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Could Michigan’s COVID tip trigger a national “fourth wave”?



If you look at the New York Times’ list of the metro areas where COVID is currently at its worst, you will find that 13 of the 20 most affected cities are in Michigan, including Jackson, Detroit and Flint. Dr. Anthony Fauci seems skeptical that eruptions like the one in Michigan could become a fully blown “fourth wave” of COVID across the country. But Abdul El-Sayed, who is in the middle of one of these localized outbursts, looks a little differently at what is happening right now. El-Sayed is a lifelong Michigander and an epidemiologist who headed the Detroit Health Department a few years back. He says Michigan is proving that unless our vaccination plans really increase, we are in danger of losing a race with this coronavirus. Vaccines could, of course, stifle the spread ̵

1; but only if they get into everyone’s arms, now. Wednesday’s episode of What Next, I spoke with El-Sayed about the weaknesses of our distribution plan, how variants raise efforts in our national race to get vaccinated, and how our progress against the virus, which seems to have stopped in other areas, could even few vise versa. Our conversation is edited and condensed for clarity.

Abdul El-Sayed: I will not lie: In early March, I felt really good about everything I heard and saw. Spring was on its way. We had a couple of really lovely days. As things started to level out in a real way and then crossed upwards, my sense of optimism started to fade a bit. Michigan “walks vertically” with new cases – when you start walking vertically, you’re talking about many more people infected per capita. Person. And the exponential growth is where we are in the state.

Mary Harris: I wonder if you see Michigan as a warning to the rest of the country.

I will be wrong about this. I want the future to look like everyone has learned their lesson. But I’m looking at this moment, and I think that every single person who gets infected right now is an opportunity for a variant to capture a set of new evolutionary traits that could potentially lead to it escaping our immune response, whether it is natural or vaccine-mediated.

So it could get worse.

I will not say that, but there is a theoretical possibility that it could get worse.

Let’s dig into exactly what the numbers are and what we see. My understanding is that Michigan leads all other states in terms of new cases. Are these cases concentrated in a specific area, or is it really just everywhere?

The outbreaks began to be concentrated in Michigan’s’ thumbs’ ‘for people familiar with Michigan’s geography. But you still had cases that grew in other communities. And now people are gathering and doing things that they did not do last year around this time. So it spread all over the state. Just the other day, we broke 10,000 cases. The day before we were out around 8,500. It gives you a sense of the pitch.

My feeling is that because some people are vaccinated, and yet there are these coronavirus variants, the increasing case load looks a little different than what we have seen before. Do we have a good sense of what is causing the tip?

You have a more transmissible, more virulent form of the virus – that’s what B.1.1.7 is, it’s faster to transmit, and it makes you sicker. And then you have reopening, which brings people together in this context. If these people are not vaccinated, then what you end up having is this toxic brew, where you have a more virulent, more transmissible version of the virus that is spreading among people who are now interfering at a higher rate than they had been previously.

And these are people who might feel safe because younger people did not get so sick in the beginning.

That’s accurate. That’s one of the alarming parts of this: If you look at the increases in admissions, it’s among young people. This is probably because B.1.1.7 is more virulent than the original coronavirus. For this reason, we are in a situation where people who feel safe, who look at the optimism generated by the headlines that the vaccines are on their way, take more risks in the context of a more risky version of the virus.

“We are in a situation where people who feel safe are taking more risks as a result of a more risky version of the virus.”

– Abdul El-Sayed

My understanding is that Michigan is roughly average in terms of how the vaccination goes, but there are these gaps in terms of who is able to access.

