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Mike Hoerger, PhD MSCR MBA Profile picture
Mike Hoerger, PhD MSCR MBA
@michael_hoerger
Expert in weighing medical evidence, cancer, COVID forecasting & mitigation, health disparities, financial analytics. 120 publications. PhD program director.
51 subscribers
Oct 11 • 20 tweets • 14 min read
PMC COVlD Wave Update (Europe)
11 October 2025 🧵

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/ world map, nations with surveillance shown in blue. URL says pmc19.com/global Data in #Austria show a rising COVlD wave. The x axis (bottom) has infrequent labels, but the data shown go through October 8th.

Find more here:

2/ pmc19.com/austrialongitudinal graph
Oct 5 • 9 tweets • 4 min read
PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵1/9

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.Heat map, grayed out. 1 in 81 estimated actively infectious, or 602,000 new daily infections, per wastewater-derived estimates. PMC COVlD Update, Week of Oct 6, 2025 (U.S.)
🧵2/9

#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. 11 wave graph
Oct 3 • 7 tweets • 3 min read
BREAKING: 3 State Pharmacy Boards Still Block COVlD Boosters without a Prescription

ACIP voted against prescriptions for boosters & 47 states + DC follow that guidance.

Georgia, Missouri, & Louisiana require prescriptions.

Key points in my letter to the pharmacy boards. 🧵1/7 Map shows only Missouri, Louisiana, and Georgia are blocking residents from routing COVlD boosters unless they have a prescription. 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.

🧵2/7 Georgia: State law does NOT require a prescription if it is a “vaccine that is included on the adult immunization schedule recommended by the Advisory Committee on Immunization Practices (ACIP)”1 ACIP voted against prescriptions, and 47 states have accepted that schedule. The law does not mention a CDC Director sign-off, which may be delayed months. Act now to save lives. 1. https://law.justia.com/codes/georgia/title-43/chapter-34/article-2/section-43-34-26-1/
Oct 1 • 25 tweets • 3 min read
I remember when they said kids don't transmit COVlD much because they are short, small, and have tiny lungs. They lied. I remember when they said COVlD doesn't transmit in schools. They lied.
Sep 30 • 8 tweets • 4 min read
PMC COVlD Update, Sep 29, 2025 (U.S.)

Summary: COVlD is everywhere.

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 🧵heat map based on CDC data, and PMC case estimates 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 🧵 Alabama High 1 in 33 (3.0%) Alaska Low 1 in 69 (1.5%) Arizona Moderate* 1 in 42 (2.4%) Arkansas High 1 in 38 (2.7%) California High 1 in 36 (2.8%) Colorado Low 1 in 69 (1.5%) Connecticut Very High 1 in 18 (5.6%) Delaware Very High 1 in 24 (4.1%) District of Columbia Low 1 in 81 (1.2%) Florida Low 1 in 62 (1.6%) Georgia Low 1 in 101 (1.0%) Guam Very Low 1 in 130 (0.8%) Hawaii Moderate 1 in 53 (1.9%) Idaho Low 1 in 62 (1.6%) Illinois Moderate 1 in 60 (1.7%) Indiana High 1 in 27 (3.8%) Iowa Moderate 1 in 58 (1.7%) Kansas Low 1 in 78 (1.3%) Kentucky Moderate 1 in 39 (2.6%) Louisiana High 1 in 3...
Sep 27 • 7 tweets • 3 min read
BREAKING: COVlD transmission surges across the Northeast amid 11th wave.

CDC levels & PMC prevalence estimates:
🔹CT: Very High (1 in 18 people actively infectious)
🔹RI: High (1 in 33)
🔹NY: High (1 in 35)
🔹MA: High (1 in 37)

Quick thread 🧵 1/7 Heat map from CDC data with PMC prevalence estimates noted in post #NewYork has "High" transmission statewide & many counties are seeing "Very High" transmission, per CDC.

PMC estimates 1 in 35 people are actively infectious statewide.

