Dr. Rob Davidson is accustomed to delivering advice. But the west Michigan emergency room physician was stunned when he received a few tips ahead of speaking at a recent Ottawa County Commission meeting.
A county staff member noticed Davidson’s shirt, which had the words “public health” emblazoned on the front.
“You might want to turn that inside out. Some people won’t like that,” Davidson said the staffer told him, before adding, “hope your shoelaces are tied tight so you can run if you have to.”
In fact, Davidson, a Democratic health care activist, did need an escort after he voiced his support for a public health order mandating masks for all schoolchildren in preschool to sixth grade who are too young for coronavirus vaccines.
The scene is far from unique: across Michigan and the country, people are protesting the mitigation measures health and safety experts say will help stymie the ongoing generational health crisis.
All the while, the pandemic rages on. The indicators of an impending surge have risen drastically: Case rates in Michigan are up more than 1,000% since June 22, the day Gov. Gretchen Whitmer’s administration rolled back the remaining statewide pandemic orders. The test positivity rate is up more than 600% over the same time frame, according to a review of state data.
COVID-19 hospitalizations are up 175% since the day the orders were rescinded. Deaths dipped but have risen back to approximately the same level recorded on that date in June.
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This is just the beginning, state health experts warn. As the ultra-transmissible delta variant bears down, they’re predicting another surge, potentially greater than the one in the spring that became the worst outbreak in the nation.
And it’s expected to hit just as hundreds of thousands of kids — many ineligible for a vaccine — are returning to in-person school in the coming days.
State leaders are urging local school boards, county commissions and health departments to enact masking rules, but have not instituted any new statewide epidemic orders. That’s prompted local officials to scramble to come up with the best way to keep students safe and residents happy.
“I just don’t know how we got to this point — how this ridiculous thing, a simple mask on someone’s face, has become so divisive and political,” said Davidson, who lives in Ottawa County and has children in a local school system.
Davidson was not physically harmed, but had to push past hundreds of angry parents and children who booed him. Chanting “Vote them out,” they held signs with phrases like “I refuse to wear a mask!” and “Our Kids Our Choice #NoMask.”
The state’s largest counties, including Wayne, Oakland, Kent and Genesee, have enacted school mask mandates. However, all district and county mandates still only cover approximately 54% of Michigan students, according to Whitmer’s office.
Polling indicates a majority of Michiganders and people in the U.S. generally support requiring masks in schools. Yet protests have erupted in school districts and counties that have required them.
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Some middle schools in Genesee County serve children in sixth, seventh and eighth grades, but the mask mandate applies only to sixth-graders, many of whom are still not old enough to be fully vaccinated. Only one coronavirus vaccine, Pfizer, is authorized for use in children as young as 12.
While sixth-graders must wear masks at all times, seventh- and eighth-graders also would need to wear masks when attending classes with the sixth-graders, a county health official said. Teachers must wear masks if there are sixth-graders in their classes.
On Friday, Halaina Burt, a 42-year-old Grand Blanc resident, was arraigned on charges of sending death threats to two Genesee County health department officials who enacted the mask rule for younger students in the mid-Michigan County.
“I understand the passion that some people feel over this mask order. It’s going on across the state, I’ve seen it in other counties as well,” said Genesee County Prosecutor David Leyton, noting Burt is innocent until proven guilty.
“Peaceful protest is a healthy thing. But there’s a line you can’t cross, and these allegations cross that line.”
Vaccines and the right masks do slow the spread of the coronavirus, and they have never been more readily available.
Despite this, some people are genuinely concerned about the efficacy of vaccines and masking. There are studies that suggest some masks are less effective or do little to stop the spread of COVID-19 in schools or elsewhere, and those vaccinated in late 2020 or early 2021 likely need a booster shot.
A widely cited study on the effectiveness of masks in schools examined the impact of masking policies in November and December on Georgia students in kindergarten through fifth grade. The study found masking by teachers and staff helped slow COVID-19 spread, but the impact of masking students “was not statistically significant compared with schools where mask use was optional.” This study was done before vaccines were widely available, and before the delta variant became the most prevalent form of the virus.
The U.S. Centers for Disease Control and Prevention still recommends universal masking in schools, pointing to other studies that showed masking by students — along with other strategies like physical distancing, improved building ventilation and testing — prevent the spread of COVID-19.
While the vast majority of recorded cases now are among unvaccinated people, the number of cases of infected people who are vaccinated is on the rise. Many are asymptomatic carriers, which is why the CDC urged all Americans — vaccinated or not — to resume wearing masks in indoor public places in areas where transmission rates are substantial or high.
