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Mike Hoerger, PhD MSCR MBA Profile picture
@michael_hoerger
Jul 31 • 3 tweets • 2 min read • Read on X
JAMA-NO Today: Masking is a new indicator of healthcare quality.

>80% of top #cancer centers have strict masking policies during #Covid waves.

#KeepMasksInHealthcare #YallMasking #SaltingTheVibesJAMA Network Open Masking Policies at National Cancer Institute (NCI)-Designated Cancer Centers During the Winter 2023-24 COVID-19 Surge Michael Hoerger, PhD, MSCR, MBA Co-authors: Dulcé Rivera, BS Brenna Mossman, PhD, MA Birney Sherard Tristen Peyser, MS, MS Taylor M. Alcorn, BS
TABLE . Proportion of National Cancer Institute–Designated Cancer Centers With Universal Masking Precautions US Census region Northeast 11/14 (78.6) Midwest 3/14 (21.4) South 8/23 (34.8) West 6/16 (37.5) NCI designation duration, quintile First, longest duration 10/12 (83.3) Second 8/13 (61.5) Third 5/15 (33.3) Fourth 3/14 (21.4) Fifth, shortest duration 2/13 (15.4) NCI-designated program funding (P30 grants), quintile First, most funded 11/13 (84.6) Second 6/14 (42.9) Third 4/13 (30.8) Fourth 6/14 (42.9) Fifth, least funded 1/13 (7.7) US News & World Report ranking, quintile First, hig...
“The JAMA-NO Masking Policy Study Defines Universal Masking in Healthcare as a Key Quality Indicator During COVID-19 Waves” -Michael Hoerger, PhD, MSCR, MBA Medical Scientist COVID is extremely dangerous for people with known and unknown medical vulnerabilities Transmission remains ongoing We examined masking policies at the best and best-of-the-best cancer centers during the 2023-24 winter surge Extremely high rates of universal masking policies at the best-of-the-best centers Masking is an indicator of healthcare quality Tips for hospitals and patients discussed tomorrow
Transmission Persists, Entering a 9th U.S. Wave “It takes 15 years to translate beneficial interventions into widespread practice. Americans are getting infected an average of approximately every 12.5 months. We need to improve understanding of the airborne transmission of COVID to accelerate that timeline. Patients cannot wait.” -Michael Hoerger, PhD, MSCR, MBA Medical Scientist GRAPH Shows the 9 U.S. COVID-19 waves, each wave labeled "during COVID"
On Thursday (Aug 1) I’ll talk about how we use the findings to empower patients, clinicians, health administrators, and scientists to accelerate progress on the airborne transmission of COVID, healthcare quality, and patient safety.
#CovidIsAirborne

x.com/i/spaces/1OdKr…
"Masking Policies at National Cancer Institute–Designated Cancer Centers During Winter 2023 to 2024 COVID-19 Surge"

Article full-text:
jamanetwork.com/journals/jaman…

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More from @michael_hoerger

Mike Hoerger, PhD MSCR MBA Profile picture
Aug 1
Slide Deck - Discussion of "Masking Policies at National Cancer Institute–Designated Cancer Centers During Winter 2023 to 2024 COVID-19 Surge"

x.com/i/spaces/1OdKr…
2/ “It takes 15 years to translate beneficial interventions into widespread practice. We need to improve understanding of the airborne transmission of COVID to accelerate that timeline. Patients cannot wait.” -Michael Hoerger, PhD, MSCR, MBA Medical Scientist
Read 26 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jul 25
PMC COVID-19 Forecast, Jul 25, 2024 (U.S.)

The U.S. is hovering around 900,000 daily infections.

Nearly 2% of the U.S. population is actively infectious with COVID. Ultimately, such infections are expected to result in >40,000 new daily #LongCovid cases.

#YallMasking?
1/CURRENT ESTIMATES FOR July 26, 2024 Wastewater Levels (copies/mL) 634 New Daily Cases 922,000 % of Population Infectious 1.93% (1 in 52 people) New Daily Long COVID Cases 4-WEEK FORECAST FOR August 23, 2024 Wastewater Levels (copies/mL) 668 (5% higher) New Daily Cases 934,000 % of Population Infectious 1.95% (1 in 51 people) New Daily Long COVID Cases 47,000 to 187,000
In the rising 9th U.S. Covid wave, we have higher transmission than 69% of the pandemic, lower than during 31% of the pandemic.

