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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Jan 22 • 9 tweets • 3 min read • Read on X
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VIDEO THREAD 🧵 - Clip 1 of 7

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"

It's for my students but great for anyone who wants to better understand the state of the pandemic in the U.S. in Jan 2024.
40 mins total across 7 chapters:

Ch 1 - Intro on the Winter 2023-24 Surge and a bit on my background

Ch 2 - The public health significance of COVID-19 at present, especially focused on Long COVID

Ch 3 - SARS-CoV-2 is Airborne, and we need multi-layered mitigation

Ch 4 - Quarantine, testing, and isolation overview

Ch 5 - Masking tips

Ch 6 - Air cleaning fundamentals

Ch 7 - Vulnerability and inclusivity
VIDEO THREAD 🧵 - Clip 2 of 7

Chapter 2: COVID is NOT “A Cold or the Flu”
#LongCOVID #LongCovidKids

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
VIDEO THREAD 🧵 - Clip 3 of 7

Chapter 3: Multi-layered Mitigation
#COVIDisAirborne #MaskUp #VaxUp #CleanAirForAll

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
VIDEO THREAD 🧵 - Clip 4 of 7

Chapter 4: Quarantine, Testing, & Isolation
#RapidTest #StayHomeWhenSick

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
VIDEO THREAD 🧵 - Clip 5 of 7

Chapter 5: Masking Tips
#MaskUp #N95 #FitTest

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
VIDEO THREAD 🧵 - Clip 6 of 7

Chapter 6: Air Cleaning Fundamentals
#HEPA #DIYAirCleaners

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
VIDEO THREAD 🧵 - Clip 7 of 7

Chapter 7: Vulnerability & Inclusivity
#EDI #DEI #KeepMasksInHealthcare

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
Please feel free to share these videos in any capacity across any platform.

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I have no financial Conflicts of Interest (COIs) for any of the products or industries mentioned in passing. I intentionally do not receive ad revenue on these videos, as that could create the appearance of a potential bias.

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Mike Hoerger, PhD MSCR MBA Profile picture
Jan 23
1/8 🧵
PMC COVID-19 Forecast, Week of Jan 22, 2024

Transmission in the U.S. is extremely high on the back of the 2nd largest surge all-time.
🔹2.5% (1 in 40) actively infectious
🔹1.2 million infections/day
🔹>60,000 resulting daily LC cases
🔹0.8-1.3 million daily infections the next month

#LongCovid
The continued high level of transmission should give everyone pause. The PMC model estimates 1.2 daily infections currently, with plausible values from other modelers in the range of 0.8-1.4 million daily infections. In estimating resulting LC cases, we defer to publications suggesting 5-20% will experience clinically meaningful LC as a result of an infection. The most minimizing estimate I've seen is 1%, which I deem implausible, based on the literature. Nonetheless, even minimizers should assume 0.8 million daily infections, 1% resulting in LC, or 8,000 resulting daily LC cases, or 56,000/week, or approximately 240,000/month at present. Those are the "minimizer" estimates. If one assumes 5% of infections result in LC, the situation is obviously much worse (5x worse, in fact), where we are talking about 60,000 resulting LC cases per day at present.

Forecasting Nuance
Over the next month, we should see 0.8-1.3 million infections per day. Biobot has made considerable post-hoc corrections to each of the prior 3 weeks of data. This essentially moved the peak back from early January to late December, and at present suggests a slightly more precipitous decline the past few weeks than noted in real time.

The details of the forecasting models can be found in the Technical Notes section online. Reviewing the graph in the next Tweet (whole pandemic), you’ll notice that after about half the waves, instead of a straightforward decline, there is occasionally a temporary deceleration, or even a small hill. Currently, this is what the forecast is showing.

