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As COVID outbreaks continue, Michigan's ability to contain cases is tested

Linda Vail isn’t sure how much longer she and her staff can keep working 18-hour days.

The Ingham County health officer is squeezing in a quick bowl of cereal for breakfast while she does this intervew over Zoom. It’s been a busy couple of weeks: As of Tuesday, her staff tallied more than 100 COVID-19 cases connected to Harper's Restaurant and Brew Pub, an East Lansing spot popular with college students.

“Our staff are scrambling once again to keep up with a number of cases per day that's as high as we've seen during this entire period of time,” Vail says. “Which is shocking, quite honestly. If you looked at our curve right now, you'd be like – hold on, I can show you,” she says, pausing to pull up the graph of climbing COVID-19 cases from the county’s website. “It's like, oh my goodness.”

While the greater Lansing area now lights up bright red on the state’s color-coded COVID map, signifying a shift to “high risk,” so far, the primary cases in this outbreak don’t appear dire. All those infected at Harper’s Restaurant and Bar are under the age of 28, according to the county, with mostly mild symptoms and no hospitalizations. Some 40% are Michigan State University students or recent graduates, a county spokesperson said.

But officials are watching for secondary infections: people who’ve come in contact with those who contracted COVID at Harper’s, and could be at greater risk due to age or health conditions. And those aren’t limited to Ingham County. Many of those at Harper’s were out-of-towners from at least a dozen other counties around the state. Already, Vail’s staff has reported more than a dozen secondary cases.

“If you're dealing with a parent in their 40s and 50s that has diabetes and heart disease, if you're going to be around grandma and stuff like that, you're putting your loved ones at risk,” Vail says. “We're starting to do some more messaging to try to get that to sink in.”

Reports indicate one more of those individuals may have spread the virus at other gatherings in Wayne County. Four of those infected at Harper’s are from Wayne County, according to a spokesperson from that county’s health department. (The spokesperson did not immediately respond to questions about how many cases Wayne County was seeing in connection to possible secondary infections related to Harper's, and whether any of those cases had been hospitalized.)

Even as Michigan reports relatively low numbers of daily new cases and hospitalizations, communities around the state are seeing clusters of COVID cases sprout up, wholly unrelated to the Ingham County outbreak.

“We had initial clusters and outbreaks that were concerning,” says Lisa Peacock, health officer for both the Northwest Michigan and Benzie-Leelanau District Health Departments. “We had a long-term care facility outbreak that we managed. We had a family’s cluster in one of our counties. We've had a workplace cluster in another county. Most recently we had a few cases over the weekend [but they are] not indicating a cluster.”

So far, Peacock says they’ve been able to quickly spot those clusters and contain them. But she says they’re expecting more to come.

“Is my awareness heightened watching what's happening in Lansing with the restaurants and bars? Absolutely,” she says. “Do I know that people travel all over Michigan at this time of year and more often come to our area? Absolutely. So we're in a state of heightened awareness and ready if things should shift. And we kind of expect them to shift somewhat.”

The new “hotspots” in Michigan

The state health department recently elevated the Grand Rapids region to “medium-High risk, due to the recent two-week increase rising above 20 new daily cases per million, as well as the increase in percent positivity during a time of increased testing.” And several areas are also being dubbed “hotspots” due to rising case numbers, from St. Clair and Lapeer in the eastern part of the state, to Eaton, Clinton, and Livingston in mid-Michigan, and Newaygo and Oceana in West Michigan.

Lapeer County alone saw a jump of 60 new cases in less than two weeks (June 17-29,) bringing the county’s total to 291 cases as of Monday.

On June 22, Lapeer County Health Department Director Kathy Haskins released a statement about initial cases being tied to migrant farm workers. “These workers are vital to

agriculture and a necessary part of the workforce here in Lapeer County,” Haskins' statement read.

“Near the end of last week we reported a cluster of eight associated cases of COVID-19. Those cases were related to the county’s migrant employee population and as a result, additional testing took place last Friday. Many of those test results have now come back, with an additional 24 cases identified, most of whom are connected with the original reported cluster. At this time, the majority of these cases involve three of the camps, and a couple private residents.”

