Mike Hoerger, PhD MSCR MBA Profile picture
Sep 23, 2024 8 tweets 5 min read Read on X
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 1/8

The U.S. continues to see an estimated 1.1 million daily COVID infections with 2.2% of the population actively infectious as we descend from the peak of a 9th Covid wave.

Transmission will remain very high the rest of 2024.Main PMC figure showing Covid transmission over time. It shows 9 waves. The current wave peaked in August, and we're still seeing >1 million infections/day in the U.S.
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 2/8

Looking at the year-over-year graph, note that we're in uncharted territory for this point in the fall. Expect a very high "lull" in early November before the winter surge sets in.

As we have noted previously, our current estimates are likely slight underestimates given elevated school-based transmission and the CDC data standardization process.

Kids: They are smaller, and make smaller "contributions" to wastewater. Basically, it takes more sick kids to produce the average amount of wastewater virus to equate to an average infection (mostly in adults). This issue evens out over time, but it means the model may underestimate during back-to-school periods.

CDC: They describe the details of their process for standardizing data over time. It's very strong, much better than what most localized wastewater orgs or WWS do. It's a bit Dunning-Kruger to question basic wastewater scientists in doing the most fundamental components of their jobs, and the data continue to correlate >.90 with other metrics like Biobot. In comparing with other data, I take their estimates as spot on, but could also see arguments that they may underestimate transmission by 0-5%. It's something we always keep an eye on. Trust, but verify.

Transmission is magnitudes higher than much of the public realizes, so we focus on the big-picture view rather than quibbling over such issues that tend to balance out over time.

I hear @jlerollblues is considering weighting a model based on estimates of the proportion of infections in children. That's actually tougher to estimate than it sounds at first glance. You should key an eye on his models too and the work he and others are doing with the WHN.Estimating a "lull" the 1st week of November, but at an alarming 850k daily infections in the U.S.
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 3/8

Zooming in from the big picture, here's the past year of the pandemic.

🔹1.1 million daily infections
🔹Bimodal peak (Aug 10 & 24) of 1.3 million daily infections
🔹50-60% of transmission happens on the back end of waves

Continue to educate family, friends, and co-workers. Look at how the wave descends much more gradually than is arose. Many infections to come, and to try to prevent! Also, most people are not monitoring wastewater. They keep track of the cumulative "anecdata" of people they know sick or diagnosed with Covid recently. In their mind, the peak will feel like late October, when the cumulative count has really built up. You may find people more open to listening during the next month.Annual graph. Shows transmission much higher than a year ago at 1.1 million daily infections today, but nowhere near the 1.9 million daily infections of last winter's peak.   The wave is descending slower than it rose, which is a reminder than much transmission happens on the back end of waves.
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 4/8

These statistics document the ongoing toll of the pandemic.

🔥Expect about 29 million infections in the U.S. over the next month if the model holds.

🔥In a classroom of 30-35 people, there's about a 50% chance at least one person is infectious if weak/no isolation policies.

🔥Transmission is higher than during 80% of the pandemic.Current Levels for Sep 23, 2024 % of the Population Infectious 2.2% (1 in 45) New Daily Infections 1,059,000  New Weekly Infections 7,413,000  Resulting Weekly Long COVID Cases 371,000 to 1,483,000  Monthly Forecast Average % of the Population Infectious 2.0% (1 in 49) Average New Daily Infections 969,467 New Infections During the Next Month 29,084,000 Resulting Monthly Long COVID Cases 1,454,000 to 5,817,000  Running Totals Infections Nationwide in 2024 214,525,000 Average Number of Infections Per Person All-Time, U.S. 3.42  How Does Risk Increase with More Social Contacts? Number of peopl...
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 5/8

Three states stand out.

Estimated percentage of populations actively infectious:

Oklahoma: 8.9%
Oregon: 5.3%
New Hampshire: 5.3%

Note, estimates get less precise when focusing on smaller geographic units, and sometimes high estimates are revised in hindsight.

Also, while these figures may seem high, keep in mind that as one focuses on narrower units, the peak is more targeted, so local peaks see higher percentages than state peaks, which are higher than regional peaks, which are higher than national peaks. Smaller units have more leptokurtic transmission.CDC heat map. Very high transmission across most of the U.S.
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 6/8

These are the present regional estimates in the U.S.