The ongoing reticence of a vocal minority of eligible adults to get vaccinated — combined with the more contagious delta variant and unknown time of protection offered by either the vaccine or a previous infection — put Michigan once again on a course likely to end with more suffering and death.
“I’ve been an ER doc for 23 years. … With everything else, people trust what their doctors say. But somehow for this, the Facebook group that they go to is a better source of information or the news channel they watch,” Davidson said.
“It’s just almost demoralizing. … We can’t just put our heads in the sand and pretend this isn’t happening. And unfortunately, that’s what’s happening and a lot of people are suffering needlessly as a result.”
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COVID-19 trends, what they mean
In Michigan, pandemic trends have gotten worse since the state rolled back the remaining pandemic regulations on June 22. Every county in the state now has high or substantial levels of community spread by CDC’s benchmarks.
The seven-day case rate average climbed to 1,743 at the end of the week. On June 22, that number was 133 cases. The seven-day average daily test positivity rate — the percentage of COVID-19 tests tracked by the state that come back positive — jumped from 1.2% on June 22 to 8.7% at the end of last week.
About 1,115 people were hospitalized with confirmed cases of COVID-19 at the end of last week, up more than three times the 332 who were hospitalized on June 22.
The average number of daily deaths over a seven-day period dipped substantially after the state’s pandemic restrictions were rescinded, falling from 13 on June 22 to 2 on Aug. 9. But that average had climbed to 17 by Wednesday.
About 5 million people ages 12 and older are fully vaccinated, about 52% of the eligible population in Michigan. But vaccination trends have dropped from a seven-day daily average of 15,000 total shots on June 22 to anywhere from 9,000 to 10,000 total shots delivered daily on average in August.
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The latest coronavirus surge is driven by unvaccinated people and is largely preventable, said CDC Director Dr. Rochelle Walensky. She cited new data Tuesday that suggests unvaccinated people are nearly five times more likely to be infected with coronavirus and about 29 times more likely to be hospitalized with COVID-19 compared with people who are vaccinated.
“These data remind us that if you are not yet vaccinated, you are among those highest at risk,” she said. “The delta variant of SARS-CoV-2 virus is highly transmissible, represents over 98% of COVID cases here in the United States, and is driving up infections, hospitalizations, and deaths across the country.”
With the current vaccination rate and mobility data in Michigan, the grimmest projection suggests the state could see as many as 1,900 new daily cases per million people at a peak that would hit in September — more than double the case rate at the height of the spring surge. In this model, deaths from the virus would top out at about 6,175 between August and November.
The best scenario predicts the fourth wave of COVID-19 infections could crest in October, and the number of new daily cases would hover below 250 per million people. About 3,900 people would die.
The middle-of-the-road projection mirrors the spring 2021 surge in Michigan, when the B.1.1.7, or alpha variant, hit the state hard.
‘We’re likely to see a lot of transmission among kids’
What isn’t factored into the state health department’s current pandemic projections is how much the state could be affected by hundreds of thousands of largely unvaccinated children returning to schools — with a share of them unmasked — in the weeks ahead.
Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services, confirmed the models predicting an upcoming surge do not take into account the impact of returning students. They instead use pandemic data from March through July.
“It’s very difficult or impossible to forecast exactly what’s going to happen,” said Joshua Petrie, an assistant professor in the department of epidemiology at the University of Michigan’s School of Public Health, where the models were created.
“But we are at high risk of another surge. We don’t necessarily need models to tell us that we’ve been increasing over the past month or so in terms of cases. It seems like it’s been a little bit slower of a pace than in previous increases, but we have been increasing and we’re at pretty high levels of transmission now.”
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By the end of last school year, about 75% of Michigan schools were either fully in-person or had an in-person option. But this year, essentially every school is expected to return to in-person classes.
“The experience that we’ve seen in other states that have started school earlier than we have … puts us at pretty high risk of really jumping up there once school gets back in session. Some of these states are having their highest transmission since the pandemic began in terms of cases, and certainly a lot of that’s been driven by schools. There’s tons of stories out there in the news right now about schools closing down almost as soon as they’ve reopened just because of cases among teachers and children,” Petrie said.
Some schools are already changing course only days into the new academic year. In Hartland Consolidated Schools, which returned to classes Aug. 18, 340 students are in quarantine and there are 25 new or confirmed cases of coronavirus among students and staff. That prompted the superintendent to institute a mask mandate for everyone at an elementary school through Labor Day.
