Mike Hoerger, PhD MSCR MBA Profile picture
Jan 9, 2024 10 tweets 7 min read Read on X
1/
PMC COVID-19 Forecast, Jan 8, 2024 (U.S.)

We're peaking at >2 million infections/day.
🔹1 in 23 people are actively infectious today
🔹1 in 3 people in the U.S. will be infected during the peak two months
🔹2nd biggest U.S. surge all-time

#MaskUp #VaxUpU.S. Winter 2023-24 COVID Surge - The Peak				 	Best Estimate		Range	 Rank among COVID waves	2nd		2nd	2nd Date of peak	Jan 5		Jan 3	Jan 10 Daily infections at peak	2.07 million/day		2.03 million/day	2.22 million/day Percentage of population infectious at peak	4.34% (1 in 23)		4.26% (1 in 23)	4.64% (1 in 22)  CURRENT ESTIMATES FOR January 8, 2024 Wastewater Levels (copies/mL) 1413 New Daily Cases 2,056,000 % of Population Infectious 4.3% (1 in 23 people) New Daily Long COVID Cases  103,000 to 411,000   4-WEEK FORECAST FOR February 5, 2024 Wastewater Levels (copies/mL) 1,096 (-22% lower) New ...
2/
Before diving into the #Covid forecast, know that YOU can make a difference!

We will soon apply for a large research grant to help people with #cancer across the U.S. reduce their risk of negative Covid outcomes.

Learn more:


#CovidCancer tulane.co1.qualtrics.com/jfe/form/SV_3C…
Announcement - 2024 Pandemic Research Grant Submission: Calling All Scientists, Clinicians, Patients, and Other Stakeholders!    We are preparing a grant application for a research project aimed at helping U.S. adults with cancer to avoid COVID infections. A letter of intent is due shortly, and the grant will get submitted in May. We are seeking a team of scientists, clinicians, patients, and other stakeholders passionate about COVID mitigation who may want to learn more about and potentially get involved with this project. Please help!  The project builds on our ongoing pilot projects fund...
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In the U.S. Covid #surge, it's not just the peak, it's the width of the mountain.

This is the 2nd highest peak all-time, but it's also brutally long. 1 in 3 people in the U.S. will get infected during the highest two months of transmission. 43% will get infected in the highest 3 months of transmission. Forecasted dates noted.

Those 142 million infections would conservatively translate into an eventual 7 million clinically significant #LongCovid cases.

Transmission will drop considerably from early February through late March. On February 13, 2.9% of the population will be actively infectious, falling to 2.1% by February 24, 1% by mid-March, and bottoming out around 0.7% in late March. These very long-range projections are more historical medians rather than precise forecasts.U.S. Winter 2023-24 COVID Surge - The Peak				 	Best Estimate		Range	 Rank among COVID waves	2nd		2nd	2nd Date of peak	Jan 5		Jan 3	Jan 10 Daily infections at peak	2.07 million/day		2.03 million/day	2.22 million/day Percentage of population infectious at peak	4.34% (1 in 23)		4.26% (1 in 23)	4.64% (1 in 22)  U.S. Winter 2023-24 COVID Surge - The Mountain			 Window	Approximate Dates	Total Infections	"% of Population Actively Infectious on End Date" Peak Month	Dec 31 to Jan 29	58 million (about 17% of the population)	3.6% (1 in 28 people) on Jan 29 Peak 2 Months	Dec 16 to Feb 13	107...
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Zooming out to the entire pandemic, you can witness the brutality of the current #Covid #surge.

2nd biggest peak all-time. It also makes the horrific 2023 late-summer wave look like nothing.

Transmission is worse in the U.S. today than during 96.5% of the days of the pandemic. We're already at 16 million Covid infections in 2024, which will conservatively ultimately result in 800 thousand #LongCovid cases.

All that remains to be settled is whether peak daily transmission will be closer to 2 million infections/day or 2.2 million per day.

You can read about the Turtle and Cheetah forecasting models in the online report. They basically adjust for the fact that Biobot has been retroactively correcting wastewater levels marginally upward. Perhaps locations with high transmission have more people out sick and report late.There is more COVID-19 transmission today        than during 96.5% of the pandemic.  CURRENT ESTIMATES FOR January 8, 2024 Wastewater Levels (copies/mL) 1413 New Daily Cases 2,056,000 % of Population Infectious 4.3% (1 in 23 people) New Daily Long COVID Cases 103,000 to 411,000  WEEKLY ESTIMATES FOR January 8, 2024 New Weekly Cases 14,400,000 New Weekly Long COVID Cases 720,000 to 2,878,000  2024 CUMULATIVE ESTIMATES AS OF January 8, 2024 Total 2024 Cases To Date 16,410,770 Total 2024 Long COVID Cases To Date 821,000 to 3,282,000
5/
U.S. Covid Risk Table for the week of Jan 8, 2024.

