How Worried to Be About Michigan

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S1: This time of year, Michiganders are used to feeling a sense of relief, can you tell me about, like, springtime in Michigan?

S2: Let me talk about winter first, then I’ll talk about spring.

S1: Abdullah said is a lifelong Michigander lives in Ann Arbor.

S2: The worst month of winter is February. February is so oppressively cold. I mean, it’s the kind of thing where you go out and if your hair’s wet, it freezes. You know, your fingers start to tingle at the end because it’s so oppressively cold, it doesn’t get any any brighter than just white sky.

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S1: And you get the picture here.

S2: And after you’ve put in the work of the winter, it just feels like you’ve you’ve earned your spring.

S1: Abdul is an epidemiologist. He ran the Detroit Health Department a few years back. He says this year, when covid rates started to fall and more and more vaccines started to be available, it felt like the folks here had earned their spring in more ways than one.

S2: I’m not going to lie in. In early March, I felt really good about everything I was hearing and seeing. Spring was on its way. We had a couple of really nice days and it felt really good. And I think when things started to level off in a real way and then tick upward, that’s when my feeling of optimism started to fade a little bit.

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S1: If you pull out the list of metro areas where covid is at its worst right now, 13 of the top 20 towns are in Michigan, Jackson, Detroit, Flint, that curve we keep talking about flattening. It is instead going vertical.

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S2: They start to go vertical. You’re talking about many more people infected per person. And that exponential growth is is where we are in Michigan.

S1: I wonder if you see Michigan as being a warning. To the rest of the country, because you you’ve made this point that while what’s happening in Michigan right now looks like it stands out and like it’s scary, the fact is, is that the dynamics that exist where you are exist everywhere else to. It’s just that what’s happening in Michigan, it’s happening first.

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S2: Yep, I want to be wrong about this. I want the future to look like everyone learned their lesson. All of these governors who were aggressively reopening looked at Michigan’s curve and said, we’re not doing that. The worry I have is that the same exact set of dynamics that is in Michigan is in every other U.S. state

S1: today on the show all across the country, progress against the coronavirus seems to be stalling. Michigan is showing how progress might even get reversed. I’m Mary Harris. You’re listening to what next? Stick around.

S2: So, Dr. Vouchering where there’s a bit of a debate going on right now on whether a fourth wave is appearing there, really

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S1: earlier this week, Dr. Anthony Fauci turned up on MSNBC to talk about the likelihood that outbreaks like the one in Michigan could become a full blown fourth wave of covid across the entire country. He sounded skeptical.

S2: Whether it explodes into a real surge or not remains to be seen. I think that the vaccine is going to prevent that from happening.

S1: But but Abdul al-Said, who’s in the middle of one of these localized outbreaks, he looks at what’s happening right now a little differently. He says Michigan proves that unless our vaccination plans really ramp up, we’re in danger of losing a race against this coronavirus. He says vaccines could smother the spread, but only if they get into everyone’s arms.

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S2: Now, it’s kind of like throwing a blanket on a fire, right? If you think about this, pandemic is a fire. If you throw a blanket on a fire, you can put out that fire if you do it right. Right. And you know that that blanket has to go on all at once. It has to stifle that fire from getting the oxygen it needs to breathe. But if you slowly feed a blanket into a fire, all that’s going to do is become more grist for that fire. And I am looking at this moment and I’m thinking every single person who gets infected right now is an opportunity for a variant to pick up a set of new evolutionary traits that could potentially lead it to escaping our immune responses, whether natural or vaccine mediated. And I think that fear is the thing that I have in my mind right now.

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S1: So it could get worse.

S2: I don’t want to say that, but there is a theoretical possibility that could get worse.

S1: Let’s dig in to the spike in Michigan and exactly what the numbers are and what we’re seeing. My understanding is that Michigan is leading all other states in terms of new cases. Are these cases concentrated in a particular area or is it really just everywhere?

