Michigan now has the fastest-growing COVID-19 case rate in the country, much to the alarm of health officials around the state.

The state ranks No. 2 behind New Jersey in average new cases per capita. The Thumb region, as well as Macomb and Jackson counties, have among the nation’s highest transmission rates.

The state’s seven-date average of new cases has doubled since March 15, and is at its highest point in 2021. Friday’s positivity rate was 10.6% on coronavirus diagnostic test results.

Even more concerning is the spike in hospitalizations. As of Friday, 1,940 people were hospitalized for COVID-19, a number that has doubled in less than three weeks.

“What we’re seeing now is very troubling,” said Jim Lee, Michigan Health & Hospital Association vice president for data policy and analytics.

“Michigan’s the hot potato right now in the United States,” said Dr. Liam Sullivan, an infectious disease specialist at Spectrum Health in Grand Rapids. “Why, is a good question. I’ve wondered that myself, because there are a lot other states much more open than we are.”

So what’s going on?

Nobody knows for sure, but it’s likely a combination of factors, experts say.

Below is a look at the various theories and likely factors.

Reopening of schools and resumption of high school sports.

Younger people are leading the increase in cases, a point emphasized by experts.

“The outbreaks among high school kids are just dramatic all over the state,” Sullivan said.

In the past three weeks, people under age 20 have accounted for 22% of new cases compared to 13% during the first year of the pandemic. Daily average case rates since March 5 are up 131% for children under 10 and 147% for ages 10-19 compared to the average for the previous year.

“It’s something we expected might happen” when schools resumed in-person classes, said Ryan Malosh, a University of Michigan epidemiologist. “Now that children are back in contact with each other, they’re susceptible. The virus is still here; it hasn’t gone away. So we’re seeing an increase in that age group, and I don’t think that’s surprising.

“That also could explain some of the speed (of the spread) because there are so many susceptible people that age” who are unvaccinated and had yet to be exposed to the virus, Malosh said. Moreover, children and teens tend to come into contact with more people than adults through school and social activities.

And classrooms themselves may not necessarily be the problem, he added. “When I drive by my daughter’s school, it looks good. They’re all masked up and only one class at a time is going out on the playground. But the second the school day ends, they all go to the park and play without their masks on, so there’s that.”

Likewise with sports, it may not be the competition itself where kids are exposed but the events around the sporting activity. “There’s definitely outbreaks from things like youth sports where people are getting together to eat afterwards,” said Emily Toth Martin, another U-M epidemiologist.

Ann Arbor Public Schools pauses spring sports after surge in COVID-19 cases

While most young people have mild cases of coronavirus, that’s not always the case, health experts caution. Some children do get very sick and require hospitalizations. Currently, 18 COVID-19 patients are hospitalized in pediatric wards around the state.

Increased mobility

During January and February, Michigan was one of the lowest states in the country in terms of mobility, based on cell phone data. People were staying home, which reduced opportunities for people to be exposed to the virus or expose others.

That changed in March, Martin said, and in some areas, mobility has returned to near pre-pandemic levels.

“If you look at cell phone data and other sources of mobility data that we have, you’re seeing that people are moving around close to levels we saw before the pandemic for certain types of trips,” she said. “So there’s definitely a lot more movement happening. And some of these outbreaks we’re hearing about are pretty big,” involving large social gatherings.

Reopening of indoor dining at restaurants

Among the 50 states, Michigan had among the lowest transmission rates through January and most of February, and experts say a big reason for that was more restrictions.

Gov. Gretchen Whitmer eased restrictions on gyms and movie theaters in January and allowed restaurants to resume in-person dining on Feb. 1. The coronavirus case numbers and positivity rate started rising about the third week of February.

Lifting of restaurant restrictions typically results in a rise in case rates, concluded a recent study by the federal Centers for Disease Control. That’s because coronavirus spreads most easily in indoor settings where people aren’t wearing masks.

“When we started letting people back into restaurants, there’s an expected increase in cases,” Malosh said. “Just putting people into contact with each other more, we know that’s going to be a little bump up. This, however, is more than that. It’s a pretty big bump up,” which indicates other factors are in play.

Martin said that eating with others or around others tends to be a common denominator for outbreaks.

“Honestly, a lot of it comes down to food, because food is such an essential component of our gatherings” and people have to take off their masks to do that, she said.

”Masks make a huge difference,” she said. In looking over the outbreak data, “I continue to be impressed by the difference in situations where people are masked versus when people are taking their masks off.”

