COVID-19 and the flu, revisited

COVID-19 isn’t the same as influenza. But the way we end up dealing with it long term may be.

As I’ve noted previously, the Rt number, representing the the average number of people who will become infected by a person infected at time “t”, is falling nearly everywhere in the U.S., due to our nation’s superior access to vaccines. (This is not happening in other parts of the world, though, which will allow the coronavirus to potentially continue to evolve into new variants over time.) Not all Americans are willing to get vaccinated, unfortunately, and it now appears that it’s unlikely we will reach the “herd immunity” numbers (whatever level that might be, since it’s inconsistent from one expert to another) if only vaccinated people are counted. (Since those who’ve already had COVID at least once also have some immunity – though it’s not clear yet how effective that is or how long it lasts compared to a vaccine – some calculations of “herd immunity” include those people, which brings us a lot closer to the typical 70 to 75 percent number.)

But as long as Rt continues to fall and remain low, many of our restrictions should be able to be relaxed or lifted. The risk will remain, especially for those who refuse to get vaccinated, but our social lives could return to something close to normal this summer.

The risk of not reaching “herd immunity,” though, is that there will still be a large number of people who potentially could contract COVID, and particularly an existing or yet-to-emerge variant that is more contagious and possibly more resistant to the existing vaccines. Our therapies for COVID patients have improved, so if there isn’t a huge spike down the road that overwhelms our healthcare system again, COVID could become endemic in a similar way to many viruses that haven’t been eradicated but are largely controlled thanks, in large part, to vaccines. This includes measles, chickenpox, and (in most years) influenza. An annual COVID shot seems likely.

The other similarity between COVID and flu, even now, is the reluctance of people to get a vaccine that promises to protect us from illnesses that, while often mild and annoying, can become serious or even deadly. Historically, only about half of Americans who could get a flu shot each year do so. Nobody likes getting the flu, which can last from hours to days or even weeks. Yet we don’t take the time to get even the partial protection offered by the seasonal flu vaccine. I’m guilty of this myself; for years, I never bothered to get the shot, not because I didn’t believe in the science, but because I didn’t think I really needed it. I was (relatively) young, healthy, and figured I’d just ride out a case of the flu if I got it. There’s a word for that: arrogant. And an even better one: stupid.

Are we absolutely sure that the various vaccines are safe in the long run? That there are no side-effects? Well, no. But I think it’s adorable how many people are suggesting that the vaccines aren’t safe who are still smoking, or overeating, or over-drinking… while also taking other over-the-counter drugs or eating packaged foods without knowing exactly what the ingredients are or how they were manufactured. We have a lot of faith in the production of our food and pharmaceuticals otherwise, and justifiably so. What’s so different about the COVID vaccines? They’re tied up, unfortunately yet inextricably, with our current political civil war.

Update on COVID statistics

A couple of weeks ago I wrote a post that included a lot of maps showing the infections per 100,000 persons throughout the United States. A month ago, on April 1, Michigan was glowing white as the worst state in America for COVID infections:

COVID-19 infections per 100K persons as of April 1, 2021

Here’s where we are a month later, on May 4 (maps from covidestim.org):

COVID-19 infections per 100K persons as of May 4, 2021

The Rt number in Michigan is up slightly from April 26, from 0.68 to 0.71, while the Rt number in St. Clair County has fallen to 0.46 from an adjusted 0.54 on April 26. The estimate of those who’ve already had COVID in the county is up to 45 percent, compared to our neighboring counties of Macomb (50%), Sanilac (49%), and Lapeer (38%).

COVID numbers are improving in Michigan

This post relies on data from covidestim.com. The map key is here:

I am not an epidemiologist, but I have a life-long fascination with numbers and the relationships between them. As I’ve written before, I’m concerned that both because of the media’s goal to reduce complex ideas to a headline that will get people to click and our collective aversion to those same complex ideas, we’ve missed the point more than once during the pandemic. It’s either a catastrophe or it’s over, depending on which day it is. As is usually the case, the reality is somewhere in between.

Remember last summer, when Michigan was one of the best states in terms of COVID spread? Here’s a map from last August 1:

COVID-19 infections per 100K persons as of August 1, 2020

Dark areas represent counties with very low rates of COVID infections per capita (specifically, per 100,000 persons). The white areas are the places that were experiencing very high rates of infections per capita; at that time it was mostly in the southern tier of the country.

Jump ahead to December:

COVID-19 infections per 100K persons as of December 1, 2020

Nearly every part of the country was experiencing high rates of infection around the holidays. Notable exceptions were Florida and the southern Atlantic coast, northern New England, the Pacific Northwest, and Hawaii. Michigan was hot, except for most of the Upper Peninsula.

COVID-19 infections per 100K persons as of March 1, 2021

By the beginning of March, things were looking pretty good all over the U.S. A slight band of elevated infections from Oklahoma east through Missouri, Kentucky, and West Virginia, but overall quite promising.

Then came April in Michigan:

COVID-19 infections per 100K persons as of April 1, 2021

Suddenly, Michigan was having some of its worst weeks of the pandemic, and if you zoom in, you’ll see that the Thumb region, including my home county of St. Clair, was white hot. We were, unfortunately, the COVID capital of North America for a few weeks.

