The Clearest Sign the Pandemic Could Get Worse

Another coronavirus outbreak is unfolding in Michigan.

The number of people hospitalized with a confirmed case of COVID-19 in the United States has been plummeting since early January. Until about three weeks ago, hospitalizations in Michigan were following the same pattern: More people with COVID-19 were leaving the hospital than were being admitted. But in the past few weeks, data from the CDC and the Department of Health and Human Services have shown that hospitalizations have risen by 45 percent from the state’s recent low on February 25. According to federal data, among U.S. metropolitan areas with more than 1 million people, the Detroit area now ranks fourth in hospital admissions—and first in a metric that combines increases in test positivity and cases.

Throughout the fall and winter, we saw a clear pattern—cases would rise, then hospitalizations about a week later, and finally, two weeks after that, deaths would follow. Nursing homes and other long-term-care facilities reported particularly heavy death tolls. If Michigan were to continue that pattern, we would expect hospitalizations to keep rising, and then more deaths.

But as a spring surge takes hold in Michigan, two new factors—variants of concern and rising vaccination levels—mean that we don’t yet know how this new rise in cases and hospitalizations will play out.

The vaccination of people 65 and older and of nursing-home residents should blunt the death toll of a rise in cases. But according to state data, Michigan has administered first doses to 61 percent of its residents aged 65–74, and 62 percent of residents 75 and older. Detroit’s figures are much lower: The city has given first doses to only 43 percent of those aged 65–74 and 39 percent of people 75 and older. For comparison, the CDC reports that 66 percent of the U.S. population aged 65 and up has received at least one dose of vaccine. The numbers are even worse for Black people in Michigan: Statewide, just 28 percent of Black residents 65 and older are known to have received at least one dose of vaccine. Overall, Michigan has administered first doses to only about a quarter of its total population, and that number falls to 15 percent in Detroit.

The reality of vaccinations in nursing homes remains difficult to understand. The CDC reports that about 182,000 people in nursing homes and other long-term-care facilities have been vaccinated in Michigan through the Federal Pharmacy Partnership​​, but doesn’t separate resident and staff doses at the state level, making it impossible to derive a percentage of facility residents who have been immunized. According to the Michigan Department of Health and Human Services, COVID-19 cases and deaths in the state’s long-term-care facilities have declined substantially through February and March, and we can hope that this decline holds even as cases and outbreaks emerge around these facilities.

As Michigan’s numbers go back up, the obvious next question is to what degree variants of concern are playing a role in this localized surge. Genomic surveillance remains limited in the United States, but from the numbers we do have, it seems as though the variant known as B.1.1.7, first identified in the U.K., is quite widespread in Michigan. In fact, according to the CDC’s tracking, the state of Michigan has the second-most confirmed cases of B.1.1.7 after Florida, despite having less than half the number of residents.

Although Michigan’s numbers indisputably show a resurgence of COVID-19, there are troubling signs in other parts of the country. Federal data show that per-capita hospitalizations in the New York area have remained among the highest in the nation. Unlike many other areas of the country, where hospitalizations have fallen close to pre-surge levels, in New York and New Jersey hospitalizations have plateaued for weeks, according to federal data. We are not yet seeing huge upticks, but it’s not a good sign that as many people are being admitted to hospitals as are leaving them.

In months past, we might have been able to make educated guesses about what might happen next as the situation worsens in Detroit: We would expect to see cases and hospitalizations increase statewide and also rise elsewhere in the region, as when the Dakotas and Wisconsin acted as sentinels for the deadly third surge of cases over the winter. We would also have seen deaths soar several weeks after cases rose, especially within nursing homes. But Michigan’s surge arrives in a national landscape altered by new viral variants and more than 100 million immune systems strengthened by vaccination. We anticipate that state and federal vaccination efforts will increase in and around Detroit—and across the country—fast enough to prevent a regional or national reversal of our hard-won progress. What the numbers incontrovertibly show, however, is that we’re not going to see COVID-19 immediately disappear. As public-health experts have suggested for months, there will be continuing outbreaks this spring—likely as a result of B.1.1.7 becoming the dominant virus. Now the question is how bad they’ll get and how far they’ll spread.

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Alexis C. Madrigal, Dave Luo, Peter Walker, Erin Kissane, Jessica Malaty Rivera, and Conor Kelly contributed to this article.