The delta variant is also known to spread easily among children. “We’re likely to see a lot of transmission among kids, because they’re susceptible and it’s just very transmissible,” Petrie said.
Requiring masks in schools, he said, would go a long way toward keeping outbreaks in classrooms at bay.
“What would be in the best interests of the health of the children is wearing masks when we are at high levels of transmission like we are today,” Petrie said. For families with children in school districts where masks are not required, his advice is to ask their children to wear them to school anyway.
The CDC’s Walensky pleaded Friday with school districts to adopt all of the agency’s recommendations around protecting schoolchildren from the virus.
“While symptomatic and severe cases in children remain less common than in other age groups, we have seen increases in pediatric cases and hospitalizations over the last few weeks, which is likely the result of overall increases in community transmission generally, or more specifically the delta variant’s increased transmissibility,” Walensky said.
“Schools should implement as many of these prevention layers as possible, simultaneously, and this serves to protect our children, even if there are inevitable breaches in any single protection layer.”
‘It’s not comfortable to make these hard decisions’
For most of 2021, Whitmer and state health officials have leaned more heavily on the carrot of vaccine encouragement than the stick of pandemic regulations.
While health and safety orders remained in place through most of June, the state stood by and pleaded with residents to get vaccinated while case rates, hospitalizations and deaths soared in the spring.
Last fall, when vaccines were not yet available, Whitmer touted the need for pandemic orders. That included a statewide school mask order, implemented Sept. 25.
“This order expands the requirement to wear a mask in the classroom to all students kindergarten and up. It is now crystal clear that COVID-19 can be deadly to younger children, and that children who become infected at school can pass the virus to their parents, leading to community spread,” the order states.
“In the absence of a widespread vaccine, wearing a covering over the nose and mouth remains the most effective tool to combat the spread of COVID-19, both in schools and the wider community.”
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The U.S. 6th Circuit Court of Appeals recently ruled the state has the authority to issue sweeping mask mandates, affirming a lower court ruling against a Lansing private school that challenged the state order.
But the state is opting against broad mandates at the moment. Now that the vaccine is widely available, Whitmer and her team have argued masking decisions should be made at the local level — even though there’s a sizable proportion of school-age children who are still too young to get the shots.
“Our school boards are, should be working with parents and working with teachers and para-pros and bus drivers to keep people they serve safe,” Whitmer said after a recent event in Lansing.
“It’s not comfortable to make these hard decisions. If anyone knows that, it’s me. But the fact of the matter is, a mask requirement is an important tool that we’re hopeful more will continue to embrace. And getting their adults inoculated is crucial. For a child who is under 12 who’s not yet eligible to get vaccinated, masking up is essential.”
‘Perpetual cycle of hospitalizations’
Detroit-based Henry Ford Health System is among the many hospitals in the state feeling the increased pressure from the delta variant.
On Friday, it had 115 patients hospitalized across its five hospitals with confirmed cases of the virus, and 111 more patients with suspected cases whose test results were pending.
The percentage of positive tests had climbed to about 10% as well.
Bob Riney, president of health care operations and COO for Henry Ford, said it’s imperative for people to come together now to slow the rising case rates, sickness and death that the delta variant threatens.
“Had we spent less time debating and more time aligning around the science and proof to fight the virus as one team, we would not be in this perpetual cycle of hospitalizations, and lives changed,” Riney said.
“We don’t know how this is going to play out in the months ahead, but we all have a stake in the outcome by getting vaccinated and … by masking up. Is it uncomfortable? Yes. But is it a means to getting us back the freedoms that we enjoyed? Yes.”
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Dr. Liam Sullivan, an infectious disease specialist at Grand Rapids-based Spectrum Health, also said he is seeing a shift.
In July, Spectrum Health, which has 14 hospitals stretching from St. Joseph to Ludington, had about 25 patients hospitalized with COVID-19 and the percentage of positive coronavirus tests hovered at about 2.5%, Sullivan said. As of Wednesday, 112 patients were hospitalized with the virus, and the seven-day positivity rate had climbed to about 10%.
“I’m sure we’re going to still see more hospitalizations,” he said. “The question is: Is it going to level off? Is it going to peak? Is it going to be a steep rise, a slow rise? That is anybody’s guess at this point in time,” Sullivan said.
“If COVID-19 has taught us anything, it’s that predictions don’t work very well and this virus does what this virus wants to do. … So we’re just getting ready for the worst and hoping for the best.”
Contact Dave Boucher: firstname.lastname@example.org or 313-938-4591. Follow him on Twitter @Dave_Boucher1.