Mike Hoerger, PhD MSCR MBA Profile picture
Director of the top public U.S. #COVID forecasting dashboard (PMC). #HealthPsych PhD Program Director, #CovidCancer scientist, over 100 science publications.
Ross Grayson, MPH, CIH Profile picture Perpetual Mind Profile picture Brian Branagan Profile picture Chris_! Profile picture AAH Profile picture 31 subscribed
Mar 1 31 tweets 10 min read
31 Reasons Why the New 1-Day COVID Isolation Policy is Wrong

#1
Experts in modeling and testing know that people are infectious with COVID for an average of 7 days, with substantial variability around that average.

"31 Reasons Why the New 1-Day COVID Isolation Policy is Wrong" #2
People use defense mechanisms to temporarily avoid the death anxiety evoked by thinking of COVID. The too-short 5-day iso was an example of this (see final example).

Such defenses provide temporary relief and are almost always harmful long-term.
Feb 29 5 tweets 4 min read
PMC COVID-19 Forecast, Week of Feb 26, 2024
1 of 5 🧵

Forecast for the next month
Over the next month, we should see transmission fall from 790,000 infections/day toward more like a range of 200,000-450,000 infections per day, depending on better or worse scenarios.

That's "good" news in the relative sense for those putting off medical appointments the past 6 months, though still extremely high transmission in any objective sense.

See the online report for details on the models.

Surge in Context
At this point in the surge, it is clear that the peak transmission day was around December 27 (1.92 million/day), and the midpoint of “surging” infections (>1 million/day) was around January 9.

We are estimated to have had 85 total days with >1 million infections per day (November 28 through February 20) during the surge, though these numbers may still fluctuate with corrections the next few weeks.

The low-point leading into the surge was October 18 at 547,000 infections/day. Infections have been at “wave” levels (>500,000 infections/day or higher) since the onset of the late summer wave surpassed that milestone on July 27. We are estimated to dip below 500,000 infections/day around March 6.

This is very unfortunate timing because the medical facilities that enacted universal masking may end policies on March 1. Many were hoping for a period of lower transmission before such policies ended. As of today, the estimated low point for transmission is March 27 (348,000 infections/day), but the level and date are subject to much uncertainty.CURRENT ESTIMATES FOR February 26, 2024 Wastewater Levels (copies/mL) 546 New Daily Cases 794,000 % of Population Infectious 1.66% (1 in 60 people) New Daily Long COVID Cases  40,000 to 159,000   4-WEEK FORECAST FOR March 25, 2024 Wastewater Levels (copies/mL) 242 (-56% lower) New Daily Cases 353,000 % of Population Infectious 0.74% (1 in 135 people) New Daily Long COVID Cases  18,000 to 71,000  PMC COVID-19 Forecast, Week of Feb 26, 2024
2 of 5 🧵

Current State of the Pandemic
🔹73 million infections in the U.S. in 2024 (so far)
🔹790,000 daily infections
🔹1.66% (1 in 60) actively infectious
🔹40,000+ resulting #LongCOVID cases/day

Deeper Dive
Transmission is finally starting to decline again, and expect major declines the next four week.

U.S. wastewater levels indicate that COVID transmission is higher than during 58.4% of the days of the pandemic (down from 85.9% a week ago). Transmission is lower than 41.6% of the pandemic.

As we noted the past two weeks, we believed the post-peak hill was itself peaking on around February 7th and that last week’s slightly higher values might get retroactively corrected downward. That was, in fact, the case (the peak was the 7th), and transmission has fallen further since.

We are still at very high “wave” levels, but no longer “surging” at over a million infections/day. The big picture remains very bad, but this is good news for people putting off medical appointments for months.There is more COVID-19 transmission today        than during 58.4% of the pandemic.  CURRENT ESTIMATES FOR February 26, 2024 Wastewater Levels (copies/mL) 546 New Daily Cases 794,000 % of Population Infectious 1.66% (1 in 60 people) New Daily Long COVID Cases 40,000 to 159,000  WEEKLY ESTIMATES FOR February 26, 2024 New Weekly Cases 5,600,000 New Weekly Long COVID Cases 278,000 to 1,112,000  2024 CUMULATIVE ESTIMATES AS OF February 26, 2024 Total 2024 Cases To Date 73,585,610 Total 2024 Long COVID Cases To Date 3,679,000 to 14,717,000
Feb 8 4 tweets 2 min read
New book about to drop.

