It's no time to get complacent.
That's the message public health leaders want Michiganders to understand as businesses open up, restrictions are lifted and coronavirus case numbers begin to inch upward.
For the fourth consecutive day Saturday, the Michigan Department of Health and Human Services announced more than 300 newly confirmed coronavirus cases. The seven-day average of daily new cases rose to 275 after bottoming out June 15 at 152.
After weeks of a downward trajectory in new coronavirus cases, a falling number of hospitalizations and COVID-19 deaths, Michigan is starting to see a rise once again.
"We are certainly concerned that as more businesses open up, there is a greater risk of spread of disease," said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services.
"We have seen a slight uptick in cases over the past couple weeks, from around 200 cases a day to more than 300 a day. ... People must maintain social distancing, wear masks and practice good hygiene like washing hands."
Pockets of infections have been tied to a bar in Ingham County; to out-of-state contractors in Bay County who came to help with clean-up after the flood in Midland, and to farmworkers in Barry, Lapeer and Oceana counties, Sutfin said.
As of late Friday, at least 76 people who visited Harper's brew pub in East Lansing had tested positive for coronavirus, according to the Ingham County Health Department. The bar has shut down, and anyone who was there June 12-20 is asked to quarantine for 14 days.
The cluster of coronavirus cases linked to Harper's has spread to the Grosse Pointes, where a college student returned home after visiting the college bar and went on to infect others at a house party and a bonfire.
Nationally, coronavirus cases are surging in places like Texas, Florida, Mississippi and Arizona as the nation's health officials reported record-setting single-day increases in newly confirmed cases since the beginning of the pandemic.
The Johns Hopkins COVID-19 Global Case Tracker reported Saturday afternoon that roughly 2.5 million Americans have contracted the virus, and more than 125,000 have died. Michigan topped 63,000 confirmed cases of the virus Saturday, and 5,907 deaths.
All of this news gives Michigan hospital leaders pause as they cautiously plan for another surge in cases.
"Honestly, we have been watching the numbers every day not only for the past week, but for the past three or four months," said Dr. Adnan Munkarah, Henry Ford Health System's executive vice president and chief clinical officer. "We keep a close eye on that, and we are definitely seeing an increase. We expected as people start getting out more and more and connecting together that we would see some increase in the numbers."
But, he said, the steadily rising numbers of new cases are not reason to panic.
"We are not at an alarming level at this point," he said, noting that hospital admissions haven't gone up and neither have emergency room visits. "We are not at a place where we're saying, 'Oh my God, what is happening?' But we definitely are watching things closely."
Dr. Justin Skrzynski, an internal medicine physician at Beaumont Hospital in Royal Oak, said predictions about the trajectory the virus will take in the weeks ahead are hard to make.
"It's unclear where those numbers will go," he said. "We are seeing a lot more of the economy reopen. People are out and about more. There's more interpersonal contact. So, that is to be expected. Now, whether or not we're going to see another surge, that's a completely different story.
"Can there be another surge? There certainly is a possibility for that. The hope is that what we're seeing is simply fluctuations in the numbers as opposed to the legitimate surge of patients that might overwhelm our capacity."
Both Munkarah and Skrzynski said the first wave of the virus gave Michigan health care systems a sense of how to better prepare for future surges.
They've stockpiled personal protective equipment such as masks, gowns and face shields; testing capability has dramatically improved, and they have learned how the disease progresses and discovered workarounds to more easily manage heavy caseloads.
But they said they hope it doesn't get to the point where Michigan's hospital intensive-care units are packed again with critically ill patients.
The key to keep that from happening is to follow public health guidelines.
"The take-home message is that this is absolutely not done yet," Skrzynski said. "Michigan's doing very, very well nationally, in terms of our numbers. And that's in large part due to the fact that we shut things down early and comprehensively.
"We're not out of the woods. And if people begin to let their guard down now, then we could definitely see cases flare again. And if people stop caring about this, we could see a repeat surge of cases. States like Florida, Texas, California are very, very hard hit right now, and seeing cases on daily basis in numbers that Michigan never did."
Cautioning that people should not relax too much, Munkarah said he's concerned about travel, especially as popular tourist destinations in the South and Southwest are seeing huge upticks in coronavirus cases.
"It's very easy when people start feeling comfortable to start going out and going back to what they used to do before COVID hit us," he said. "But you need to remember this virus is around. It is spreading around the world, and it is still spreading here in the U.S.
"We need to continue to follow the guidelines," he said. "We need to continue to social distance. We need to continue to wear our masks. We need to continue to follow hand hygiene rules, and wash our hands and not touch our faces. We need to continue to avoid being in large crowds and being close to each other, especially in enclosed areas so that we are not increasing the risk of those kinds of transmission."
Sutfin at the state health department recommended that Michiganders put off travel as much as possible.
And, she said, if out-of-state residents "must travel into Michigan, they are asked to contact the local health department when they arrive to let the staff know that they just came from another state," she said. "Health department staff can provide guidance on the best procedure to follow."
Dr. Rana Awdish, director of the Pulmonary Hypertension Program at Henry Ford Hospital in Detroit and the medical director of care experience for the Henry Ford Health System, said she's troubled by the reports of rising case numbers.
When the state shut down and people stayed home to flatten the coronavirus curve in March and April, "it felt like love," she said. "I would look at my patients and be like, 'This city cares about you so much, they're all staying home so you could have everything you need.' "
But now, weeks after the surge subsided, seeing the public refusing to wear masks and going to bars and parties in defiance of social-distancing guidelines feels like a betrayal to the health care workers who risked everything to heal the sick through the initial surge.
"I think people are just tired of worrying," said Awdish, who wrote a best-selling memoir, "In Shock," based on her battle with a critical illness and how to improve the patient experience across the system, "and so it's easier to pretend that it's not happening.
"I see so much of it as just being fear-based, right? When people want to pretend that things are normal, somewhere in there is just a deep fear that things are not normal, and they may not be normal for a long time. And so it's a reaction to fill a need. They need to be comforted and the way that they're comforting themselves is pretending like it's not a danger."
The trouble, she said, is that kind of thinking is very dangerous, and is likely to fuel the growing case numbers.
"People are worrying that the masks are toxic for them, or that they hold in carbon dioxide or make them more prone to infection. I think those are common myths right now. That is dangerous. We all wear masks all the time. We're perfectly fine. It protects people. But some of these beliefs are almost so fervent that they're not rational.
"I worry most about the distrust of science," she said. "That's what I've got as a tool to try to communicate to people what we need to do. And when people don't believe science, I don't know what to do with that."
Contact Kristen Jordan Shamus: 313-222-5997 or email@example.com. follow her on Twitter @kristenshamus.
Michigan Radio, Bridge Magazine, and The Detroit Free Press are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb firstname.lastname@example.org at Bridge, Kristen Jordan Shamus email@example.com at the Free Press and Kate Wells firstname.lastname@example.org at Michigan Radio.