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%
3/
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.
4/
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%
5/
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
6/
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	 ...
8/
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More from @michael_hoerger

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
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
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
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
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
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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