The new year is off to a rocky start as the omicron coronavirus variant is “spreading like wildfire” in Michigan, the nation and across the world, Michigan’s top doctor told the Free Press on Monday.
It’s driving case rates to new pandemic highs, and is pushing up hospitalizations just as Michigan began to come down from its monthslong delta wave, said Dr. Natasha Bagdasarian, the chief medical executive for the Michigan Department of Health and Human Services.
On Monday, the state health department reported 61,235 new coronavirus cases from the long holiday weekend and 298 deaths. That amounts to an average of 12,247 new cases per day over the five-day reporting period from Thursday to Monday.
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Hospitalizations from COVID-19, which had started to dip in mid-December, are trending upward yet again. Nearly 4,000 people were hospitalized with confirmed cases of the virus statewide Monday — including 96 children.
Bagdasarian, who is an infectious disease physician, spoke with the Free Press about what the state can expect from the coming omicron surge given the shortages of tests and monoclonal antibodies, whether a mask mandate could be on the horizon, and the controversy over new recommendations from the U.S. Centers for Disease Control and Prevention over isolation and quarantine.
The questions and answers below are lightly edited for clarity and brevity.
QUESTION: Can you talk about where Michigan is right now in the pandemic and how we got to this place?
ANSWER: “We are not in a good situation in Michigan. Our cases continue to go up. We are in a place that I don’t think any of us imagined being in a year ago.
“Our percent positivity continues to rise. (It had reached 28.37{baa23cc4f5ece99ce712549207939d5bbd20d937d534755920e07da04276f44d} on Dec. 28, the highest point since mid-April of 2020.) Our hospitals continue to be overburdened.
“We’ve had a slow rise in cases since the beginning of the K-12 school year, followed by a more rapid rise when the weather got colder and people came inside. All of that was our delta wave and now we’re being hit with omicron on top of delta.
“So how we got here, I think, was really people not complying with public health guidance. And we now have a more transmissible variant that is coming at a time that really couldn’t be worse in Michigan.
“The weather is still cold. People are still gathering indoors and our hospitals are really struggling.”
Q: Could you detail for us what Michigan can expect in the weeks ahead with this newer highly contagious variant and how it’s likely to affect our lives?
A: “Omicron has proved to us that it is more transmissible. This is a variant that is not behaving like the initial strain of SARS-CoV-2, the virus that causes COVID-19 … which really required people to be in close proximity for a longer duration of time to spread.
“It is not behaving like that at all. This is something that is spreading like wildfire.
“One of the misconceptions is omicron causes mild disease and so this is not a big deal. … There is some data that shows it causes milder disease overall in people who are young and healthy. But there is still great potential for negative outcomes … for those who are elderly, for those who are immunocompromised, for those who have other co-morbidities. We also know that those who are not fully vaccinated are likely to have worse outcomes.
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“And so when we look at this as a population, and we look at how (quickly) omicron is spreading in other places, once we get that level of transmission of omicron here, it will lead to higher hospitalization rates and it will lead to more negative outcomes just based on sheer numbers. So even if the proportion of those getting severe outcomes is lower, the numbers could be higher because so many more people are getting infected.
“And now is really the time to use these tools that we have … had available,” such as wearing masks in indoor public places, avoiding large, indoor gatherings, taking COVID-19 vaccines, including booster shots for those who are eligible, testing and social distancing.
“It’s a great public health failure that the tools are there, and they’re just not being used in a way to prevent the deaths and the other negative consequences of COVID.”
Q: What kinds of masks should people be wearing to protect themselves from the omicron variant?
A: “From the beginning, we have talked about the two components to finding a good mask, and those two components are fit and filtration.
“So fit means how well does that mask adheres to your face? Are there gaps where air is leaking through? You want to make sure that the air you’re breathing is coming through the mask, not around the mask.
“And the second component is filtration, meaning is the mask thick enough to actually filter out those smaller particles. Those two components continue to be the most important thing to look for in terms of finding a mask but they have become even more important with omicron.
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“With previous variants, we could be a little bit sloppy; there was a little bit of leeway. We could make mistakes. And if we were complying with overall guidance … we were still pretty safe. But with omicron, there is no leeway. We can’t afford to make those same sorts of mistakes.