S2: They started out outbreaks started out being concentrated in Michigan thumb for folks who are familiar with the geography of Michigan. Michiganders will very quickly pointed out to you that Michigan looks like a a mitten. And the thumb of the mitten is where these outbreaks started. But you still had cases growing in in in other communities. And now people are are are collecting. They’re gathering. They’re doing things that, you know, last year around this time, they were not doing. And and and so it’s spreading across the state now. Last year, just yesterday, we broke 10000 cases. The day before we were out at about 8500. And that gives you a sense of the trajectory of what going vertical means.

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S1: How does that compare to what was happening earlier in the year?

S2: Well, you know, when I was optimistic, we were talking about cases in the in the low thousands. And and you can see where we are now.

S1: My sense is that because some people are vaccinated and because there are these coronavirus variants, the rising caseload looks a little bit different than what we’ve seen before. Do we have a good sense of what’s causing the spike?

S2: Well, I mean, you have a more transmissible, more more virulent form of the virus that that’s what B one one seven is, it’s faster to transmit and it makes you sicker. And and then you have reopening, which is bringing people together in the context of this more transmissible, more virulent virus. And if those folks aren’t vaccinated, which we know that we vaccinated frontline workers and and seniors first, then what you end up having is this toxic brew where you have a more virulent, more transmissible version of the virus spreading among people who are now mixing at a higher rate than they had been in the past.

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S1: And people who may be feeling safe because younger people weren’t getting as sick in the beginning.

S2: That’s exactly right. That is that is one of the alarming pieces of this. If you look at the increases in hospitalizations, it’s among young people, and that’s probably attributable to the fact that one one seven is more virulent than garden variety coronavirus. And so for that reason, we are in a situation where people who feel safe, who are, you know, looking at the optimism that’s generated by the headline that the vaccines are on their way, are taking more risks and taking more risks in the context of a more risky version of the sars-cov-2 virus.

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S1: Variants are raising the stakes in our national race to get vaccinated, and Abdul says Michigan shows the weak spots in our distribution plan. My understanding is that Michigan is about average in terms of like how many people have been vaccinated there and how the vaccination rollout is going, but that there are these gaps in terms of who’s able to get access, like the Atlantic wrote last month, that first doses of the vaccine had been administered to 61 percent of Michiganders aged 65 to 74. But then it was just 28 percent of black residents 65 and older had gotten at least one shot. Did that surprise you?

S2: Unfortunately not. And I was the health commissioner for the city, Detroit, which is America’s largest majority, black and poorest city. And those two things are not a coincidence. I walked into a department that had five city employees and 85 contractors in the back of the building where people pay parking tickets because the city of Detroit in 2012 made the decision to defund its public health department. And so the city did not have a functioning department for years. My job was to rebuild it. And you think about where we are right now, where the city of Detroit is battling the worst pandemic in over a century with a health department that’s functionally five years old. And that is a function of choices that we make about how we allocate a whole bunch of different resources. It’s not just health care, but it’s 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 come with that that education. All of those things end up patterning access to resources in the midst of a pandemic like this one. The other part of that is that if your experience in the health care system is that you are constantly looked down upon because we as a society don’t provide people universal health care, and you may be someone who has your health insurance via Medicaid that commands far lower reimbursement rates. And doctors and hospitals see you as a charity case and therefore look down on you because our system literally discriminates against you and says that your body is not worth giving health care, then the downstream consequences are that you won’t be treated terribly. And and that’s the experience a lot of people have. So you’re talking

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S1: about two things, which is, first of all, Detroit underfunding health care and public health infrastructure and then also the result of that being folks in Detroit not trusting the health system because it really hasn’t been there for them when they needed it. And now you both desperately need the infrastructure to be there to get vaccines and arms. And you desperately need people to trust the infrastructure because you got to get them to these sites and convince them that this vaccine is a good thing.

S2: Yeah, that’s right. I’m I’m actually talking about one thing with two manifestations, right. It’s structural racism and it shows up in our our inability to provide these resources because we’ve just invested in infrastructure and the lack of trust in the community in that infrastructure because it has not been provided in the past. And when folks have tried to use it, they have seen firsthand the fact that they’re being discriminated against.