1/4
Ralph Nader's "Unsafe at Any Speed: The designed-in dangers of the American automobile," cover modified to "COVID-19 Unsafe as we breathe: The designed-in dangers of the California 1-day isolation policy" Dr. Moriarty & other modelers know people are infectious for an average of about 7 days, per high-quality studies. Many for much longer.

Dr. Mina's pinned Tweet lays out a sample timeline.

Sending kids to school on Day 2 positive will essentially maximize infections.
2/4 Pinned tweet from Michael Mina showing a heuristic infection timeline for an individual patient. Sending someone to school 1 day after positive basically means they're being sent to school right at peak infectiousness.
Feb 5 6 tweets 3 min read
1 / 6 🧵
PMC COVID-19 Forecast, Week of Feb 5, 2024

We are seeing escalating transmission in a post-peak hill.
🔹2.8% (1 in 36) actively infectious
🔹1.3 million infections/day
🔹Hill peaks in 2 days 🤞
🔹>65,000 resulting #LongCOVID cases/dayCURRENT ESTIMATES FOR February 5, 2024 Wastewater Levels (copies/mL) 909 New Daily Cases 1,323,000 % of Population Infectious 2.77% (1 in 36 people) New Daily Long COVID Cases  66,000 to 265,000   4-WEEK FORECAST FOR March 4, 2024 Wastewater Levels (copies/mL) 520 (-43% lower) New Daily Cases 757,000 % of Population Infectious 1.58% (1 in 63 people) New Daily Long COVID Cases  38,000 to 151,000  2 / 6 🧵
PMC COVID-19 Forecast, Week of Feb 5, 2024

We began to see evidence of a post-peak hill 3 weeks ago. I was skeptical. The real-time data now bear this out. Hopefully we are not in a Terminator-style scenario where the technology outsmarts the maker. 🤣Visual shows line graphs for today and each of the past 3 weeks. The post-peak hill becomes more pronounced over time, as the model gains more precision.
Feb 4 22 tweets 5 min read
The poor drainage infrastructure in #NewOrleans is a detriment to housing justice, quality of life, and productivity.

A thread of videos in and around the area.
🧵
Jan 29 8 tweets 5 min read
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PMC COVID-19 Forecast, Week of Jan 29, 2024

Transmission in the U.S. is extremely high & stable from last week on the back of the 2nd largest surge all-time.

🔹2.5% (1 in 39) actively infectious
🔹1.2 million infections/day
🔹>60,000 resulting daily LC cases
🔹0.8-1.3 million daily infections the next month

Detailed Forecast:
We are in the 2nd largest U.S. surge of the pandemic. Over the next month, we should see 0.8-1.3 million infections per day.

Biobot has made considerable post-hoc corrections to each of the prior 4 weeks of data. This essentially moved the peak earlier, with real-time estimates corrected downward in hindsight the past several weeks, including last week’s numbers getting corrected downward by 3%. The details of the forecasting models can be found in the Technical Notes section in the online report.

Post-Peak Hill? Reviewing the graph of the whole pandemic (Tweet #3), you’ll notice that after about half the waves, instead of a straightforward decline, there is occasionally a temporary deceleration, or even a small hill. Currently, this is what the forecast is showing. It’s unclear whether we will see a very small hill (rebound), a couple weeks with a flat plateau, or just descend at a gradual pace, but it looks like there will continue to be more transmission on the back end of the mountain than the start, as the models have continued to forecast for a long time now.

Good News: The model suggests that around Valentine’s Day (Feb 14), transmission should begin to fall for rapidly. The good news, if any, is that we can begin to discern the “end” of the surge toward late February, when daily infections will likely drop below 1 million nationwide.

Bad News: The bad news is that even the apparent "end" will still have a long ways to go down. For example, note that the starting point of the blue line on the left of the graph is actually the peak of the late-summer wave, which was quite bad.

Technical Note: If you go to the Biobot Dashboard, you'll see levels down 4% from last week, but our model shows levels marginally higher. For Biobot's Jan 27 data point, we enter that as Jan 24 (it's actually the average for the preceding week), assume that data point is a very slight underestimate (pattern the past several weeks), and model that we're already starting to tick up into that little hill. I'd avoid over-interpreting, and just take this to mean transmission is pretty stable at the moment.CURRENT ESTIMATES FOR January 29, 2024 Wastewater Levels (copies/mL) 836 New Daily Cases 1,216,000 % of Population Infectious 2.54% (1 in 39 people) New Daily Long COVID Cases  61,000 to 243,000   4-WEEK FORECAST FOR February 26, 2024 Wastewater Levels (copies/mL) 621 (-26% lower) New Daily Cases 903,000 % of Population Infectious 1.89% (1 in 53 people) New Daily Long COVID Cases  45,000 to 181,000  2/
What's with the Post-Peak Hill?

