97 takeaways from epidemiologist’s deep-dive into Michigan COVID-19 spread, deaths, future outlook

LANSING, Mich. – A state epidemiologist took a deep dive into Michigan’s COVID-19 numbers, including case spread, death rates, hospitalization trends and what to expect in the future.

Sarah Lyon-Callo, the Director of the Bureau of Epidemiology and Population Health at the Michigan Department of Health and Human Services, spoke from 11:15 a.m. to noon Wednesday in the form of a virtual presentation and Q&A.

You can watch the full presentation in the video above.

NOTE: MDHHS Chief Medical Executive Dr. Joneigh Khaldun and MDHHS Director Robert Gordon both participated in the Q&A portion at the end of the presentation.

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Here’s a list of the facts Lyon-Callo shared in the presentation:

National trends and how Michigan compares

1. Michigan has the sixth highest number of COVID-19 cases in the nation, with 272,034 as of Tuesday (Nov. 17).
2. Michigan has the fifth highest number of COVID-19 deaths in the nation, with 8,128 as of Tuesday (Nov. 17).
3. Michigan has the 10th highest hospitalization rate in the nation, in terms of total beds occupied by COVID-19 patients.
4. Michigan has the sixth highest number of COVID-19 patients in intensive care units.
5. All 50 states are seeing increases over the last two weeks in terms of the number of COVID-19 cases.
6. In the Midwest:
   1. Wisconsin has seen rising hospitalizations and case rates.
   2. Indiana now has higher hospitalization rates than Wisconsin and has exceeded its spring peak in terms of cases and hospitalizations.
   3. Illinois is showing rapid growth in hospitalizations and cases.
   4. Ohio is also experiencing growing hospitalizations and cases, as well as positivity rate. The state is far above its spring levels.
7. Michigan continues to rank among the top five states in daily tests and weekly percentage of population tested.
8. This week, Michigan has worsened in national percent positivity rank and is now 24th in terms of lowest rate among all states.

Michigan’s current COVID-19 trajectory

1. The case rate per million people for COVID-19 is now above 500 cases per million, and continues to climb.
2. The state’s percent positivity is at 12.5%.
3. Complaints of coronavirus-like illness in the emergency department have been increasing for seven or more weeks.
4. More than 15% of available inpatient beds in Michigan hospitals are currently occupied by COVID-19 patients. That trend has been continuing exponentially over the last five weeks.
5. The week of Nov. 1 through Nov. 7, the state had nearly 300 people die from COVID-19.
6. Michigan’s death rate is currently 5.2 deaths per million people.
7. More than 53,000 people are being tested for COVID-19 each day in the last week. These are diagnostic tests.
8. Our testing rate is over 6,000 tests per million people.
9. Michigan has seen a rapid rise in cases and hospitalizations, and is currently at about 75% of its spring peak.
10. Between Nov. 8 and Nov. 14, most counties in Michigan averaged 10%-20% positivity.

Confirmed and probable case indicators for Michigan’s future

1. Michigan’s case rate of 500 people per million will continue to grow, based on the Centers For Disease Control and Prevention’s case trend indicator.
2. All eight of the state’s geographical regions are over 300 cases per million.
3. Positivity -- the percentage of COVID-19 tests that come back positive -- is expected to increase from it’s current 12.5%.
4. All regions of the state are over 9% positivity, and the percentages are increasing in all areas.
5. The Kalamazoo Region has the highest positivity percentage in the state, at 15% positivity.
6. Testing is increasing statewide, but it’s not keeping up with positivity or case rates.
7. In most regions, the number of coronavirus-like symptom complaints has increased over the past week to four weeks.

