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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.
47 subscribers
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).
Jul 2 • 43 tweets • 25 min read
🌍Want to track COVID transmission accurately worldwide?

This PMC thread walks you through leading dashboards with information more up to date than WHO & EU directories.

🧵 1/ World map, countries with high-quality up-to-date surveillance systems shown in blue. The Pandemic Mitigation Collaborative (PMC) Dashboard provides weekly COVID updates for the U.S., using wastewater surveillance derived case estimation models and analytic forecasting.

We have added a list of international dashboards:
🧵 2/
pmc19.com/data/index.php…Australia: NSW Health Australia Department of Health, Western Australia Austria: Federal Government of Austria City of Vienna - Regional Coron-A Consortium Austria Czech Republic: State Health Institute Czech Republic Belgium: Belgian Institute for Health Canada: Government of Canada Andrew Young's Canada Visualization C19 Resources Canada * World Health Network (WHN) Canada **
Denmark: Statens Serum Institut Denmark Europe (multi-national): EU Wastewater Observatory Finland: National Institute for Health and Welfare Finland WHN Finland ** France: French Republic Data Airborne Risk Reduction Association (ARRA) France Zan Armstrong's France Visualization COVID Weather App France (Android, IOS, or Web) Thomas Delattre's France Visualization Germany: Infection Radar Germany Bay-VOC Bavaria Region Berlin Waterworks WHN Germany **
Hong Kong: Centre for Health Protection, Hong Kong Hungary: National Center for Public Health and Pharmacy of Hungary India: Pune Knowledge Cluster of India Gujarat Biotechnology Research Centre of India Ireland: Health Protection Surveillance Centre Ireland Japan: Japan Institute for Health Security Latvia: Institute of Food Safety, Animal Health and Environment Latvia Lithuania: National Public Health Centre of Luthuania Luxembourg: Microbs Luxembourg Netherlands: National Institute for Public Health and the Environment Netherlands WHN Netherlands ** New Zealand: New Zealand Institute for...
Slovenia: National Institute of Public Health Slovenia Spain: Government of Catalonia - Regional South Africa: National Institute for Communicable Diseases of South Africa South Korea: Korea Disease Control and Prevention Agency Sweden: Pathogens Sweden Switzerland: Swiss Confederation Federal Office of Public Health ETH Zurich Switzerland WISE Dashboard U.K.: Public Health Scotland Buckinghamshire Disability Service (BuDS) U.K. *See the numbers 1-21 along the lower left. Click on 3-6 for national and regional data. ** Click on the dropdown menu. May need to try a different web browser.
Jun 24 • 6 tweets • 3 min read
PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

🔥Biggest uptick since Jan
🔥1 in 167 actively infectious
🔥>2 million weekly infections
🔥700-1,200 resulting excess deaths from weekly infections

Track transmission closer to home w/our new state & international resources 👇

🧵1/6 PMC COVlD Dashboard, Jun 23, 2025 (U.S.)

🔹With >90% probability, we have entered the 11th COVlD wave.
🔹In a room of 50 people, there is already a 1 in 4 chance of an exposure.
🔹We expect nearly 15 million infections in the next month, and rising.

🧵2/6Current Levels for Jun 23, 2025 % of the Population Infectious 0.6% (1 in 167) New Daily Infections 287000 New Weekly Infections 2009000 Resulting Weekly Long COVID Cases 100,000 to 402,000 Resulting Weekly Excess Deaths 700 to 1,200 Monthly Forecast Average % of the Population Infectious 1.0% (1 in 97) Average New Daily Infections 493300 New Infections During the Next Month 14799000 Resulting Monthly Long COVID Cases 740,000 to 2,960,000 Resulting Monthly Excess Deaths 5,300 to 8,800 Running Totals Infections Nationwide in 2025 74869000 Average Number of Infect...
Jun 17 • 7 tweets • 3 min read
1) PMC COVlD Dashboard, June 16, 2025 (U.S.)

Current transmission (red line) closely tracks that of summer 2023 (yellow line).

We expect to break 500k daily infections between July 9 and the end of July. Our current forecast...Year over year graph of tranmission 2) PMC COVlD Dashboard, June 16, 2025 (U.S.)

Our current forecast is a bit more aggressive, predicting breaking 500k daily infections by July 9. The 2023 trend suggests end of July.