I was the health commissioner for the city of Detroit, which is America’s largest majority – the black city and its poorest city. These two things are not random. I went into a department that had five employees in the city and 85 contractors at the back of the building because the city of Detroit made the decision to ward off its public health department. It did not have a functioning department for years. My job was to rebuild it. You think about where we are right now, where the city of Detroit is struggling with the worst pandemic in over a century with a health department that is functionally 5 years old – it’s a function of choices we make about how we distribute an entire herd different resources. It is not only health care, but it is also who gets access to good, stable housing, who gets access to water, who gets access to good schools, who gets access to the jobs that come with that education. The other part of it is that your experience in the health care system is that you are constantly looked down upon because we as a society do not give people universal health care. You may be someone who has health insurance through Medicaid, who has much lower reimbursement rates, and doctors and hospitals see you as a charity and therefore look down on you because our system literally discriminates against you and says your body does not is worth providing health care. This is the experience that many people have.

There is this other problem that is not just about access, which is people who do not want to be vaccinated in Michigan. Who says they want to take a passport this time?

Michigan is almost a microcosm of the United States: We have a large urban community, we have a large suburban community, we have a large rural community. You have two large groups of hesitants. The first is conservative white people in rural Michigan, and the second is colored if the hesitation is more born of distrust of their own experience with the medical system. It is not a hesitation that suits everyone and I think we need to think about dealing with it on different fronts.

Do you see targeted campaigns that want to reach each of these groups of people?

I think there has been a really coordinated push to take this on. I do not think it has been enough, nor do I think it has been imaginative enough. But I think it has been great to see leaders of denominations take up the matter, and I think they have been met by a set of leaders at the federal and state level who want to strengthen them and ensure that they have the resources they have have to take on this hesitation. But I think that kind of has been a secondary goal rather than being in focus.

Do you think this is a mistake?

Oh, absolutely. Here’s the thing: We’ll get to a point in the next month where the amount of vaccine exceeds the demand for vaccine. Solving the supply problem is of course a key goal, but it is in demand that it takes more time.

It requires more trust.

Exactly. And it takes time. It requires a level of long-term, consistent conversation. If you look at a set of institutions that you do not trust, and suddenly they are like, “We really want you to take this vaccine, and then we’re just going back to where we were before,” it is not really a confidence-building exercise. It requires a coordinated long-term investment. And we do not have that much time.

The thing about leadership that matters is that it signals what should must be done, even more than just doing it right. When you signal that we are now reopening what is telling people is, be happy, enjoy what is being reopened and it sends the wrong signal. It is not only the actions that need to be taken, but it is also the message that needs to be conveyed through these actions that this thing is serious.

You had this really elegant idea, which was that the state should tie reopens to local vaccination rates. Mayors really want to open their cities for many reasons. They need that tax base back. They want their cities to feel “normal” again. If everyone was on the same page about the vaccinations, it would help. That would at least be a start, though vaccinations may not be everything. Does anyone take this idea seriously?

I do not know. I hope they are, because I think one of the things we need right now is an incentive to work towards. I’m actually worried that the freedom that should come with a high enough vaccination rate has come without the vaccination rate. It’s like, just because the vaccines exist, in theory we act as if everyone has been vaccinated – and these two things are not the same. I think what we need to say, “Look, here’s the benefit to us all,” not just by saying I’m protected and I can do things safely, but by saying, ‘I really want to go to a local restaurant. It’s my favorite place. I really want to go back to a gym. I really want to be able to go to a concert. Here’s what we need to do to get there. Let’s do that thing. “

Biden has said he hopes the fourth of July can usually look like the one where we could gather in small groups and celebrate outdoors. I wonder if what’s happening in Michigan changes your mind about how realistic that idea is?

The distance between now and July is really quite long. A lot can go right if we make the right decisions to get us back on track, but I also worry about where other states will be. Like I said, Michigan is not the only place with this kind of dynamism. It’s just the place where it happens first. If we start seeing this dynamic happen in other states a few weeks from now, a month from now, it could really throw that timeline away. The important thing to remember is that the more we do now to prevent that kind of thing from happening, the closer we are to the ultimate “normal” that we all want to get to. It is a matter of choice we make. The virus has no mind of its own. It just follows the path we create for it. And our job is to shut these paths down.

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