COVID-19 variants

It’s clear one factor is the emergence of the new COVID-19 variants, which are more contagious than the dominant strain of coronavirus.

What’s unclear is exactly how big of a factor variants are right now.

Along with Florida, Michigan has one of the highest numbers of identified cases of the B.1.1.7 strain that first emerged in the United Kingdom. That variant has been identified more than 1,000 cases in 41 Michigan counties.

However, Malosh and Martin -- the U-M epidemiologists -- caution that Michigan is much more aggressive than most states about testing for variants, so it’s hard to know if the higher case count here is simply due to that.

“We know it’s here, and last time I checked in mid-March it seemed to be about 10% to 20% of cases,” Martin said. “So it’s not the mainstream strain yet, but it’s increasing.

“I think what we’re seeing now is the variant happening plus a lot of behavior change happening at the same time,” she said.

Lee, the MHA data analyst, thinks the spread of variant strains in Michigan explains both the speed of the case increases as well as a worrisome spike in hospitalizations among COVID-19 patients in their 30s and 40s.

“The reason why I believe that the (B.1.1.7.) variant is impacting our hospitalization rates is that fact that we had younger individuals coming into our hospitals,” Lee said. “And we know the variant causes more severe illness and is more transmissible especially those in the younger population. And we also see a faster rise in our hospitalization rates than what I would expect.”

Sullivan, the Grand Rapids infectious disease doctor, agreed.

“I think this is sort of a perfect storm for that variant, and it’s licking its chops advantage of the situation,” he said. “I have got to believe, with how fast numbers are going up, that many of these cases are probably B.1.1.7. variant cases.”

COVID fatigue

No question, a big factor is that after a year of COVID-related restrictions and the hope offered by coronavirus vaccines, many are ignoring the coronavirus mitigation strategies such as wearing a mask, avoiding crowds and social distancing, especially indoors.

“Lots of people are just sick of COVID,” Sullivan said. “They’re saying, ‘I’m done with this.’ They’re tired of it. Plus there’s this sense that things are going great now that we do have vaccinations, and we don’t have to worry about COVID anymore.”

Martin offers a similar perspective.

“There’s this innate feeling among many people of, ‘The vaccines are here. They’re about to be broadly available. Let’s go ahead and start behaving as if we’re already vaccinated,’ ” she said. “There’s such a strong desire to start getting together that people are going to do it whether or not they’re vaccinated.”

The good news

The very good news is that vaccinations are proving to be hugely successful for those who have been immunized so far.

MHA officials say they’ve heard no reports of hospitalizations among people who are fully or partially vaccinated.

In fact, COVID-19 cases among residents in Michigan’s skilled nursing facilities have dropped 96% since the start of the federal vaccination program for long-term care facilities in late December, according to the Health Care Association of Michigan.

That especially significant because long-term care residents have comprised a third of COVID-19 deaths in Michigan.

COVID-19 cases in Michigan nursing homes drop 96%, deaths drop 99% since late December

Coronavirus cases among senior citizens in the general population also are plummeting, the data shows. Even as case numbers skyrocket among other age groups, the average number of daily new cases per capita is down 54% this month for ages 80 and older and down 26% for those in their 70s compared to the average rate for the first year of the pandemic.

And Lee said increases in COVID-hospitalizations among the elderly are a fraction of what they were during the last surge.

On the other hand, 70% of adult Michiganders and 100% of children are still unvaccinated, leaving many, many people vulnerable in this surge.

The rise in hospitalizations is particularly worrisome, said Lee and others. It appears that the big wave of infections among children has now spilled over into a surge of COVID cases among their parents and others around them.

So even while children and teens are rarely hospitalized for coronavirus, Lee said the number of recent hospitalizations for people under 60 is of great concern.

Michigan COVID-19 hospitalizations among younger adults hitting same levels as previous peak

Considering the encouraging trendlines among senior citizens, it appears vaccinations offer the best road out of the current surge, experts agree. But right now a race between the vaccine and the variant.

Martin said the variant is all the more reason people should double-down on coronavirus mitigation strategies until they are vaccinated.

“It’s like you’re running a race and the other runner starts running 50% faster,” she said. “You want to catch him while you still have a chance.”

Read more on MLive:

6 reasons that Michigan’s COVID-19 numbers are surging

How to find a COVID-19 vaccination appointment in Michigan

Pharmacies help ramp up coronavirus vaccines in Michigan

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