COVID-19 spread in Michigan

1. Positivity continues to increase statewide, within all eight geographical regions, so the increasing case totals aren’t simply due to increased testing.
2. Testing has increased 89% since Oct. 1, whereas positivity rate has increased 290%.
3. The state’s case rate has increased 425% during the above timeframe, which could indicate more testing is needed. People who feel they need a test should get one.
4. It’s important to know where cases are occurring so the state can respond appropriately to slow the potential spread from those cases.
5. Cases and deaths are rising in all age, racial and ethnic groups.
6. The number of COVID-19 outbreaks that local health departments are investigating continues to rise.
7. COVID-19 outbreaks have been frequently linked to long-term care facilities, schools, sports, in-person work places, restaurants and bars.
8. When testing done in Michigan Department of Corrections facilities is added, the state’s positivity is at around 12.1%.
9. Last week, Michigan had 57,636 diagnostic tests for COVID-19 per day with an average of 6,945 positive results.
10. Positivity rate increase is an early indicator that the number of cases will continue to increase.

COVID-19 cases, deaths by onset date

1. Lyon-Callo said the information she’s most interested in as an epidemiologist is understanding when someone became ill.
2. In the last week, Michigan reported more than 47,000 new COVID-19 cases.
3. Currently, Michigan’s daily case rate is more than five times what it was in early October.
4. The number of confirmed probable COVID-19 deaths in Michigan are a lagging indicator, so even if the case numbers start to drop now, the number of daily deaths will continue to climb.
5. The concurrent number of deaths is over 14 times the number of deaths in the beginning of October.
6. Currently, all counties in Michigan are over 150 cases per million.

COVID-19 trends by age, race, ethnicity

1. The age group of people from 30-49 years old is continuing to have the highest case rate per million people in Michigan.
2. Case rates have exponentially increased for all age groups in the state.
3. COVID-19 case rates are increasing for people in all race groups in Michigan.
4. White and American Indian/Alaskan Native residents are currently seeing the highest case rates in Michigan.
5. Hispanic and Latino residents have seen the case rate rapidly increase, but not as much as residents who are not considered Hispanic or Latino.
6. Comparing these numbers from the fall to the spring is difficult because the testing environment was so different early in the pandemic. In the spring, cases were highly focused in Southeast Michigan.
7. Health departments working to try to make sure testing is available in communities with social vulnerabilities.

COVID-19 outbreaks

1. There are many factors, including the ability/inability to conduct effective contact tracing, that could result in the under recording or under identification of outbreaks. Some outbreaks are easier to spot than others.
2. Just because there aren’t identified outbreaks in a certain setting doesn’t mean the setting is without outbreaks.
3. Local health departments are currently investigating 980 outbreaks in the state.
4. The total number of active outbreaks is up 32% from the previous week.
5. Michigan is currently seeing its highest number of recorded outbreaks since officials started tracking the data.
6. Following long-term care facilities and educational settings, the newest number of new outbreaks are reported in manufacturing/construction, restaurants/bars, retail and social gatherings.
7. The total number of reported outbreaks is highest among manufacturing/construction, health care, restaurants/bars, social gatherings, offices, child care settings and retail settings.
8. There are 200 outbreaks that including students and/or staff members at K-12 Michigan school buildings.
9. Officials said 97 of those 200 outbreaks occurred in high schools.
10. The number of cases associated with different settings shows that 565 of 881 outbreak-associated cases in K-12 schools are occurring in a high school setting.

COVID-19 deaths

1. In the past 30 days, deaths are highest among people over age 80.
2. Deaths among people under age 60 are also increasing. Most age groups are experiencing increases in new deaths.
3. Experts are seeing an exponential increase in the COVID-19 mortality rate.
4. There has been an increase in the average daily new deaths for all racial and ethnic groups.
5. New mortality rate (seven-day rolling average) is currently highest among White residents and non-Hispanic/Latino residents.
6. The mortality rate will continue to climb because it tends to go up a couple of weeks after case rates increase.

