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https://twitter.com/michael_hoerger/status/1752080063489523858

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Mike Hoerger, PhD MSCR MBA

@michael_hoerger

Jan 29

1/
PMC COVID-19 Forecast, Week of Jan 29, 2024

Transmission in the U.S. is extremely high & stable from last week on the back of the 2nd largest surge all-time.

🔹2.5% (1 in 39) actively infectious
🔹1.2 million infections/day
🔹>60,000 resulting daily LC cases
🔹0.8-1.3 million daily infections the next month

Detailed Forecast:
We are in the 2nd largest U.S. surge of the pandemic. 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 4 weeks of data. This essentially moved the peak earlier, with real-time estimates corrected downward in hindsight the past several weeks, including last week’s numbers getting corrected downward by 3%. The details of the forecasting models can be found in the Technical Notes section in the online report.

Post-Peak Hill? Reviewing the graph of the whole pandemic (Tweet #3), 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. It’s unclear whether we will see a very small hill (rebound), a couple weeks with a flat plateau, or just descend at a gradual pace, but it looks like there will continue to be more transmission on the back end of the mountain than the start, as the models have continued to forecast for a long time now.

Good News: The model suggests that around Valentine’s Day (Feb 14), transmission should begin to fall for rapidly. The good news, if any, is that we can begin to discern the “end” of the surge toward late February, when daily infections will likely drop below 1 million nationwide.

Bad News: The bad news is that even the apparent "end" will still have a long ways to go down. For example, note that the starting point of the blue line on the left of the graph is actually the peak of the late-summer wave, which was quite bad.

Technical Note: If you go to the Biobot Dashboard, you'll see levels down 4% from last week, but our model shows levels marginally higher. For Biobot's Jan 27 data point, we enter that as Jan 24 (it's actually the average for the preceding week), assume that data point is a very slight underestimate (pattern the past several weeks), and model that we're already starting to tick up into that little hill. I'd avoid over-interpreting, and just take this to mean transmission is pretty stable at the moment.

2/
What's with the Post-Peak Hill?

We're anticipating a post-peak hill. However, I wouldn't be surprised if it's instead a temporary plateau (flat) or simply a deceleration.

The best explanation is that transmission remains high with considerably geographic heterogeneity.

Examples of heterogeneity:
1) Single peak. Many places appear to have a single winter peak this year. In Western Mass, they peaked with 38% of the population actively infectious. Nearly unbelievable. It's hard to imagine a 2nd hill after that. Many other places peaked around 10% actively infectious on the worst day.

2) Late peak: Some places haven't peaked yet. This could account for a post-peak hill.

3) Rebound: Some places had an apparent winter peak but are starting to rebound. The rebound may be marginally higher or lower than the existing apparent "peak." Likely, the earlier peak was lower than in places experiencing a true single peak. They "flattened the curve" a little, but it's a tough fight against in-school transmission.

4) Rollercoaster. More extreme example of the Rebound case. Several peaks and valleys.

5) Flat. Some places have looked pretty flat on transmission for months. Perhaps they are wiser on engineering controls, or perhaps they are approaching a late peak.

3/
Zooming out to the full pandemic:
🔹Stable transmission relative to last week
🔹Transmission remains higher than during 85% of the entire pandemic, i.e., not "over"
🔹We are still in the 2nd-highest wave all-time with >1.2 million U.S. infections/day

Read 8 tweets

Mike Hoerger, PhD MSCR MBA

@michael_hoerger

Jan 24

1/
In the most personal of my publications, I describe how a #mild virus killed my mom. It took 14 years.

This is the future of laissez-faire policies toward in-school COVID transmission. >10 million children have lost a parent to COVID, at last count 1.5 years ago. Kids account for 70% of in-home transmission.

Where do kids get COVID that they then spread within the home? Hint: the densely-populated place where they spend much of their day, with near-zero levels of vaccine boosting, testing, masking, or air cleaning. Schools. Now, COVID+ kids in California are told they should go to school while actively infectious.

Such policies are anticipated to disable and kill parents, grandparents, and others in the community. These policies will leave kids at high risk of complicated bereavement and toxic long-term sequelae.

Not so "mild."
#ForgottenChildren
#DeathTrajectoriesliebertpub.com/doi/epub/10.10…

https://twitter.com/michael_hoerger/status/1749678609680208313

2/
These are examples of the #DeathTrajectories of parents and grandparents who will get bring-home COVID from children in schools.

It may be 6 months. It may be 14 years. Many will get disabled. Many will die. We need to stop transmission.

https://twitter.com/michael_hoerger/status/1749678609680208313

3/
When talking to political & politicized leaders, use a 2-pronged approach like my article & like the recent #LongCOVID hearing.

1) State the facts. But these aren’t enough.
2) Make it personal/emotional. These are the stories people remember.

Cite the 10 million figure. Cite the 70% estimate. Then, tell leaders who in your family is known to be vulnerable or why this matters to you. That's how to stop the California 1-day isolation policy.

Read 4 tweets

Mike Hoerger, PhD MSCR MBA

@michael_hoerger

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.

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

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.

Read 8 tweets

Mike Hoerger, PhD MSCR MBA

@michael_hoerger

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

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

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

Read 7 tweets

Mike Hoerger, PhD MSCR MBA

@michael_hoerger

Jan 22

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"

Read 9 tweets

Mike Hoerger, PhD MSCR MBA

@michael_hoerger

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.

#DescentNeglect

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

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.

Read 7 tweets

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