The West is coming down from a second peak this wave but still with approximately 2.8% of the region actively infectious.

The Northeast region saw atypically low transmission this wave, relative to other regions. That area may see a different pattern of transmission than the rest of the U.S. the next several months. For example, within the northeast region, the winter peak could be larger than other areas. However, expect to also see more localized units where instead of 2 big waves (late summer and winter), there is 1 big wave in late Nov / early December, or a bumpy wave in the months ahead, like the west just saw. Last winter, we often posted examples of the "weird" transmission patterns in some areas.

I'd keep a closer eye on local data if in the Northeast region.Regional graph of transmission from the CDC.  Table from PMC  Estimated Percentage Actively Infectious National	2.2% (1 in 45) Northeast	1.2% (1 in 85) Midwest	2.4% (1 in 42) South	2.2% (1 in 45) West	2.8% (1 in 36)
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 7/8

Come join our team! I am accepting applicants for the Health Psychology PhD program at Tulane! 🎉

I'd love to work with someone passionate about research, cancer, & Covid safety. Should have a psych/similar background. 😷🧠Tulane University - Health Psychology PhD  Seeking applicants to our PhD program who Understand and are cautious about COVID, Have a background in psychology or a closely-related undergraduate or Master’s degree program, Plan to pursue a research-intensive career spanning multiple scientific disciplines, and Have a desire to help people with serious health conditions like cancer. Learn more: HealthPsychPhD.com or mhoerger@tulane.edu  Small images of a Tulane logo, a cancer ribbon, and a VFlex N95 mask
PMC COVID-19 Forecasting Model, Sep 23, 2024
🧵 8/8

Current state of the COVID-19 pandemic in the U.S.

🔹1.1 million daily COVID infections
🔹1 in 45 actively infectious
🔹High "lull" coming early November
🔹Winter surge to follow

Full dashboard: pmc19.com/dataDashboard has 6 sections, summarized in Tweets 1-6

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More from @michael_hoerger

Jan 25
During this 12th COVlD wave, the CDC reports 1-in-3 states have "High" or "Very High" levels.

PMC estimates the proportion of residents actively infectious (prevalence):
◾️USA: 1 in 67
◾️IA: 1 in 27
◾️MI: 1 in 25
◾️IN & CT: 1 in 23
◾️ME: 1 in 21
◾️OK & SD: 1 in 17

🧵1/ Heat map using CDC data. National PMC prevalence estimate noted; estimated incidence of 732,000 new daily infections.
On average, Americans have have 5.0 cumulative SARS-CoV-2 infections.

This week's infections are expected to result in 1/4 to 1 million new #LongCOVID conditions and ≈2,000 excess deaths.
🧵2/ Column 1: Table of state-level prevalence estimates. Highest estimates noted in the thread text.  Column 2:  Proportion Actively Infectious										1 in 67 (1.5%) New Daily Infections										 732,000  Infections the Past Week										 5,220,000  Infections in 2026										 24,000,000  Cumulative Infections per Person										 5.04  										 Long COVID										 Long COVID Cases Resulting								37,000 to 146,000		   from New Daily Infections										 Long COVID Cases Resulting								261,000 to 1,040,000		   from New Weekly Infections										 										 Excess Deaths										 Ex...
The wave peak is now estimated >10% higher than last week at 1.2 million new daily infections, nearly double the Delta wave.

We expect sustained high transmission (≈600,000 to 750,000 new daily infections) the next few weeks as COVlD circulates through schools/families.
🧵3/ Fig 1: Graph of 12 waves  Fig 2: "Barometer" showing above average transmission  Fig 3: Year-over-year graph, which informs the analytic forecast  Fig 4: Forecast described in post
Read 4 tweets
Jan 17
Based on today's CDC & Biobot data, we estimate the following for the week of Jan 19:

🔸1 in 52 people in the U.S. actively infectious
🔸25% chance of exposure in a room of 15 ppl
🔸Nearly 1 million new daily infections
🔸5 cumulative infections per person all-time (avg)
🧵1/5 Heat map from CDC data with PMC estimates. Description of "Very High" states in next post
Transmission estimates have been marginally corrected upward.