In a gathering of 15-20 people, it's a coin toss whether at least one person has infectious Covid.

Avoid large gatherings. #VaxUp #MaskUp. DIY fit test. Turn that thermostat from 'auto' to 'on,' or better yet, get outside or remote. Add supplemental air cleaning with HEPA and #DIYAirCleaners. Keep testing.How Does Risk Increase with More Social Contacts?	 Number of People  |  Chances Anyone is Infectious	 1	4.3% 2	8.4% 3	12.4% 4	16.1% 5	19.7% 6	23.2% 7	26.5% 8	29.7% 9	32.7% 10	35.6% 15	48.3% 20	58.5% 25	66.7% 30	73.3% 35	78.5% 40	82.8% 50	88.9% 75	96.3% 100	98.8% 150	99.9% 200	>99.9% 300	>99.9% 400	>99.9% 500	>99.9%
6/
Warning: U.S. schools likely have very high Covid transmission throughout January 2024.

The following table shows the risk that anyone would have COVID in classrooms, based on varying size, date, and region.

Left table: The left table shows the chances someone is infectious with Covid based on class size and date. Class size matters considerably. Date does not (for January), as we'll be riding out the peak of the surge, which is more like a month-long plateau. In a class of 8, there's about a 25-30% chance someone would have Covid at any given time in January, absent any precautions using screening, testing, isolation, or quarantine. In a college class of 50, it's more like an 85-90% chance.

Right table: We do not model separately by region. However, if you track Biobot, you'll note levels are higher in the Northeast and Midwest than in the South and West. If we assume the same ratio for Jan 8, this table shows you how the risk varies geographically. The true risk levels could be a bit higher in the South/West if they catch up. The geographic comparisons arguably are not particularly useful because the regional differences tend to be more about the number of specific counties in an extreme surge, while most counties in a region follow the national average. If good local data from Verily or elsewhere, consider that, but otherwise focus more on national numbers. Even using these estimates for the South/West, they are very bad. A class of 32 would have a >50% chance of COVID, absent any screening/testing/isolation/quarantine precautions.

Summary: Schools are often among the highest risk settings for COVID transmission because of the high density of people in classrooms, presenteeism, discontinuation of testing programs, lack of masking requirements, use of ill-fitting and low-quality masks, low vaccination rates, low air cleaning rates, and an emphasis on droplet dogma (handwashing, Lysol) for an airborne virus. As indicated in the letter linked in the next section, the solution is to re-implement comprehensive COVID mitigation, as the U.S. is in the 2nd-largest COVID surge of the pandemic.

Letter: Dr. Hoerger has prepared a letter for parents seeking to advocate for better COVID mitigation at schools. Parents can consider attaching the letter as an appendix to their own letter. Alternatively, they can replace Dr. Hoerger’s letter with their own and use the tables provided, or any graphics from this website. No permission is required to use any of the graphics or data.
pmc19.com/data/pmc_schoo…Estimated Chances Someone in a U.S. Classroom is Infectious by Week & by Region (pmc19.com model)  Estimates by Date, U.S. Average				 Class Size	Jan 1	Jan 8	Jan 15	Jan 22 8	29.1%	29.6%	28.4%	26.9% 16	49.7%	50.5%	48.7%	46.5% 24	64.3%	65.2%	63.3%	60.9% 32	74.7%	75.5%	73.7%	71.4% 40	82.0%	82.8%	81.2%	79.1% 50	88.3%	88.9%	87.6%	85.9% 75	96.0%	96.3%	95.6%	94.7% 100	98.6%	98.8%	98.5%	98.0% 200	99.9%	99.9%	99.9%	99.9% 300	99.9%	99.9%	99.9%	99.9% 500	99.9%	99.9%	99.9%	99.9%  Estimates by Region, Jan 8 Only		 Class Size	"Northeast & Midwest (Jan 8, Steady)"	"South & West  (Jan 8, Sti...
7/
International COVID Statistics

Independent estimates across 3 countries show that 4.2-5.0% of residents are actively infectious with Covid.

