Michigan is heading into an autumn surge of coronavirus, which has many steeled for a reprise of the coronavirus crisis that beset metro Detroit in March and April.
But there are some important ways in which this surge is likely to be different.
Certainly, we know a lot more about COVID-19 now, including a better understanding of how the virus is spread and how to effectively treat symptoms caused by the virus.
Health-care providers, public officials and the public have a better idea of what to expect. There’s been time for various organizations -- from hospitals to schools to businesses -- to make contingency plans.
There’s also some new challenges.
Sharp political divisions make a coordinated response more problematic. COVID fatigue has set in, even among those supportive of tougher mitigation strategies. The current surge is involving a much larger geographic area. The overlap with flu season is a huge concern.
And some challenges we faced in the spring haven’t gone away: COVID-19 remains a highly contagious, potentially lethal virus without a vaccine, and the vast majority of Michiganders still do not have immunity.
Below is a deeper look at how the spring surge is different from the current situation and how it’s the same.
What’s different: We know a lot more about how coronavirus is transmitted.
Remember when we were all wiping down groceries or putting them outside for days?
As a novel virus, there was a lot of uncertainty in the spring about how coronavirus is transmitted. Although many questions remain, we have more information now and two points in particular have been game-changers.
Initially, scientists and doctors thought the virus was primarily contracted when someone touched a contaminated surface and then touched their face. But it quickly became apparent the primary mode of transmission is breathing contaminated air.
Also a game-changer: The realization that people with coronavirus are highly contagious before they exhibit symptoms, and a significant number of coronavirus patients never exhibit symptoms even though they can infect others.
Those realizations in March and early April are why health experts went from downplaying the value of masks to aggressively promoting their use. While masks aren’t foolproof, they are now seen as one of the most effective prevention strategies in limiting spread of coronavirus.
What’s the same: Skepticism and resistance to masking continues
Even as the federal Centers for Disease Control announced in April that it was recommending use of masks, President Trump stressed the recommendation was voluntary -- and one that he would not be following.
Trump has continued to be lukewarm about masks, and has offered incorrect information about whether masks are effective.
About three-fourths of Americans says they always use a mask outside the home, according to a Oct. 5 survey, but there are still significant pockets of resistance, particularly among Trump’s supporters.
What’s different: Access to testing has greatly improved.
One of the huge issues in March and April was the severe shortage of coronavirus tests and test supplies. That allowed coronavirus to spread under the radar in late February and early March:
By the time Michigan confirmed its first two cases on March 10, the state already had 532 people sickened by infections later confirmed to be coronavirus.
The real number was many times that. A recent study by University of California Berkeley study estimates Michigan had 12 undetected cases of coronavirus in March and early April for every confirmed case.
Testing is still problematic in some areas of the state, but access has improved considerably since the spring. In early April, the state was averaging about 5,000 tests a day; it’s now more than 40,000.
What’s the same: Challenges in identifying people with coronavirus and those who have been exposed.
More testing has made it much easier for public-health officials to track the spread of the virus and when people test positive, use contact tracing to warn those who might have been exposed.
But there are still significant challenges in that area.
Shortages of test and test kits remain “very concerning” in rural areas, said John Karasinski, communications director for the Michigan Health and Hospital Association.
And even in urban areas, cases are still going undetected, partially because people can have coronavirus and not realize it. “I’ve seen estimates now that there are three to six missed cases” for every confirmed case, said Ryan Malosh, a University of Michigan epidemiologist.
Another issue: While counties have expanded the number of contact tracers, local health officials report a growing issue with coronavirus patients refusing to identify others who the patients might have exposed. Inability to contact trace makes it much harder to stem the spread of the virus.
What’s different: Fewer deaths and hospitalizations
In mid-April, about 4,000 people were hospitalized with coronavirus and the state was averaging more than 140 deaths a day.
Currently, about 1,000 are hospitalized with confirmed coronavirus and Michigan is averaging 22 deaths per day.
That’s because the demographics of confirmed coronavirus patients has changed considerably.
In the spring, confirmed coronavirus cases generally tended to involve patients who were older and seriously ill, simply because those groups were most likely to be tested.
Now that testing is much more available, confirmed coronavirus patients include many more younger patients with mild symptoms or who are asymptomatic. In fact, people age 20 to 30 now make up the largest age group of coronavirus cases in Michigan.
What’s the same: Fear hospitals could be overwhelmed.
Just because hospitalization numbers are lower now doesn’t mean it will stay that way.
The current surge is just beginning, and it’s likely that we’re far from the peak. Moreover, unlike the spring, the current surge is coinciding with the start of flu season, which can strain hospital resources even in years without a pandemic.
Hospitals are specifically worried that a second surge of COVID-19 could create new shortage of personal protective equipment and test supplies, and strain hospital staffing, Karasinski said.
“Currently, having physical beds available is not a concern, but having enough staff throughout the state to care for and treat those patients is a worry,” he said. “As with PPE and testing supplies, there is national demand for direct patient care staff, including nurses and other clinicians. In the spring, traveling nurses were one source of staffing utilized by our Michigan hospitals and healthcare systems to increase bed staffing capabilities, but this has also become more challenging.”
