Epidemiologists say these factors are causing Michigan's COVID-19 surge
As Michigan health officials warn of a second wave of COVID-19 and the state comes off its highest weekly total of confirmed cases, epidemiologists are attributing the rise to colder temperatures driving people indoors where the virus thrives as well as "pandemic fatigue."
In rural parts, there are feelings of invincibility because those areas were previously unaffected by the disease, they say.
"It’s cooler, and the virus loves cold weather because it can survive longer. And we are socializing indoors and unfortunately letting down our guard," said Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington.
People are socializing less at bars and restaurants, which are restricted in many places, Mokdad said. But they have a false sense of security from the virus when they socialize at home with friends, he added.
"As humans, throughout our history, we feel more safe indoors than outdoors. We watch our back more when we are outside than when we are inside our home ... especially when you're around people you know and trust, " Mokdad said.
Some people have become lax on safety measures, such as mask-wearing and social distancing, due to "pandemic fatigue," said Dr. Arnold Monto, a professor of epidemiology and global public health at the University of Michigan.
"It's not simply the regulations that are in place, it’s the way people are behaving — either because of the regulations, because of their own feelings about the regulations, and also pandemic fatigue," Monto said.
"Some of them are just getting tired of being home, of not seeing their friends and a feeling that ‘I’m not high risk, I’ll take a chance.’"
Michigan's surge in coronavirus infections this month is part of a global upswing that has cases increasing in more than 30 states, Canada, and parts of Europe and South America.
Michigan set a record for its highest number of cases in a week for the period that ended Saturday. The state added more than 1,500 cases on Tuesday, bringing the state's total number of confirmed cases to 149,392.
The World Health Organization reported a new record high for weekly infections for the fifth consecutive week. The worldwide total grew to 2.44 million cases, up 5 % from the prior week.
In Michigan, cases are exploding in Houghton, Iron, Menominee and Delta counties in the rural Upper Peninsula. Epidemiologists expected the surge of cases across rural America, Mokdad said.
"This is not unique to Michigan," the University of Washington expert said. "Historically, when COVID-19 came to the United States, it entered the large urban areas, New York City, Seattle.
"It took a long time to get to rural communities. So people in rural communities didn’t see COVID-19, and they felt 'That’s not our problem, that’s the problem of big cities. Nobody lives in a bubble. COVID-19 is going to happen anywhere eventually."
Rural communities also lack resources to deal with COVID-19 outbreaks, Mokdad noted. Michigan has 1,177 COVID-19 hospitalizations as of Tuesday, according to the Michigan Department of Health and Human Services.
"Detroit has more capacity for public health, more hospitals, more ICUs, more ventilators," Mokdad said. "So in reality, rural communities should be more careful …because the deck of cards is stacked against them — they have less access to public health, less capacity to do tracing, less capacity to do testing, than do the big cities."
In Grand Rapids, Kent County Public Health Officer Adam London said there’s been an increase in cases and hospitalizations. He attributes the uptick to lack of compliance with public health measures.
“The challenge for us now is that we don’t have consistent mask use, and we have COVID," London said. "... And we’re not going to be able to keep these numbers down if we don’t have consistent use across the board.”
Are mutations a new threat?
Scientists at Los Alamos National Laboratory and the University of Missouri have identified mutations in the virus they believe are contributing to the global increase in cases, but the theory is controversial in the scientific community.
Kamlendra Singh, a molecular biochemist, and a team of researchers at the University of Missouri recently identified three specific mutations to the COVID-19 virus that have evolved since the first cases of COVID-19 were identified in China.
The mutations co-exist in every single case of COVID-19 in the United States and might play a role in how infectious it is. The peer-reviewed study was published Sept. 15 in the Journal of Neuroimmune Pharmacology.
"These mutations are at certain critical points where they can enhance the replication of the virus. Right now we’re doing experiments that are showing these results," said Singh, noting a new paper on the team's research will be published in the next month.
"Epidemiologists have their own view. Based on our results we definitely think these mutations do enhance the replication and efficiency of the virus."
UM's Monto discounted the theory, saying the SARS-CoV-2 virus appears to have fewer mutations than influenza viruses.
"We haven’t had to worry about more than one virus to put in the (COVID-19) vaccine," Monto said. "With flu, we always have to worry about the virus changing from year to year and having to replace it.
COVID-19 has been "pretty stable," he said, adding the data isn't strong in showing the mutations result in changing the behavior of the virus.
"There are molecular biologists who love to look for changes," Monto said. "If you look for them, you’re going to find them. The question is: Are they important or not?"
America's large share of cases
Though cases are increasing across the globe, they are increasing most in the United States.
America has just over 4% of the world's population but about 20% of global coronavirus cases — a problem many epidemiologists attribute to political division.
"That division within our country, and that misinformation, lack of faith in science — we’ve paid dearly for it," Mokdad said.
The University of Washington epidemiologist said the public has been confused by debates about ideas such as herd immunity, which occurs when a large percentage of the population has been infected and become immune to a virus.
The theory has been promoted by some officials in President Donald Trump's administration, causing an uproar among public health experts and lawmakers across the nation. The theory was initially adopted as a public health approach in Sweden but officials there later disavowed it.
In Michigan, five public health experts reacted with a letter to Senate Majority Leader Mike Shirkey this month, expressing outrage over comments the Clarklake Republican reportedly made in support of the approach.
The letter came two days after the Senate leader told MLive "I’m also a big believer that there’s an element of herd immunity that needs to take place."
Critics say trying to achieve herd immunity, by allowing people to become infected, could lead to four times as many coronavirus deaths as have already been reported in the state.
Mokdad said about 70% to 80% of the population would have to be infected by the virus to achieve herd immunity. In Sweden, about 15% have become infected — with far higher mortality than neighboring countries such as Norway.
New Jersey's infection rate is the highest in the United States at about 25%, Mokdad noted. Michigan's infection rate is at about 10%, with 7,053 deaths as of Tuesday. To achieve herd immunity in America would result in about 1.2 million deaths, he said.
"To seek herd immunity from COVID without a vaccine (means) 80% of us have to be infected, and that’s not acceptable in the U.S. because it means that a lot of people will die," Mokdad said. "That's not American."
U.S. vs. Canada
An appropriate comparison for the United States would be with Canada, which neighbors Michigan, Mokdad said.
While cases are on the rise in Canada, it remains far behind the U.S. in its rate of COVID-19 infections. Both UM's Monto and Mokdad attributed the difference to the political climate in the United States.
"They have a surge like us because they have a very cold winter and are moving indoors, but Canada is doing much better than the United States," Mokdad said.
"...There was a national response in Canada that everybody rallied behind. Here we are so divided, even within the state. Atlanta will do something and the Georgia government will do something. Miami will do something, and the (state of) Florida will do something."
Monto said the mindset of Canadians worked in the interest of public health.
"Canada was very ... Canadian," Monto said. "They did what they needed to do."
But a recent increase of cases north of the border can be attributed to "pandemic fatigue — that they just got sick and tired of being as compliant and contained as they have been, and the numbers are going up," he said.
"What is so remarkable to me is how the spikes follow behavior changes," Monto added. "We’ve seen this over and over in various countries of the world, in various climates, and it’s been totally consistent."