A lot of sites are offline, but notice the overall coverage remains strong. Bad picture statewide.
🧵 2/7 Heat map with prevalence estimate, noted in post
Sep 23 • 8 tweets • 3 min read
PMC COVlD Dashboard, Sep 22, 2025 (U.S.)

The CDC reports 29 states & DC are experiencing High or Very High transmission.

The heat map is a patchwork quilt with COVlD levels varying considerably state by state.

Transmission is shifting north + east.
🧵1/8 Heat map: 29 states and DC in high/very high transmission PMC: Estimates 850,000 new daily infections or 1 in 57 people actively infectious PMC COVlD Dashboard, Sep 22, 2025 (U.S.)

COVlD levels by state, AL to MS.

Note that even levels the CDC calls "Low" like Guam at 1.5% actively infectious are at the threshold where I would tell people who have lapsed that it's time to #MaskUp.

🧵2/8 State CDC Level Actively Infectious Alabama Very High 1 in 24 (4.2%) Alaska High 1 in 38 (2.6%) Arizona Low 1 in 101 (1.0%) Arkansas Very High 1 in 25 (4.0%) California Very High 1 in 25 (4.0%) Colorado Moderate 1 in 56 (1.8%) Connecticut Very High 1 in 20 (4.9%) Delaware High 1 in 33 (3.1%) District of Columbia High 1 in 28 (3.6%) Florida Very High 1 in 25 (3.9%) Georgia Moderate 1 in 53 (1.9%) Guam Low 1 in 68 (1.5%) Hawaii Very High 1 in 25 (4.1%) Idaho Very High 1 in 22 (4.6%) Illinois Moderate 1 in 53 (1.9%) Indiana Very High 1 in 18 (5.7%) Iowa Moderate 1 in 56 (1.8%) Kansas High 1 i...
Sep 20 • 5 tweets • 2 min read
Three years ago, the American public was told in passing that the "pandemic is over."

PMC estimates that since that day, U.S. residents have experienced nearly 1 billion SARS-CoV-2 infections. Specifically, 974,190,702 infections, based on wastewater-derived estimates.

1/5 Far from harmless, recent high-quality data (e.g., PCORnet) suggest each infection leads about 30% of people to experience long-term health sequelae.

Per infection.

Some of these changes will be temporary, and others permanent.

2/5
Sep 16 • 7 tweets • 4 min read
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...
Sep 13 • 4 tweets • 2 min read
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
Sep 10 • 12 tweets • 2 min read
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/
Sep 7 • 9 tweets • 3 min read
#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.
Sep 3 • 9 tweets • 4 min read
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
Aug 21 • 6 tweets • 2 min read
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...
Aug 19 • 7 tweets • 2 min read
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.
Aug 16 • 5 tweets • 2 min read
🚩🚩🚩
As a vigorous defender of #CDC data, their switch from using normalized to non-normalized COVlD wastewater surveillance data today harms data quality.

"Normalizing" means accounting for basic confounders like rain levels. It is a choice to use worse data.
1/5🧵 Image Historically, the CDC data have correlated near-perfectly with similar metrics, such as Biobot's wastewater estimates (still active) or the IHME true case estimates (through mid-2023).

The changes reduce those correlations. It's like going from an A+ to a B.

2/5🧵
Aug 12 • 12 tweets • 5 min read
PMC COVID Dashboard, August 11, 2025 (U.S.)

The CDC says transmission is heating up.

"Very High" (3)
🔺Guam
🔺Hawai'i
🔺Louisiana

"High" (12)
🔺Alabama
🔺Alaska
🔺California
🔺Colorado
🔺Delaware
🔺Florida
🔺Indiana
🔺Mississippi
🔺Nevada
🔺S. Carolina
🔺Texas
🔺Utah

🧵1/12Heat map from CDC data. High/Very high states noted in post Transmission is highest in these regions. Graphics note the CDC levels and PMC prevalence estimates.

