Mike Hoerger, PhD MSCR MBA Profile picture
Dec 10, 2024 1 tweets 3 min read Read on X
PMC COVID-19 Forecasting Model, Dec 9, 2024

My over/under for how many daily Covid infections the U.S. will see by the end of the year is 750,000.

Our model has us hitting about 1 million daily by New Year's Eve. The model accounts for historical variation and current trends, but not the atypical state of subvariant evolution. If winter transmission picks up more like usual, such as if LP.8.1. takes off, 1 million is likely spot on.

However, if LP.8.1. does not take off, 700K is probably a better estimate. If the CDC numbers are flat next Friday, take 200k of the model's Dec peak, putting it closer to 800k. If flat in their next two reports, expect closer to 600k. These low-end predictions are greatly at odds with the prior winters of the pandemic and would support a broader change in strategy in how public health agencies advice the public on "winter virus season."

There is more uncertainty now than any time in the past 2.5 years, IMO. The data coming in are very slow, volatile to retroactive corrections, and variable by region. Examples:
🔹Biobot (20% weight in our model) did not report last Wednesday, and still has not reported.
🔹Several technical issues with the CDC dashboard (80% model weight), such as some likely minor coding errors two reports ago.
🔹Walgreens shows an increasing national average in testing positivity
🔹WastewaterSCAN shows a moderate increase in the Midwest and huge increase in the Northeast, but their estimates often change considerably in hindsight
🔹The CDC has Covid ED visits rising as of late Nov, transmission forecasted to be increasing in 28 states and declining in 3 states.

Stay tuned, and if the peak in the remainder of 2024 is at the smaller end, encourage others to track transmission more closely in early 2025, where we could see concerning transmission.

Info for new readers:

For those unfamiliar with the PMC model, find full weekly reports for the past 14+ months at pmc19.com/data

The models combine data from IHME, Biobot, and CDC to use wastewater to estimate case levels (r = .93 to .96) and forecast levels the next month based on typical levels for that date and recent patterns of changes in transmission the past 4 weeks. Our work has been cited in top scientific journals and media outlets, which are fully sourced in a detailed technical appendix at pmc19.com/data/PMC_COVID…

Examples include JAMA Onc, JAMA-NO, BMC Public Health, Time, People, TODAY, the Washington Post, the Institute for New Economic Thinking, Salon, Forbes, the New Republic, Fox, CBS, and NBC. See pgs 11-13 at the above link.

We will have a pre-print out in the next month documenting very compelling evidence for the validity of using wastewater to estimate case rates. Forecasting is challenging in the context of the current viral evolution, but the real-time estimates of cases are impressively accurate to the best we can evaluate it.Year-over-year graph. It shows transmission likely lower for the start of December than any year. If transmission follows the model, expect about 1 million infections/day by the end of 2024. Accounting for viral evolution, the peak may be closer to 750,000.

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More from @michael_hoerger

Mar 31
🧵1 of 5
PMC Dashboard, March 31, 2025 (U.S.)

🔹800-1,400 deaths expected to result from this week's infections (new stat, see video next Tweet)
🔹100,000+ Long Covid conditions to result from this week's infections
🔹1 in 142 actively infectious todayCurrent Levels for Mar 31, 2025	 % of the Population Infectious	 0.7% (1 in 142)	 New Daily Infections	 337000	 New Weekly Infections	 2359000	 Resulting Weekly Long COVID Cases	 118,000 to 472,000	 Resulting Weekly Excess Deaths	 800 to 1,400	 	 Monthly Forecast	 Average % of the Population Infectious	 0.8% (1 in 120)	 Average New Daily Infections	 397233.3333	 New Infections During the Next Month	 11917000	 Resulting Monthly Long COVID Cases	 596,000 to 2,383,000	 Resulting Monthly Excess Deaths	 4,300 to 7,100	 	 Running Totals	 Infections Nationwide in 2025	 52303000	 Average Number of ...
🧵2 of 5
PMC Dashboard, March 31, 2025 (U.S.)

This video explains U.S. COVID excess death statistics, which we have incorporated into the dashboard.

🧵3 of 5
PMC Dashboard, March 31, 2025 (U.S.)

The transmission forecast suggests 300-500k daily infections the next month. If the data get retroactively corrected downward, we could dip to 200k.

Check local dashboards, and time events accordingly.Forecast graph, described in post
Read 5 tweets
Mar 24
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵1/5

🔹3 million new weekly infections in a persistent "lull" of substantial transmission
🔹1 in 107 (0.9%) of the population actively infectious
🔹1 in 3 regions in high/very high transmission (16 states and DC)Heat map of transmission, described in Tweet
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵2/5

We have had a steady state of about a half million infections the past several weeks. That's over 50 million estimated infections so far in 2025.

