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. Cancer center program leader. pmc19.com/data psychmike.com

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Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

We post weekly COVlD updates at pmc19.com by the end of the day on Mondays. You can also check out our interactive COVlD map at pmc19.com/interactive.php We prioritize updating the interactive map ASAP on Fridays during these uncertain time periods. 🧵10/10

The US has 5 regional COVlD outbreaks and 4 isolated outbreaks. The regional outbreaks include much of Alaska, California and western Nevada, much of Texas (central Texas sites have been shut off), the region from Kentucky through southern Illinois, and much of southern Florida. Isolated outbreaks include Franklin County in Washington, Bannock County in Idaho, Floyd County in Georgia, and Jasper County in South Carolina. Levels are rising across much of the US but later and slower than typical.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

Here is part 2 of the state-by-state risk table. Notice the CDC labels (e.g., Low) show *relative* transmission since pandemic onset. This may be useful for timing non-urgent medical/dental care. The *absolute* risk is concerning even in relative lulls. 🧵9/10

Missouri Very Low 1 in 150 (0.7%)
Montana Very Low* 1 in 222 (0.5%)
Nebraska Very Low 1 in 435 (0.2%)
Nevada Low 1 in 96 (1.0%)
New Hampshire Very Low 1 in 347 (0.3%)
New Jersey Very Low 1 in 326 (0.3%)
New Mexico Very Low 1 in 142 (0.7%)
New York Very Low 1 in 222 (0.5%)
North Carolina Very Low 1 in 164 (0.6%)
North Dakota Very Low* 1 in 282 (0.4%)
Ohio Very Low 1 in 222 (0.5%)
Oklahoma Very Low* 1 in 528 (0.2%)
Oregon Low 1 in 88 (1.1%)
Pennsylvania Very Low 1 in 222 (0.5%)
Puerto Rico Moderate* 1 in 58 (1.7%)
Rhode Island Very Low 1 in 222 (0.5%)
South Carolina Very Low 1 in 123 (0.8%)
South Dakota Very Low 1 in 616 (0.2%)
Tennessee Very Low 1 in 127 (0.8%)
Texas Low 1 in 70 (1.4%)
Utah Very Low 1 in 288 (0.3%)
Vermont Very Low 1 in 258 (0.4%)
Virginia Very Low 1 in 222 (0.5%)
Washington Low 1 in 91 (1.1%)
West Virginia Very Low 1 in 1,848 (0.1%)
Wisconsin Very Low 1 in 222 (0.5%)
Wyoming Very Low 1 in 222 (0.5%)

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

Risk varies considerably by state (table part 1 of 2). Among 100 random people in Alaska, there would be a 97% chance of an exposure, whereas only a 13% chance in Massachusetts at the moment. (Every state has waves at different times, so they are not special) 🧵8/10

Alabama Low 1 in 83 (1.2%)
Alaska High 1 in 29 (3.5%)
Arizona Low 1 in 90 (1.1%)
Arkansas Very Low* 1 in 161 (0.6%)
California Moderate 1 in 64 (1.6%)
Colorado Very Low 1 in 222 (0.5%)
Connecticut Very Low 1 in 148 (0.7%)
Delaware Very Low 1 in 238 (0.4%)
District of Columbia Low 1 in 74 (1.3%)
Florida Low 1 in 87 (1.2%)
Georgia Low 1 in 79 (1.3%)
Guam Moderate 1 in 54 (1.8%)
Hawaii Moderate 1 in 63 (1.6%)
Idaho Very Low 1 in 336 (0.3%)
Illinois Very Low 1 in 193 (0.5%)
Indiana Very Low 1 in 222 (0.5%)
Iowa Very Low 1 in 222 (0.5%)
Kansas Very Low 1 in 238 (0.4%)
Kentucky Moderate 1 in 56 (1.8%)
Louisiana Very Low 1 in 127 (0.8%)
Maine Very Low 1 in 222 (0.5%)
Maryland Very Low 1 in 352 (0.3%)
Massachusetts Very Low 1 in 715 (0.1%)
Michigan Very Low 1 in 226 (0.4%)
Minnesota Very Low 1 in 222 (0.5%)
Mississippi Low* 1 in 76 (1.3%)

