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A recent jump in Michigan Covid cases and hospitalizations is alarming public health officials and raising fear that it could be an early sign of things to come across the rest of the country.
Michigan recorded nearly 17,000 new cases last week, which represents a more than 300% increase from the same week last month. Its per-capita rate over the last week is the nation’s fourth highest, while its positivity rate recently hit 9% – the highest mark since mid-January.
The state’s numbers, especially hospitalizations, are a cautionary tale that underscores the need for a speedier vaccine rollout here and nationwide, said Dr Jennifer Nuzzo, an epidemiologist at the Johns Hopkins University School of Public Health.
“We could very well see an increase of cases in a number of states, and we already are seeing that in Michigan, but if you address the vaccine supply bottleneck then it won’t translate into a huge surge,” she said. “At the end of the day, whether there’s a real surge will depend on vaccinations.”
The state’s latest jump is attributable to the confluence of several developments, experts say: the proliferation of more contagious variants, reopening of schools, Covid fatigue and a loosening of Covid restrictions, among other issues.
Though mortalities remain low, increases in deaths have followed similar jumps in cases and hospitalizations during the state’s previous surges. Hospitalizations surged by 20% between Friday and Monday, which Nuzzo called a “worrisome detail”. Though the number of cases is still important, hospitalization figures are “key” as the vaccination effort races against time.
“Now I’m looking even more closely at hospitalizations and deaths because what we should see is that those continue to decline, even if cases go up,” Nuzzo said. “[Michigan’s hospitalization numbers] suggest that there are some vaccination gaps that need to be plugged.”
The state ranks in the nation’s bottom third in percentage of the population that’s fully vaccinated, but as of 22 March had the second-highest increase in new vaccinations over the last week, indicating that its rollout is accelerating.
The data on who is being vaccinated may offer some clues as to why hospitalizations are up despite the rollout. While about 25% of the state’s population has received a first dose, only 15% of Detroit residents have. The city’s residents on the whole suffer from a higher rate of underlying health issues that are often behind the more serious cases.
Nuzzo said vaccine distribution has generally lagged in large cities around the nation, and Michigan’s numbers “shine a spotlight on places where the state has to do a better job at vaccinating”. States can avoid a similar scenario by bringing the vaccine to lower-income people in cities who may not have easy access to transportation, she added.
Still, Michigan’s increasing numbers “may or may not” be a harbinger of a nationwide surge, said Josh Petrie, an assistant professor in the department of epidemiology at the University of Michigan’s School of Public Health.
Higher percentages of the populations have been infected in states where restaurants, schools and businesses have largely remained open, so a new surge could be delayed, or may not happen to the degree it will in Michigan where more people are still susceptible.
That combined with the percentage of residents vaccinated could determine “whether it takes off in other states around the country”, Petrie said.
About 60% of Michiganders aged 65 years old and up have received at least one dose, representing a bright spot in the rollout. However, most children still aren’t receiving the vaccination and the state this week reported 53 new clusters in K-12 schools that have infected 253 students and staff. Those are in addition to dozens of ongoing clusters. State officials have said sports and extracurricular activities are more responsible for school transmissions than the classroom.
Either way, Michigan’s increasing cases “are very much linked to the schools because children can’t get vaccinated at this time”, said Dr Teena Chopra, an infectious disease professor at Wayne State University in Detroit.
“Schools should be open, but they should open in a phased manner, and only as long as they have all the resources to keep children safe,” she added.
Chopra also pointed to the proliferation of the B1117 variant, the faster-spreading variant first identified in the UK, in Michigan. The state’s 725 confirmed B1117 cases represent the nation’s second-highest tally.
Though the variant is unquestionably spreading, others noted that Michigan is doing more testing for variants, and methodology can make it difficult to know how prevalent the variant is state by state. Moreover, many of Michigan’s B1117 cases can be traced to a prison outbreak.
Still, as people travel for spring break or other reasons, it’s inevitable that the variant will spread in Michigan and other states, Chopra said, and she fears that could boost the number of transmissions and hospitalizations.
Experts also pointed to the 2 March relaxation of restrictions on indoor gatherings by the Michigan governor, Gretchen Whitmer, which allowed gyms, movie theaters, bars and restaurants to increase capacity to 50% and stay open later. The state also began allowing family visitations after testing at nursing homes.
Concurrently, Covid fatigue appears to be setting in, Dr Sarah Lyon-Callo, the state’s chief epidemiologist, said last week in a press conference. Her data shows that people are moving about at near pre-pandemic levels, and a “consistently low proportion” are continuing to stay home.
Outside of reinstating stricter orders and renewed vigilance, the only measure that can slow the new surge is boosting the number of vaccinations, Chopra said. She expects that the state will have vaccinated about 70-80% of the population by July, at which time “we can slowly phase out restrictions”.
“We need to remember that it is not over yet,” she said. “It will be over soon, but it’s not yet.”
Dr Anthony Fauci expressed a similar sentiment last week when discussing the state’s increasing cases on CNN. He said Whitmer should “just hold off a bit” on further loosening of restrictions.
“When you get the overwhelming majority of your population vaccinated, the chances of there being a surge are minuscule,” he added. “Just hang in there. Don’t turn the switch on and off.”
Source: The Guardian
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