In a deck of cards, imagine the J, Q, K, & Ace as days with higher transmission, all other cards the days with lower transmission.
2/ There is more COVID-19 transmission today than during 69% of the pandemic. CURRENT ESTIMATES FOR July 26, 2024 Wastewater Levels (copies/mL) 634 New Daily Cases 922,000 % of Population Infectious 1.93% (1 in 52 people) New Daily Long COVID Cases 46,000 to 184,000 WEEKLY ESTIMATES FOR July 26, 2024 New Weekly Cases 6,500,000 New Weekly Long COVID Cases 323,000 to 1,291,000 2024 CUMULATIVE ESTIMATES AS OF July 26, 2024 Total 2024 Cases To Date 149,473,220 Total 2024 Long COVID Cases To Date 7,474,000 to 29,895,000
How many people will you interact with this week? Here are the chances at least one of those people is infectious with Covid.

20 people? --> 1 in 3 chance
100-300 on an airplane? --> 85-99% chance

Wear a well-fitting high-quality mask (respirator) to avoid breathing virus.
3/ How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1 1.9% 2 3.8% 3 5.7% 4 7.5% 5 9.3% 6 11.0% 7 12.7% 8 14.4% 9 16.1% 10 17.7% 15 25.3% 20 32.3% 25 38.6% 30 44.3% 35 49.4% 40 54.1% 50 62.2% 75 76.8% 100 85.7% 150 94.6% 200 98.0% 300 99.7% 400 >99.9% 500 >99.9%
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jul 20
Long COVID Risk Tables

You probably saw this week's NEJM article on #LongCOVID. We did a special section on it in this week's PMC COVID-19 Forecasting Report (pgs 6-8).


THREAD of tables. 🧵🔢

1/
Details:
Our model continues to provide estimates of Long COVID cases that will ultimately result from each day’s infections.

We provide a credible interval that 5-20% of infections will result in Long COVID.

This week, Al-Aly and colleagues reported in the New England Journal that in the more recent era of the pandemic, vaccinated individuals have a 3.5% chance of developing Long COVID from a particular infection.

They focused on medically documented new serious health conditions. We continue to view 5% as a useful lower bound for two reasons.

Long COVID chances were higher in unvaccinated individuals in their study, and there were no analyses based on time since last vaccination.

With many Americans still unvaccinated and many not vaccinated in the past year, the true estimate for a 2024 infection could well surpass 5% for a medically documented new serious health condition.

Moreover, Long COVID is a heterogeneous condition, and many cases are likely not medically documented, especially at the less debilitating end of the spectrum.

The following tables show the risk of ever developing Long COVID from an infection assuming 3.5%, 5.0%, and 20.0% rates.

These statistics document the seriousness of Long COVID with Americans getting infected nearly once a year (average of 12.5 months by our estimates).

However, it is also important to know that some effects are enduring, and others more likely to improve, so many with Long COVID will improve.

Many will also have repeated bouts of Long COVID, likely with different phenotypes.pmc19.com/data/
If you assume 3.5% of people get Long COVID per infection, the risk grows sizably with reinfections, which are happening nearly once per year. Avg of 9 infections/American the next decade.

In the previous Tweet, we note how 3.5% is an obvious underestimate.

2/ What are the chances of developing new Long COVID? Number of Infections | Chances of Long Covid 1 3.5% 2 6.9% 3 10.1% 4 13.3% 5 16.3% 6 19.2% 7 22.1% 8 24.8% 9 27.4% 10 30.0% 15 41.4% 20 51.0% 25 59.0% 30 65.7% 35 71.3% 40 76.0% 50 83.2% 75 93.1% 100 97.2% 150 99.5% 200 >99.9% 300 >99.9% 400 >99.9% 500 >99.9%
Based on that 3.5% estimate, a more realistic low-ball estimate of serious long COVID is 5-7%, given that not all serious new health conditions are documented in medical records & rates are higher among those unvaxxed or not recently vaxxed.

Bad decade (9 inf's) ahead.

3/ What are the chances of developing new Long COVID? Number of Infections | Chances of Long Covid 1 5.0% 2 9.8% 3 14.3% 4 18.5% 5 22.6% 6 26.5% 7 30.2% 8 33.7% 9 37.0% 10 40.1% 15 53.7% 20 64.2% 25 72.3% 30 78.5% 35 83.4% 40 87.1% 50 92.3% 75 97.9% 100 99.4% 150 >99.9% 200 >99.9% 300 >99.9% 400 >99.9% 500 >99.9%
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Jun 28
PMC COVID-19 Forecast, June 28, 2024 (U.S.)

You've got about 1 good month left for higher risk medical and dental visits.

