How do we fight a 2nd COVID-19 wave? Here’s what the U of M doctor known for the ‘flatten the curve’ strategy says.

What a double curve for COVID-19 could look like | University of Michigan Medicine

Michigan and other states shuttered by the COVID-19 pandemic are slowly relaxing some regulations and opening businesses. Many people are hoping a return to “normal” may soon be on the horizon — but health experts say easing up on social distancing and other precautions too quickly could cause another wave of cases and deaths.

A second COVID-19 wave has the potential to be worse, according to Dr. Howard Markel, a professor of medicine, history and public health at the University of Michigan. Markel helped come up with the mantra of “flatten the curve.” 

Dr. Howard Markel

As of April 29, Michigan has reported more than 40,000 positive COVID-19 cases and 3,670 deaths. In total, the United States is at 1.04 million cases and 60,475 deaths.

In an article for the University of Michigan’s Health Lab, Markel says social distancing efforts have proven effective at reducing the spread of the virus. Stay-home orders, reduced travel, wearing personal protective equipment (PPE) and working virtually have all aided in reducing case and death totals, Markel said.

Such measures have even caused a drop in the percentage of positive cases in Michigan, according to state data. Both the number of COVID-19 hospitalizations and patients on ventilators have decreased since peaking in mid-April.

But the virus could quickly gain a better footing if restrictions are relaxed too soon.

In Michigan, Markel’s own state, Gov. Gretchen Whitmer’s statewide stay-home order has been met with protest from some conservatives, most notably in the form of a large vehicular gridlock at the Michigan State Capitol on April 15. Another smaller protest is taking place Thursday. There appear to be coordinated efforts from right-wing groups in other states that have seen similar protests, with demands to reopen businesses, schools and public spaces. 

Gov. Whitmer office graphic

Markel said he understands the demands for states to reopen. Some people say the restrictive measures aren’t worth the damage they’re dealing to the national economy. It’s similar to how people behaved during the 1918-19 flu pandemic, he said. 

“In every pandemic, there’s a tug of war,” he said. “On one end, there are the economic and business interests, and on the other end is the public’s health.”

History shows that when citizens protest to leaders about lifting sanctions too early, another spike in cases can occur. Sometimes, the second wave is worse than the first, Markel said. He is looking through history, trying to see how infectious diseases behaved in previous pandemics. A “double curve” occurred in several cities during the 1918 flu pandemic, per a study he worked on.

A double curve forming means efforts already enacted to limit the coronavirus’s spread — like stay-home orders and closure of nonessential businesses — could be rendered futile.

There is currently no vaccine or antiviral treatment for the novel coronavirus. Health experts say it could take a year or more to develop an effective vaccine. While supplies of tests have increased, it’s still difficult to get tested in the United States. There’s also a lack of contact tracing, or monitoring infected people and to see how they’re spreading the virus.

“This creates a situation where you have endured shelter-in-place sanctions and crippled the economy for nothing,” Markel said.

It’s a matter Dr. Anthony Fauci — an immunologist and the chief medical advisor to the White House Coronavirus Task Force — is concerned about, too. Fauci said Wednesday a second, more severe wave of the coronavirus in the fall is “inevitable” if sanctions are lifted too early. 

“If by that time we have put into place all of the countermeasures that you need to address this, we should do reasonably well,” Fauci told CNN. “If we don’t do that successfully, we could be in for a bad fall and a bad winter.”

Public health experts said the restrictions are needed because they’ve bought additional time for scientists to look into COVID-19 treatments. Social distancing and lockdowns are effectively reducing the spread of the virus, COVID Act Now models show. The much-talked-about curve isn’t as sharp — meaning cases and deaths are not as high — as it would be if operations had continued as usual during the pandemic. 

For example, Michigan was projected to reach 220,000 hospitalizations when COVID-19 case predictions were first made by the state in late March. That would have greatly overwhelmed the state’s health care system. 

However, the state saw about 3,000 hospitalizations by late April, according to a Monday update by Dr. Joneigh Khaldun, Michigan’s chief medical executive. She credited Whitmer’s social distancing interventions with reducing the spread of the virus, leading to less overall hospitalizations. 

Khaldun: Michigan’s COVID-19 fight likely will last until 2021

Because the curve is flattening, several Michigan medical facilities haven’t yet been overwhelmed by patients requiring hospitalization. The restrictions allow them to operate below peak capacity, meaning they have enough beds and PPE to effectively treat cases. 

But a sweeping lift on restrictions could upend that narrow stability. 

In metropolitan cities like Detroit, hospitals were operating at peak capacity in early April. Areas in West Michigan are now reporting large increases in cases at a rate that exceeds Detroit and the region’s hospitals are bracing for it. And even in rural Michigan counties like Arenac, Branch, Lapeer and Mecosta — which reported intensive care units already at 100% capacity on Monday, per the Michigan Department of Health and Human Services (DHHS) — a second spike could send a deluge of new patients into an already overburdened health care system.

So how do we know when it’s truly safe to return to some sense of normalcy?

Markel said we need to wait for what’s called a de-inflection point — the moment when there’s a drop-off in case growth and the pandemic slows down. More widespread testing of people with COVID-19 symptoms would aid in determining that point until effective treatments and vaccines are found, he said. 

Whitmer extends stay-home order, but allows some businesses to open

“If we don’t listen to the experts in infectious disease, epidemiology and pandemic preparedness, and follow their lead, we will all be contributing to the spread of this virus,” Markel said. “As a historical epidemiologist, I really don’t want to see my research play out before my eyes.”

Some governors — including Whitmer, plus others from the Midwest — are devising strategies to gradually reopen their economies, not all at once. 

Whitmer on Monday unveiled her own plan for that, calling the process of reengaging various economic sectors something that would happen “step-by-step.” It was formed in consultation with a health advisory group made up of various Michigan medical executives, who appear to share Markel’s cautions about a second wave occurring.  

To reduce the risk of a second wave, businesses whose environments pose a low risk of COVID-19 transmission will reopen at first, Whitmer said. For instance, construction companies can start back up by May 7, with other outdoor enterprises and to-be-determined industrial sectors set to follow. 

“I’m going to sound like a broken record, but we have to be really smart. We have to get this right,” Whitmer said of the plan. “None of us wants to see a second wave, and we can’t risk that happening.”