What caused this flare-up? There are a lot of possibilities: pandemic fatigue has been mentioned numerous times, and does seem likely (though I think it’s safe to say that people in other states are just as tired of the virus as we are in Michigan). I wrote a post recently where I expressed my feeling that we were giving up. Younger Michiganders also got a chance to gather more regularly, particularly as contact sports were allowed to resume in middle- and high-schools. But it’s hard to imagine that these students weren’t gathering prior to the resumption of sports, though perhaps not at the same frequency and without as much intermix between groups from different cities. But it did skew the infection rate among younger people in the state somewhat higher.

The state government didn’t intervene as strongly this time. After the Michigan Supreme Court ruled against Gov. Gretchen Whitmer’s authority to impose restrictions by executive order, perhaps there was a reluctance on the part of her administration to shut things down again. There are also political negotiations on how to spend the relief money the state received from the federal government in the most recent stimulus package, and it may have been necessary to avoid upsetting the Republicans, who control both chambers of the state legislature, as that process continued.

In any case, Michigan, one of the model states for its response to the pandemic last summer, was now the poster child for an out-of-control virus.

At some point, though, I wondered how long that could last. After all, Michigan has rapidly expanded the availability of vaccines since January along with the rest of the country, so a significant number of citizens have had at least one dose of one of the available vaccines by mid-April. And I guessed that quite a few people have already had COVID at this point as well, especially among those who were less compliant with stay-at-home, masking, and social distancing requests. My guess was that, in St. Clair County specifically, about 20 to 25 percent of residents may have already had COVID.

My estimate was far too low. According to the data from covidestim.org, 44 percent of St. Clair County residents have been infected at one point or another during the pandemic:

Percent Ever Infected values for St. Clair County, Michigan

The graph’s upward trend, starting around the holidays, makes sense. Early on, there were few people who’d been infected, making the spread manageable by basic measures like masks and social distancing. During the holidays, more people started to choose to get together with family and friends (though not at a normal rate), allowing the virus to spread to a much broader population. The expanded contact between younger people in mid-March and beyond allowed additional spread.

At this point, then, we’re approaching half of the population in St. Clair County that’s already had COVID. Add to that the expanding number of people who’ve had at least one vaccine shot (or who are already fully vaccinated at this point), and you’d expect the numbers to decline simply because the virus should start to run out of people to infect.

And sure enough, the most recent map bears this out:

COVID-19 infections per 100K persons as of April 24, 2021

We’re not out of the woods yet, but things are trending much better again.

Last spring and summer, there was some coverage of the “basic reproduction number,” or R0, that is the expected number of cases directly generated by one case in a population where all individuals are susceptible to infection. This was the case last summer, when relatively few people had already had COVID and vaccines were still several months away from being available. The number was important because of the health care system being overwhelmed by the early cases, with a lack of ICU beds, ventilators, personal protective equipment (PPE), and other resources. It was critical to reduce that number under 1.0 in order to bring the spread under control and relieve the pressure on our health care infrastructure, not to mention the health care workers themselves.

Now, with the virus having been more widespread, which resulted in large numbers of mostly older Americans dying from COVID-19, and the rollout of vaccines, the more significant number is the “effective reproduction number,” or Rt, which (per covidestim.org) is “the average number of people who will become infected by a person infected at time t. If it’s above 1.0, COVID-19 cases will increase in the near future. If it’s below 1.0, COVID-19 cases will decrease in the near future.”

Effective Reproduction Number (Rt) values for St. Clair County, Michigan

St. Clair County reached its highest Rt number (excluding the initial days of the pandemic last spring) on March 5, when it was 1.61. Accordingly, the peak infection rate per capita was on April 2, when it was around 520 cases per 100,000 people in the county. (St. Clair County’s population is around 165,000.) Yesterday, April 24, the Rt number has dropped to 0.50 for the county, its lowest point in the pandemic so far, and it’s trending significantly downward. The number of infections has also dropped, to 101.6 per 100,000 persons as of yesterday.

By comparison, the state of Michigan has similarly seen a decline in the Rt number. After peaking at 1.30 on March 14, the number now stands at 0.68 as of Saturday.

What might this mean? While there are still possibilities for additional infections in the county – and COVID-19 remains serious, especially for older residents who haven’t been vaccinated for whatever reason and for whom the virus is particularly deadly – we appear to be approaching the often-mentioned “herd immunity,” where a large number of people (75% or more is the most common benchmark) have at least some immunity from the virus due to already having survived an infection or through vaccination – or both.

It will be important to continue to encourage those who are hesitant about getting vaccinated (again, for whatever reason) to do so. It’s unlikely that COVID-19 can be completely eradicated, and it seems likely that there will continue to be variants that will require periodic “booster” vaccinations, similar to getting an annual shot against influenza strains. At some point, we will have to determine what level of ongoing infection will be acceptable, and whether we are willing to keep our restrictions in place in order to protect those who have deliberately chosen not to participate in protecting themselves. There are always a small number of people for whom a vaccination may not be possible, due to sincere religious, moral, or medical reasons. But those people are often at risk from infections, including the flu, pneumonia, measles, and now COVID, and they will need to continue to be cautious and we will need to continue to support them by making health care available and affordable.