The 95% confidence interval shows large variation. Note that...Past 12 months of transmission (U.S.) and forecast
Jun 16 • 13 tweets • 3 min read
1) Here's a quick example of how the federal government is censoring the best scientific research. It's not just cuts to ongoing research.

It's new grant submissions too... "No forbidden words found" 2) In January, I re-submitted a promising Covid/cancer grant to a non-federal funder. Hundreds of pages. Hundreds of hours of work. The best proposal I've submitted as a scientist.

Out of curiosity, I used Sean Mullen's Scan Assist tool to see how many banned words it had...
Jun 9 • 7 tweets • 3 min read
1) PMC COVlD Dashboard, June 9, 2025

CDC wastewater surveillance data show transmission rising. This is our forecast if transmission growth follows typical patterns.

The high & low estimates could be thought of as optimistic & pessimistic scenarios for NB.1.8.1.Forecast graph: Rising transmission the next month 2) PMC COVlD Dashboard, June 9, 2025

Notice that current transmission (red line, lower left) tracks closely with two years ago (yellow), slightly below the median (gray), and not far below last year (orange).

Consider each of these trajectories realistic scenarios.Image
Jun 3 • 5 tweets • 3 min read
1/ PMC COVlD Dashboard, June 2, 2025 (U.S.)

National COVlD transmission recently fell to its lowest levels since the pre-Delta era.

It's go-time for many who have delayed medical appointments. The situation will likely get much worse in Jul/Aug. 2/ PMC COVlD Dashboard, June 2, 2025 (U.S.)

An estimated 1 in 211 are actively infectious. Most states are "low" or "very low" per CDC.

The situation remains serious even in a relative "lull." >1.5 million weekly estimated infections to result in 600-900 excess deaths.C19 heat map
year over year graph, tracking closely with the median and past 2 years
Current Levels for Jun 2, 2025 % of the Population Infectious 0.5% (1 in 211) New Daily Infections 227000 New Weekly Infections 1589000 Resulting Weekly Long COVID Cases 79,000 to 318,000 Resulting Weekly Excess Deaths 600 to 900 Monthly Forecast Average % of the Population Infectious 0.7% (1 in 139) Average New Daily Infections 344566.6667 New Infections During the Next Month 10337000 Resulting Monthly Long COVID Cases 517,000 to 2,067,000 Resulting Monthly Excess Deaths 3,700 to 6,200 Running Totals Infections Nationwide in 2025 70132000 Average Number of Infe...
Graph of the whole pandemic, 11th wave forthcoming
May 26 • 7 tweets • 3 min read
1) PMC Dashboard, May 26, 2025 (U.S.)

The lull exit is coming. Despite being in a lull:

🔥1 in 180 actively infectious
🔥1.9 million weekly infections
🔥>93,000 new #LongCOVID cases from the week's infections
🔥1,100 excess deaths from the week's infections

This is a "lull." 2) PMC Dashboard, May 26, 2025 (U.S.)

The forecast calls for a near-doubling in transmission the next month to 450k daily infections.

The 95% confidence interval includes flat transmission (percolating), or escalating to 650k (if NB.1.8.1 takes off). Forecasting graph, summarized in post
May 25 • 6 tweets • 2 min read
1) CDC & Biobot wastewater surveillance both show the West region in an apparent uptick in C19 transmission.

Here's the graph of regional transmission from CDC data with the West in green: Estimated Percentage Actively Infectious* PMC Model Raw CDC Data National 0.6% (1 in 180) 0.5% (1 in 196) Northeast 0.4% (1 in 236) 0.4% (1 in 257) Midwest 0.5% (1 in 209) 0.4% (1 in 227) South 0.6% (1 in 160) 0.6% (1 in 175) West 0.8% (1 in 129) 0.7% (1 in 140) 2) This image zooms in on the West (green line) so you can see the apparent departure from the C19 lull more easily. Zoomed in graph from prior post. More stats in the ALT text there.
May 20 • 6 tweets • 3 min read
PMC COVlD Report, May 19, 2025 (U.S.)