Healthcare capacity

1. Since September, COVID-19-like illness has gone from under 2% to more than 7% of the emergency department visits.
2. Hospitalizations and ICU utilization for COVID-19 are both increasing.
3. The doubling rate is at 2.5-3 weeks, meaning the number of COVID-19 patients being seen in hospitals is doubling every three-week time period. The doubling time for the previous week was two weeks.
4. Five of the state’s eight geographical regions have seen over 30% of adult ICU beds become occupied with COVID-19 positive patients.
5. Statewide, 27% of adult ICU beds are occupied with COVID-19 positive patients.
6. The percentage of people in the emergency department who are seen because they have a coronavirus-like illness or COVID-19 diagnosis has risen drastically from September to November.
7. This week, for COVID-19 patients in the hospital, Michigan had a census that was 33% higher than last week.
8. Michigan is now at around 75% of its spring peak level of hospitalizations, though they are now more widespread across all regions.
9. The northern part of the Detroit Region, the Saginaw Region and the Traverse City Region show the most rapid growth rate for the week of Nov. 8 through Nov. 15.
10. The northern part of the Detroit Region, the Saginaw Region and the Grand Rapids Region are the most pressured on a per population basis.
11. Case investigation and contact tracing is becoming overwhelmed with the influx of new cases and contacts and is at or near all-time lows.
12. MDHHS recently released a phone proximity notification app, Mi COVID Alert, to help contact tracing. More than 280,000 people have already signed up for the app.
    1. The app records which phones your phone might have been near, if other phones also have the app. If you become a COVID-19 case, the local health department will give you a code to type in, and it identifies which other phones you were near, and sends them an exposure notification.
13. For any lab that has reported more than 1,000 results in the past two weeks, the average turnaround time for tests during that timeframe is 2.7 days -- stable since last week. That’s the time from when a sample was collected to when public health received the results.
14. As Michigan sees positivity increase, it means there are likely more cases, and testing needs to be expanded.
15. MDHHS is working to expand antigen tests across the state, focusing on vulnerable populations, and hopes to see more supplies for antigen tests from the federal government.
16. MDHHS is looking to expand its capacity with in-state testing and looking very closely at working with partners across the country to increase capacity there.
17. MDHHS is aggressively working to plan for vaccine distribution. The day that vaccine becomes available, it will only be available in limited quantities and for those the Centers For Disease Control and Prevention considers the highest-risk population, starting with health care providers.
18. It will be several months, well into 2021, before a COVID-19 vaccine can be available and widely distributed to the general population.
19. Gordon said Washington’s “failure” to provide additional COVID-19 response funding for public health expenses is an enormous challenge for MDHHS.

Case investigation

1. Case investigation metrics remain low since last week.
2. MDHHS is adding staff and working to investigate as many COVID-19 cases as possible -- both at the local and state levels.
3. From Nov. 7 through Nov. 13, 39,199 cases were referred for investigation. Officials were able to get a full complete case investigation for about 23% of those -- 9,106 cases had a complete investigation, which is the highest number completed during the pandemic.
4. About 44% of investigated COVID-19 cases could identify the potential source of infection, which is down from 47% for the previous week.
5. Only 28% of investigated cases noted that they were quarantining before symptoms. That means less than one-third of infected patients were quarantining at the point when they are most infectious.
6. Over the last week, the number of complete cases investigations increased 29%, while the number of cases has increased 59%.
7. Because of the influx of cases, MDHHS is trying not to fall farther behind in time, so officials are working with local health departments to prioritize case investigation.
8. Officials are reaching 45% of known contacts of COVID-19 cases within one day -- a percentage that has increased.
9. People identified as known contacts of COVID-19 cases can call Trace Force to ask questions and get more information, and those calls have more than tripled this week.
10. It’s much easier to trace cases to places where people live, work or go to school because they have core identification with those places. At restaurants or bars, infected patients might have only been there for an hour, so it’s much harder to contact trace.

Indirect impacts of COVID-19

1. Childhood preventative services such as lead testing and vaccinations fell during the spring, but are rebounding.
2. Emergency department visits are lower than in years past.
3. EMS use for opioid overdose has increased. Total EMS responses decreased, but EMS opioid responses increased 22% since 2019.
4. Mental health impacts, directly and indirectly, related to the pandemic, are visible in Michiganders. The proportion of emergency department visits for mental health appears to increase 50% at the end of March to near 3%, but is trending back to pre-pandemic levels around 2%.

RELATED: Studies reveal alarming trends of anxiety, depression among young adults during COVID-19 pandemic

On Tuesday, Michigan officials reported 7,458 new cases and 79 additional deaths. The state has confirmed 272,034 COVID-19 cases and 8,128 deaths since the start of the pandemic.