DETROIT - As Michigan leads the nation in COVID-19 cases - despite restrictions and mandates - states that don't have them, including Texas and Florida, are seeing significantly lower rates of infection.
Compared to the Great Lakes State, it looks like an entirely different year down south. Texas has completely lifted its mask mandate while Florida has removed occupancy restrictions on its businesses. Meanwhile, in Michigan, masks are still required in restaurants and schools while outdoor stadiums can only seat 20% capacity.
Conventional wisdom would expect Florida and Texas to see its cases rise, but that’s not happening.
Michigan sticks out like a sore thumb in the U.S. and it's not even close. New cases are popping up at a rate of 72.16 per 100,000 people, according to Johns Hopkins tracking data. In second place is Minnesota, reporting at 49.05 per 100,000 people.
Models of a coronavirus (edited with Photoshop) (Photo by Peter Endig/picture alliance via Getty Images)
Michigan’s infection rate over the last few weeks remains an outlier for a country that has rolled out one of the world’s more successful vaccine campaigns, fully inoculating at least 24% of its citizens.
The state’s third surge is "just like a runaway train right now," according to Beaumont Health’s chief infectious disease expert. And yet, even as the governor has declined to implement new restrictions on businesses and schools amid the surge, it still has more strict gathering rules than other states with fewer cases.
It may be a while before Michigan’s spread starts falling and even longer before scientists fully understand the anomaly that is playing out. But epidemiologists have a few ideas.
"We’ve got reservoirs of people that we kept safe for a long period of time who don’t have antibodies and variants that are easier to catch," she said this week.
Dr. Aubree Gordon, an associate professor of epidemiology at the University of Michigan’s School of Public Health says that both rates of vaccinations and prior infections can improve immunity within a population. Michigan has fully vaccinated about 24% of its population. Florida and Texas weren’t far behind, at 22% and 21%, which means there’s not much difference between the two groups. Similar trends were reported in the rates of people who have gotten at least one vaccine dose.
"So (vaccine rates are) not contributing to an increase in transmission," Gordon said. "But for prior infections, Texas and Florida had larger peaks earlier in the pandemic than Michigan did."
It’s not entirely clear how much transmission was present in the state during its March and April wave last year. Testing wasn’t as good back then as it is now. It was better by the time southern states in the U.S. began reporting higher infections during the 2020 July and August surge.
That same rate of cases was absent in Michigan, which didn’t start reporting new waves of cases until October. That’s when the governor restarted lockdowns for in-person dining and classroom learning. By the time Michigan had flattened its second wave, Texas and Florida were still working to get its latest surge under control.
"So it certainly seems like, despite inconsistencies in reporting, Texas and Florida sustained more infections earlier in the pandemic and they have fewer people susceptible," said Gordon.
While rare, reinfection of COVID-19 can still occur. However, Gordon said it wouldn’t happen enough to influence the surges in states.
‘A canary in the coal mine’
When COVID-19 first arrived in the U.S., it was areas like New York City and New Orleans that showed up as hot spots for increased transmission.
That was also true in Detroit, which became the site of one of the hardest-hit regions in the country. Already struggling with poverty, it was ripe for more infections with worse outcomes. Some of its citizens couldn’t stay at home because their jobs required them to be onsite. Pre-existing conditions that many citizens had before the pandemic worsen the symptoms.
By the time Detroit successfully pushed its curve down, its hospitals had hit capacity and staff were considering policies that forced them to prioritize which patients received care and which didn’t.
The waves that slammed into Michigan soon rolled over into other states that had avoided it first.
"The thing I worry about, what if Michigan is foreshadowing what other states will see at a later point in time?" said Dr. Darline El Reda, an adjunct professor of public health at Michigan State University. "That’s a potential hypothesis as well."
"If Michigan is a canary in a coal mine, based on the December peak, you’d expect a few months from now to see a big peak like last year in the southern states," said Gordon
According to Texas’s dashboard that tracks hospitalizations linked to COVID-19, rates hit their lowest in months on April 4. Since then, the number of people being admitted has ticked up ever so slightly, from 2,772 to 2,931 over the last 10 days. So far, its 7-day average for new cases has continued to fall since the end of February. Data from the beginning of April to now shows that the decline may have plateaued. It's not clear if officials expect case counts to start going back up.
In Florida, its dashboard shows a gradual increase in positive tests as well. For the week of March 14, the number of people who tested positive was 31,959. The week after it was 35,493, then it was 37,421, and finally, on April 4, it was 41,896. The state’s percent positive rate is around 6.66%.
But what’s different about this scenario is the presence of vaccines. If the number of people getting protected grows, then public health departments would expect the next wave to not hit as hard.
"(It) gives a few months to continue to rollout vaccinations and hopefully by the time we get there, the grant majority is vaccinated," said Gordon.
Pandemic fatigue and human behavior
Even with Michigan’s restrictions in place, it may not deter everyone from following proper guidelines for slowing the pandemic’s spread.
The state applauded its citizens last year for their collective effort remaining indoors and abiding by Whitmer’s stay-home order. Close to half of the state stayed put during the first surge last April, according to mobility data tracked by Facebook. That number then fell in the summer months as restrictions were lifted and then rose again during the November and December surge. In January, about 40% of the state was staying home.
But by March 2021, that number has been closer to 20%.
Pandemic fatigue and exhaustion from our pandemic year have contributed to fewer people abiding by the rules, the governor has said, which has led to more potential for transmission.