We're anticipating a post-peak hill. However, I wouldn't be surprised if it's instead a temporary plateau (flat) or simply a deceleration.

The best explanation is that transmission remains high with considerably geographic heterogeneity.

Examples of heterogeneity:
1) Single peak. Many places appear to have a single winter peak this year. In Western Mass, they peaked with 38% of the population actively infectious. Nearly unbelievable. It's hard to imagine a 2nd hill after that. Many other places peaked around 10% actively infectious on the worst day.

2) Late peak: Some places haven't peaked yet. This could account for a post-peak hill.

3) Rebound: Some places had an apparent winter peak but are starting to rebound. The rebound may be marginally higher or lower than the existing apparent "peak." Likely, the earlier peak was lower than in places experiencing a true single peak. They "flattened the curve" a little, but it's a tough fight against in-school transmission.

4) Rollercoaster. More extreme example of the Rebound case. Several peaks and valleys.

5) Flat. Some places have looked pretty flat on transmission for months. Perhaps they are wiser on engineering controls, or perhaps they are approaching a late peak.5 examples of Biobot graphs showing varying patterns of winter transmission. Summarized in Tweet.
Jan 24 4 tweets 2 min read
1/
In the most personal of my publications, I describe how a #mild virus killed my mom. It took 14 years.



This is the future of laissez-faire policies toward in-school COVID transmission. >10 million children have lost a parent to COVID, at last count 1.5 years ago. Kids account for 70% of in-home transmission.

Where do kids get COVID that they then spread within the home? Hint: the densely-populated place where they spend much of their day, with near-zero levels of vaccine boosting, testing, masking, or air cleaning. Schools. Now, COVID+ kids in California are told they should go to school while actively infectious.

Such policies are anticipated to disable and kill parents, grandparents, and others in the community. These policies will leave kids at high risk of complicated bereavement and toxic long-term sequelae.

Not so "mild."
#ForgottenChildren
#DeathTrajectoriesliebertpub.com/doi/epub/10.10…Journal of Palliative Medicine: Public Health's Forgotten Children of the COVID-19 Pandemic 2/
These are examples of the #DeathTrajectories of parents and grandparents who will get bring-home COVID from children in schools.

It may be 6 months. It may be 14 years. Many will get disabled. Many will die. We need to stop transmission.

Line graphs depicting three examples of death trajectories. 1)“Quick” non-acute death, 6 to 36 months 2)Organ-failure roller-coaster, 3 to 20 years 3)“Quick” decline, followed by “slow” death
Jan 23 8 tweets 5 min read
1/8 🧵
PMC COVID-19 Forecast, Week of Jan 22, 2024

Transmission in the U.S. is extremely high on the back of the 2nd largest surge all-time.
🔹2.5% (1 in 40) actively infectious
🔹1.2 million infections/day
🔹>60,000 resulting daily LC cases
🔹0.8-1.3 million daily infections the next month

#LongCovid
The continued high level of transmission should give everyone pause. The PMC model estimates 1.2 daily infections currently, with plausible values from other modelers in the range of 0.8-1.4 million daily infections. In estimating resulting LC cases, we defer to publications suggesting 5-20% will experience clinically meaningful LC as a result of an infection. The most minimizing estimate I've seen is 1%, which I deem implausible, based on the literature. Nonetheless, even minimizers should assume 0.8 million daily infections, 1% resulting in LC, or 8,000 resulting daily LC cases, or 56,000/week, or approximately 240,000/month at present. Those are the "minimizer" estimates. If one assumes 5% of infections result in LC, the situation is obviously much worse (5x worse, in fact), where we are talking about 60,000 resulting LC cases per day at present.

Forecasting Nuance
Over the next month, we should see 0.8-1.3 million infections per day. Biobot has made considerable post-hoc corrections to each of the prior 3 weeks of data. This essentially moved the peak back from early January to late December, and at present suggests a slightly more precipitous decline the past few weeks than noted in real time.