S1: And once you’re in this pattern, it feels to me like it’s really hard to get out of. Like people may remember how I think it was last month. The mayor of Detroit initially refused to the Johnson and Johnson vaccine because, you know, the idea was this was a less than vaccine. It might not be as good as the others. And you can kind of understand when you understand the way people in Detroit may be feeling left behind, why the mayor might make that decision, why that might be frustrating for public health officials. You can sort of see all sides of that.

S2: That’s right. And if you’re trying to address decades of disinvestment on the fly in the middle of a pandemic is going to be really, really hard to do. And the cynic, one out of public health is preparation. Right? We aim to be prepared so that we might respond adequately if and when something like this happens. And here’s the here’s the key point, right. It demonstrates the fallacy of this notion that every every man should operate for him or her, every man for himself. Right. It’s that all of us are actually in this collective together. And particularly when you think about something like herd immunity, it requires all of us to participate. Requires I heard. Yeah, exactly. Exactly. And when we have been dividing our own societies for so long, it undercuts collective action. And, you know, it largely explains why in the richest, most powerful country in the world, we account for one fifth of all of the world’s covid-19 deaths despite being four percent of the world’s population.

S1: OK, so we’ve talked about access to vaccines and how it’s especially constrained in communities of color. But there’s this other issue that isn’t just about access, which is folks not wanting to get vaccinated in Michigan. Who is it that is saying, you know? I’m going to take a pass this time,

S2: yeah, you have two large two two main groups. The first are conservative white folk in rural parts of Michigan, and the second are people of color. Who you know, whose hesitancy, I think is more borne out of a distrust of their own experience with the medical system. And so it’s those those two for very different reasons. And, you know, in Michigan, we are a almost a microcosm of the United States. We have a large urban community. We have a large suburban community with a large rural community. And if you if you sort of play the averages, it leads to a higher than average hesitancy across the state. But it’s not a one size fits all hesitancy. And I think we have to think about dealing with it on different fronts.

S1: So are you seeing targeted campaigns looking to reach each of these groups of people?

S2: I think there’s been a real concerted push to take this on. I, I don’t think it’s been enough and I also don’t think it’s been imaginative enough. I think it’s been great to see leaders of of church communities and in block club captains take up the cause. And I think that that they’ve been met by a set of leaders at the federal and state levels who want to empower them and make sure that they have the resources that they need to take on this this hesitancy. But I just think that it needs it’s sort of been a secondary goal rather than being the focus.

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S1: Do you think that’s a mistake?

S2: Oh, absolutely. Because, I mean, here’s the thing. We’re going to come to a point in the next month where the the amount of vaccine outstrips the demand for vaccine and working on demand. You know, solving the supply problem obviously is a key goal. But I will say that the thing about demand is it takes more time. It really is about seeding a cultural norm.

S1: It’s more trust.

S2: Exactly. And that takes time. It takes it takes a level of of prolonged, consistent conversation. If you know, you’re looking at an institution or a set of institutions that you don’t trust and all of a sudden they’re like, here, we really want you to take this vaccine and then we’re just going to, you know, go back to where we were before that, that that’s not really a trust building exercise. And so it does take a concerted long term investment and we don’t have that much time.

S1: We’ll be right back. So what should Michigan do now if Abdul had his way, things would look pretty different than they do at the moment, because even though cases have been on the rise, the governor, Gretchen Whitmer, she hasn’t been closing down businesses, just the opposite casinos, movie theaters, restaurants, indoor exercise classes. They are all open with some restrictions. That means individual communities are largely deciding for themselves how to muddle through this latest surge.

S2: If you take 23 north up to Brighton or you stay on 23 north, it’ll take you to Flint. You get to very different kinds of communities in Michigan. And, you know, if you stay on 23 north from there, you go into two very rural towns. In fact, it’ll take you right up into the thumb there. And you see the different ways that people have looked at this pandemic and and changed or not change their behavior accordingly. And here’s the crazy thing. Twenty three north is not that long and the virus can also take twenty three north. Right. And 23 south. And so the point here is that we are in this thing together. If we cannot get on the same page about what this virus is, what it means for us, how it affects us, then it’s really hard to get on the same page about what we need to do about it. And if we can’t do that, then, you know, the virus will have a field day and that’s exactly what it’s doing.