11 states have Very High COVlD levels:

🔸PA: 1 in 25 estimated actively infectious
🔸MI: 1 in 23
🔸OH & KY: 1 in 22
🔸SD: 1 in 20
🔸NE & IA: 1 in 18
🔸IL & ME: 1 in 17
🔸IN: 1 in 16
🔸WV: 1 in 11
🧵2/5 Proportion Actively Infectious										1 in 52 (1.9%) New Daily Infections										 941,000  Infections the Past Week										 6,020,000  Infections in 2026										 18,000,000  Cumulative Infections per Person										 5.01  										 Long COVID										 Long COVID Cases Resulting								47,000 to 188,000		   from New Daily Infections										 Long COVID Cases Resulting								301,000 to 1,200,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									270 to 450	   from New Daily Infections										 Excess Deaths Resulting 				...
We're in the middle of a 12th COVlD wave.

The peak has likely passed, but with students headed back to school, transmission is expected to remain high for at least the next several weeks.

🧵3/5 1) Graph of 12 waves 2) Barometer showing above-average transmission 3) Year over year graph 4) Forecast for transmission to decline and then percolate at high levels
Read 5 tweets
Jan 10
The size of the winter COVlD wave has been revised upward as post-holiday data come in.

We estimated 1 in 55 people in the U.S. are actively infectious.

🔥WV: 1 in 14
🔥IN: 1 in 15
🔥MI & OH: 1 in 21
🔥MO: 1 in 22
🔥CT: 1 in 24
🔥KS: 1 in 25
🔥MA & IL: 1 in 27

Quick 🧵 1/4 Heat map and PMC estimates, 1 in 55 infectious and 892,000 new daily infections for Jan 12.  We expedited the report to release it two days early.
Nationally, we are seeing an estimated 892,000 new daily SARS-CoV-2 infections, meaning a 1 in 4 chance of exposure in a room of 15 people. Risk varies considerably by state.

We are approaching an average of 5 infections per person since pandemic onset.
🧵 2/4 Alabama	Moderate Alaska	Very Low Arizona	Very Low Arkansas	High* California	Very Low Colorado	Low Connecticut	Very High Delaware	Moderate District of Columbia	Very Low Florida	Very Low Georgia	Very Low Guam	Very Low Hawaii	Very Low Idaho	Very Low Illinois	Very High Indiana	Very High Iowa	High Kansas	Very High Kentucky	Moderate Louisiana	Moderate Maine	High Maryland	High Massachusetts	Very High Michigan	Very High* Minnesota	Moderate Mississippi	Low* Missouri	Very High* Montana	High Nebraska	High Nevada	Very Low New Hampshire	Moderate New Jersey	Low New Mexico	Moderate New York	High* North Ca...
We are in the 12th COVlD wave of the U.S.

Current transmission is higher than 68% of all days since the pandemic onset in 2020.
🧵 3/4 12 waves of COVlD  Pandemic barometer: Higher than 88% of the past 100 days, 73% of the past year, 68% of the entire pandemic.  Year over year graph  Forecast of slowly declining transmission.
Read 4 tweets
Jan 8
You might not have heard, but the northeastern U.S. is in a COVlD surge.

We use wastewater levels to derive estimates of the proportion of people actively infectious in each state (prevalence), e.g., 1 in 24 people in Connecticut.

Let me walk you through it...

🧵1/8 Colors show CDC levels PMC prevalence estimates noted: -Maine 1 in 38 actively infectious with COVlD -New Hampshire 1 in 35 (limited data) -Vermont 1 in 75 -New York 1 in 44 (limited data) -Pennsylvania 1 in 44 -Massachusetts 1 in 36 -Connecticut 1 in 24 -Rhode Island 1 in 41 -New Jersey 1 in 82
Notice that #Connecticut has excellent SARS-CoV-2 wastewater surveillance. It's "Very High" across much of the state, per CDC.

Based on wastewater levels, we estimate 1 in 24 residents are actively infectious w/COVlD. That's a 66% exposure risk in a room of 25 people.

🧵2/8 Colors show CDC levels PMC estimate of prevalence
The CDC reports "Very High" levels in #Massachusetts.

The surveillance is less robust, but we estimate 1 in 26 residents are actively infectious, similar to our estimate in CT where coverage is better.

In a room of 25 people, that's a 62% chance of an exposure.

🧵3/8 Colors show CDC levels PMC prevalence estimates provided
Read 8 tweets
Jan 8
We're in the middle of a 12th COVlD wave in the U.S., with transmission particularly high in the Midwest and Northeast.