The U.S. numbers are now up to date, while the estimates in Canada and the U.K. are delayed by the holidays.International COVID Statistics from High-Quality Data Sources			 Compiled by the Pandemic Mitigation Collaborative (PMC19.com), January 8, 2024			 	U.S.A.	Canada	U.K. % of Population Actively Infectious	4.3% (1 in 23)	5.0% (1 in 20)	4.2% (1 in 24) Chances Someone is Infectious…			      In a Group of 10	35.6%	40.1%	34.9%      In a Group of 30	73.3%	78.5%	72.4%      In a Group of 50	88.9%	92.3%	88.3% Primary Data Source	Wastewater	Wastewater	Surveillance Testing Reference	"Michael Hoerger, PhD, MSCR, MBA @michael_hoerger pmc19.com/data"	"Tara Moriarty, PhD @MoriartyLab covid19r...
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Toll of the COVID-19 pandemic in the U.S. in 2023

There were an estimated >250 million infections in the U.S. in 2023.

If assuming within-year reinfections were 0-30% of total reinfections, an estimated 53-76% of the U.S. population was infected at least once in 2023.

With a conservative estimate that 5% of infections will result in clinically significant Long Covid, that’s >12 million new #LongCovid cases.

These outcomes are the product of a highly-risky laissez-faire public health response to widespread viral transmission that contradicts the precautionary principle.CUMULATIVE TOTAL ESTIMATE OF 2023 U.S. SARS-CoV-2 Infections  Total infections = 254,670,431 (53-76% of population infected at least once, depending on the percentage of infections that were reinfections)  Total resulting long covid cases = 12-50 million
9/
Full PMC COVID-19 Forecasting Dashboard for the Week of Jan 8, 2024

Here's the entire dashboard. You can read the full report, which includes supplemental tables and analysis online:
pmc19.com/dataThere is more COVID-19 transmission today	        than during 96.5% of the pandemic.	 	 CURRENT ESTIMATES FOR	 January 8, 2024	 Wastewater Levels (copies/mL)	 1413	 New Daily Cases	 2,056,000	 % of Population Infectious	 4.3% (1 in 23 people)	 New Daily Long COVID Cases	 103,000 to 411,000	 	 WEEKLY ESTIMATES FOR	 January 8, 2024	 New Weekly Cases	 14,400,000	 New Weekly Long COVID Cases	 720,000 to 2,878,000	 	 2024 CUMULATIVE ESTIMATES AS OF	 January 8, 2024	 Total 2024 Cases To Date	 16,410,770	 Total 2024 Long COVID Cases To Date	 821,000 to 3,282,000	 	 4-WEEK FORECAST FOR	 February 5,...
10/end
Thank you to everyone engaged in pandemic advocacy.

The current surge demonstrates that public policy underlies human behavior that will continue to guide high transmission, viral evolution, and continued waves.

It's up to us to change that trajectory. 🙏

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More from @michael_hoerger

Sep 13
California COVlD Surge Rages Higher

🔸CDC SARS-CoV-2 wastewater levels "Very High," and up from last week
🔸1 in 21 estimated actively infectious
🔸>250,000 estimated new daily infections statewide

Four figures...
1/4🧵 CDC: Very High: PMC Estimate: 1 in 21 actively infectious
CDC wastewater data in California show COVlD cases increasing from the already "Very High" levels last week.

2/4🧵 Line graph of the past 6 months showing the surge in wastewater viral levels
With an estimated 1 in 21 (or 4.8%) of California residents actively infectious of COVlD, risk increases dramatically in larger and more frequent social gatherings.

Interact with 25 people of average risk of being positive, and that's a >70% chance of exposure.
3/4🧵 How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1	4.8% 2	9.4% 3	13.7% 4	17.9% 5	21.8% 6	25.6% 7	29.1% 8	32.5% 9	35.8% 10	38.9% 15	52.2% 20	62.6% 25	70.8% 30	77.1% 35	82.1% 40	86.0% 50	91.5% 75	97.5% 100	99.3% 300	99.9%
Read 4 tweets
Sep 10
Let's say you're a dairy farmer. You have 100 cows. Each year, about 5 cows die, and another 5 cows are born. Then, along comes a virus. Let's call it "cowvid"...
1/
Let's say "cowvid" wipes out about half the cows over the course of a couple years. Now, you're down to 50 cows....
2/
The local mayor declares "cowvid" to be over. This surprises you as a farmer because 5 of your cows keep dying annually. 5 of 50 instead of 5 out of 100. Seems like more, but you're not a city slicker...
3/
Read 12 tweets
Sep 7
#DuringCOVID is today.

