As Michigan nears the predicted apex of the coronavirus pandemic, some areas of the state have faired far better than hard-hit Southeast Michigan and Detroit. But the whole state won’t peak at the same time. For outstate areas like Ingham County—with 254 cases and a population of more than 290,000 –it’s virtually impossible to predict when cases of COVID-19 will peak, and how long life here may be disrupted.
The Testing Issue
Weeks after President Donald Trump promised readily available drive-through and at-home testing across the country, tests are still being rationed in Michigan for healthcare workers, who are among the most vulnerable, inpatients in hospital, who are among the sickest, and patients who have an order from a physician.
At most drive-through testing sites in the state, you need an order from a physician, in order to be tested. That’s the case at the Michigan State University healthcare site that occupies the parking lot behind the MSU pharmacy.
Initially the site was supposed to be open for four-weeks, but organizers acknowledge that timeline can be adjusted as needed. Since April 1st, the site has tested 224 people.
Large trucks and sedans idle into a large white canvas tent in the parking lot where Kristin Dunkle—normally a pediatric pulmonology nurse now a COVID-19 drive through nurse—gives a muffled overview of the swab she’s about to stick deep up the patient’s nose to test for COVID-19.
“The first part of this test, is I’m going to have you blow your nose, into two of these tissues put ‘em back in the plastic bag. You’re going to keep those with you, save one tissue for afterwards,” she says over the layers of personal protective equipment, or PPE, that’s she’s wearing.
She’s decked from head to toe in an N-95 respirator mask, a face shield that covers both sides of her face down to her chest area, a surgical gown, booties, hair net, and eye-protection under the face masks.
The drive-through testing site is one of several in Ingham County which as of Sunday afternoon had 250 confirmed cases of COVID-19 and three deaths.
Linda Vail is a senior official at the Ingham County health department. She says there’s still not enough cases here to do a complex analysis.
“Despite the fact that we have great, great concern over the numbers we have and them continuing to be reported every day. And, the number of deaths we could see. We do still have a small number in the county relative to our total population to be able to do a lot of hotspot analysis.”
While the county has three zip codes with the most cases, Vail said there’s such a high-level of community spread—cases with no known travel history, or contact with a positive patient—even with contact tracing it’s hard to pinpoint where the outbreak initially spread here.
Peak Predictions Are Difficult With Few Cases
Without enough numbers to crunch, it becomes almost impossible to predict when cases will peak in Ingham County. “I’d like to give you an answer to that, but I just don’t know. We’re using the models to give us the best sense that we can,” said Vail in a Friday media briefing.
She said one of the models the county is relying on is also the model that Governor Gretchen Whitmer has been citing created by the University of Michigan.
Emily Martin is an epidemiologist at the U of M who helped create that model. She says because the coronavirus is known for hotspots and it take a long time to make people sick, when cases get introduced into a population outside of rapid spread, they can take a while to show up.
“So, what this is going to do, it’s going to mean that Lansing is going to have a different peak than Detroit will, and even Ann arbor will have a different peak time,” said Martin.
The U of M model has a huge range of outcomes. By May 3rd the model predicts Ingham County could have anywhere from 265 cases to 1,860. That’s the difference between local hospitals managing or being overwhelmed—similar to the situation of health systems in Southeast Michigan.
“It’s a little tricky when you’ve got very few cases to start with, like we do in Ingham County. And so that’s why we see this wide variation in the predictions,” said Martin.
Martin said, even without a peak as a marker, it’s important to remember that the epidemic won’t be over when the state or county reaches the predicted apex. Under the current stay-at-home order with stringent social distancing in place, it’s possible that the peak could be delayed into late May.
“Everyone is so focused on this idea of the apex or the peak and maybe not remembering that most models show that as an about half-way point, so if we’re lucky enough to be getting to the peak—it means that we’ve got at least half of the epidemic left,” said Martin.
The View From The Hospitals
Melinda Baker is one of the people hoping for an end. She’s a nurse in charge of a MedSurge floor at Sparrow hospital in Lansing.
She says her floor was originally a COVID “rule-out” unit—meaning most of their patients turned out to be negative—but now everyone is positive and there are more patients every day.
“We leave every day and say it kind of feels like Groundhog Day for the last month. It feels like we’re doing the same thing over and over and over. And it doesn’t feel like there’s an end in sight right now. And I think if I focus on that—it feels really heavy and it feels hard,” said Baker.
She says she’s worried people will get sick of social distancing before the downslope of the curve. Baker has already had to make incredible sacrifices in her personal life to serve on the front-lines and pleaded with people to think bigger than themselves.
“My daughter is 19 and in college, and she lives in an apartment—so I haven’t seen her since the beginning of March. And to not know when I can see her, that’s really hard for me right now. Um, so just thinking this could go into June…I mean I haven’t been in a store since March 13th. I haven’t been anywhere besides my home and Sparrow Hospital.”
Her voice caught as she paused before adding, “So that’s just overwhelming to me right now to be honest.”
Baker says the doctors and nurses at Sparrow are prepared. A spokesman for the hospital added they’ve found a way to sterilize and re-use N-95 masks using industrial ovens at MSU which will allow them to be re-used up to 20 times instead of the usual single-use, and they can increase bed capacity by 200 beds if they need to.
But the rest of the epidemic—is still uncharted territory—especially, outside of hotspots.