The CDC announced this week that COVlD continues to kill more Americans than breast and prostate cancer combined.

Get boosted & #MaskUp 💉💪😷
1/4🧵 Heat map of CDC data with PMC prevalence estimate
Levels are "Moderate" to "Very High" in 26 states.

However, data reporting is slow, and about 1/3 of states have low-quality data this week due to the holidays and illness.

2/4🧵 National estimates: Number of People		Chances Anyone is Infectious			 1				1.5%	 2				3.0%	 3				4.5%	 4				6.0%	 5				7.4%	 10				14.3%	 15				20.7%	 20				26.5%	 25				32.0%	 30				37.0%	 50				53.8%	 75				68.6%	 100				78.6%	 200				95.4%	 300				99.0%
Barometer: Higher transmission than 90 of the past 100 days (perhaps higher still, due to low data reporting quality)
State	CDC Level	Actively Infectious Alabama	Moderate	1 in 48 (2.1%) Alaska	Very Low	1 in 152 (0.7%) Arizona	Very Low	1 in 201 (0.5%) Arkansas	High*	1 in 36 (2.8%) California	Very Low	1 in 484 (0.2%) Colorado	Moderate	1 in 49 (2.0%) Connecticut	Very High	1 in 24 (4.2%) Delaware	Low*	1 in 70 (1.4%) District of Columbia	Very Low	1 in 5,835 (0.0%) Florida	Very Low	1 in 284 (0.4%) Georgia	Low	1 in 90 (1.1%) Guam	Very Low	1 in 687 (0.1%) Hawaii	Very Low	1 in 874 (0.1%) Idaho	Very Low	1 in 169 (0.6%) Illinois	Moderate*	1 in 56 (1.8%) Indiana	High*	1 in 34 (2.9%) Iowa	Moderate	1 in 41 (2.4%) Kansas...
State	CDC Level	Actively Infectious Missouri	Moderate*	1 in 42 (2.4%) Montana	High	1 in 34 (2.9%) Nebraska	Very High	1 in 26 (3.9%) Nevada	Very Low	1 in 138 (0.7%) New Hampshire	High*	1 in 35 (2.9%) New Jersey	Low	1 in 82 (1.2%) New Mexico	Low	1 in 87 (1.2%) New York	Moderate*	1 in 44 (2.3%) North Carolina	Low	1 in 82 (1.2%) North Dakota	High*	1 in 34 (3.0%) Ohio	Very High	1 in 27 (3.7%) Oklahoma	Moderate*	1 in 62 (1.6%) Oregon	Very Low	1 in 170 (0.6%) Pennsylvania	Moderate	1 in 44 (2.3%) Rhode Island	Moderate	1 in 41 (2.4%) South Carolina	Moderate	1 in 54 (1.9%) South Dakota	Very High	1 in...
If like years 1-4 of the pandemic, the winter wave has peaked. If like last year, we could hover near peak levels for a month.

Forecasting quality is low with 1/3 of states having data issues. Hopefully, we'll know a lot more in a few days.

3/4🧵 12 waves
Proportion Actively Infectious										1 in 65 (1.5%) New Daily Infections										 749,000  Infections the Past Week										 5,390,000  Infections in 2026										 3,000,000  Cumulative Infections per Person										 4.88  										 Long COVID										 Long COVID Cases Resulting								37,000 to 150,000		   from New Daily Infections										 Long COVID Cases Resulting								270,000 to 1,080,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									220 to 370	   from New Daily Infections										 Excess Deaths Resulting 					...
year over year graph
forecast
Read 4 tweets
Jan 5
We told you that 109,000-175,000 Americans would died of COVID (excess deaths) in 2025.

Today, the CDC estimates 101,000 deaths/year (flat from Oct 2022 to Sep 2024), and likely higher when considering more nebulous non-acute excess deaths (heart attack 6 months later).
1/5
The CDC estimates are actually higher than I would have guessed, given their methodology, which models estimates based on easily countable factors in healthcare and expert input on multiplier values. It lends credence to the PMC upper bound of excess deaths of 175,000/yr.
2/5
What's troubling is the CDC has annual mortality flat. My expectation based on mortality displacement and Swiss Re data is that it should be declining. If is stays flat, we're running on something like breast+prostate cancer or lung cancer deaths per year in perpetuity.
3/5
Read 6 tweets

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