Roughly six months after the COVID-19 pandemic began, Michigan hit a grim threshold on August 14, 2020: 100,000 confirmed and probable cases.
But it took just 80 days after that for cases to double. By November 2nd, the state had 204,326 confirmed and probable cases, including 7,716 deaths.
It’s news to no one that cases are spiking, with tied to assisted living centers, K-12 schools, college campuses, and an uptick in social gatherings. As pandemic fatigue intensifies and colder weather drives an exponential growth, public health experts find themselves continually echoing the same concerns and offering the same prescriptions, over and over again.
“Most of the interviews I do about COVID, it’s 95% applied common sense,” Dr. Arnold Monto, an internationally renowned University of Michigan epidemiologist who recently chaired the meeting of the Vaccines and Related Biological Products Advisory Committee meeting. “We keep reinventing the wheel because it’s a news item, and people feel compelled to write about it, even though very little changes.”
Expert: social distancing was designed for much shorter pandemics
Monto, whose work over the decades has shaped what we know about respiratory viruses outbreaks, says some of the tools we’re using to combat COVID-19 weren’t designed for the situation we’re in now.
“Where contact tracing really comes from...is [tracking] sexually transmitted diseases,” Monto says. “It gets so much more complicated when you're gonna be looking at something that's transmitted by the respiratory [virus.]”
Then there’s just the sheer length of this pandemic. Most viruses are seasonal, Monto says, and prefer colder weather. Even he was surprised by how little COVID-19 seemed to change over the summer.
“By this time, with a normal flu outbreak, we would have a good 50, 60% of the population experience some degree of infection - most of them mild, some of the more severe. And we would be out of the woods in terms of the necessity for social distancing,” Monto says.
That may be because this is a completely novel virus, he says. With the flu, even when new strains emerge, the population has already built up at least some level of immunity.
“That’s where this whole business about social distancing came from. The idea was that it would go on for 2, 3 months, and then it would be over. Because we’d have [developed flu] vaccines and antivirals would be available. So with a flu outbreak, it was over in a relatively limited time period, and not going on for months and months and months, and [restrictions] being loosened and not loosened. So that's that's part of the problem: the length of time, and the fact that we've never had to deal with pandemic fatigue because it was over by now.”
But clearly, we do have to deal with it.
“And I worry that what we saw [this spring and summer...] was a prelude to something that might be getting worse, with getting into the winter season.”
The “sledgehammer” approach vs. the “scalpel"
To be fair, we’ve already flattened this curve once.
“Michiganders deserve some credit for doing the things that we had to do in May, June, July, August to slow the spread,” says Ryan Melosh, an infectious disease epidemiologist at the University of Michigan. “We were staying home. We were wearing our masks. We were doing all the right things. And we saw the spread slowdown.
“And then, you know, we're all tired of living that way. And we've gotten used to maybe taking some risks. And I think this is one thing that's a little bit harder to gauge, but like once you take a little bit of a risk and everything works out fine, then you're willing to take a little bit more risk the next time. And so we've gotten to that point, not just in Michigan, but around the country where we're all starting to feel like we can take a little bit more risk...and the virus doesn't care that you are done with it,” Melosh says.
But going into another lockdown, like several countries in Europe are currently doing, carries its own costs.
“They're a blunt instrument and they cause a lot of damage,” Melosh says. “I would refer to them as a sledgehammer, right? And then if we were able to do the contact tracing and the isolating and things like that, that's more of a scalpel. And we can sort of be more refined about how we lock people down, or how we get people away from others.”
Shorter quarantines? Small Thanksgivings?
Part of the “scalpel” approach may be giving people a more nuanced message about living with the virus, says Joseph Eisenberg, professor and chair of the epidemiology department at Michigan.
“We need to think about ways to relax, even where we think there are some risks, but the risks are low, in order to stay really focused on what are the most important ways to control [the spread of the virus,]” he says. “So we want to just make sure that that messaging allows people to have some sort of social connection and interaction, while preventing these higher risk events that cause most of the cases we’re seeing.”
Take the 14 day quarantine, which some public health officials at the county level say people are increasingly breaking in order to return to work or attend social gatherings.
“And so we might need to consider, ‘Well, what if we say 10 days?’” Eisenberg says. “We know that most of the people will present [with COVID symptoms] in the first 10 days if they are infected. So we do lose a little bit, but not a lot. But if we gain in compliance, that all of a sudden people are more likely to comply, then maybe 10 days becomes the optimal choice of quarantine time.”
On college campuses, most cases appear to be coming from group housing, large dorms, and Greek houses, he says.
“[But] the risks of the classroom setting and being on campus during the day have been relatively low. So...we want to focus on engaging with the students in doing the right thing with respect to what happens in the dormitory after hours, and the large parties and such. We want to get those tamped down. It's less important if you're walking down the street to be wearing a mask and less important if you're walking down a sidewalk to be like, in passing each other, 8-10 feet apart.”
Same thing for masks, he says: going inside the grocery store? Wear it. Walking back out to your car? Less critical. Having a few family members for Thanksgiving, and you all wear masks? It’s not zero risk, Eisenberg says, but it’s safer than having 10 or 20 relatives over.
“It's these large clusters of events that are causing most of the cases. So if you think about the lower risk events, those are the ones that you want to maybe relax a little bit on, if it's a difference between a population getting super fatigued in 2 or 3 or 4 months or not.”