Expect 500,000 to 600,000 infections/day the next month -- in a summer "lull."

1/CURRENT ESTIMATES FOR June 28, 2024 Wastewater Levels (copies/mL) 367 New Daily Cases 534,000 % of Population Infectious 1.12% (1 in 90 people) New Daily Long COVID Cases 4-WEEK FORECAST FOR July 26, 2024 Wastewater Levels (copies/mL) 415 (13% higher) New Daily Cases 586,000 % of Population Infectious 1.23% (1 in 82 people) New Daily Long COVID Cases 29,000 to 117,000
PMC COVID-19 Forecast, June 28, 2024 (U.S.)

1.1% of the U.S. is actively infectious (1 in 90). We're looking at 3.7 million infections/week and 187,000+ resulting Long COVID cases/week.

That's 129 million infections in 2024 so far.

2/There is more COVID-19 transmission today than during 44% of the pandemic. CURRENT ESTIMATES FOR June 28, 2024 Wastewater Levels (copies/mL) 367 New Daily Cases 534,000 % of Population Infectious 1.12% (1 in 90 people) New Daily Long COVID Cases 27,000 to 107,000 WEEKLY ESTIMATES FOR June 28, 2024 New Weekly Cases 3,700,000 New Weekly Long COVID Cases 187,000 to 748,000 2024 CUMULATIVE ESTIMATES AS OF June 28, 2024 Total 2024 Cases To Date 129,801,250 Total 2024 Long COVID Cases To Date 6,490,000 to 25,960,000 4-WEEK FORECAST FOR July 26, 2024 Wastew...
PMC COVID-19 Forecast, June 28, 2024 (U.S.)

How does transmission compare to late June in past years?

2023: 1.9x higher today
2022: 2.3x higher in 2022 (BA.2 surge) than today
2021: 5.6x higher today
2020: 2.8x higher today

We're in a hot "lull" with #backtoschool soon.

3/Zoomed in version of "whole pandemic" graph from the prior Tweet. The rates show how transmission varies presently versus this time in prior years.
Read 6 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Apr 29
PMC COVID-19 Forecast, April 29, 2024 (U.S.)

Transmission continues to decline. About 1 in 161 people in the U.S. are infectious, the lowest levels since July 1. Transmission levels are higher than during 27% of the pandemic, but a good time to catch up on delayed care.
1/4 There is more COVID-19 transmission today than during 27.7% of the pandemic. CURRENT ESTIMATES FOR April 29, 2024 Wastewater Levels (copies/mL) 203 New Daily Cases 296,000 % of Population Infectious 0.62% (1 in 161 people) New Daily Long COVID Cases 15,000 to 59,000 WEEKLY ESTIMATES FOR April 29, 2024 New Weekly Cases 2,100,000 New Weekly Long COVID Cases 104,000 to 414,000 2024 CUMULATIVE ESTIMATES AS OF April 29, 2024 Total 2024 Cases To Date 105,544,710 Total 2024 Long COVID Cases To Date 5,277,000 to 21,109,000 4-WEEK FORECAST FOR May 27, 2024 Wa...
I have some concerns about Biobot's real-time data quality at the moment. Their real-time data have over-reported levels the past 8 weeks (11% last week, previously 6%, 10%, 7%, 5%, 9%, 4%, 5%) relative to later corrections. Huge bias!
2/4
Qualitatively, the over-reporting in real-time data lead me to believe there's a 50-50 chance we see a May "wavelet" versus continued decline for a couple months. Some of the county-level Biobot data seem implausible (e.g., levels of "3" in Mason County, WA, but others too).
3/4 Mason County, WA Levels of 3 copies/mL, per Biobot. About 1 in 10,000 actively infectious, if accurate.
Read 4 tweets
Mike Hoerger, PhD MSCR MBA Profile picture
Mar 1
31 Reasons Why the New 1-Day COVID Isolation Policy is Wrong

#1
Experts in modeling and testing know that people are infectious with COVID for an average of 7 days, with substantial variability around that average.

"31 Reasons Why the New 1-Day COVID Isolation Policy is Wrong"
#2
People use defense mechanisms to temporarily avoid the death anxiety evoked by thinking of COVID. The too-short 5-day iso was an example of this (see final example).

Such defenses provide temporary relief and are almost always harmful long-term.
#3
Dropping isolation policies to 1 day will predominantly harm people in poor-ventilation environments.

Restaurants have 35-50x less ventilation than the ASHRAE standards, so this will harm the service industry and unsuspecting “brunch class.”
Read 31 tweets

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