The details of the forecasting models can be found in the Technical Notes section online. Reviewing the graph in the next Tweet (whole pandemic), you’ll notice that after about half the waves, instead of a straightforward decline, there is occasionally a temporary deceleration, or even a small hill. Currently, this is what the forecast is showing.

I suspect that the hill in the graphical depiction below is an artifact and we’ll head toward a more steady decline, reaching 0.8-0.9 million cases/day in a month. Why? First, the models are based on all data, not just wave-based data, and in my experience tend to be less precise in the very middle of the ascent or descent of a wave. In the 2.0 version of the forecast coming out in a few months, we will likely add complexity to the model to refine the wave phases. Second, Biobot has made huge retroactive corrections to their real-time levels in each recent report. Their current real-time level may be off, and that can throw off the models. Overall, consider that the decline in daily cases may slow, or there might be a small hill on the way, but if lucky, transmission will continue to decline a little faster than depicted. Unfortunately, my qualitative analysis of this "rosy" scenario is still quite bleak, with 800,000 daily infections a month from now.CURRENT ESTIMATES FOR January 22, 2024 Wastewater Levels (copies/mL) 824 New Daily Cases 1,200,000 % of Population Infectious 2.51% (1 in 40 people) New Daily Long COVID Cases  60,000 to 240,000   4-WEEK FORECAST FOR February 19, 2024 Wastewater Levels (copies/mL) 743 (-10% lower) New Daily Cases 1,081,000 % of Population Infectious 2.26% (1 in 44 people) New Daily Long COVID Cases  54,000 to 216,000  2/8🧵
Zooming out to the full pandemic:
🔹Transmission remains higher than during 85% of the entire pandemic, i.e., not "over"
🔹We are in the 2nd-highest wave all-time
🔹There is every reason to believe similar or larger waves will recur in the future There is more COVID-19 transmission today        than during 85.1% of the pandemic.  CURRENT ESTIMATES FOR January 22, 2024 Wastewater Levels (copies/mL) 824 New Daily Cases 1,200,000 % of Population Infectious 2.51% (1 in 40 people) New Daily Long COVID Cases 60,000 to 240,000  WEEKLY ESTIMATES FOR January 22, 2024 New Weekly Cases 8,400,000 New Weekly Long COVID Cases 420,000 to 1,680,000  2024 CUMULATIVE ESTIMATES AS OF January 22, 2024 Total 2024 Cases To Date 32,876,330 Total 2024 Long COVID Cases To Date 1,644,000 to 6,575,000
Jan 23 7 tweets 3 min read
Let's talk #DeathTrajectories 🧵

One of the biases in #PublicHealth policy is the focus on acute COVID deaths. It's a lagging indicator and only covers 1 of 5 common death trajectories.

For COVID, people imagine the upper left. Get COVID, then a quick death.
1/7 Figure shows a line graph where an individual has a sustained level of physical functioning, gets COVID, and dies shortly thereafter. This was a good model of acute COVID deaths in the early pandemic. It's also useful for considering accidents, homicide, suicide, and sometimes catastrophic health events like heart attacks. This is another common death trajectory. You see this a lot with serious cancer diagnoses.

However, you can see it with COVID too. Someone was doing well, gets COVID, and then experiences a decline over 1-2 years. It may cause or aggravate another health condition.
2/7 Line graph. Shows high level of physical functioning, stable over time. Then, someone gets COVID and it causes or aggravates health problems, leading a decline toward death over 1-2 years.
Jan 22 9 tweets 3 min read
VIDEO THREAD 🧵 - Clip 1 of 7

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"

It's for my students but great for anyone who wants to better understand the state of the pandemic in the U.S. in Jan 2024.
40 mins total across 7 chapters:

Ch 1 - Intro on the Winter 2023-24 Surge and a bit on my background

Ch 2 - The public health significance of COVID-19 at present, especially focused on Long COVID

Ch 3 - SARS-CoV-2 is Airborne, and we need multi-layered mitigation

Ch 4 - Quarantine, testing, and isolation overview

Ch 5 - Masking tips

Ch 6 - Air cleaning fundamentals

Ch 7 - Vulnerability and inclusivity VIDEO THREAD 🧵 - Clip 2 of 7

Chapter 2: COVID is NOT “A Cold or the Flu”
#LongCOVID #LongCovidKids

"Surviving the COVID-19 Pandemic -- Things I've Learned (So Far) - 2024 Edition"
Jan 16 7 tweets 5 min read
1/7
PMC COVID-19 Forecast, Week of Jan 15, 2024

🔹1.2-1.5 million daily U.S. infections the next month
🔹41.2 million total infections the next month
🔹66.7 million total infections over the next 2 months

These infection rates are 30% higher than a year ago. Yet, expect considerable minimizing. Many people believe that once the peak day has passed, it's smooth sailing, what I would call "Descent Neglect."