In a room of 40-50 people, there's a 1-in-3 chance of exposure if no testing/isolation.Current Levels for Mar 24, 2025	 % of the Population Infectious	 0.9% (1 in 107)	 New Daily Infections	 446000	 New Weekly Infections	 3122000	 Resulting Weekly Long COVID Cases	 156,000 to 624,000	 	 Monthly Forecast	 Average % of the Population Infectious	 1.0% (1 in 96)	 Average New Daily Infections	 496566.6667	 New Infections During the Next Month	 14897000	 Resulting Monthly Long COVID Cases	 745,000 to 2,979,000	 	 Running Totals	 Infections Nationwide in 2025	 50757000	 Average Number of Infections	 Per Person All-Time, U.S.	 3.708526284	 	 How Does Risk Increase with More Social Co...
PMC Dashboard, Mar 24, 2025 (U.S.)
🧵3/5

There's a good chance of steady transmission the next month. Often, we'd head into a low lull about now. BUT there are no universal precautions, immunity is waning from the fall & winter 2023-24, & viral evolution looks less 'lucky.'Middle forecast shows 400-600k daily infections.
Read 5 tweets
Mar 11
1) 5-yr Anniversary of the WHO Pandemic Declaration

🔥10 waves
🔥Covid mortality rivals lung cancer
🔥8 infections/person by 2030
🔥Long Covid as catastrophic
🔥Death trajectories becoming complex
🔥"During Covid" as anti-science rhetoric
🔥Serious ppl take Covid seriously
🧵
2) Wastewater-derived estimates of case rates show international consensus 20-26% of populations got Covid during the peak 2 months of the 2023-24 winter wave in the U.S., Canada, and the U.K.
3) The ratio of reported cases versus true cases has remained consistent, demonstrating the validity of wastewater-derived estimates. True cases are 15-30x reported cases, a consistent ratio. There are no examples demonstrating low case rates.
Read 25 tweets
Feb 26
1) Mardi Gras 2020 was 5 years ago today. ⚜️

It was before the pandemic declaration, before the federal government recommended masking.

COVlD spread quickly through New Orleans, leading to one of the highest mortality rates per capita in the U.S.... Timeline showing Mardi Gras 2020 just 4 days before the first known reported death of C19 in the U.S.  Note. "Peak" diagnoses refers to the peak of the 1st wave.
2) New Orleans service workers were disproportionately hit by the early pandemic. Many died. Many developed #LongCOVID at the time or have now through repeat infections. Many have switched to other sectors....

3) The sad fact is that many service workers are continuing to get #LongCOVID through repeat infections today because the pandemic is ongoing and many restaurants have high occupant density and horrendous air quality....

Read 4 tweets
Feb 17
1) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

🔥1 in 72 actively infectious
🔥Sustained high transmission
🔥30 states in high/very high transmission (CDC)
🔥3x the transmission of Feb 2021
🔥668,000 daily infections
🔥Only 1 in 28 cases reportedGraph shows 10 waves of the pandemic.  Tables summarized partially in post. Additionally, transmission is higher than during 59% of the pandemic.  How Does Risk Increase with More Social Contacts? Number of People | Chances anyone is infectious 1	1.4% 2	2.8% 3	4.1% 4	5.5% 5	6.8% 6	8.1% 7	9.4% 8	10.6% 9	11.9% 10	13.1% 15	19.0% 20	24.5% 25	29.7% 30	34.4% 35	38.9% 40	43.0% 50	50.5% 75	65.2% 100	75.5% 300	98.5%
2) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

This is a mid-sized wave, meaning substantial transmission. Notice that transmission remains steady at high rates.

Expect steady or slightly declining transmission, unless the real-time data are retroactively corrected.Two graphs, showing year-over-year transmission and the forecast, summarized in the post.
3) PMC COVlD Dashboard, Feb 17, 2025 (U.S.)

Notice that 30 states remain in high/very high transmission, per CDC categories.

This is the same as last week. Transmission is 3x higher than in Feb 2021, when people were taking more precautions around masking and testing.Transmission heat map and CDC line graph of regional variation in transmission.
Read 5 tweets
Feb 11
1) A lot of high-risk/aware patients I talk to -- mostly getting cancer treatment -- tend to protect themselves from infection by staying home more.

In the work we do, we help patients to understand that a well-fitting high-quality mask can allow them to attend events safely.
2) These are some tips for finding a well-fitting mask among common options in the U.S. and Canada.

3) Here's a more comprehensive diagram of masks that fit most. Aside from #5, these are widely available.

*#5 (Aegle) was the first N95 widely available during the ongoing pandemic for <$1. Hard to find these days, but I gave some to students.
Read 7 tweets

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