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

Nationally, in a room of 100 people, it's a coin toss whether one would experience a COVlD exposure, if nobody is testing or isolating. Exposures do not have to equal infections. Mask up and get a booster if you haven't recently. 🧵7/10

Number of People Chances Anyone is Infectious
1 0.6%
2 1.3%
3 1.9%
4 2.5%
5 3.2%
10 6.2%
15 9.2%
20 12.1%
25 14.9%
30 17.6%
50 27.5%
75 38.3%
100 47.5%
200 72.4%
300 85.5%

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

Our model suggests people have had ~5.4 cumulative SARS-CoV-2 infections. This continues to cause significant morbidity, including childhood and adult cognitive deficits, worker disability, midlife heart attacks, and more. Excess mortality remains elevated. 🧵6/10

Infections
Proportion Actively Infectious 1 in 156 (0.6%)
New Daily Infections 315,000
Infections the Past Week 2,020,000
Infections in 2026 92,000,000
Cumulative Infections per Person 5.36

Long COVlD
Long COVlD Cases Resulting from New Daily Infections 16,000 to 63,000
Long COVlD Cases Resulting from New Weekly Infections 101,000 to 400,000

Excess Deaths
Excess Deaths Resulting from New Daily Infections 80 to 140
Excess Deaths Resulting from New Weekly Infections 500 to 900

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

"During COVlD" is today. We've had 12 waves in the US, two per year. We use the term "wave" at the national level to signify 500,000 estimated new daily infections. The PMC model suggests an 80% chance of surpassing that threshold for a 13th wave. 🧵5/10

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

Nationally, COVlD levels are their highest since approximately April 1. However, in the grand scheme of all days since pandemic onset, levels are higher than 25% of days and lower than 75% of days. 🧵4/10

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

We've had 2 national COVlD waves/year since pandemic onset. This is the latest we made it into a calendar year w/o a major increase. The spring/summer wave has never peaked later than Sep 7. If that holds, levels are capped at how much they can rise before then. 🧵3/10

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

PMC forecasts national COVlD levels to continue to rise. 🧵2/10

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 3d

PMC COVlD Update, Week of Aug 10, 2026 (US) 🔹National levels rise to their highest in 130 days 🔹5 major regional outbreaks, 4 isolated hot spots 🔹1 in 156 people estimated actively infectious 🔹2 million estimated new weekly infections See Alt text for details. THREAD🧵1/10

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 7d

How to use the PMC interactive county-level COVlD map

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 7d

Viewed over 400,000 times on IG and the devil bird app. 👀 "It is neglect of the highest order to look children in the eyes and say: 'We knew how to protect you, and we didn't do it.'" -Violet Affleck to the UN

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 8d

There are 15 COVlD hot spots across the US, according to our county-level map of CDC wastewater data. See Alt text for details. PMC Weekly COVlD Report: pmc19.com New Interactive Map: pmc19.com/interactive.php

The US has 15 hot spots. These include central California (Fresno, San Benito, Alameda), northern Oregon (Wasco County), Alaska (Juneau), Hawai’i (Kauai and Honolulu), southeastern Idaho (Bannock County), central Colorado (Summit County), northwestern Illinois (Whiteside County), the northern LP of Michigan (Gaylord area), central Kentucky (Lexington), northeastern Ohio (Ashtabula County), southern Florida (Palm Beach area), southeastern Pennsylvania (Lancaster County), central New Hampshire (Grafton County), and southern Maine (Knox County).

Southern Texas still has an outbreak (Webb County). Most Texas sites that had high or rising levels have not reported since July 11. Central Texas may have higher levels than depicted.