What’s different: Doctors better able to treat coronavirus
The demographic shift in confirmed cases isn’t the only reason the mortality rate has gone down, experts say.
Another factor: Lack of knowledge about coronavirus in the spring had doctors struggling to understand all the symptoms and the most effective treatments.
While there are still many question about what works and what doesn’t, physicians today have a better handle on what to do. Critically ill patients are more likely to survive today compared to six or seven months ago, thanks to medications such as steroids and remdesivir; better use of supplemental oxygen and ventilators, and more awareness of complications such as blood clots and cardiac issues.
What’s the same: Coronavirus can result in significant illness or even death.
Health experts stress that coronavirus remains a potentially lethal virus, especially for those age 65 and older and/or have pre-existing conditions.
Since July 1, almost 100,000 Americans have died of COVID-19. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die.
A new CDC study underscores that coronavirus is much more deadly than flu, and more likely to result in complications. The study looked at hospitalized patients with COVID-19 in the Veterans Health Administration, finding they were five times more likely to die and more likely to respiratory and non-respiratory complications compared to hospitalized patients with influenza.
Meanwhile, a new University of Michigan study of 638 people with confirmed coronavirus found one in four had not fully recovered months after contracting the virus. Long-lingering symptoms included fatigue (50%), shortness of breath (44%) and altered taste and/or smell (18%).
What’s different: Outbreak is statewide
In the spring, the state’s coronavirus crisis was largely confined to southeast Michigan. In fact, 68% of the coronavirus cases confirmed in March and April involved residents of just three of Michigan’s 83 counties: Wayne, Oakland and Macomb.
This time, high rates of coronavirus are being seen throughout the state, and some of the highest per-capita numbers are occurring in the Upper Peninsula.
Coronavirus in more rural areas can be especially problematic, experts say, because those areas tend to be underserved by hospitals and health-care providers.
For instance, there are only 61 adult intensive-care unit beds in the entire Upper Peninsula. On Friday, 44 -- or 72%, of those beds were occupied. Twenty-one of the ICU patients had a confirmed case of coronavirus and two had suspected coronavirus.
What’s the same: Coronavirus doesn’t pay attention to county and state lines.
Among the things that’s become readily apparent in the past seven months is that coronavirus ignores geographic boundaries.
That was apparent in the spring, when the initial outbreak in Wayne and Oakland counties spread to surrounding counties in southeast Michigan. It was apparent this summer when Indiana and Wisconsin reopened their economies before Michigan, and border counties saw spikes. It’s been apparent this fall as numbers surged in the Upper Peninsula, which some have attributed in part to summer tourists.
What’s different: Political climate.
As Gov. Gretchen Whitmer took drastic actions in March to stem the epidemic in Michigan, she had bipartisan support from the Legislature and the backing of business organizations such as the Michigan Chamber of Commerce.
That fell apart within weeks as Republican lawmakers chafed at Whitmer’s continuance of emergency executive orders without getting legislators' input. A months-long series of court battles resulted in a Oct. 2 decision by the Michigan Supreme Court that revoked the Whitmer’s coronavirus mitigation orders, saying the authority she was citing was unconstitutional.
The Michigan Department of Health and Human Services has reissued many of the orders, such as a mask mandate and limitations on occupancy in bars and restaurants, and the Legislature also has agree to reinstate some orders.
But there’s also widespread recognition that there is little appetite now for the kind of lockdown that occurred in March, and public officials are looking to less onerous mitigation strategies to bring down the current numbers.
What’s stayed the same: Widespread support for mitigation strategies
Even though a lockdown is unlikely, coronavirus mitigation strategies continue to have widespread support.
A Oct. 15 poll of Michigan residents found 63% of those surveyed say they approve of using the Michigan Public Health Code to keep Whitmer’s coronavirus orders in place.
And last week, a coalition of 32 health care, labor, higher education and business executives issued an open letter calling on Michigan political leaders to cease litigation and let the new public health orders stand.
Signers of the letter include the top executives at Barton Malow, Dow Inc., DTE Energy Co., General Motors Co., Herman Miller, Lear Corp., Meijer Inc., Rocket Companies Inc., Steelcase, TCF Financial Corp. and the United Auto Workers.
The next week, leaders from 110 of Michigan’s 137 hospitals issued a joint statement Thursday, calling it “imperative” that every Michigan resident follow safety protocols put in place to prevent the spread of COVID-19 and keep hospitals from being overwhelmed in the near future.
In the statement, the chief medical officers and chief clinical officers noted that Michigan has recently seen coronavirus hospitalizations surge by more than 80%.
“This concerning jump puts our entire healthcare system at risk of another capacity crisis,” the statement reads. “If the trend continues, doctors and nurses, therapists and custodians, food services and support staff, who have barely begun to recover from the terrible stress of the initial COVID-19 surge will suffer additional stress and risk their own infection, illness, and mortality.”
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