With 17 variant cases, it's a race against the clock to detect the spread
It’s going to take about a week for the state’s lab to answer an urgent question.
“Can we take some more proactive and aggressive action [against the more contagious COVID-19 variant] and really control these clusters that we're currently seeing?” Susan Ringler-Cerniglia, a Washtenaw County Health Department spokesperson, said Monday. “Or is, in fact, the variant already circulating more than we've detected?”
The answer may depend on a batch of 350 test samples collected over the weekend in Washtenaw County, where so far 13 cases of the so-called “U.K. variant” (also known as the B.1.1.7 variant) have been confirmed. Another four were confirmed in Wayne County, the county health department said in a press release issued Monday night.
But that’s almost certainly an undercount, and possibly a dramatic one. Currently about 37,000 COVID tests are administered on average every day across the state. But since mid-December, not long after the new variant was first identified in the United Kingdom, only 1,282 positive test samples have actually been sequenced by the Michigan Department of Health and Human Services, a spokesperson said.
“There are likely more cases that we have not yet identified, and there is possibly spread of the variant that is happening right now,” Dr. Joneigh Khaldun, chief medical executive at MDHHS, said at a press conference Monday. “This variant is more easily spread from person to person. That means that for any given case, it will likely infect more people and lead to more spread. And this means possibly more cases overall, more hospitalizations, and deaths.”
Since January 16, a scramble to detect new cases
The initial state case of the B.1.1.7 variant was identified on January 16, from an individual in the University of Michigan community who’d recently traveled to the U.K., according to the Washtenaw County Health Department. By January 23, another five cases had been detected, though it’s not clear if they were all related to that first case. Then, on Saturday, January 23, came a warning about possible public exposures the previous weekend: Sunday, January 17 at Meijer and the Briarwood Mall in Ann Arbor.
While “brief, public exposures are not normally a COVID-19 exposure concern,” the county health department still issued an advisory for anyone who may have been exposed to get tested, because “the B.1.1.7 variant is more easily transmitted and could lead to more cases, hospitalizations, and deaths.”
In response, the county also set up additional testing over the weekend at Pioneer High School in Ann Arbor, in hopes of tracking the spread. The 350 or so samples collected have gone to the MDHHS lab for testing, spokesperson Lynn Sutfin said in an email Monday. “All the positive tests are being sequenced. It will take about a week for that to be completed.”
Health officials one county over have embarked on a similar undertaking. On Saturday, MDHHS announced that a Wayne County resident had tested positive for the variant, and on Monday night, the Wayne County health department said that it had identified four cases of the variant total. It was also investigating four additional COVID cases among contacts of those variant-infected individuals, and noted that sequencing for those tests had not yet been completed.
The four confirmed Wayne County cases — two male, two female — range from 35 to 42 in age. The two men had recently returned from international travel. All have been advised to quarantine for 14 days, but one of the travelers, the department said, "has since left the country."
Do we need to close indoor dining again?
Those results, as well as others gathered in the coming days, will be crucial. If more cases are detected, and don’t appear to be connected to the initial case, then it’s likely the variant is widespread.
“That opens up the possibility, as we start to look for this variant, that it has been circulating,” Ringler-Cerniglia said. “Or was introduced in similar ways from another state, or another area where it had already been circulating?”
The answer won’t change what people should do on an individual level, she said. “That masking, that distancing, that isolation and quarantining if appropriate...We know those strategies reduce spread and prevent spread, especially when layered up and used consistently.”
But it could determine whether local officials enact new restrictions, especially with indoor dining set to resume in just a few days on February 1.
“Certainly we're talking multiple times a day with both our university partners, as well as the state, about the evolving situation,” Ringler-Cerniglia said. “So we're kind of looking at, what can we determine really in the next two weeks? So that we can look at a couple of cycles of these results. And what is that telling us? Is that telling us we can keep taking these actions, that we're stemming the tide, if you will, on these clusters? Or are we seeing greater transmission of it? And I think we just don't know that yet.”
University of Michigan pauses athletics, but is it taking additional steps?
On Saturday, January 23, the university received a memorandum from the MDHHS citing the detection of B.1.1.7 cases among “members of multiple UM athletic teams” and urging the university to place “ALL UM varsity athletic programs in quarantine until further notice and up to 14 days from today’s date.” The memo goes on to make a number of recommendations pertaining to mitigation in both the athletic department and the university as whole.
The most sweeping recommendation was to pause all athletic department activities; on Saturday, U of M athletic director Warde Manuel announced the department would be doing just that. As for the document’s more specific recommendations — for example, to test all quarantined athletes three days a week — it’s unclear how the university will respond.
The same goes for the document’s campus-wide recommendations. One is to set up rapid testing sites within a certain geographical range of known B.1.1.7 cases. Another is to require all students returning to campus from another state or country to quarantine for 10 days.
“We continue to seek added clarity and develop a response to the very detailed recommendations shared by the state on Saturday afternoon,” said U of M spokesperson Rick Fitzgerald.
Why aren’t we doing more testing to detect this variant?
The genomic sequencing required to single out the variant requires uncommon expertise, and lots of time.
The bulk of Michigan’s sequencing — in which viral RNA from a test sample is stimulated and processed into revealing its genetic makeup — is carried out by two labs: the state lab in Lansing, and a research lab at the University of Michigan run by Dr. Adam Lauring, who studies and treats infectious diseases.
The state lab processes anywhere from 1,500 to 4,000 test samples a week, according to MDHHS spokesperson Lynn Sutfin, and attempts to sequence every one that comes back positive. Since mid-December, not long after the variant was first detected in the U.K., the Lansing lab has sequenced 1,282 positive samples. The lab is capable of completing 500 sequences a week, but depending on a sample’s characteristics, such as low viral content, not all can be sequenced.
Lauring’s lab has the same goal: to sequence every COVID-positive specimen that goes through the U of M testing system. Recently, says Lauring, the lab boosted its capacity from 192 to 250 sequences per week. That means that for the week ending January 24, during which U of M’s testing program recorded 200 positive cases, Lauring’s lab should be able to sequence everything (that is, once it receives the samples).
Quest Diagnostics also conducts genomic sequencing in Michigan, according to spokesperson Kimberly Gorode, but it’s unclear how much, since the company doesn’t share state-level data.
Lauring told Michigan Radio earlier this month that although other labs in the state are interested in helping with sequencing, preparing to do so is expensive and time-consuming. And, compared to the rest of the U.S., Michigan is “doing a reasonable job,” said Lauring. As MDHHS officials have pointed out, the state is responsible for about 6% of all U.S. sequences contributed to the international database GISAID.
*This post was last updated on January 26 at 12:23pm.