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...
3/
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...
4/
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...
8/
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

May 3
30 million excess deaths attributable to COVID is a tremendous underestimate because most analyses insufficiently account for mortality displacement.

In the U.S., it's about 50% worse than people realize.
Mortality displacement or "harvesting" is the idea that so many people died of COVID in the early pandemic that we should actually expect to see *fewer* deaths today if COVID were "over."
In fact, we see similar or slightly higher mortality relative to pre-pandemic levels. Despite the millions of people that have died, the mortality faucet keeps running strong. It should have slowed.
Read 9 tweets
Apr 22
🧵1 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

🌤️Only 1 in 5 days of the pandemic have seen transmission as low as today
🌤️1 in 196 actively infectious
⚡️BUT still 1.7 million weekly infections, resulting in >85,000 LC cases and up to 1,000 deaths

I'll walk you through it... Current Levels for Apr 21, 2025	 % of the Population Infectious	 0.5% (1 in 196)	 New Daily Infections	 244000	 New Weekly Infections	 1708000	 Resulting Weekly Long COVID Cases	 85,000 to 342,000	 Resulting Weekly Excess Deaths	 600 to 1,000	 	 Monthly Forecast	 Average % of the Population Infectious	 0.7% (1 in 147)	 Average New Daily Infections	 324800	 New Infections During the Next Month	 9744000	 Resulting Monthly Long COVID Cases	 487,000 to 1,949,000	 Resulting Monthly Excess Deaths	 3,500 to 5,800	 	 Running Totals	 Infections Nationwide in 2025	 62331000	 Average Number of Infecti...
🧵2 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

We're in the 6th year. See the small red line, bottom left. Notice how closely it tracks the median (gray), year 4 (yellow), & year 5 (orange).

Acknowledging caveats, those are plausible gist-level scenarios for months ahead. year over year graph, summarized in post
🧵3 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

Expect steady transmission bouncing up and down around the current national lull-level estimate the next several weeks. 200-350k daily infections nationally.

This is about as low as lulls bottom out anymore. Past 12 months and forecast, summarized in post
Read 8 tweets
Apr 14
🧵1/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

🔹2.2 million weekly infections
🔹1 in 149 actively infectious
🔹>100,000 LC cases resulting from the week's infections
🔹>800 deaths resulting from the week's infections
🔹"Lull" transmission steady/slightly decliningCurrent Levels for Apr 14, 2025	 % of the Population Infectious	 0.7% (1 in 149)	 New Daily Infections	 320000	 New Weekly Infections	 2240000	 Resulting Weekly Long COVID Cases	 112,000 to 448,000	 Resulting Weekly Excess Deaths	 800 to 1,300	 	 Monthly Forecast	 Average % of the Population Infectious	 0.7% (1 in 138)	 Average New Daily Infections	 345366.6667	 New Infections During the Next Month	 10361000	 Resulting Monthly Long COVID Cases	 518,000 to 2,072,000	 Resulting Monthly Excess Deaths	 3,700 to 6,200	 	 Running Totals	 Infections Nationwide in 2025	 60891000	 Average Number of ...
🧵2/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

Year-over-year transmission (red line, lower left) is tracking the median (grey), year 4 (yellow), and year 5 (orange) closely.

If that trend continues, expect steady yet bumpy transmission the next couple months, until June/July.line graphs, described in tweet
🧵3/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

The heat map shows only 4 states in the CDC 'high' level and none in the 'very' high level.

Check local data. Those timing activities to lulls may see a clear opportunity.heat map, described in tweet
Read 6 tweets
Apr 9
The NIH Clinical Center drops universal masking after 5 months of protecting patients, family, & staff.

Wastewater-derived estimates indicate 2.79 million Americans are getting Covid per week AND top actuaries suggest an American dies of Covid every 3 minutes.

🧵1/5 Masks are optional beginning April 11. Staff will mask on request.
These are the current wastewater-derived estimates of transmission.

2.79 million Covid infections/week in the U.S. in the current high "lull."
🧵2/5
This thread with video explains in exquisite detail how every 3 minutes in 2025 an American dies of Covid.

🧵3/5
Read 5 tweets
Apr 7
1) PMC COVlD Dashboard, April 7, 2025 (U.S.)

🔹1 in 120 actively infectious
🔹1 in 3 chance of exposure in a room of 50
🔹2.8 million weekly infections
🔹>140,000 resulting LC cases from the week's infections
🔹>1,000 deaths resulting from the week's infections Current Levels for Apr 7, 2025	 % of the Population Infectious	 0.8% (1 in 120)	 New Daily Infections	 399000	 New Weekly Infections	 2793000	 Resulting Weekly Long COVID Cases	 140,000 to 559,000	 Resulting Weekly Excess Deaths	 1,000 to 1,700	 	 Monthly Forecast	 Average % of the Population Infectious	 1.0% (1 in 105)	 Average New Daily Infections	 455766.6667	 New Infections During the Next Month	 13673000	 Resulting Monthly Long COVID Cases	 684,000 to 2,735,000	 Resulting Monthly Excess Deaths	 4,900 to 8,100	 	 Running Totals	 Infections Nationwide in 2025	 55591000	 Average Number of...
2) Watch this video to understand how we use excess death data from one of the world's largest reinsurers to estimate how this week's infections will result in >1,000 deaths.
3) Transmission is steady or declining across much of the nation, but remains high in 11 states and DC, per the CDC.

Other sources, such as WastewaterSCAN, show a near doubling of transmission in the Northeast the past few weeks, so remain cautious.
Read 4 tweets
Mar 31
🧵1 of 5
PMC Dashboard, March 31, 2025 (U.S.)

🔹800-1,400 deaths expected to result from this week's infections (new stat, see video next Tweet)
🔹100,000+ Long Covid conditions to result from this week's infections
🔹1 in 142 actively infectious todayCurrent Levels for Mar 31, 2025	 % of the Population Infectious	 0.7% (1 in 142)	 New Daily Infections	 337000	 New Weekly Infections	 2359000	 Resulting Weekly Long COVID Cases	 118,000 to 472,000	 Resulting Weekly Excess Deaths	 800 to 1,400	 	 Monthly Forecast	 Average % of the Population Infectious	 0.8% (1 in 120)	 Average New Daily Infections	 397233.3333	 New Infections During the Next Month	 11917000	 Resulting Monthly Long COVID Cases	 596,000 to 2,383,000	 Resulting Monthly Excess Deaths	 4,300 to 7,100	 	 Running Totals	 Infections Nationwide in 2025	 52303000	 Average Number of ...
🧵2 of 5
PMC Dashboard, March 31, 2025 (U.S.)

This video explains U.S. COVID excess death statistics, which we have incorporated into the dashboard.

🧵3 of 5
PMC Dashboard, March 31, 2025 (U.S.)

The transmission forecast suggests 300-500k daily infections the next month. If the data get retroactively corrected downward, we could dip to 200k.

Check local dashboards, and time events accordingly.Forecast graph, described in post
Read 5 tweets

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