DETROIT – A Beaumont Health expert provided a concerning update about COVID and hospital trends in Metro Detroit this week, calling this the “fourth surge” and sharing three reasons why he believes numbers are once again on the rise.
Nick Gilpin, an infectious disease physician and the medical director of infection prevention for Beaumont Health, held a virtual briefing Thursday, Nov. 11, to discuss what he’s seeing in Metro Detroit. You can watch the full briefing in the video player above.
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Fourth COVID surge in Metro Detroit
“Over about the last four to five days, we’ve seen a considerable increase in our hospital COVID numbers,” Gilpin said. “We have currently about 397 -- almost 400 COVID patients across our hospitals.
“With around 400 COVID patients in our hospitals right now, I consider this to be our fourth COVID surge.”
Gilpin said the first surge happened in March/April 2020. Beaumont Health peaked around 1,300 patients during that surge.
“That was by far our most crushing wave,” he said.
Several months later, in the fall and winter months, the second surge arrived. Gilpin singled out the period between November 2020 and January 2021, saying the hospital system peaked at around 700 COVID patients.
In the brief period between April/May 2021, a third surge saw Beaumont Health peak at around 800 COVID patients, according to Gilpin.
“That was the wave that was predominantly driven by the new delta variant,” he said.
Gilpin said there was a stretch during the summer in which COVID numbers dropped, community positivity fell and life appeared to be going back to normal.
“Everything felt good,” Gilpin said. “Then, for the last couple of months, I’d say starting in about late August/early September, we’ve been experiencing this slow burn -- this slow, steady increase, with a very shallow slope -- of increases in COVID patients in our hospitals, and that number has gone over the last few months (from) a very slow slope to in the last week or so, a very sharp increase to where we currently are.”
While hospitals are seeing fewer COVID patients right now than in previous surges, Gilpin said he’s “very concerned” about the trajectory of this wave.
“This fourth surge that we’re in right now could shape up to be a four- or five-month long affair,” he said.
Metro Detroit COVID trends
Gilpin said the COVID trends in the Metro Detroit community seem to mirror what Beaumont officials are seeing in their eight hospitals.
“The numbers across the state jumped about 30% in the past week, and the community positivity -- the percentage of tests positive in the tri-county Metro Detroit area -- has also increased and is now around 11.5%,” Gilpin said.
That percentage signals that Metro Detroit is officially in a period of “substantial to high” community COVID transmission, he said.
For reference, in the summer, the percentage of positive tests in the area was below 3%, according to Gilpin.
He said Macomb County is around 12-13% positivity, Oakland County is around 8-9% and Wayne County is around 5%.
“When you put it all together, Metro Detroit is around 11% or so,” he said. “That’s an incredibly high number.”
Vaccinated vs. unvaccinated in hospitals
Gilpin was asked how many of the COVID patients in hospitals are vaccinated.
“What we’ve seen is that generally around 65-70% of all of our COVID patients in the hospital at any given time are unvaccinated,” Gilpin said. “That holds true for any COVID patient who comes into the hospital. That number is also approximately the same for our ICU patients.”
Gilpin said as of Wednesday, with around 400 COVID patients at Beaumont hospitals, about 260 were unvaccinated and about 115 were fully vaccinated.
“I can tell you, I’ve looked at those numbers in more detail: Most of those patients who are coming in who are fully vaccinated -- there’s usually an explanation for this,” Gilpin said. “The explanation typically is that the person either has chronic medical conditions that put them at greater risk, that mean the vaccine may not be as effective in that population -- for example, immune-compromising conditions, older age -- or these may be people who got vaccinated very early on in the pandemic and they may be experiencing some waning immunity.”
He said that waning immunity is what led to recommendations for the third booster shot.
Also, as the proportion of the general population becomes increasingly vaccinated, the proportion of COVID hospital patients who are vaccinated is obviously going to increase because there are simply more people who fit that category, Gilpin explained.
Metro Detroit ‘becoming a hotspot’
Metro Detroit’s percent positivity is currently more than double the rate experts are seeing across the nation, according to Gilpin.
“Metro Detroit, once again, is becoming a hotspot,” he said.
Now that transmission is so high in the area, Gilpin said it’s as important as ever to follow precautions such as making and social distancing.
Why are COVID cases rising in Metro Detroit?
Gilpin prefaced his comments about the surge by saying nobody knows for sure what’s driving the rise in COVID numbers. But as an infectious disease expert, he has some theories.
