Sep 2024), and likely higher when considering more nebulous non-acute excess deaths (heart attack 6 months later).
1/5
The CDC estimates are actually higher than I would have guessed, given their methodology, which models estimates based on easily countable factors in healthcare and expert input on multiplier values. It lends credence to the PMC upper bound of excess deaths of 175,000/yr.
2/5
What's troubling is the CDC has annual mortality flat. My expectation based on mortality displacement and Swiss Re data is that it should be declining. If is stays flat, we're running on something like breast+prostate cancer or lung cancer deaths per year in perpetuity.
3/5
Read 6 tweets

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