Take an analogy: More people die, supposedly, going down Mt. Everest than going up. With COVID surges, people also underestimate how bad the 2nd half of surge mountain is likely to be. They overestimate how spiky or leptokurtic a a surge tends to be. Transmission will go down gradually, meaning extremely high transmission the next 4-6 weeks especially.

This may be fueled by a misunderstanding of how quickly transmission declines, defense mechanisms to temporarily and artificially reduce anxiety, short-term political or capital interests, or a combination of these factors.

#DescentNeglectCURRENT ESTIMATES FOR January 15, 2024 Wastewater Levels (copies/mL) 999 New Daily Cases 1,453,000 % of Population Infectious 3.04% (1 in 33 people) New Daily Long COVID Cases  73,000 to 291,000   4-WEEK FORECAST FOR February 12, 2024 Wastewater Levels (copies/mL) 893 (-11% lower) New Daily Cases 1,300,000 % of Population Infectious 2.72% (1 in 37 people) New Daily Long COVID Cases  65,000 to 260,000  2/7
Zooming out, see with certainty this is the 2nd biggest U.S. pandemic surge.

Today, transmission remains greater than during 90% of the pandemic.
🔹Nearly 1.5 million daily infections
🔹3% (1 in 33) actively infectious
🔹>70,000 resulting daily #LongCovid cases There is more COVID-19 transmission today        than during 90% of the pandemic.  CURRENT ESTIMATES FOR January 15, 2024 Wastewater Levels (copies/mL) 999 New Daily Cases 1,453,000 % of Population Infectious 3.04% (1 in 33 people) New Daily Long COVID Cases 73,000 to 291,000  WEEKLY ESTIMATES FOR January 15, 2024 New Weekly Cases 10,200,000 New Weekly Long COVID Cases 509,000 to 2,034,000  2024 CUMULATIVE ESTIMATES AS OF January 15, 2024 Total 2024 Cases To Date 25,253,430 Total 2024 Long COVID Cases To Date 1,263,000 to 5,051,000
Jan 9 10 tweets 7 min read
1/
PMC COVID-19 Forecast, Jan 8, 2024 (U.S.)

We're peaking at >2 million infections/day.
🔹1 in 23 people are actively infectious today
🔹1 in 3 people in the U.S. will be infected during the peak two months
🔹2nd biggest U.S. surge all-time

#MaskUp #VaxUpU.S. Winter 2023-24 COVID Surge - The Peak				 	Best Estimate		Range	 Rank among COVID waves	2nd		2nd	2nd Date of peak	Jan 5		Jan 3	Jan 10 Daily infections at peak	2.07 million/day		2.03 million/day	2.22 million/day Percentage of population infectious at peak	4.34% (1 in 23)		4.26% (1 in 23)	4.64% (1 in 22)  CURRENT ESTIMATES FOR January 8, 2024 Wastewater Levels (copies/mL) 1413 New Daily Cases 2,056,000 % of Population Infectious 4.3% (1 in 23 people) New Daily Long COVID Cases  103,000 to 411,000   4-WEEK FORECAST FOR February 5, 2024 Wastewater Levels (copies/mL) 1,096 (-22% lower) New ... 2/
Before diving into the #Covid forecast, know that YOU can make a difference!

We will soon apply for a large research grant to help people with #cancer across the U.S. reduce their risk of negative Covid outcomes.

Learn more:


#CovidCancer tulane.co1.qualtrics.com/jfe/form/SV_3C…
Announcement - 2024 Pandemic Research Grant Submission: Calling All Scientists, Clinicians, Patients, and Other Stakeholders!    We are preparing a grant application for a research project aimed at helping U.S. adults with cancer to avoid COVID infections. A letter of intent is due shortly, and the grant will get submitted in May. We are seeking a team of scientists, clinicians, patients, and other stakeholders passionate about COVID mitigation who may want to learn more about and potentially get involved with this project. Please help!  The project builds on our ongoing pilot projects fund...
Jan 9 6 tweets 3 min read
Excited to share some good news!
2023 Pandemic Mitigation Collaborative (PMC) Advocacy Awards

Five Awardees: @LauraMiers @BettyB2007 @EmAndElOrganics @luckytran @ChristinaVirgil

Top Commendation to Christina Virgil!

