Mike Hoerger, PhD MSCR MBA Profile picture
Sep 2, 2024 8 tweets 4 min read Read on X
PMC COVID-19 Forecasting Model, Sept 2, 2024
🧵1/8

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.Graph of the 9 waves. 1 in 35 infectious nationally. Peak currently estimated at 1.4 million, but that may shift to as high as 1.5 million.
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.Graph of year-over-year transmission. Much higher than most prior years. The peak may or may not surpass that of 2 years ago. It will be very close.
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.Zoomed in graph on transmission the past year, with 1-month forecast. Shows a peak estimated near 1.4 million daily infections.
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.Current Levels for Sep 2, 2024 % of the Population Infectious 2.8% (1 in 35) New Daily Infections 1,360,000  New Weekly Infections 9,520,000  Resulting Weekly Long COVID Cases 476,000 to 1,904,000  Monthly Forecast Average % of the Population Infectious 2.7% (1 in 37) Average New Daily Infections 1,280,367 New Infections During the Next Month 38,411,000 Resulting Monthly Long COVID Cases 1,921,000 to 7,682,000  Running Totals Infections Nationwide in 2024 191,899,000 Average Number of Infections Per Person All-Time, U.S. 3.36  How Does Risk Increase with More Social Contacts? Number of peop...
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.

Everywhere but Michigan has high transmission.

PMC COVID-19 Forecasting Model, Sept 2, 2024
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Nationally, we see 1 in 35 people are actively infectious. The South is the highest with about 1 in 30 actively infectious.CDC regional graph of transmission levels.   Estimated Percentage Actively Infectious National	2.8% (1 in 35) Northeast	2.6% (1 in 38) Midwest	2.7% (1 in 37) South	3.3% (1 in 30) West	3.1% (1 in 33)
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.Graph and figure show below-average transmission in Michigan only.
PMC COVID-19 Forecasting Model, Sept 2, 2024
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View the entire dashboard and weekly report at

Improve and share any images across platforms and the web. Thanks! Enjoy the holiday.pmc19.com/dataEntire dashboard. Summarized in Tweets 1-6 of the thread. See ALT text too.

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More from @michael_hoerger

Sep 13
California COVlD Surge Rages Higher

🔸CDC SARS-CoV-2 wastewater levels "Very High," and up from last week
🔸1 in 21 estimated actively infectious
🔸>250,000 estimated new daily infections statewide

Four figures...
1/4🧵 CDC: Very High: PMC Estimate: 1 in 21 actively infectious
CDC wastewater data in California show COVlD cases increasing from the already "Very High" levels last week.

2/4🧵 Line graph of the past 6 months showing the surge in wastewater viral levels
With an estimated 1 in 21 (or 4.8%) of California residents actively infectious of COVlD, risk increases dramatically in larger and more frequent social gatherings.

Interact with 25 people of average risk of being positive, and that's a >70% chance of exposure.
3/4🧵 How Does Risk Increase with More Social Contacts? Number of People | Chances Anyone is Infectious 1	4.8% 2	9.4% 3	13.7% 4	17.9% 5	21.8% 6	25.6% 7	29.1% 8	32.5% 9	35.8% 10	38.9% 15	52.2% 20	62.6% 25	70.8% 30	77.1% 35	82.1% 40	86.0% 50	91.5% 75	97.5% 100	99.3% 300	99.9%
Read 4 tweets
Sep 10
Let's say you're a dairy farmer. You have 100 cows. Each year, about 5 cows die, and another 5 cows are born. Then, along comes a virus. Let's call it "cowvid"...
1/
Let's say "cowvid" wipes out about half the cows over the course of a couple years. Now, you're down to 50 cows....
2/
The local mayor declares "cowvid" to be over. This surprises you as a farmer because 5 of your cows keep dying annually. 5 of 50 instead of 5 out of 100. Seems like more, but you're not a city slicker...
3/
Read 12 tweets
Sep 7
#DuringCOVID is today.

Image pack 1 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
1 million New Daily Infections.

Today!

Image pack 2 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Where are the free vaccines, N95s, and tests?