I suspect that the hill in the graphical depiction below is an artifact and we’ll head toward a more steady decline, reaching 0.8-0.9 million cases/day in a month. Why? First, the models are based on all data, not just wave-based data, and in my experience tend to be less precise in the very middle of the ascent or descent of a wave. In the 2.0 version of the forecast coming out in a few months, we will likely add complexity to the model to refine the wave phases. Second, Biobot has made huge retroactive corrections to their real-time levels in each recent report. Their current real-time level may be off, and that can throw off the models. Overall, consider that the decline in daily cases may slow, or there might be a small hill on the way, but if lucky, transmission will continue to decline a little faster than depicted. Unfortunately, my qualitative analysis of this "rosy" scenario is still quite bleak, with 800,000 daily infections a month from now.CURRENT ESTIMATES FOR January 22, 2024 Wastewater Levels (copies/mL) 824 New Daily Cases 1,200,000 % of Population Infectious 2.51% (1 in 40 people) New Daily Long COVID Cases 60,000 to 240,000 4-WEEK FORECAST FOR February 19, 2024 Wastewater Levels (copies/mL) 743 (-10% lower) New Daily Cases 1,081,000 % of Population Infectious 2.26% (1 in 44 people) New Daily Long COVID Cases 54,000 to 216,000
2/8🧵
Zooming out to the full pandemic:
🔹Transmission remains higher than during 85% of the entire pandemic, i.e., not "over"
🔹We are in the 2nd-highest wave all-time
🔹There is every reason to believe similar or larger waves will recur in the future There is more COVID-19 transmission today than during 85.1% of the pandemic. CURRENT ESTIMATES FOR January 22, 2024 Wastewater Levels (copies/mL) 824 New Daily Cases 1,200,000 % of Population Infectious 2.51% (1 in 40 people) New Daily Long COVID Cases 60,000 to 240,000 WEEKLY ESTIMATES FOR January 22, 2024 New Weekly Cases 8,400,000 New Weekly Long COVID Cases 420,000 to 1,680,000 2024 CUMULATIVE ESTIMATES AS OF January 22, 2024 Total 2024 Cases To Date 32,876,330 Total 2024 Long COVID Cases To Date 1,644,000 to 6,575,000
3/8🧵
As of the week of January 22, 2024, large groups remain high risk.

Absent quarantine, testing, and serious isolation, there's about a 50% chance that at least one person would be infectious in a group of 25-30 people.How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1 2.5% 2 5.0% 3 7.3% 4 9.7% 5 11.9% 6 14.1% 7 16.3% 8 18.4% 9 20.5% 10 22.5% 15 31.7% 20 39.9% 25 47.0% 30 53.4% 35 58.9% 40 63.8% 50 72.0% 75 85.1% 100 92.1% 150 97.8% 200 99.4% 300 >99.9% 400 >99.9% 500 >99.9%
Read 8 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 23
Let's talk #DeathTrajectories 🧵

One of the biases in #PublicHealth policy is the focus on acute COVID deaths. It's a lagging indicator and only covers 1 of 5 common death trajectories.

For COVID, people imagine the upper left. Get COVID, then a quick death.
1/7 Figure shows a line graph where an individual has a sustained level of physical functioning, gets COVID, and dies shortly thereafter. This was a good model of acute COVID deaths in the early pandemic. It's also useful for considering accidents, homicide, suicide, and sometimes catastrophic health events like heart attacks.
This is another common death trajectory. You see this a lot with serious cancer diagnoses.

However, you can see it with COVID too. Someone was doing well, gets COVID, and then experiences a decline over 1-2 years. It may cause or aggravate another health condition.
2/7 Line graph. Shows high level of physical functioning, stable over time. Then, someone gets COVID and it causes or aggravates health problems, leading a decline toward death over 1-2 years.
This is a 3rd common death trajectory, often typical of organ failure. You can see someone get COVID, and somewhere down the line it causes or aggravates organ damage.

Dips in functioning are common, often with rebounding improvement, but sometimes a steep decline.
3/7 Line graph characteristic of organ failure. Someone has 4 big dips in physical functioning, rebounds and improves to just below the previous baseline, until finally there is a big dip that leads to death. Pattern is predictable, but the number of dips before death is not, so there's a chronic state of uncertainty surrounding how severe a dip in functioning will be.
Read 7 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 16
1/7
 PMC COVID-19 Forecast, Week of Jan 15, 2024

🔹1.2-1.5 million daily U.S. infections the next month
🔹41.2 million total infections the next month
🔹66.7 million total infections over the next 2 months

These infection rates are 30% higher than a year ago. Yet, expect considerable minimizing. Many people believe that once the peak day has passed, it's smooth sailing, what I would call "Descent Neglect."

Take an analogy: More people die, supposedly, going down Mt. Everest than going up. With COVID surges, people also underestimate how bad the 2nd half of surge mountain is likely to be. They overestimate how spiky or leptokurtic a a surge tends to be. Transmission will go down gradually, meaning extremely high transmission the next 4-6 weeks especially.

This may be fueled by a misunderstanding of how quickly transmission declines, defense mechanisms to temporarily and artificially reduce anxiety, short-term political or capital interests, or a combination of these factors.