Note that these outbreaks are relatively isolated compared with the widespread high levels in the southern and western states at this time a year ago. Levels are rising but much more slowly than typical.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 14d

California, Oregon, Washington, Alaska, and Hawai'i are experiencing ongoing COVlD outbreaks. Use layered protection, encourage local media to cover COVlD to protect communities, and urge public health programs to promote boosters and offer free N95s and tests.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 16d

Since pandemic onset, the US has never made it this late in the year without a national wave picking up. We forecast transmission to increase. The peak is highly uncertain (see Alt text). Late 2026 would be a terrible time to cut wastewater surveillance. (2/2)

If levels increase at the “typical” historical rates, models suggest a summer peak of about 500,000 new daily infections in early September. A slight upward correction & “catch up” could push the peak to 700,000+. Levels may not increase as much as they usually do this time of year, which would put the peak closer to 450,000. We typically use 500,000 new daily infections to define a “wave” & 1,000,000 a “surge.” There is a possibility of no summer wave in the technical sense, much like Pluto is technically not classified as a planet.

Levels continue to have profound public health impacts on morbidity & mortality during “lulls” / mini-waves, so this is a relative technical consideration, not an absolute assertion of safety. We noted several times over the past 3 months that the July 17-24 data would have implications for understanding the pandemic. The mere possibility of no summer “wave” is key (increased uncertainty, pessimism for winter, optimism for long-term).

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 16d

US COVlD Update, PMC, July 27, 2026 ▪️10 hot spots (see Alt text) ▪️Persistent high/very high levels in TX ▪️FL, AK, HI, & the continental northwest picking up ▪️1 in 198 people estimated actively infectious nationally ▪️1.57 million estimated weekly infections & rising (1/2)

The US has 10 hot spots. There are major outbreaks across much of Texas (high/very high). Houston, denoted by the light blue county in the southeast (Harris) has 1-3-week reporting lags at most sites so may be worse than noted. Hardin county, two counties over to the east/northeast, continues to experience BA.1 Omicron-level transmission. The Texas surge is bleeding into estimates for western Louisiana.
There are 9 other outbreaks: southeast Alaska (Juneau, high), Hawai’i (Honolulu and Kauai, high), north central Oregon through the Washington coast (high), western Nevada (Carson City, high), the Utah-Idaho border region (very high), southwestern Colorado (high/very high), southern Florida (high/v high), Atlantic City, New Jersey (high), and Grafton County, New Hampshire (high). The outbreaks in the Bay Area and Guam declined since last week. Note that the CDC state-level map shows no state median in the high/very high range, which is atypical. Higher levels tend to be more widespread.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 19d

This week, the US CDC launched a new webpage, stating the following: “ ‘Vɑccines do not cause autism’ is not an evidence-based claim. ”

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 23d

As of July 20, the US has 10 COVlD outbreaks. ✴️1 in 243 Americans estimated actively infectious ✴️200,000 estimated new daily infections ✴️Enduring outbreaks persist in Texas + Guam ✴️Outbreaks in the Bay Area (CA), NV, ID, CO, KS, KY, SC, HI Details in Alt text. pmc19.com

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· 29d

Friday's CDC data show a COVlD outbreak in the Bay Area. Median levels are "High" in Alameda County. The 6 wastewater monitoring sites read Very High, Very High, High, High, Low, and Very Low. #MaskUp PMC: pmc19.com CDC data (click CA from the dropdown menu): www.cdc.gov/wastewater/r...

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jul 12

The US may soon enter a 13th wave. We will likely know on Friday the 17th. If no major increase by the 24th, the pandemic dynamic will have shifted. 🧵3/3

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jul 12

The US is estimated to experience 1.35 million SARS-CoV-2 infections/week during a "lull." Infections continue to cause excess deaths, the plurality being from cardiovascular events (e.g., tinyurl.com/swiss19). 🧵2/3

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jul 12

PMC COVlD Update, Week of Jul 13, 2026 (US) ▪️1 in 250 Americans estimated actively infectious ▪️8 hot spots ▪️Texas and Guam outbreaks persist ▪️Florida outbreak worsens ▪️California Bay Area now with high levels See Alt text for more detail. pmc19.com THREAD 🧵1/3