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S1: Yeah, I mean, I have a colleague who lives in Michigan who is saying that he feels like the state has kind of given up on infection control, like his local Italian restaurant is just booming, like people crowded. It looks, quote unquote, normal. And I think he’s really struggling with like what what would the right response be here and who do I blame? And I’m sort of curious how you would answer that question.

S2: The thing about leadership that matters is that it signals what ought to be done even more so than just doing it. When you signal that we are now reopening, what that tells people is that, you know, be merry, enjoy, enjoy what’s being reopened and it sends the wrong signal. And so it’s not just the actions that need to be taken, but it’s also the message that needs to be delivered through those actions about the fact that this thing is serious.

S1: You had this really elegant idea, which was. That the state should be tying reopenings to local vaccination rates and I thought it was elegant because it kind of has the benefit of getting everyone on the same page, you know, mayors really want to open up their cities for a lot of reasons. They need that tax base back. They want their cities to feel, quote unquote, normal again. And if everyone was on the same page about the vaccinations, it would help. It would at least be a start. Even though vaccinations can’t be everything. Is anyone taking that idea seriously?

S2: You know, not that I. I don’t know. I hope that they are, because I think one of the things that we need right now is that we need an incentive to work toward. And I actually kind of worry that the the freedom that ought to come with a high enough vaccination rate has come without that vaccination rate. It’s like just because the vaccines exist, in theory, we’re sort of acting like everyone’s been vaccinated and those two things are not the same. And so if you, you know, yoke our ability to get back to normal, to actually doing the thing that we need to do to do normal safely, then it may incentivize more people to go out and do that thing in. Implicit in vaccines is that there is a collective action problem. Right. And advocates have been writing that for a long time. They say, well, you know, I know my kid who I’m choosing not to vaccinate is protected by all the other kids who are vaccinated from getting this disease through herd immunity. So maybe I’m going to be the one who free rides. And I just think that we need to do something about taking that on, because even though these are safe and effective vaccines, people have been fear mongering them create a a sort of cost that exists in people’s minds taking one. And I think what we need to do is create a counterpoint to that and say, look, here’s the benefit for all of us and not just in saying I know I’m protected and I can do things safely, but I’m saying I really want to go to a local restaurant. That’s my favorite place I’d really like to eat in there. I really want to go back to a gym. I really want to be able to go to a concert. All right. So here’s what we need to do to get there. Let’s do that thing. Hmm.

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S1: You know, Joe Biden has said he’s hoping that the Fourth of July can look something like it does usually where we could gather in small groups and and celebrate outdoors. I’m wondering if what’s happening in Michigan changes your thoughts about how realistic that idea is.

S2: Oh, it certainly has the potential to in covid time, the distance between now and July is really quite long and so a lot can go right if we make the right decisions to get us back on track. I also worry about where other states are going to be. Like I said, you know, like we talked about, the premise of our conversation is that Michigan is not the only place with these kinds of dynamics. It’s just the place where it’s happening first. And so if we start to see these dynamics happening in other states. A couple of weeks from now, a month from now, it really could throw that timeline off. And the important thing to remember is that the more we do now to prevent that kind of thing from happening, the closer we are to the ultimate normal that all of us would like to get to. And it’s a it’s a matter of choices that we make. The virus doesn’t have a mind of its own. It just follows the path that we create for it. And our job is to shut those parts down.

S1: Abdullah said, thank you so much for joining me.

S2: Yeah, thank you so much for having me. I really appreciate it.

S1: Dr. Abdullah al-Said is an epidemiologist based in Michigan. He’s also got a podcast. You should go check it out. It’s called America Dissected. And that’s the show What Next is produced by Daniel Hewitt, Mary Wilson, Alan Schwarz, Kamal Dilshad and Devis Land were helped each and every day by Allison Benedikt and Alicia Montgomery. And I am Mary Harris. You can go find me on Twitter. I’m at Mary’s desk. I will catch you back here tomorrow.