We wanted to acknowledge the work people are doing sharing data from the PMC Dashboard to help protect others from Covid. These five people are contributing plenty of good, well beyond just anything with the PMC, and we appreciate their hard work.

Please share your appreciation for their work. Awardees, please DM me an address in the next week if you'd like to receive a small token of appreciation. Thanks again!🙏
1/6PMC 2023 Advocacy Awards Laura Miers (Twitter: @LauraMiers)  Liz O (Twitter: @BettyB2007)  Em & El Organics (Twitter: @EmAndElOrganics)   Dr. Lucky Tran (Twitter: @luckytran)  Christina Virgil (Twitter: @ChristinaVirgil)  From the start, @LauraMiers has been a leader sharing PMC data on case rates and estimates of resulting Long Covid cases.

2/6

Example Tweet:
Dec 26, 2023 10 tweets 4 min read
Someone has purchased a low-quality high-volume anti-#COVID-awareness bot farm. I've had to block 500 people the past few days. I appreciate good humor, but these bots are sub-pun-level basic, not even any fun.

These are my Top 7 tips for dealing with #bots & #trolls.
🧵Troll eyes within COVID images Bot Tip #1: In settings, shut off direct messaging from people you don't follow.

Bye-bye #bots & #trolls.Shows how to shut off non-follower DMs in settings
Dec 25, 2023 8 tweets 5 min read
1/
PMC COVID-19 Tracker, Dec 25, 2023 (U.S.)

At peak surge, we will have 2 million U.S. #COVID infections/day.

Nearly 1 in 3 Americans will get infected during the peak 2 months of this winter surge. That’s 105 million infections & >5 million resulting #LongCOVID cases.U.S. Winter 2023-24 COVID Surge				 	Best Estimate		Range	 Rank among COVID waves	2nd		2nd	4th Date of peak	Jan 10		Jan 3	Jan 17 Daily infections at peak	2.0 million/day		1.7 million/day	2.1 million/day Percentage of population infectious at peak	4.1% (1 in 24)		3.7% (1 in 27)	4.4% (1 in 23)  CURRENT ESTIMATES FOR December 25, 2023 Wastewater Levels (copies/mL) 1137 New Daily Cases 1,655,000 % of Population Infectious 3.46% (1 in 29 people) New Daily Long COVID Cases  83,000 to 331,000  4-WEEK FORECAST FOR January 22, 2024 Wastewater Levels (copies/mL) 1,293 (14% higher) New Daily Cases 1,8... 2/
Today on Christmas, 3.5% of the U.S. population (1 in 29) is actively infectious with #COVID & rising toward a Jan 10 peak.

COVID transmission is higher than during 94.7% of the pandemic. There's a 50% chance of a COVID exposure if interacting with 20 people today. There is more COVID-19 transmission today        than during 94.7% of the pandemic.  Number of People  |  Chances Anyone is Infectious	 1	3.5% 2	6.8% 3	10.0% 4	13.2% 5	16.2% 6	19.1% 7	21.9% 8	24.6% 9	27.2% 10	29.7% 15	41.1% 20	50.6% 25	58.6% 30	65.3% 35	70.9% 40	75.6% 50	82.8% 75	92.9% 100	97.1% 150	99.5% 200	99.9% 300	>99.9% 400	>99.9% 500	>99.9%
Dec 24, 2023 5 tweets 2 min read
As COVID transmission spikes, you may have opportunities to raise awareness about #LongCOVID.

These are a few of the the most popular videos I've shared that people found useful. A family member or friend might find one of them relatable too.

Video Thread 📽️🧵 Screenshots of four #LongCovid videos provided in the thread 2/
"I hope to god I'm wrong. I've never wanted to be more wrong in my life.... Worst case scenario... we are going to see a tsunami of cardiovascular disease over the next few decades." #LongCovid

The whole talk is well worth listening to.
Dec 20, 2023 9 tweets 8 min read
As a clinical health psychologist, I notice that many people are using psychological defense mechanisms to downplay the risk of COVID.

These are my Top 7 examples:

🧵 Top 7 Psychological Defense Mechanisms Used to Downplay COVID #1 – Denial – Pretending a problem does not exist to provide artificial relief from anxiety.

