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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.
53 subscribers
Jan 25 • 4 tweets • 2 min read
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...
Jan 17 • 5 tweets • 2 min read
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 ...
Jan 10 • 4 tweets • 2 min read
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...
Jan 8 • 8 tweets • 5 min read
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
Jan 8 • 4 tweets • 3 min read
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...
Jan 5 • 6 tweets • 2 min read
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
Dec 31, 2025 • 10 tweets • 4 min read
PMC COVlD Update, Week of Dec 29, 2025
🧵1/10

Happy New Year's Eve! #nye

Based on today's CDC data, we estimate 1 in 51 Americans are actively infectious with COVlD. That's nearly 1 million new daily infections.

Be wise. Vax up, mask up. #oneofthetwo Heat map from CDC data and PMC estimates. 🧵2/10

Many states are surging presently. True levels are higher than shown in most places due to state-level reporting lags. Alabama Moderate 1 in 46 (2.2%) Alaska Low 1 in 93 (1.1%) Arizona Very Low 1 in 201 (0.5%) Arkansas High* 1 in 32 (3.1%) California Very Low 1 in 351 (0.3%) Colorado Low 1 in 71 (1.4%) Connecticut High 1 in 33 (3.1%) Delaware Low 1 in 90 (1.1%) District of Columbia Very Low 1 in 300 (0.3%) Florida Very Low 1 in 282 (0.4%) Georgia Very Low 1 in 125 (0.8%) Guam Very Low 1 in 585 (0.2%) Hawaii Very Low 1 in 855 (0.1%) Idaho Very Low 1 in 221 (0.5%) Illinois Moderate 1 in 41 (2.5%) Indiana Very High 1 in 14 (6.9%) Iowa Low 1 in 69 (1.4%) Kansas Moderate 1 in 46 (2.2%) Kentucky High 1 in 34 (2.9...
Dec 15, 2025 • 9 tweets • 4 min read
PMC COVID Update, Dec 15, 2025 (U.S.)

In the latest CDC data, 15 states have moderate to very high transmission.
🔹1 in 63 estimated actively infectious nationally, rising fastest in the Midwest & Northeast
🔹Very High: Indiana
🔹High: Nebraska, Vermont, Connecticut

🧵1/9 Heat map from CDC data and PMC estimates of 1 in 63 actively infectious and >700,000 new daily infections, based on wastewater derived estimates using models noted in the Technical Appendix at the website listed in the image. PMC estimates 1 in 26 people in Indiana are infectious and 1 in 39 in Connecticut.

MI, MS, and AR may have higher levels than shown due to poor reporting.

States AL to MS shown.

🧵2/9 Alabama Moderate 1 in 41 (2.4%) Alaska Very Low 1 in 220 (0.5%) Arizona Very Low 1 in 118 (0.8%) Arkansas Low* 1 in 68 (1.5%) California Very Low 1 in 382 (0.3%) Colorado Very Low* 1 in 230 (0.4%) Connecticut High 1 in 39 (2.6%) Delaware Very Low 1 in 222 (0.4%) District of Columbia Very Low 1 in 131 (0.8%) Florida Very Low 1 in 320 (0.3%) Georgia Very Low 1 in 275 (0.4%) Guam Very Low 1 in 426 (0.2%) Hawaii Very Low 1 in 670 (0.1%) Idaho Very Low 1 in 108 (0.9%) Illinois Low 1 in 71 (1.4%) Indiana Very High 1 in 26 (3.8%) Iowa Low 1 in 76 (1.3%) Kansas Moderate 1 in 62 (1.6%) Kentucky Mode...
Dec 8, 2025 • 9 tweets • 4 min read
PMC COVlD Update, Dec 8, 2025 (U.S.)
1/9
🔥🔥🔥Very High: Arizona (Yuma)
🔥🔥High: Indiana and Vermont
🔥Moderate: Nebraska and Alabama

Data only go through late November, and levels often increase following Thanksgiving. Heat map and PMC estimates of transmission (1 in 102 actively infectious). PMC COVlD Update, Dec 8, 2025 (U.S.)
2/9
State-by-state estimates (part 1). Arizona is Very High, but sites were only online in the Yuma area. Indiana remains high.

MI and MS have considerable uncertainty.

DC is exceptionally low. Alabama Moderate 1 in 47 (2.1%) Alaska Very Low 1 in 220 (0.5%) Arizona Very High* 1 in 18 (5.7%) Arkansas Very Low* 1 in 138 (0.7%) California Very Low 1 in 574 (0.2%) Colorado Low 1 in 76 (1.3%) Connecticut Low 1 in 91 (1.1%) Delaware Very Low 1 in 307 (0.3%) District of Columbia Very Low 1 in 5,777 (0.0%) Florida Very Low 1 in 494 (0.2%) Georgia Very Low 1 in 180 (0.6%) Guam Very Low 1 in 289 (0.3%) Hawaii Very Low 1 in 704 (0.1%) Idaho Very Low 1 in 121 (0.8%) Illinois Very Low 1 in 112 (0.9%) Indiana High 1 in 30 (3.3%) Iowa Low 1 in 83 (1.2%) Kansas Low 1 in 105 (1.0%) Kentucky Very L...
Nov 23, 2025 • 10 tweets • 4 min read
PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵1/10

With CDC data operational again, the transmission map is back. The data are always a week old, so transmission is likely worse than depicted.