“The types of masks that I’m recommending, especially for poorly ventilated or crowded spaces, are masks like KN95 masks. There are other masks that are being manufactured that are similar in terms of fit and filtration, so if you feel comfortable that it’s a mask that is fitting well to your face, and it’s multilayered, that would be the mask to choose right now with what we’re seeing with omicron transmission.”
Q: Are we likely to see the state health department reconsider its stance on mask mandates, especially in K-12 schools, given the omicron variant?
A: “We continue to look at the data to see what’s happening in Michigan and what’s happening elsewhere. With mask-wearing specifically the language of the guidance has been very strong since the beginning of this school year and even before that.
“We strongly recommend mask policies in K-12 settings. And then we issued the mask advisory (in November urging all Michiganders to wear masks in indoor, public settings), doubling down on wearing masks.
“There seems to be a great reluctance to follow that guidance. But my hope is that as people see the effects of omicron not just here but around the world and around the country, that they start to realize this is something that we have to take seriously.”
Q: Let’s talk about those effects a little bit. We’re already starting to see some disruption, such as with airline travel. What else do you envision happening in the weeks ahead?
A: “Businesses may be disrupted because of staffing constraints. … We’re already seeing that health care is crumbling partially because of … lack of staffing and numbers of people who are ill.
“So I think that there’s a great possibility for omicron to affect businesses in other settings the same way. But again, we have the tools. We know how to make these settings safer.
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“If a setting is requiring vaccination or encouraging vaccination, if a setting is encouraging testing or requiring testing, if a place is well-ventilated and distancing protocols are in place and if people are wearing high-quality masks, those are all things that can make these settings much, much safer and can potentially avoid these disruptions.”
Q: Should K-12 schools require negative tests for students to return to in-person learning? What about for athletes who play winter sports?
A: “We saw … in the spring and last winter sports season how helpful testing could be for facilitating kids to come together and play sports, which I know is something that’s really been sorely missing and sorely lacking in a lot of kids’ lives.
“So we continue to encourage testing. We continue to supply tests. … MDHHS has been supplying the onsite version of these tests for many, many months now. And we continue to make those available to schools that need them or schools that want them.
“And then not only that we’ve got our MI Backpack program, where we’re putting tests in children’s backpacks to take home so that they can be used for not only those children but also anyone in the family who may have been exposed or who has symptoms.
“So far, we’ve sent almost 120,000 tests to 118 school districts. We’re continuing to enroll schools and ship those out. And then we sent out 60,000 additional over-the-counter tests to other settings and partners, including local health departments.
“We continue to get and distribute about 25,000 over-the-counter tests per week and (we’re) hoping to expand that in the upcoming weeks. So we’re doing everything we can to not only encourage testing, but also facilitate testing.”
Q: Yet many Michiganders say it’s still difficult to find tests right now. What is the state health department doing to bolster the supply of tests everywhere, not just among school kids?
A: “We really need to get as many tests out there as possible. The goal would be that if every American had access to tests that they could take before any sort of gathering or anytime they have symptoms or after they’d been exposed, we really wouldn’t see this type of transmission.
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“So the goal is to get as many of these over-the-counter tests out there as possible. Unfortunately, supply just has not been there. So we have been … doing our best to obtain as many tests as we can, but even for the state, the supply has not been there.
“Working with our federal partners, and now the (President Joe) Biden plan to distribute half a million tests directly to Americans. I’m hoping that that will help. But really testing needs to be thought of as a much bigger priority, I think, than we have made it thus far in the in the pandemic.”
Q: Are the coronavirus case numbers the state is reporting accurate, given that people who take at-home tests may not report them?
A: “What you’re seeing in terms of our numbers, those are not capturing all the at-home tests. Right now, when you take an at-home test, you can call your local health department. You are also encouraged to call your physician … if you have any concerning signs or symptoms, but you don’t have to report that test to anyone.
“And so for a lot of people who have been concerned about privacy issues, this could be an encouraging thing. This may encourage people to test more.
“We are, however, asking people to do the right thing in terms of isolating and then notifying their contacts. So that is the bare minimum. If you test positive, you should isolate and you should notify your close contacts.