Examples:

“During COVID” or “During the pandemic” (past tense)

“The pandemic is over”

“Covid is mild”

“It’s gotten milder”

“Covid is now like a cold or the flu”

“Masks don’t work anyway”

“Covid is NOT airborne”

“Pandemic of the unvaccinated”

“Schools are safe”

“Children don’t transmit COVID”

“Covid is mild in young people”

“Summer flu”

“I’m sick but it’s not Covid”

Taking a rapid test only once

Using self-reported case estimates (25x underestimate) rather than wastewater-derived case estimation

Using hospitalization capacity estimates to enact public health precautions (lagging indicator)

Citing mortality estimates rather than excess mortality estimates. Citing excess mortality without adjusting for survivorship bias.This is from a psychology book by Nancy McWilliams. I will post a link to a PDF of newer edition of the full book at the end of the thread. If someone has a better "ALT" trick, please educate me on this one.
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Dec 18, 2023 11 tweets 5 min read
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PMC COVID-19 Tracker, Dec 18, 2023

We are headed into potentially the 2nd largest COVID surge all-time in the U.S.

If #wastewater levels follow historic trends, we will reach 2 million infections/day at peak surge with 4.2% of the population actively infectious on Jan 10.U.S. Winter 2023-24 COVID Surge				 	Best Estimate		Range	  Rank among COVID waves	2nd		2nd	4th  Date of peak	Jan 10		Jan 3	Jan 17  Daily infections at peak	2.0 million/day		1.7 million/day	2.2 million/day  Percentage of population infectious at peak	4.2% (1 in 24)		3.7% (1 in 27)	4.6% (1 in 22) 2/
The winter peak should arrive between Jan 3 and Jan 17. The model estimates a peak of 1.7 to 2.2 million infections per day.

If unlucky, 1 in 20 people will be infectious, and it will be the 2nd largest wave. If lucky, more like 1 in 30, and the 4th largest wave.

Consider optimistic and pessimistic scenarios not captured by these models.

Optimism:
A rosy scenario would be that the peak occurs a week earlier at a slightly lower level (1.6-1.7 infections/day like last winter or the preceding summer). The level of acceleration in transmission argues against that, in favor of a higher peak, but Biobot is reporting some unusual regional variation (much lower transmission in the U.S. South and West). Moreover, historical patterns of how transmission should or should not accelerate cannot account for existing variation on population-level immunity due to variation in prior exposure history, recency of vaccination, and how well the current vaccine matches disseminating subvariants relative to prior vaccines. Finally, Biobot wastewater sites could be overreporting, and levels could get corrected downward. Each of these factors is highly plausible, but the “rosy” scenario remains quite bleak and suggests the pandemic remains far from “over.”

Pessimism:
Also, consider more pessimistic scenarios. Current vaccination rates remain extremely low, and several other countries are reporting atypically high acceleration via wastewater data. Placing plausible hypothetical values in the model, it is difficult to imagine a scenario where the U.S. reaches 2.5 million infections/day. Sometimes, people draw graphs showing a continued acceleration like BA.1, but such models seem to reflect imagination rather than data. The data do not suggest an evidence for a BA.1-level surge.U.S. Winter 2023-24 COVID Surge				 	Best Estimate		Range	  Rank among COVID waves	2nd		2nd	4th  Date of peak	Jan 10		Jan 3	Jan 17  Daily infections at peak	2.0 million/day		1.7 million/day	2.2 million/day  Percentage of population infectious at peak	4.2% (1 in 24)		3.7% (1 in 27)	4.6% (1 in 22)
Dec 11, 2023 8 tweets 5 min read
PMC COVID-19 Tracker, Dec 11, 2023
The surge continues.

Today:
🔹1.2 million daily infections
🔹1 in 41 infectious (2.5%)

In 4 weeks (Jan 8):
🔹1.6 million daily infections
🔹1 in 30 infectious (3.3%)

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A few key methodologic updates.
1) Biobot correct levels downward for the past two weeks, so you might notice that this week's estimates seem similar to last week's or marginally lower.

2) Our forecasting model uses a combination of historic data (situation past several years) and current data (past 4 weeks). In the historic model, we switched from using mean-type data to median-type data. This avoids overestimating levels based on the BA.1 surge and allows us to predict accurately a little faster, rather than predicting high and waiting for the current 4-week's data to correct it.

