As state cases plateau, here's how we avoid another surge | Michigan Radio
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As state cases plateau, here's how we avoid another surge

Apr 21, 2020

We know that hospitalizations, and the number of new cases being added each days, have generally flattened - even though they're still relatively high. Experts say we need at least 3 key things to avoid another big surge in the future.
Credit Markus Spiske on Unsplash

As lawmakers debate how we can safely start returning to normal life, here’s what you need to know about this “plateau” in Michigan cases, and how the experts say we can avoid a second surge.

(Stateside’s April Baer talked to Michigan Radio reporters Kate Wells and Will Callan. You can listen to the segment in the audio file above, and we’ve edited the basics below.)

When we say things have hit a plateau, what does that even mean? We know we’re not out of the woods, but it feels like, aren’t a LOT of new cases still being added everyday?

Definitely.

But, around the beginning of April, things did start to level off. They just leveled off at a pretty high peak - and have generally stayed there since then.

Look at hospitals. Around April 9, Beaumont Health hit a peak of about 1,274 hospitalized COVID cases. Up to that point, their hospitals had been filling up rapidly. But since then, their numbers have been drifting downwards, and are now closer to about 736 cases. That’s even below where they were near the end of March. Henry Ford Health System and Michigan Medicine say they’re experiencing similar trends: peak, plateau, and even a little bit of a downward curve.

Same general principle applies to the number of new cases the state is announcing each day. Around April 5th, the state hits a “peak” about about roughly 1,300 new cases for that day.

Since then, we’ve seen a lot of daily fluctuations (because testing is less reliable than hospitalizations - it can change based on, say, a long holiday weekend.) But we’ve generally stayed at or below that “peak.”  (In fact over the last six days, the number of new cases has been dropping steadily, with about 570 cases being added on Monday.)

And experts agree that this is reason for some cautious optimism: we know that we can contain this virus if we’re all really good at social distancing.

So, obviously if we stop social distancing all at once, we’ll hit a second surge. What does the state need in order to start loosening things up?

Experts in Michigan generally say you need a three-pronged approach.

First is a phased return from social distancing (I go to the office one week, you go the next, etc.). If you do that, then you’ve got a better chance of successfully using contact tracing, which is the second prong. If I get sick and I’ve only been in contact with a handful of folks, it’s much easier to track them down and try to contain the spread if I’ve only been to the office with a skeleton staff, as opposed to attending a massive football game.

"That will save lives," says Neil Mehta, a public health professor at the University of Michigan who specializes in demographics and epidemiology. "Because if we do unfortunately infect a colleague at work, and they're living with their elderly parents or grandparents, then we can identify that that colleague’s risk, and potentially save the lives of them or their families. So it's another tool in our arsenal to combat the virus and save lives."

And in order to have contact tracing, you also need universal testing. Our capabilities there as a state are definitely expanding, and the state just announced they’ll start testing essential employees even if they aren’t symptomatic. But we’re still not at universal testing.

“We need more testing and we need more tracing,” Mehta says. “The testing and tracing, these should become household words. Contact tracing and testing that will really, really help us sort of formulate policies that can sort of open our economy up again.”

How does that fit with what lawmakers are proposing?

Both Governor Gretchen Whitmer and Republican leaders in the legislature seem to agree on the need for all three of those things (phasing in the return, contact tracing, universal testing.)

And we’ve seen a general overview of a plan from conservative lawmakers, where they’d essentially assign each county a danger level. What that would boil down to is tighter restrictions on Metro Detroit and Southeast Michigan, and looser restrictions for areas farther north.

But if we do that right now, we still don’t have the systems in place that we’ll need to do contact tracing. The state’s working on it, and says it’s recruited some 2,000 volunteers, but this would be a massive effort that no one has ever really attempted before at this scale.

So let’s say there is a second surge. Would it look any different than what we saw the first time around?

The size of a second surge is directly proportional to how much you ease up on social distancing. So there could be a series of smaller surges as we test things out. But they could be happening in parts of Michigan that haven’t been hot spots yet - say, up north, where the health systems aren’t as large or as well-resourced to handle a big influx of patients.

We also don’t know what would happen with drug supplies. We’re seeing lots of health systems experience shortages when it comes to the sedatives and painkillers needed to intubate someone (and excruciating process) to put them on a ventilator. Right now, only about 53% of the orders for those drugs are getting filled.

And just three weeks ago, Beaumont Health was down to a 48-hour supply of those drugs. Thankfully, they were able to get all their vendors on a call and get emergency shipments. But those vendors and wholesalers aren’t required to report inventory levels to the FDA. So we have no idea if they have what it takes to bail out another large hospital system if there is a second surge.

So there's a lot of uncertainty. But we do have some context for this. You’ve heard a lot of comparisons to the 1918 flu epidemic. Howard Markel, a medical historian at the University of Michigan, compared the responses and social distancing in 43 different cities during that time period.

“We found that cities that did them early, that did more than one — they layered them in a way that was very effective — and did them for a long period of time,” he says. “Because social distancing doesn’t cure a virus. It doesn’t really prevent you from, if you have contact with the virus, of getting sick from it. What it does is buy you time.”

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