#DescentNeglectCURRENT ESTIMATES FOR January 15, 2024 Wastewater Levels (copies/mL) 999 New Daily Cases 1,453,000 % of Population Infectious 3.04% (1 in 33 people) New Daily Long COVID Cases 73,000 to 291,000 4-WEEK FORECAST FOR February 12, 2024 Wastewater Levels (copies/mL) 893 (-11% lower) New Daily Cases 1,300,000 % of Population Infectious 2.72% (1 in 37 people) New Daily Long COVID Cases 65,000 to 260,000
2/7
 Zooming out, see with certainty this is the 2nd biggest U.S. pandemic surge.

Today, transmission remains greater than during 90% of the pandemic.
🔹Nearly 1.5 million daily infections
🔹3% (1 in 33) actively infectious
🔹>70,000 resulting daily #LongCovid cases There is more COVID-19 transmission today than during 90% of the pandemic. CURRENT ESTIMATES FOR January 15, 2024 Wastewater Levels (copies/mL) 999 New Daily Cases 1,453,000 % of Population Infectious 3.04% (1 in 33 people) New Daily Long COVID Cases 73,000 to 291,000 WEEKLY ESTIMATES FOR January 15, 2024 New Weekly Cases 10,200,000 New Weekly Long COVID Cases 509,000 to 2,034,000 2024 CUMULATIVE ESTIMATES AS OF January 15, 2024 Total 2024 Cases To Date 25,253,430 Total 2024 Long COVID Cases To Date 1,263,000 to 5,051,000
3/7
 Although we're waiting on an update in Canada, note how similar transmission is the U.S. and U.K. for early-to-mid January.

3% (1 in 33) of the U.S. & 3.1% (1 in 32) of the U.K. are actively infectious with COVID. International COVID Statistics from High-Quality Data Sources Compiled by the Pandemic Mitigation Collaborative (PMC19.com), January 15, 2024 U.S.A. Canada U.K. % of Population Actively Infectious 3.0% (1 in 33) 5.0% (1 in 20) 3.1% (1 in 32) Chances Someone is Infectious… In a Group of 10 26.6% 40.1% 27.0% In a Group of 30 60.4% 78.5% 61.1% In a Group of 50 78.6% 92.3% 79.3% Primary Data Source Wastewater Wastewater Surveillance Testing Reference "Michael Hoerger, PhD, MSCR, MBA @michael_hoerger pmc19.com/data" "Tara Moriarty, PhD @MoriartyLab covid19...
Read 7 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 9
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...
Read 10 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jan 9
Excited to share some good news!
2023 Pandemic Mitigation Collaborative (PMC) Advocacy Awards

Five Awardees: @LauraMiers @BettyB2007 @EmAndElOrganics @luckytran @ChristinaVirgil

Top Commendation to Christina Virgil!

We wanted to acknowledge the work people are doing sharing data from the PMC Dashboard to help protect others from Covid. These five people are contributing plenty of good, well beyond just anything with the PMC, and we appreciate their hard work.

Please share your appreciation for their work. Awardees, please DM me an address in the next week if you'd like to receive a small token of appreciation. Thanks again!🙏
1/6PMC 2023 Advocacy Awards Laura Miers (Twitter: @LauraMiers) Liz O (Twitter: @BettyB2007) Em & El Organics (Twitter: @EmAndElOrganics) Dr. Lucky Tran (Twitter: @luckytran) Christina Virgil (Twitter: @ChristinaVirgil)
From the start, @LauraMiers has been a leader sharing PMC data on case rates and estimates of resulting Long Covid cases.

2/6
Example Tweet:
Anticipating the winter surge, @BettyB2007 was instrumental in getting the word out to a large audience on TikTok.

She also gave useful feedback that people wanted a methodology explainer, so I made a long methods video.

3/6
 Example Video:
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Dec 26, 2023
Someone has purchased a low-quality high-volume anti-#COVID-awareness bot farm. I've had to block 500 people the past few days. I appreciate good humor, but these bots are sub-pun-level basic, not even any fun.

These are my Top 7 tips for dealing with #bots & #trolls.
🧵Troll eyes within COVID images
Bot Tip #1: In settings, shut off direct messaging from people you don't follow.

Bye-bye #bots & #trolls.Shows how to shut off non-follower DMs in settings
Bot Tip #2: In settings, shut off notifications from people who don't follow you.

This will reduce #bot & #troll notifications.

Consider other options. I prefer this over blocking notifications from people I don't follow because it could be have new follower.Settings: Mute notifications from people who don't follow you.
Read 10 tweets

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