“It’s probably a combination of things,” Gilpin said. “For starters, it’s for certain that we still have a significant proportion of unvaccinated in the community.”
He said numbers from Beaumont experts, as well as medical officials from the state of Michigan, verify that this surge is driven predominantly by people who have not received the COVID vaccine.
Even though Michigan is a state in which the vaccine is easily available, many people have decided not to get the shot, Gilpin said.
“We know that cooler weather that we’ve been experiencing over the last couple of weeks creates conditions that are more favorable for the virus to transmit,” Gilpin said. “Not only because temperature and humidity tend to favor transmission, but also because behaviorally, when it gets cold, we all start to gather indoors again, and that means more opportunity for transmission.”
The third factor in this surge is a national narrative that COVID is in decline, Gilpin said. That creates a false sense of security because while it might be true for many regions in the country, it’s “certainly not our experience” in the Midwest, he said.
“I think some signaling that things are starting to get better has led to some more relaxed attitudes,” Gilpin said. “We’re seeing relaxed behaviors with regards to masking, physical distancing. We’re seeing more and more large gatherings take place, and we know that those are the conditions that are going to make for more transmission.”
How to flatten the curve
During previous surges, there was a drastic rise in cases followed by a drastic drop due to certain mitigation strategies, such as lockdowns and government mandates. But this surge is different, Gilpin believes.
The virus is spreading more gradually this time, and there are strategies (such as the vaccine) in place to slow the spread.
“We have things in place that we know can flatten that curve effectively without having to necessarily resort to those techniques that we’ve used in the past,” Gilpin said. “What I would like to see, personally, is I would like to see more people taking common sense approaches.”
Vaccines for children
Gilpin said hospitalizations are “certainly up” for children across the state of Michigan, including at Beaumont hospitals.
The largest case increases right now in Michigan are happening among school-aged children -- between 10 and 18 years old, according to Gilpin.
“Much of that is because there is still a significant portion of that population that is yet to be vaccinated,” Gilpin said.
He also said most new COVID outbreaks across the state are happening inside schools.
“It’s not even close,” he said. “So you’ve got schools driving a large proportion of outbreaks.”
Many children won’t get seriously ill from the disease, but some of them will, and they can all spread it to others, Gilpin warned.
“They can still spread COVID to their teachers,” Gilpin said. “They can spread it to their households, and then it just becomes a way for the virus to propagate more.”
Michigan is nearing its original goal of getting 70% of residents 16 and older vaccinated against COVID -- but case counts are still climbing across the state.
Does that mean the vaccines aren’t living up to their expectation? Here’s a look at Michigan’s current breakthrough rate.
Vaccines aren’t perfect and even vaccinated people do become infected. But that does not mean the vaccines aren’t still having an important effect.
Between Jan. 1, roughly when vaccines became available and Oct. 26 there have been 621,564 new COVID cases. Out of those cases, 552,935 were in unvaccinated people and 68,629 cases occurred in fully vaccinated people. So about 11% of the COVID cases since the start of the year are breakthrough cases. But that 11% is actually an average for the past 10 months.
When you look at the percent of cases that were breakthrough cases since January, you can see at the start of the year they were very uncommon. After June, the percentage of cases occurring in fully vaccinated people -- the breakthroughs have been running in the mid 20% range.
And when you similarly look at breakthrough hospitalizations and deaths, you see exactly the same trend. There has been an increase in the percentage of cases, hospitalizations and deaths since the summer. But the breakthrough data does show the vaccines are working.
For example, in October, when 27% of the new cases were breakthroughs -- 73% of cases were in the unvaccinated. When you do the math and account for the fact that there are more vaccinated people in the state than unvaccinated -- in the time from Jan. 1 to Oct. 26, an unvaccinated person was 13 times more likely to become infected or die from COVID-19.
Another critical piece of information is that people over 65 are far more likely to die from a breakthrough infection -- of the 795 breakthrough deaths since Jan. 1 -- 699, that’s 88% of them were in people 65 years or older.
So does that data say anything about the efficacy of the vaccine?
That’s something the data can’t sort out. Waning efficacy is possible, and there’s also the more contagious delta variant to factor in. That’s why there is the push for boosters and continued mask use when appropriate.
The main reason for the increase in the number of vaccinated people being infected is because a larger portion of the population is now vaccinated.