Image pack 1 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
1 million New Daily Infections.

Today!

Image pack 2 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Where are the free vaccines, N95s, and tests?

Image pack 3 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Read 9 tweets
Sep 3
PMC Dashboard Update (U.S.) 🧵1 of 8

The 11th wave is still rising.
🔥23 states/territories High/Very High
🔥Very High: Alabama, DC, Guam, Hawai'i, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah
🔥1 in 56 estimated actively infectious
🔥876,000 new daily infections CDC heat map, very high states noted in post. PMC estimate of 1 in 56 actively infectious nationwide
PMC Dashboard Update (U.S.) 🧵2 of 8

Note that the CDC has modified 📉 how transmission levels correspond to the categorical bins.

Take California. We estimate 1 in 30 actively infectious statewide. This would have previously been "Very High," now just "High."
#NewNormal CDC heatmap, with PMC estimate of 1 in 30
PMC Dashboard Update (U.S.) 🧵3 of 8

Here are the prevalence estimates for the first half of states/territories.

Notice how high the levels are in some of the "Moderate" states. State	CDC Level Alabama	Very High Alaska	High Arizona	High Arkansas	Moderate California	High Colorado	Moderate Connecticut	High Delaware	High District of Columbia	Very High Florida	High Georgia	Moderate Guam	Very High Hawaii	Very High Idaho	High Illinois	Very Low Indiana	Moderate* Iowa	Low Kansas	Low Kentucky	High Louisiana	Very High Maine	Low Maryland	Moderate Massachusetts	Moderate Michigan	Very Low Minnesota	Moderate Mississippi	High*
Read 9 tweets
Aug 21
During times like these when COVlD transmission heats up in the U.S., expect to see a lot more angry outbursts for three central reasons.

First, "displacement," or people trying to deny the reality of their anxiety by taking it out on other people....
Second, a lot of people can sustain a strong denial of reality about the ongoing pandemic during lulls. They suppress the existence of COVlD waves and excess deaths, disability, and retirements.

During waves, those defenses burst. Loss of control = anger...
Third, a lot of people (many reading this) understand COVlD correctly & experience righteous indignation during COVlD waves. We quite reasonably do not like all of the unjust and gratuitous suffering.

I find it helpful to channel that intensity into helping other people....
Read 6 tweets
Aug 19
I submitted my comment to endorse universal high-quality masks (respirators) in healthcare. Today is the final day.

Alt text continues in the following posts. RE: Z94.4, Selection, use, and care of respirators (New Edition)  Dear Colleagues,  As the director of a population science program at a major U.S. cancer center, I strongly endorse this draft proposal to increase the use of high-quality well-fitting masks (respirators) in medical settings. I will comment on the relevance of this proposal mainly for cancer care. In the U.S., cancer care is commonly more organized than other specialty care and, thus, often leads the way on policy initiatives, which then translate to other elements of care over time.  1. COVID-19 continues to cause excess dea...
They put forth projections, with the most granular detail for the U.S. and U.K., suggesting excess deaths will persist through at least 2033. Their projections do not show excess deaths stopping in 2033; that is simply the final year of their current analysis. Moreover, while they provide the most data for the U.S. and U.K., their analysis suggests a more general trend throughout the globe. The COVID-19-associated excess deaths are commonly identified as cardiovascular and cancer causes of death.   Swiss Re Institute. (2024). The future of excess mortality after COVID-19. https://www.swissr...
Alt text continued 2. The SARS-CoV-2 virus that causes COVID-19 continues to transmit at high rates worldwide. Overall, 28 nations continue to use wastewater surveillance to monitor SARS-CoV-2 levels. A directory is available at the dashboard that I oversee (pmc19.com/data). In the U.S., we are currently experiencing our 11th wave of transmission. Many nations are experiencing annual or twice annual waves of transmission.
Alt text continued 3. International consensus standards identify a broad range of patients at known high-risk of severe outcomes of COVID-19. The largest group at known high risk of severe outcomes is patients with cancer. Other diagnoses associated with above average risk include people undergoing transplants or receiving dialysis, and patients with any of these diagnoses: immunodeficiencies, renal disease, systemic-immune mediated or single-site immune-mediated inflammatory conditions, asplenia, anatomical barrier defects, pregnancy, and diabetes. These findings underscore the importance of standards in hea...
Read 7 tweets

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