The US has 8 hot spots. There are major outbreaks in central/east Texas (high/very high), southern Florida (high/very high), and Guam (very high). Note, 0 of 62 sites in Harris County, TX (Houston) reported this week, so the “very low” levels may be over-optimistic (2 of 8 sites “very high” last week, with 5 of 8 rising). These counties have isolated hot spots: Alameda (Bay Area), California (high); Larimer (Fort Collins), Colorado (very high); Jasper, South Carolina (high); Cabarrus (Concord), North Carolina (very high); and Ulster (Kingston), New York (very high).

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jul 1

Reminder: BlueSky is unethical in its own unique ways, including implementing mandatory ID Tracking in specific US locations. For public health updates the next week, find me on the devil app, IG, Threads, LinkedIn, TikTok, MySpace, or tin cans. 🙏

Requirement for DL, credit card, or social linked to other information.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 30

The US has 10 COVlD hot spots (June 29, 2026) 🔹1 in 264 people actively infectious 🔹Levels flat or slightly rising, with volatility in CDC and Biobot reporting 🔹Ongoing major hot spots in Texas & Guam 🔹Isolated spikes in California, OR, NV, AL, GA, WV, NJ, and NY

PMC county-level national heat map from CDC data.

There are major outbreaks in central/southeast Texas (Very High) and Guam (Very High). Other spikes include south central Oregon (Klamath; High), specific counties in California (San Benito, Fresno, Napa; High to Very High), northeast Nevada (Very High), southeast Alabama (High), Newton County in Georgia (High), western West Virginia (High to Very High), Hunterdon County in New Jersey (High), and Chenango County in New York (Very High).

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 29

CDC Update 🦠 New Orleans - Very High levels of RSV, which is particularly dangerous for young children & older adults. The entire state is shown as Very High, but the 2 monitoring sites are in NOLA. In fact, one is Very Very High (likely West Bank) & the other Very Low.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 25

Central and SE #Texas have been on fire w/COVID for 21 days. Levels are extremely high in College Station, followed by near Houston, then Waco. The CDC defines Texas as "very low" because 52% of wastewater sites are very low. That misses the public health opportunity.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 23

US COVlD Update (PMC) ◾️1 in 310 Americans estimated actively infectious ◾️9 hot spots (see Alt text) ◾️Large, lingering outbreaks in Central/SE Texas & Guam ◾️Levels are stable or slowly rising 1/3

The US has 9 hotspots. There are major outbreaks in Central/Southeast Texas (High/Very High) and Guam (Very High). Other spikes are at individual wastewater sites: Summit County, Colorado (Very High); Tompkins County, New York (Very High); Lincoln County, Maine (Very High); Fresno County, California (High); Jackson County, Mississippi (High); Barbour County, Alabama (High); and Swain Country, North Carolina (High). Note, New York state only has two CDC sites reporting; their state-run dashboard suggests the outbreak may be more isolated than depicted here.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 23

COVID Alert❗️Biobot released their 1st COVlD report in a month, and it shows levels rising in the US after the prolonged national relative "lull" in transmission. biobot.io/risk-reports...

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 22

In 2026, the biggest COVlD concerns are #LongCOVID and excess deaths. However, with the massive outbreak in Central and SE Texas the past few weeks, COVlD emergency department (ED) visits have escalated in the region, likely underestimates due to diminished testing and reporting the past 2 yrs.

Screenshot from Twitter. CyFi's current and recent posts emphasize the ED visit increases in two large TX cities in the region.

Mike Hoerger, PhD, MSCR, MBA@michael-hoerger· Jun 14

We got our COVlD map out 3 days early this week on Friday. One of you alerted the local news media in #Idaho, and it was breaking news by Saturday. Everyone should replicate this approach with local hot spots. 👏👏👏 www.idahostatejournal.com/news/local/l...