“But we do know that we are not capturing all tests done in the state. And I think that’s the way this is moving. … This is no longer an event where there are a handful of cases in the state or a few hundred cases in the state. This is now a disease that we are living with and have been living with for two years. … The way forward is really to give people the tools that they need to stay safe and then allow them to use those tools as encouraged or as we recommend.”
Q: Could you talk about the shorter CDC guidelines for isolation and quarantine after testing positive for coronavirus or post-exposure to the virus, and what led state health leaders to reverse course last week after saying MDHHS wouldn’t adopt them?
A: “I would actually love to talk about this and just set the record straight. There was no reversal of course. We trust the scientists at the CDC. … The intent was always to adopt the CDC guidelines.
“However, what was issued last week were not a full set of guidelines. They released a media briefing … (that) didn’t have a lot of the nuance that we need to update our guidelines. So there were a lot of questions that our stakeholders were asking about.
“For example, what do you do with children under the age of 2 who can’t wear masks? What do you do with them after day 5? What happens in congregate settings? Will there be additional guidance, specifically for congregate settings? Are there any activities that we shouldn’t do between days six and 10 (following an exposure or positive test)?
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“And so we had indications that the CDC was changing guidance, but the actual guidance had not been released. And so the intent was for the Michigan Department of Health and Human Services to wait for that full set of guidance and to wait for the briefing from the CDC that would answer those questions. And we … continue to wait for that information to come from them.
“So it was more of a clarification that yes, we do intend to follow the CDC guidance, but it still has not been issued.”
Q: Has anyone from the CDC told you when it plans to release those details?
A: “I anticipate it will be any day now. But again, I just want to say that … it’s easy to criticize and it’s easy to look back and say they should have done things this way or that way, but we really do trust the science that has been issued.
“As an infectious disease physician, I can tell you that they are correct in saying that most transmission occurs early in disease course. And so, again, we’re just waiting for that full set of guidance to come out so that we can properly adapt the components in our various guidance (for congregate care settings, testing and other details). We really need the full nuance and the full thought process behind this as well as their FAQs before we update our documents.”
Q: Can you talk tell us about the shortage of monoclonal antibodies and the new Pfizer treatment paxlovid? What is the state health department doing to try to secure more for Michigan?
A: “One of the core strategies to keeping people healthy and preventing death from COVID has been the use of these therapeutics, including monoclonal antibodies.
“We have data that suggests that two of our monoclonal antibodies that we had been relying very heavily upon Regeneron and BAM-ETE (a combined treatment of bamlanivimab and etesevimab, made by Eli Lilly), are no longer effective against omicron. And so we are left with one monoclonal antibody sotrovimab, which reduces our arsenal.
“And we were very excited for the Pfizer pill, paxlovid. … This is a very exciting development to have an oral therapeutic that does seem to be effective against omicron. However, supplies are very, very limited and we received a small number of courses for the state.
“We do not have enough to treat everyone who would be eligible at this time, but our hope is that the supply increases over time. … With this very limited quantity that we have, we’re looking to areas that have been hardest hit. We’re looking to make sure that our most vulnerable populations are covered.
“We issued guidance to health care providers talking about which age group would be most appropriate and … which underlying conditions would be most appropriate to receive paxlovid. So the goal is to really use these medications in a very strategic way to try to cover first our highest-risk individuals and then try to make it available for as many other people as we can.”
Q: Any last thoughts?
A: “When we look at our vaccination rates, that’s where I become particularly concerned because our vaccination rates are lagging behind the rest of the country. Our vaccination rates are lagging overall, particularly when we look at younger age groups and particularly when we look at certain demographics.
“What we are seeing is this inequity in terms of vaccine uptake that is predominantly affecting some communities that are socially vulnerable, and affecting minorities, especially younger age groups.
“It really worries me because when we have that sort of inequity it’s leaving … socially vulnerable communities at much higher risk as we face omicron.
“My last thoughts are to any readers out there who have been on the fence about receiving your vaccine or thinking that you’re in a younger age group and so perhaps you don’t need to get vaccinated, we really need to use all of the tools we have and we need to start thinking (of the larger community).
“So perhaps you yourself are not someone who’s in a high-risk group, but there are people around you who are. If we can get vaccinated to protect the most vulnerable in our communities, I think it is really our civic responsibility to do so.”
Contact Kristen Shamus: [email protected]. Follow her on Twitter @kristenshamus.