3) The forecasts depend a lot on the most recent week's data. To the extent Biobot is accurate or inaccurate in real-time, this leads to divergent forecasts.CURRENT ESTIMATES FOR December 11, 2023 Wastewater Levels (copies/mL) 807 New Daily Cases 1,174,000 % of Population Infectious 2.46% (1 in 41 people) New Daily Long COVID Cases  59,000 to 235,000   4-WEEK FORECAST FOR January 8, 2024 Wastewater Levels (copies/mL) 1,083 (34% higher) New Daily Cases 1,576,000 % of Population Infectious 3.3% (1 in 30 people) New Daily Long COVID Cases  79,000 to 315,000  You'll see the forecasts differ considerably (1.3 to 1.9 million daily infections) in 4 weeks.

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However, they mostly agree on the peak. It could be as early as Jan 1 or as late as Jan 15. It's a moot point. Transmission will be similar across that timespan and the weekly reports lack the precision to say whether it will peak on the 4th or 9th, for example. Early Jan will remain bad.

Details:

The real-time model (purple) anticipates the highest surge levels. This assumes that Biobot real-time reports are accurate, but they were substantially corrected for the past two weeks, and there were some issues with real-time accuracy during the summer wave. The turtle model (green) discount’s the most recent week’s data as an aberration, assumes transmission should be corrected upward a little, and predicts a steady rise with peak around January 1. The cheetah model (yellow) says that because last week’s data were corrected downward, this week’s estimate should be too, so it’s much more conservative on the next several weeks. The average of all models (red) guides forecasted numbers for the next four weeks. A month from now, we will see about 1.6 million new U.S. cases per day (range of 1.3 to 1.9 million across forecasting models), with 3.3% of the U.S. population or 1 in 30 people actively infectious.Zoomed in version of prior tweet
Dec 11, 2023 16 tweets 5 min read
There's a lot of dichotomous thinking about #COVID risk on #airplanes.

Some believe it's completely safe, others completable dangerous.

I minimize flight travel and wouldn't fly without a fit-tested high-quality mask (N95 or elastomeric respirator). Here's why. 🧵

1/16 "COVID-19, Unsafe As We Breathe: The designed-in dangers of the American Airplane, By Dr. Hoerger"  A play on words of the book, "Unsafe at any speed: The designed-in dangers of the American automobile" (1965) by Ralph Nader Field research from @sri_srikrishna found that across 3 models of aircrafts, they had an air cleaning rate of 10.9-11.8 air changes per hour (ACH).

A U.S. operating room should have 15 ACH, so flights are pretty good, right?

Wrong. I'll explain why.
2/16 Figures showing an average of 11.7 ACH on three flights, from Devabhaktuni Srikrishna's pre-print, "What ACH is equivalent to a passenger airplane inflight for protection from SARS-Cov-2 and other aerosol contaminants?"
Dec 4, 2023 7 tweets 3 min read
PMC COVID-19 Tracker, Dec 4, 2023
The U.S. surge is worsening faster than anticipated.

Today:
🔹1.2 million daily infections
🔹1 in 38 infectious (2.6%)

In 4 weeks (New Year's Day):
🔹1.8 million daily infections
🔹1 in 26 infectious (3.9%)

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CURRENT ESTIMATES FOR December 4, 2023 Wastewater Levels (copies/mL) 865 New Daily Cases 1,258,000 % of Population Infectious 2.63% (1 in 38 people) New Daily Long COVID Cases  63,000 to 252,000   4-WEEK FORECAST FOR January 1, 2024 Wastewater Levels (copies/mL) 1,284 (49% higher) New Daily Cases 1,869,000 % of Population Infectious 3.91% (1 in 26 people) New Daily Long COVID Cases  93,000 to 374,000  You'll note the diverging forecasts. Biobot #wastewater levels increased more than anticipated this week, and they updated last week's numbers upward too.

The cheetah forecast (yellow) assumes this week's levels will also get revised upward like last week's. The turtle model (green) ignores this week's data as an aberration. The real-time forecast (purple), which assumes all real-time estimates are accurate, is barely visible behind the red line. The red line is the composite average of all 3 forecasts.

You'll notice the blue line (wastewater levels) and red line (forecast) overlap marginally. Biobot reports levels for Nov 29, and we carry them forward in the forecasting model through Dec 4 (today). Transmission is accelerating so much, usually this 5 day lag isn't even visible graphically.

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Zooming in on the forecast. See prior tweet for more detail.