"Psychologically, we want this to be over," El Reda said. "That would be a misinterpretation on our part. Sending kids back to school didn’t mean the virus was gone. We never said it was gone."
Beyond extended mask orders workplace restrictions, Michigan hasn’t rolled out new rules for businesses or gatherings. Whitmer has instead strongly recommended people remain at home.
She’s also strived for more vaccines, in hopes of inoculating enough of the population that a new wave of cases could be held at bay by increased protection.
That may have led to a false sense of security instead.
"I think we’re doing a good job with vaccination efforts, but I also think we’re letting our guard down," El Reda said. "There’s a time from vaccine to protection. And that’s not the time to let our guard down in terms of preventative measures, mandate or not."
Sequencing for variances
Variants from the United Kingdom or Brazil have complicated vaccine rollouts and strategies for slowing the spread.
There’s little question that the B.1.1.7 variant has successfully spread across Michigan. Many predicted it would be the dominant strain in the U.S. by March because it has an easier time spreading. Last week, the CDC confirmed that was true.
Michigan has the 2nd-highest number of B.1.17 cases in the country, behind, ironically, Florida, according to the CDC. Early outbreaks within some of the state’s jails allowed for the strain to spike in the state. In Texas, only 414 cases have been detected.
In Macomb County, which has seen its daily cases rise from 100 to 800, the health department director said the B.1.1.7 variant was the driving factor behind its climb.
"The current surge is attributed to community-wide transmission, and infections have been identified in all types of settings and prominent clusters are evident where there is more activity that increases risk of transmission," said Andrew Cox.
Examples include households being shared with infected people, workplaces, schools, youth sports, and travel.
This information is likely incomplete, however, since not every state sequences for different strains at the rate that Michigan does. In Detroit, which is reporting positive cases in almost 20% of its residents, the city's medical director Dr. Najibah Rehman says they have to wait about two weeks after sending a test to the state before they'll know if they identified a particular strain.
The city also detected its first P.1 variant last Friday, another strain that's known to be more infectious.
Infections in kids
Whitmer had pressed school districts to offer in-person learning by the beginning of March. Almost every district met that benchmark, with a few stragglers coming in afterward. Detroit public schools started teaching in classrooms by mid-March.
That was around the same time the state’s honeymoon of fewer infections ended and cases began ticking back up.
"The beginning of our wave was in pediatrics and now we're seeing it in all types of high-risk facilities," said Dr. Rehman.
The cases were transmitted between students and teachers in the classrooms, as well as between student-athletes and coaches. The spike in cases from kids in school was a factor when DPSCD went remote after its spring break. Since then, Rehman said cases started appearing in more employer-based settings, then in nursing homes and homeless shelters.
Many hospitals caring for COVID-19 infected patients are seeing a younger demographic filling up their beds. These are people in their 20s, 30s, and 40s who may have been exposed to kids that brought it home from school before they started feeling worse. Rehman says 42.9% of all cases in Detroit are those aged 20-39.
Those are the same age groups that weren’t eligible to get a vaccine until the beginning of April, a month after most kids were offered the option to go back to school.
A review of COVID-19 data from the Michigan Department of Health and Human Services by Chalkbeat Detroit, which covers education in the city, paired outbreaks in schools with cases associated with outbreaks between September to April.
As outbreaks climbed by the dozens, infections rosed by the thousands.
"We need to better monitor for infections, not cases," Dr. Gordon said. "I also think the data needs to be made more available so schools can assess what’s happening there."
Outdoor vs. Indoor conditions
Florida may have more B.1.1.7 cases, but its citizens also aren’t crowding indoors like Michigan. Colder temperatures in the north mean that people are spending more time indoors, both at home and when they travel to businesses or to see family.
Beaumont Health’s Dr. Nick Gilpin said temperature and weather are also variables to consider.
"Part of this is environmentally-related," he said. "Cooler weather and dryer air are better for the virus to move around in."
That dynamic is present during flu season when more people are sent home with colds during the winter months. Florida’s climate makes spending time outside easier, where the virus can’t as easily transmit.
So what can be done?
So with a "perfect storm" swirling over Michigan, with a number of factors colliding at once to push what should have been an encouraging few months of protecting people against the pandemic into more of a nightmare of spiking caseloads, what can be done?
There are two things, experts say: Reduce risk and get a vaccine.
"Every day ask yourself, what can I do?" Dr. El Reda said. "Everyone should be thinking about risk reduction. If everyone thought about minimizing the risk, collectively, then it makes an impact."
By minimizing the time people are around other people, it reduces the chance of exposure. These are strategies that have been deployed from the start. And they worked in slowing the state’s spread both times infections rose.
"To help slow the spread, we all need to continue to practice the same mitigation strategies that have proven effective in slowing the spread of COVID-19 – wearing a face mask, social distancing, washing our hands frequently, avoiding concentrated groups of people, and getting a vaccination when we’re eligible," said Cox of the Macomb County Health Department.
Getting a vaccine will also work. It’s been effective in reducing hospitalizations among more vulnerable groups as witnessed in Michigan’s current makeup. Despite "extremely strict" infection controls in nursing homes, some infections have still slipped through, mainly via staff, Rehman said. But any exposure hasn't translated to cases and deaths among nursing home residents due to acquired immunity from vaccines.
Gilpin said the way people have thought about the vaccine is wrong.
"We're so upside down in terms of our thinking that it would be better to get Covid than a Covid vaccine and I think that is the completely wrong way to go about doing this," he said.