Image pack 3 of 9 🧵 Graph of the 11 waves of the pandemic in the U.S., tailored to a key message noted in the post.
Read 9 tweets
Sep 3
PMC Dashboard Update (U.S.) 🧵1 of 8

The 11th wave is still rising.
🔥23 states/territories High/Very High
🔥Very High: Alabama, DC, Guam, Hawai'i, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah
🔥1 in 56 estimated actively infectious
🔥876,000 new daily infections CDC heat map, very high states noted in post. PMC estimate of 1 in 56 actively infectious nationwide
PMC Dashboard Update (U.S.) 🧵2 of 8

Note that the CDC has modified 📉 how transmission levels correspond to the categorical bins.

Take California. We estimate 1 in 30 actively infectious statewide. This would have previously been "Very High," now just "High."
#NewNormal CDC heatmap, with PMC estimate of 1 in 30
PMC Dashboard Update (U.S.) 🧵3 of 8

Here are the prevalence estimates for the first half of states/territories.

Notice how high the levels are in some of the "Moderate" states. State	CDC Level Alabama	Very High Alaska	High Arizona	High Arkansas	Moderate California	High Colorado	Moderate Connecticut	High Delaware	High District of Columbia	Very High Florida	High Georgia	Moderate Guam	Very High Hawaii	Very High Idaho	High Illinois	Very Low Indiana	Moderate* Iowa	Low Kansas	Low Kentucky	High Louisiana	Very High Maine	Low Maryland	Moderate Massachusetts	Moderate Michigan	Very Low Minnesota	Moderate Mississippi	High*
Read 9 tweets
Aug 21
During times like these when COVlD transmission heats up in the U.S., expect to see a lot more angry outbursts for three central reasons.

First, "displacement," or people trying to deny the reality of their anxiety by taking it out on other people....
Second, a lot of people can sustain a strong denial of reality about the ongoing pandemic during lulls. They suppress the existence of COVlD waves and excess deaths, disability, and retirements.

During waves, those defenses burst. Loss of control = anger...
Third, a lot of people (many reading this) understand COVlD correctly & experience righteous indignation during COVlD waves. We quite reasonably do not like all of the unjust and gratuitous suffering.

I find it helpful to channel that intensity into helping other people....
Read 6 tweets
Aug 19
I submitted my comment to endorse universal high-quality masks (respirators) in healthcare. Today is the final day.

Alt text continues in the following posts. RE: Z94.4, Selection, use, and care of respirators (New Edition)  Dear Colleagues,  As the director of a population science program at a major U.S. cancer center, I strongly endorse this draft proposal to increase the use of high-quality well-fitting masks (respirators) in medical settings. I will comment on the relevance of this proposal mainly for cancer care. In the U.S., cancer care is commonly more organized than other specialty care and, thus, often leads the way on policy initiatives, which then translate to other elements of care over time.  1. COVID-19 continues to cause excess dea...
They put forth projections, with the most granular detail for the U.S. and U.K., suggesting excess deaths will persist through at least 2033. Their projections do not show excess deaths stopping in 2033; that is simply the final year of their current analysis. Moreover, while they provide the most data for the U.S. and U.K., their analysis suggests a more general trend throughout the globe. The COVID-19-associated excess deaths are commonly identified as cardiovascular and cancer causes of death.   Swiss Re Institute. (2024). The future of excess mortality after COVID-19. https://www.swissr...
Alt text continued 2. The SARS-CoV-2 virus that causes COVID-19 continues to transmit at high rates worldwide. Overall, 28 nations continue to use wastewater surveillance to monitor SARS-CoV-2 levels. A directory is available at the dashboard that I oversee (pmc19.com/data). In the U.S., we are currently experiencing our 11th wave of transmission. Many nations are experiencing annual or twice annual waves of transmission.
Alt text continued 3. International consensus standards identify a broad range of patients at known high-risk of severe outcomes of COVID-19. The largest group at known high risk of severe outcomes is patients with cancer. Other diagnoses associated with above average risk include people undergoing transplants or receiving dialysis, and patients with any of these diagnoses: immunodeficiencies, renal disease, systemic-immune mediated or single-site immune-mediated inflammatory conditions, asplenia, anatomical barrier defects, pregnancy, and diabetes. These findings underscore the importance of standards in hea...
Read 7 tweets

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