Mike Hoerger, PhD MSCR MBA Profile picture
Sep 16, 2025 7 tweets 4 min read Read on X
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵1/7

COVlD-19 levels are "Very High" or "High" in the majority of states, per the CDC.

This includes 27 states & D.C.

🔥🔥Very High:
Alaska, Hawai'i, California, Nevada, Idaho, Utah, S. Dakota, Nebraska, Texas, Louisiana, Indiana, Kentucky, Tennessee, Florida, S. Carolina, N. Carolina, D.C., Maryland, and Connecticut.

🔥High:
Washington state, Oregon, Montana, probably N. Dakota (imputed), Arkansas, Alabama, Virginia, Delaware, Rhode Island, and Massachusetts.

PMC estimates 1 in 38 people (2.7%) are actively infectious. Wastewater-derived case estimates suggest 1.3 million new daily infections.Heat map using CDC levels. Key findings summarized in the post.
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵2/7

Transmission is peaking nationally, but regional variation is common. Know what's happening in your state, and get the word out.

Note that the levels CDC calls "low" are still quite alarming.State | CDC Level | PMC Estimate, % Actively Infectious Alabama	High	1 in 30 (3.4%) Alaska	Very High	1 in 22 (4.6%) Arizona	Moderate	1 in 40 (2.5%) Arkansas	High	1 in 28 (3.6%) California	Very High	1 in 21 (4.8%) Colorado	Moderate	1 in 50 (2.0%) Connecticut	Very High	1 in 19 (5.3%) Delaware	High	1 in 33 (3.0%) District of Columbia	Very High	1 in 17 (6.0%) Florida	Very High	1 in 24 (4.2%) Georgia	Moderate	1 in 46 (2.2%) Guam	Low	1 in 64 (1.6%) Hawaii	Very High	1 in 26 (3.8%) Idaho	Very High	1 in 14 (7.3%) Illinois	Moderate	1 in 44 (2.3%) Indiana	Very High	1 in 16 (6.1%) Iowa	Moderate	1 in 40...
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵3/7

Note that transmission is increasingly spreading from the South & West toward other areas. Know your state-level risk.

Transmission remains alarming even in areas CDC labels "Very Low" (e.g., Missouri, estimated 1 in 109). State | CDC Level | PMC Estimate, % Actively Infectious Missouri	Very Low	1 in 109 (0.9%) Montana	High	1 in 36 (2.8%) Nebraska	Very High	1 in 18 (5.5%) Nevada	Very High	1 in 17 (5.9%) New Hampshire	Low	1 in 64 (1.6%) New Jersey	Moderate	1 in 56 (1.8%) New Mexico	Very Low	1 in 106 (0.9%) New York	Low	1 in 73 (1.4%) North Carolina	Very High	1 in 17 (5.8%) North Dakota	High*	1 in 32 (3.2%) Ohio	Moderate	1 in 47 (2.1%) Oklahoma	Moderate*	1 in 44 (2.3%) Oregon	High	1 in 31 (3.2%) Pennsylvania	Moderate	1 in 44 (2.3%) Rhode Island	High	1 in 30 (3.3%) South Carolina	Very High	1 in 15 (6.6%) South D...
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵4/7

"During COVlD" is today.

The U.S. experiences semi-annual waves. Wastewater-derived case estimates suggest the surge is peaking near 1.3 million new daily infections.

Note. CDC and Biobot made significant upward corrections to their levels reported last week, 5% and 31%, which pushes the estimated wave peak much higher.11 waves of the pandemic (U.S.)
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵5/7

Wastewater-derived case estimates suggest the U.S. is seeing approximately 9.0 million infections per week.

The past week's infections will result in up to 4,200 excess deaths.

Vaccination choice and access are being limited. Infections						Sep 15, 2025				pmc19.com/data Proportion Actively Infectious										1 in 38 (2.7%) New Daily Infections										 1,301,000  Infections the Past Week										 9,030,000  Infections in 2025										 172,000,000  Cumulative Infections per Person										 4.63  										 Long COVID										 Long COVID Cases Resulting								65,000 to 260,000		   from New Daily Infections										 Long COVID Cases Resulting								452,000 to 1,810,000		   from New Weekly Infections										 										 Excess Deaths										 Excess Deaths Resulting 									370 to 610	   from New Daily...
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵6/7

Current transmission (red) has closely tracked that of year 4 (yellow). Data through Sep 6 are shown.

If transmission drops sharply, like in year 4, Sep 6 would be the peak. Otherwise, we would have the latest U.S. summer peak so far.year over year graph
PMC COVlD Report, Sep 15, 2025 (U.S.)
🧵7/7

Last week we noted the following as a plausible scenario. “A very large retroactive correction could shoot the peak substantially higher.” In fact, transmission was retroactively corrected upward, and that creates more uncertainty about the timing of the peak between the 6th and 13th.

The central projection for the current forecast appears to show a plateau heading into a gradual decline in transmission. However, it is best to consider this as an average scenario that must account for both a sudden drop as well as the possibility of continued increases.

Scenario #1: Peak on September 6 (approximately 40% chance). This would be similar to year 4 (see year-over-year graph), with a sharp, pointed peak. The peak would be estimated at approximately 1.25 million new daily infections.

Scenario #2: Peak on September 13 or late (approximately 60% chance). This would more resemble years 3 and 5, where transmission came down more gradually. The peak would be estimated at approximately 1.30 million new daily infections.

The truth may be somewhere in between, but the data only update weekly, so that level of precision is rarely possible. More importantly, transmission varies considerably regionally, so track local data closely.

Finally, note that significant transmission occurs post-peak, so ongoing multi-layered mitigation remains key. We advocate for national policy to increase vaccine eligibility and access across the nation, not merely in select states. I have volunteered to speak at ACIP, and if selected through the lottery system, will focus comments on ongoing and long-term excess mortality.Forecasting model, described in the post

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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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