Despite the impressive progress in COVID vaccinations across the country, cases and hospitalization rates are stubbornly rising again in many states. But one state in particular has been leading the new surge: Michigan. The Great Lakes state has been reporting thousands of new infections per day, and hospitals are nearing capacity again. Governor Gretchen Whitmer of Michigan asked the Biden administration for more vaccine supplies but was rebuffed, with the government saying vaccination is not the answer to an acute surge. Now case numbers are starting to climb in several other states, including Minnesota and Pennsylvania. But what is going on in Michigan?

Benjamin Stix is an anesthesia critical care medicine fellow at the University of Michigan.* He treated patients in New York City during its disastrous first wave of COVID last spring, and he is currently doing so in Ann Arbor, Mich. Scientific American spoke with Stix about what conditions are like in Michigan right now, what kinds of patients he is seeing—and whether the surge is a harbinger for the rest of the country.

[An edited transcript of the interview follows.]

What is the situation like in Michigan right now?

When the initial surge was happening in New York, that was on a whole other level and scale. I think what’s a lot different and sort of surprising about what’s been going on in the past couple weeks is that Michigan—in January and February, when other places were having a surge—had pretty low levels of infection. And there weren’t a lot of people in the ICU [intensive care unit]. There were still people who had been diagnosed months earlier, who had very long, chronic critical illness, but they technically didn’t have COVID anymore. I was in the surgical ICU at the University of Michigan Hospital, which is the place where all the ECMO [extracorporeal membrane oxygenation] consultations happen. [In these cases], your acute respiratory distress syndrome [ARDS] is so severe, it’s [resistant] to all medical management, and you need additional support beyond just a ventilator—otherwise you’ll die.

What ended up happening a couple of weeks ago was: all of a sudden, over a period of days, we were getting call after call after call that there were people that needed ECMO evaluations from all over the state (because the University of Michigan Hospital is a regional medical center for the entire state and parts of Ohio). These smaller hospitals were saying, “Hey, we have a patient that has COVID that we can’t medically manage well anymore and who we’re worried is going to not make it. Can we transfer them to Michigan for an ECMO evaluation?”

Are the kinds of patients you are seeing now similar to those you treated in previous waves of the pandemic?

What is different about this time, compared with previous times, is that it is a lot of young people—because the first people that got vaccinated were people over the age of 75, health care workers [and later] people over the age of 65. There’s this gap that’s going on right now where there’s a huge portion of the population that’s not vaccinated, and they range in age from children through people in their 50s and 60s. We were getting calls about people in their 30s, in their 40s, in their 50s who had COVID, all of a sudden, really badly.

What do you think is causing the surge in cases in the state? Is it the variants, people’s behavior or what?

Do I think that Michigan as a state has behaved drastically differently over those weeks? No, I don’t—I think it was bad timing. And there was something about just that sort of window of time—whether it’s the British [B.1.1.7] variant, I don’t know. [Editor’s Note: The B.1.1.7 variant is now the most common form of the virus spreading in the U.S. and is thought to be more contagious than the original strain.] But there was, all of a sudden, all these people who were, right as the state was opening up, exposing themselves to the community more, essentially. And now we’re in a really bad, bad situation. That being said, in aggregate, Michigan is still not at the top [among U.S. states] in terms of number of cases in an absolute way. It’s sort of just that there’s this uptick in the trend overall.

The problem is: we don’t still really understand how these new variants are being transmitted and whether they all actually are more contagious or not and what is different about now versus a year ago. Because I think a lot of science just isn’t there yet. It’s hard to know exactly why this thing ebbs and flows so much, every couple of months, all over the country.

In these younger patients that you’re seeing, does their disease look like the older patients you had before, or do they present differently?

I don’t think it’s different. What gets you to an ICU is illness severe enough to cause [ARDS]. And often there’s a superimposed bacterial pneumonia on top of COVID. What I think gets you to an ICU, or at least to this level of care where it’s so severe that you need to be intubated, is: you often have a coexisting illness. Even people in their 30s who are otherwise “healthy,” a lot of them have obesity or hypertension—all the sorts of comorbidities that have been associated with severe illness.

I think it is really surprising that there are so many young people. In the beginning, the published data [suggested] that when you’re younger, your risk of getting severe illness is extraordinarily low. But that may just have been because, at least in New York, when there was this huge surge, it was ravaging the nursing homes. The numbers [were] skewed, because there are so many old people, and they were getting COVID from everyone. Everyone was, like, ping-ponging COVID all over the nursing homes in New York, and that was a big driver of death and critical illness. I just think many young people were at home, so they just weren’t exposed.

You’re seeing these cases in Michigan, but not all states are doing the same level of testing. Are you hearing anything about surges from colleagues in neighboring states?

I haven’t heard. It’s all happening at different times. I have friends in the ICU in California—they had this huge surge while we had very few cases, and they were also putting people on ECMO: pregnant women and lots of patients who were extremely sick and young. But the timing was different. It’s not like California wasn’t locking down. It’s kind of surprising that they had such a severe surge, and I think people were speculating about new variants there, too. But it’s so hard to know what was causing that—if it’s just pandemic fatigue or [some combination of fatigue and variants]. We don’t really understand how the virus is transmitted. I mean, we have some data, but as things evolve, it may be different, in terms of how long you need for exposure. How are people who don’t have a medical background supposed to navigate that? It’s challenging. I think, in a perfect world, we would shut down completely for a couple of weeks. But it’s just not in the cards, and it wasn’t in New York last spring. I wish we could, because I think if people realized how bad this was, they would want to. But, you know, it’s also easier said than done.

Do you agree with what Governor Whitmer has been doing in terms of leaving it up to individuals? Or do you think there should be a stricter lockdown?

I don’t know how to answer that. I think the only real way to stop infection is to socially distance. And we don’t have a lot of good treatments right now for COVID once you get it. So, yeah, I do think that if we’re going to ever stop this, it’s not just about vaccination, it’s about socially distancing. Right now we don’t have enough vaccines, and vaccines don’t prevent COVID if it’s already in the community—it’s a future prevention. If there is a ton of community transmission, then really the only thing that treats it is prevention. And prevention means mask wearing and socially distancing—and a lot of testing, but testing is very widely available here. You know, I think if you want to be tested, you can get tested quite easily. I think what’s challenging is that people clearly are transmitting this before they have symptoms, or they’re having low-grade symptoms. But it’s not like testing isn’t available. It’s widely available.

So I don’t know what to do, because it’s a fourth wave, technically, and I really hope that it’s not going to happen out in the entire country soon—if Michigan is a harbinger for what’s to come. It’s certainly possible. But I can’t predict that. This year has been so unpredictable.

*Benjamin Stix is the son of Gary Stix, Scientific American’s senior editor for the mind and the brain.

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