We've headed from a false summit toward a larger peak in back-to-school transmission. Next week we'll know whether this is the largest or 2nd largest summer wave all-time. Expect 1.4-1.5 million daily infections at the peak.
This secondary peak is larger than anticipated previously, even when accounting for patterns of back-to-school transmission in prior years.
One, the West and South were peaking earlier, and the Northeast and Midwest have transmission picking up much faster than its falling off elsewhere. These are atypical regional differences.
Two, the 1-day isolation policy and general decline in school-based mitigation have unleashed transmission at higher levels than would be anticipated in prior years, even when accounting for the already-high levels of transmission as children went back to school.
Three, our model uses a combination of CDC and Biobot (former CDC contractor) data, using a 60% versus 40% mix for current case estimation. Biobot has not updated their data the prior two weeks without explanation. They were running much cooler than the CDC data, whether reflective of reality, or merely reporting delays. We have downgraded them to 20% in the model, and they will be downgraded further to 0% if they do not update their data this week.
You can take points 1 and 2 to account for the secondary and higher peak (shape of transmission), when models accounting for prior years would have suggested transmission slowing already, and point 3 accounting for a shift toward a slightly higher overall estimate of transmission.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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This graph shows year-over-year transmission. It clarifies the unusual shape of the transmission distribution. A "peak" or false summit, followed by a very slight decline in transmission (negligible), then a 2nd (true) peak.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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Presently, we estimate a peak at 1.4 million daily infections. Next week, we will have a much better sense. It could be in the 1.3-1.5 million range. There's about a 50% chance it will be the largest summer wave.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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Happy Labor Day!
We're seeing higher transmission than during 91.6% of the pandemic, so COVID is very much not "over." In a gathering of 10 people of average risk, there would be a 1 in 4 chance someone has COVID if no special rules (testing, isolating, etc.).
Some schools still have not started yet and will begin tomorrow. Classrooms should presume someone has COVID. Mask, test, isolate until repeatedly negative.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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Here's the heat map of transmission. You'll see a lack of a clear pattern because the South/West are slowing and the Midwest/Northeast are picking up.
Nationally, we see 1 in 35 people are actively infectious. The South is the highest with about 1 in 30 actively infectious.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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Michigan (yellow line) has atypically low transmission. Happy to hear theories on this.
They have typically had unusual patterns of transmission. Perhaps the extended precautions during the 1st two years of the pandemic play some ongoing role.
About 0.9% are actively infectious in MI, about 1/3 the national average.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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SARS-CoV-2 transmission has fallen.
🔹1 in 191 (0.5%) actively infectious
🔹"Lull" levels at 20% of the summer peak
🔹255,000 new daily infections (still concerning)
Many will knock out higher-risk activities the next 2-4 weeks.
🧵1/11
PMC COVlD Update, Oct 20, 2025 (U.S.)
"Lull" transmission remains dangerous:
🔹1.8 million estimated new weekly infections
🔹>90,000 estimated new #LongCOVID conditions from this week's infections
🔹>500 excess deaths to result from this week's infections
🧵2/11
PMC COVlD Update, Oct 20, 2025 (U.S.)
Exposure risk during "lull" transmission remains high when engaging in many social interactions.
Interacting with 25 people yields a 12% chance of exposure. 100 people? 41% chance of exposure, assuming no testing/isolation.
The PMC website includes an international directory of websites with COVlD wastewater monitoring. It is more up to date than the directories of the EU and WHO.
Let's review what's happening in Europe...
1/
Data in #Austria show a rising COVlD wave. The x axis (bottom) has infrequent labels, but the data shown go through October 8th.
An estimated 1 in 81 people are actively infectious during the ongoing 11th wave.
The "shutdown" has created a blackout at the state level.
Transmission is half that of the peak one month ago, and we anticipate a relative national "lull" in early-to-mid November, albeit still at dangerous levels.
Our model uses a combination of CDC and Biobot data, so we are able to estimate national statistics despite the CDC data going offline. On the map, note that Puerto Rico continues to update; they use a CDC-style system but were dropped by the CDC long ago. For full methodology, review the technical appendix on the website.
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
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#DuringCOVID is today. We estimate >600,000 new daily infections. This is about half the peak on September 6.
Notice current levels are similar to the estimated peaks of the first 3 waves.
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
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Weekly estimates:
🔹4.5 million infections
🔹>200,000 resulting long-term health conditions
🔹>1,300 resulting excess deaths
Key points in my letter to the pharmacy boards. 🧵1/7
Georgia law indicates that the pharmacy board is to follow ACIP. They do not dictate further nuance. Georgia continues to require prescriptions, going against the spirit of the law, ACIP, and 47 other states.
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Louisiana law tells the pharmacy board to follow ACIP. ACIP says do not require a prescription, and 47 other states agree.
The Louisiana pharmacy board continues to require a prescription.
On the back end of this unprecedented 11th wave, "times they are a-changin." In particular, COVlD levels are shifting north and east.
Notice that few states are in the highest and lowest categories. Much of the south and west have considerable transmission post-peak. Many places in the north and east are seeing steady or increasing transmission after relatively lower levels.
Overall, levels are lower than the past few weeks, but transmission remains considerable. Those relying on anecdata (friends, coworkers, and family infected) may increasingly realize we are in a wave.
We estimate nearly 750,000 new daily infections nationwide, meaning approximately 1 in 66 people or 1.5% are actively infectious.
These estimates are derived by linking wastewater levels to IHME true case estimates using methodology commonly employed worldwide, detailed on the website, noted in a pre-print. Many publications in leading medical journals link wastewater data to key metrics that matter, noted in the online technical appendix.
In this week's report, we note adding North Dakota and Puerto Rico to the heat map in support of health equity. We have been imputing ND levels since the launch of PMC 3.0 using data from neighboring states. PR continues to report qualitative levels using the CDC format but is not longer included on the CDC website.
1/8 🧵
PMC COVlD Update, Sep 29, 2025 (U.S.)
State-level prevalence estimates, AL to MS. The levels use CDC labels, which tend to have an optimistic portrayal of risk. For example, CO is listed at "low" (by our estimate 1.5% infectious).
#MaskUp at 1.5% if having lapsed.
2/8 🧵
PMC COVlD Update, Sep 29, 2025 (U.S.)
State-level prevalence estimates, Missouri to Wyoming.
New York had *huge* retroactive upward corrections, and is now "High," as many residents hypothesized.
Note, Puerto Rico only provides CDC qualitative levels, so no data.