In this national "lull" in transmission, we are seeing...
🔥A quarter-million daily infections
🔥90-360k Long COVlD cases from the week's infections
🔥600-1,100 deaths from the week's infections
🔥LA, SD, NE, & GU in high transmission10 waves of C19
Heat map, summarized in post
Current Levels for May 19, 2025 % of the Population Infectious 0.5% (1 in 185) New Daily Infections 259000 New Weekly Infections 1813000 Resulting Weekly Long COVID Cases 91,000 to 363,000 Resulting Weekly Excess Deaths 600 to 1,100 Monthly Forecast Average % of the Population Infectious 0.8% (1 in 129) Average New Daily Infections 371566.6667 New Infections During the Next Month 11147000 Resulting Monthly Long COVID Cases 557,000 to 2,229,000 Resulting Monthly Excess Deaths 4,000 to 6,600 Running Totals Infections Nationwide in 2025 66986000 Average Number of I...
Year-over-year graph, currently closely tracking the median, Y4, and Y5 Full report: pmc19.com/data
May 15 • 5 tweets • 2 min read
1) Good luck getting any new federal research to support #LongCOVID until "covid" is dropped from the dirty words that get grant applications triaged to the trash bin.

You know which senator to call.

I just did, and got a staffer instead of voicemail.Lengthy list of words that get federal grants triaged to the trash bin, unfunded after favorable review, or defunded if already in progress. Includes "Covid-19," and no, it's not a matter of simply restating as "SARS2" or "The Rona." It might make it one step further in the review process, but this gets checked closed, and it will get canned. Hundreds of hours of work, flushed down the toilet. And that's the point. 2) I told the staffer that #LongCOVID is affecting millions and that no research will be funded to address this while "covid" remains on the banned word list.

I asked if they wanted to hear more. He did...

Here's the word list, btw
pen.org/banned-words-l…
May 3 • 9 tweets • 2 min read
30 million excess deaths attributable to COVID is a tremendous underestimate because most analyses insufficiently account for mortality displacement.

In the U.S., it's about 50% worse than people realize. Mortality displacement or "harvesting" is the idea that so many people died of COVID in the early pandemic that we should actually expect to see *fewer* deaths today if COVID were "over."
Apr 22 • 8 tweets • 4 min read
🧵1 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

🌤️Only 1 in 5 days of the pandemic have seen transmission as low as today
🌤️1 in 196 actively infectious
⚡️BUT still 1.7 million weekly infections, resulting in >85,000 LC cases and up to 1,000 deaths

I'll walk you through it... Current Levels for Apr 21, 2025 % of the Population Infectious 0.5% (1 in 196) New Daily Infections 244000 New Weekly Infections 1708000 Resulting Weekly Long COVID Cases 85,000 to 342,000 Resulting Weekly Excess Deaths 600 to 1,000 Monthly Forecast Average % of the Population Infectious 0.7% (1 in 147) Average New Daily Infections 324800 New Infections During the Next Month 9744000 Resulting Monthly Long COVID Cases 487,000 to 1,949,000 Resulting Monthly Excess Deaths 3,500 to 5,800 Running Totals Infections Nationwide in 2025 62331000 Average Number of Infecti... 🧵2 of 8 | PMC Dashboard, April 21, 2025 (U.S.)

We're in the 6th year. See the small red line, bottom left. Notice how closely it tracks the median (gray), year 4 (yellow), & year 5 (orange).

Acknowledging caveats, those are plausible gist-level scenarios for months ahead. year over year graph, summarized in post
Apr 14 • 6 tweets • 2 min read
🧵1/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

🔹2.2 million weekly infections
🔹1 in 149 actively infectious
🔹>100,000 LC cases resulting from the week's infections
🔹>800 deaths resulting from the week's infections
🔹"Lull" transmission steady/slightly decliningCurrent Levels for Apr 14, 2025 % of the Population Infectious 0.7% (1 in 149) New Daily Infections 320000 New Weekly Infections 2240000 Resulting Weekly Long COVID Cases 112,000 to 448,000 Resulting Weekly Excess Deaths 800 to 1,300 Monthly Forecast Average % of the Population Infectious 0.7% (1 in 138) Average New Daily Infections 345366.6667 New Infections During the Next Month 10361000 Resulting Monthly Long COVID Cases 518,000 to 2,072,000 Resulting Monthly Excess Deaths 3,700 to 6,200 Running Totals Infections Nationwide in 2025 60891000 Average Number of ... 🧵2/5 | PMC Dashboard, Apr1il 14, 2025 (U.S.)

Year-over-year transmission (red line, lower left) is tracking the median (grey), year 4 (yellow), and year 5 (orange) closely.

If that trend continues, expect steady yet bumpy transmission the next couple months, until June/July.line graphs, described in tweet