If you look at the New York Times list of metro areas where COVID is currently at its worst, you will see that 13 of the 20 most affected towns in Michigan, including Jackson, Detroit and Flint. Dr. Anthony Fauci seems skeptical that outbreaks like the one in Michigan could become a full-fledged ‘fourth wave’ of COVID across the country. But Abdul El-Sayed, who is in the middle of one of these localized outbreaks, looks a little differently at what is currently happening. El-Sayed is a lifelong Michigander and an epidemiologist who ran the Detroit Department of Health a few years ago. He says Michigan is proving that we are in danger of losing a race with this coronavirus unless our vaccination plans really take off. Vaccines can naturally suffocate the spread – but only if it gets into everyone’s arms, now. On Wednesday’s episode of What Next, I spoke to El-Sayed about the weaknesses in our distribution plan, how variants have increased interest in our national race for vaccinations, and how our progress against the virus, which appears to be, has stalled. other areas, can even get reversed. Our conversation has been edited and summarized for clarity.
Abdul El-Sayed: I’m not going to lie: In early March, I felt very good about everything I heard and saw. Spring was on its way. We had some really nice days. When things started to flatten out in a right way and then tap upwards, my sense of optimism started to fade a bit. Michigan goes vertical with new cases – when you start getting vertical, you’re talking about a lot more people being infected per person. And that 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 want to be wrong about this. I want the future to look like everyone has learned their lesson. But I look at this moment and think that every person who becomes infected now is given the opportunity for a variant to take on a set of new evolutionary traits that could lead to escape of our immune response, whether natural or vaccine mediated.
So it could get worse.
I do not want to say it, but there is a theoretical possibility that it could get worse.
Let’s see exactly what the numbers are and what we see. My understanding is that Michigan leads all other states in terms of new business. Are these cases concentrated in a specific area, or are they really just everywhere?
The outbreaks first concentrated in Michigan’s “thumbs up” for people familiar with the geography of Michigan. But there are still cases in other communities that are growing. And now people are putting things together and doing things they did not do last year around this time. It therefore spreads across the state. Just the other day, we broke 10,000 cases. The day before we were out about 8,500. It gives you an idea of the trajectory.
My sense is that because some people are vaccinated and yet these coronavirus variants exist, the rising case load looks a little different than what we have seen before. Do we have a good idea of what is causing the peak?
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 the people are not vaccinated, it is a toxic brew where you have a more virulent, more transmissible version of the virus that is spreading among people now mixing at a higher rate than in the past.
And these are people who may feel safe because younger people did not get so sick in the beginning.
That’s exactly right. This is one of the worrying aspects of this: if you look at the increase in hospitalizations, it is among young people. This is probably due to the fact that B.1.1.7 is more virulent than the initial coronavirus. Therefore, we find ourselves in a situation where people who feel safe and look at the optimism produced by the headlines that the vaccines are on their way, take more risks due to a riskier version of the virus.
“We are in a situation where people who feel safe are taking more risks because of a riskier version of the virus.”
– Abdul El-Sayed
My understanding is that Michigan is roughly average in terms of implementing the vaccine, but there are these gaps in terms of who can access it.
I was the health commissioner for the city of Detroit, which is America’s largest majority black city and its poorest city. These two things are not accidental. I walked into a department that had five city employees and 85 contractors at the back of the building because the city of Detroit made the decision to disregard its Department of Public Health. It has not had a functioning department for years. My job was to rebuild it. You think of where we are right now, where the city of Detroit is fighting 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 make a whole bunch different resources. It is not only health care, but 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 go along with it. The other part of this is that you are constantly looked down on for your experience in the health care system because we as a society do not offer universal health care to people. You could be someone who has health insurance through Medicaid, which requires 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 is not worth health to give. care. This is the experience that many people experience.
There’s another problem that not only has access, but people do not want to be vaccinated in Michigan. Who says they succeed 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 major groups that are hesitant. The first are conservative white people in rural parts of Michigan, and the second are coloreds whose hesitation is more born out of distrust in their own experience with the medical system. This is not a one-off hesitation, and I think we need to think about dealing with it in different areas.
Do you see targeted campaigns to reach each of these groups of people?
I think there has really been a real effort made to tackle it. I do not think it was enough nor do I think it was imaginative enough. But I think it was great to see church community leaders involved, and I think they were met by a set of federal and state leaders who want to empower them and make sure they have the resources they need. adopt. But I think it was a secondary goal rather than the focus.
Do you think this is a mistake?
Oh, absolutely. This is the thing: we’re going to get to a point in the next month where the amount of vaccine exceeds the demand for vaccine. Solving the supply problem is obviously an important goal, but the question to the question is that it takes longer.
It requires more confidence.
Exactly. And it takes time. It requires a long, consistent conversation. If you look at a set of institutions you do not trust, and all of a sudden it is like, ‘We really want you to take this vaccine, and then we’re just going back to where we were before,’ it’s not really a build-up of trust. It does require a joint long-term investment. And we do not have that much time.
The thing about leadership that matters is that what indicates should be must be done, even more than just to do it right. If you mean that we’re reopening now, this is what people are saying: be cheerful, enjoy what’s reopening, and it’s sending 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 by the actions about the fact that this matter is serious.
You had this very elegant idea, namely that the state should link reopening to local vaccination rates. Mayors really want to open up their cities for many reasons. They need that tax base. They want their cities to feel ‘normal’ again. If everyone was on the same page about the vaccinations, it would help. It would at least be a start, though vaccinations may not be everything. Does anyone take the idea seriously?
I do not know. I hope so, because I think one of the things we need right now is an incentive to work. I’m actually worried that freedom should come with a high enough vaccination rate without that vaccination rate. It’s as if, just because the vaccines exist, we theoretically act as if everyone has been vaccinated – and the two things are not the same. I think what we should say: ‘Look, here’s the benefit to us all’, not only to say that I am protected and that I can do things safely, but also to say: ‘I really want to have a local restaurant go. This is my favorite place. I really want to go back to a gym. I really want to be able to go to a concert. This is what we need to do to get there. Let’s do that thing. ”
Biden said he hopes the fourth of July can look something like usual, where we can gather in small groups and celebrate outside. I wonder if what’s happening in Michigan changes your mind about how realistic the idea is?
The distance between now and July is really quite long. Many can go right if we make the right decisions to get us back on track, but I’m also worried about where other states are going to be. Like I said, Michigan is not the only place with this kind of dynamics. This is just the place where it first happens. If we start seeing these dynamics in other states in a few weeks from now, a month from now, it could really shed the timeline. The most important thing to remember is that the more we do now to prevent such a thing from happening, the closer we get to the ultimate ‘normal’ we all want to get to. It’s a matter of choices we make. The virus is not considered. It just follows the path we create for it. And our job is to close those roads.
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