By June 26, the county was reporting 13 new cases for the day. “At least four of the new cases are not related to our valued, migrant worker population,” Haskins said in a written statement. “More of the workers tested negative than did positive.” Since then, the growth in Lapeer appears to have slowed, with just three new cases coming in over three days.

A very different picture from states like Texas, Arizona

Still, Michigan’s scattered outbreaks are far different from the record high case numbers and hospitalizations currently happening in states like Texas.

“We do see that as you see spikes in different areas of the state, local public health has the tools they need to get in there and respond to things,” says Emily Martin, an epidemiologist at the University of Michigan. “And what we don't see is a lot of community transmission from completely unknown sources – like, exponential epidemic growth that we don't know where it's coming from.

"It's sort of like a whack-a-mole game going forward. So it is a little bit of a trial by fire to see whether this is going to hold."

“And so that tells me that our current levels were a really good place to try to manage this going forward. But it's sort of like a whack-a-mole game going forward, where we have to be continually vigilant and responsive as we sort of look for these patches of cases. So it is a little bit of a trial by fire to see whether this is going to hold.”

At its peak in April, Michigan was reporting some 1,251 new daily cases (based on a rolling seven-day average.) Now, even with additional testing, the state is seeing an average closer to 300 new cases per day. Hospitalizations are also low, with just 471 patients admitted across the state, according to the most recent available data.

Even with additional testing, Michigan is seeing just 2.4% of daily COVID tests come back positive (the World Health Organization recommends states hit 5% or lower before reopening.)

“[That] tells us that for every hundred people they’re testing, only two to three of them are coming back positive,” Martin says. “And with that ratio, they've been able to kind of keep things under control.”

To compare, 24.4% of Arizona’s COVID tests are coming back positive, based on a weekly average. Florida is at 15.6% positive test rates, while Texas is at 14.1%.

But Martin cautions against considering this a new wave of infections.

“The thing that’s driving me nuts is that everyone’s calling this the second wave. And I’m just like, people, you’re not done with the first wave. Slow your roll. Because the second wave is going to be ugly.”

The fall could get ugly

Michiganders have to prepare themselves for the possibility that their county, or even the entire state, may have to shut down again in the fall. That’s what Vail, the Ingham County health officer, says she wants people to take away from their current outbreak.

“Everybody that's planning events, planning a wedding, planning a gathering, planning going back to campus going back to school has got to be prepared for that at any moment,” she says. “We could see what's going on here in Ingham County right now [become a larger outbreak.]”

"Everyone's calling this the second wave. You're not done with the first wave."

And Michigan’s resources for identifying and containing these outbreaks are not unlimited. Vail, along with several other county health departments, is worried about the budget they have to do the necessary testing, contact tracing, and case investigation. Right now, there are about 20-30 county public health workers doing those case investigations, and the state has offered volunteers who’ve been trained to help with contact tracing.

“Economically, the county, just like anybody else, is looking at a significant budget deficit,” she says. “I had to submit a budget narrative going forward with the budget that we submitted for this year. And the vast majority of my budget narrative literally was about, this is not a time when you can make cuts to public health. I understand that you're going to have to make budget cuts, but we are facing a pandemic. And if there are less of us, we can't control it.”

That will become especially critical when the weather gets colder, people are spending more time inside, and schools presumably resume some level of in-person instruction.

"Right now, we have enough tests to take care of people, and then do a fair amount of surveillance to try to see what we might be missing, which is good.” Martin says. “But this is in the summertime, when there's not a lot of illness happening and there's actually less illness happening in the communities than we would normally expect in the summer. We're seeing this in our studies, because people are staying home....

“So what I really am concerned about is when we move into the fall, and we move into cold and flu season.... If you have a school where 20% of the kids suddenly have a fever, like happens all the time with influenza, that is going to be so frightening for parents and for public health and for everybody, if we don't have these systems in place to figure out what is actually causing the fever. Is it flu or is it something else? Or is it COVID?”