🔥Louisiana (Very High): 1 in 19 actively infectious
🔥Guam (Very High): 1 in 26
🔥Hawai'i (Very High): 1 in 28
🔥Texas (High): 1 in 45

🧵2/12 Graphics show heat maps and prevalence estimates, noted in the post
Jul 29 • 12 tweets • 8 min read
PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵1/12

PMC estimates 400,000 new daily infections. 1 in 118 people actively infectious.

Weekly stats:
🔹2.8 million infections (>40x reported cases)
🔹>140,000 resulting #LongCOVID cases
🔹>1,000 resulting excess deaths Heat map Very High: Louisiana, Guam High: Hawai'i, Florida PMC COVID Dashboard, July 28, 2025 (U.S.)
🧵2/12

Please excuse any typos and delays. Any time Mimal's boot turns deep red, we're doing local outreach in addition to dashboard work, etc.

If you don't know Mimal yet, you won't be able to unsee them.
es.wikipedia.org/wiki/MIMALDeep red boot = Louisiana
Minnesota (M), Iowa (I), Missouri (M), Arkansas (A), Louisiana (L) = Mimal Louisiana is the boot. Sometimes depicted with Kentucky fried chicken on a Tennessee pan.
Jul 25 • 6 tweets • 2 min read
U.S. CDC numbers just released. Good news (for those not in Louisiana). "Only" a 5% national increase.

2025 has closely tracked with summer 2023 transmission. A 12-13% increase would have been expected based on those numbers. That said... Up: Midwest, Northeast Down: West, South real-time data have been prone to retroactive corrections. This is frustrating, of course, because it leaves people making decisions based on data that are only of good quality when 2 weeks old.

If we saw a 12% increase this week, I'd say look at 2023 for a glimpse...
Jul 21 • 12 tweets • 6 min read
1. PMC COVlD Dashboard, July 21, 2025 (U.S.)

COVlD is surging in 7 states, according to the CDC.
🔹Hawai'i (Very High)
🔹California (High)
🔹Nevada (High)
🔹Texas (High)
🔹Louisiana (High)
🔹Florida (High)
🔹South Carolina (High) Heat map, summarized in post 2. PMC COVlD Dashboard, July 21, 2025 (U.S.)

Western surge:
🔹California: 1 in 63 actively infectious, much higher in LA & Bay areas
🔹Hawai'i: 1 in 35 actively infectious
🔹Nevada: 1 in 63 actively infectious

These are wastewater derived estimates, not from individual tests CA map with stat summarized in post
NV map with stat summarized in post
HI map with stat summarized in post
Jul 15 • 11 tweets • 6 min read
1) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

We estimate 1 in 148 Americans are actively infectious. This equates to 2.3 million infections/week, expected to result in >100,000 new #LongCOVID conditions & >800 deaths.

A room of 100 people is a coin toss of an exposure. Figure shows each wave of the pandemic. Tables: Current Levels for Jul 14, 2025 % of the Population Infectious 0.7% (1 in 148) New Daily Infections 324000 New Weekly Infections 2268000 Resulting Weekly Long COVID Cases 113,000 to 454,000 Resulting Weekly Excess Deaths 800 to 1,300 Monthly Forecast Average % of the Population Infectious 1.3% (1 in 80) Average New Daily Infections 598766.6667 New Infections During the Next Month 17963000 Resulting Monthly Long COVID Cases 898,000 to 3,593,000 Resulting Monthly Excess Deaths 6,400 to 10,700 Running Totals Infection... 2) PMC COVlD Dashboard, July 14, 2025 (U.S.) 🧵

Transmission (red) is closely tracking the path of 2 years ago (yellow). However, the incoming data are spotty. >20% of CDC states have limited/no data, & Biobot hasn't reported in weeks.

Could be MUCH worse or slightly better. Graph of year over year transmission. The current year (red) is tracking the path of two years ago (yellow) extremely closely. Two years ago, the peak was around September 1, at about 1 million daily estimated infections, and significantly higher than the Delta wave (blue).