We estimate 1 in 116 people actively infectious and 422,000 new daily infections. Heat map: Indiana and Arkansas with "moderate" transmission. All others, "low" or "very low" (CDC categories). PMC COVlD Update, Week of Nov 24, 2025 (U.S.)
🧵2/10

State level estimates are back. Note, the CDC changed their data processing approach in August, which tends to downplay transmission.

Does 1 in 45 in Indiana seem "moderate"?

Levels in MI may be mod/high (poor reporting). Alabama Very Low 1 in 153 (0.7%) Alaska Very Low 1 in 272 (0.4%) Arizona Low 1 in 63 (1.6%) Arkansas Moderate* 1 in 47 (2.1%) California Very Low 1 in 365 (0.3%) Colorado Very Low 1 in 137 (0.7%) Connecticut Low 1 in 103 (1.0%) Delaware Very Low 1 in 262 (0.4%) District of Columbia Very Low 1 in 418 (0.2%) Florida Very Low 1 in 408 (0.2%) Georgia Very Low 1 in 292 (0.3%) Guam Very Low 1 in 887 (0.1%) Hawaii Very Low 1 in 426 (0.2%) Idaho Very Low 1 in 116 (0.9%) Illinois Very Low 1 in 116 (0.9%) Indiana Moderate 1 in 45 (2.2%) Iowa Very Low 1 in 108 (0.9%) Kansas Very Low 1 in 109 (0.9%) Ke...
Nov 8, 2025 • 6 tweets • 3 min read
PMC COVID Update, Week of Nov 10, 2025 (U.S.)
1/6🧵

🔹301,000 new daily infections based on wastewater-derived models
🔹1 in 162 people (0.6%) actively infectious
🔹Levels the past 2 months corrected upward by Biobot
🔹"Lull point" estimated between Nov 5-21. Rising soon. Year over year graph, emphasizing that levels commonly rise in mid November PMC COVID Update, Week of Nov 10, 2025 (U.S.)
2/6🧵

The central estimate of the forecast suggests we will surpass 500,000 new daily infections on Nov 22.

There's a 25% chance of a prolonged lull like last year. More likely, we are in wave territory by the end of the month. Close up of the most recent 3 months of data, including the forecast.
Nov 3, 2025 • 9 tweets • 4 min read
PMC COVlD Update, Nov 3, 2025 (U.S.)
1 of 9 🧵

The relative "lull" in SARS-CoV-2 transmission is unlikely to go much lower.

✨1 in 209 people are estimated actively infectious, likely the lowest levels of 2025 nationwide.

Get boosted. Stock up on masks, tests, & filters. Year-over-year graph PMC COVlD Update, Nov 3, 2025 (U.S.)
2 of 9 🧵

No data presently suggest the rise of a winter wave any earlier than "usual."

If following historical trends, transmission will pick up Nov 15-29. Last year's rise was atypically late. Forecasted transmission
Oct 28, 2025 • 9 tweets • 4 min read
PMC COVlD Update, Oct 27, 2025 (US)

Transmission typically accelerates in mid-November.

We are currently in a relative 'lull.' We estimate about a quarter-million new daily infections with 1 in 185 people actively infectious. Still bad, likely to get worse.

1/9 🧵 year over year graph PMC COVlD Update, Oct 27, 2025 (US)

Our forecast through November 8 calls for flat transmission.

Nothing yet indicates the onset of a winter wave, but it would also be atypical for the lull to last much longer than another 2-3 weeks.

2/9 🧵 Graph of recent transmission and current forecast
Oct 21, 2025 • 11 tweets • 5 min read
PMC COVlD Update, Oct 20, 2025 (U.S.)

SARS-CoV-2 transmission has fallen.
🔹1 in 191 (0.5%) actively infectious
🔹"Lull" levels at 20% of the summer peak
🔹255,000 new daily infections (still concerning)

Many will knock out higher-risk activities the next 2-4 weeks.
🧵1/11 Graph of the 11 waves, shows current lull. PMC COVlD Update, Oct 20, 2025 (U.S.)

"Lull" transmission remains dangerous:
🔹1.8 million estimated new weekly infections
🔹>90,000 estimated new #LongCOVID conditions from this week's infections
🔹>500 excess deaths to result from this week's infections

🧵2/11 Infections Proportion Actively Infectious 1 in 191 (0.5%) New Daily Infections 255,000 Infections the Past Week 1,800,000 Infections in 2025 191,000,000 Cumulative Infections per Person 4.69 Long COVID Long COVID Cases Resulting 13,000 to 51,000 from New Daily Infections Long COVID Cases Resulting 90,000 to 360,000 from New Weekly Infections Excess Deaths Excess Deaths Resulting 70 to 120 from New Daily Infections Excess Deaths ...
Oct 11, 2025 • 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, 2025 • 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, 2025 • 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, 2025 • 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, 2025 • 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, 2025 • 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, 2025 • 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...