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Tuesday November 30, 2021
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Susan Ringler-Cerniglia

The Fourth Wave

Covid-19 is rising again, and it's here to stay. What does that mean?

by James Leonard

From the October, 2021 issue

Since reopening at the end of July, the Blind Pig had put on about thirty successful shows and was all set to celebrate its "Grand Reopening Extravaganza" at the end of August: three nights featuring eleven eclectic acts, ranging from local progressive jam-rock quartet Stormy Chromer to electronic down-tempo dance musician Scueter.

"These shows were such an obvious relief for all the people," emails the Pig's veteran talent buyer, Jason Berry. "Keeping up with the [audience] demand is the issue these days. Bands cancel due to Covid now. Tours cancel due to Covid now. It's hand to hand combat every day in the booking office."

In an interview, Berry describes the music bar's pandemic precautions. "We have touchless flushing toilets, faucets, handwashing sinks, and hand dryers," he says, with "hand-sanitizer stations throughout the entire venue, including at the pool tables and bars. Masks available for patrons who need one." They "doubled the ductwork and added ceiling fans to increase ventilation throughout the building." And when they reopened, some shows would require that fans show a Covid vaccination card or negative test result.

But Covid came anyway. A doorman and a manager caught it a week before the reopening--even though both were fully vaccinated.

Berry says they recovered at home after experiencing what they described as no worse than a heavy cold, and no patrons tested positive. But the Pig called off its Grand Reopening Extravaganza.

Covid infections in Washtenaw County surged from eighteen a week in June to 497 at the start of September. The fourth wave since the virus arrived here early in 2020, it's fueled by the highly contagious Delta variant and hitting hardest among the unvaccinated.

Unlike earlier waves, most victims this fall are people between eighteen and thirty-nine, with students at the U-M and EMU accounting for about a quarter of the cases. But most folks hospitalized are still over fifty, because age and preexisting health conditions matter.

The earlier waves killed more than 300 county

...continued below...


residents. Thankfully, mortality is much lower this time, because 89 percent of seniors sixty-five and up are fully vaccinated. Among county residents who are eligible to be vaccinated, 68 percent are fully vaccinated--close to the state's 70 percent target. But there's still no vaccine approved for kids under twelve, and when they're included, the rate drops to 60 percent.

According to a September statement from the CDC, studies show that "vaccinated people are 8 times less likely to be infected and 25 times less likely to experience hospitalization or death" than unvaccinated people. That still leaves a minority, like the Blind Pig staffers, at risk of less severe "breakthrough" infections. Though 92 percent of U-M students reported that they were vaccinated at the start of the term, within weeks, 2 percent of them still got infected. (See, "Breaking Through.")

"It's pretty bad," says U-M physician and medical historian Howard Markel. "The numbers are rising steadily, and they're particularly bad in Michigan right now."

Since the start of the pandemic, there's been talk that once enough people have been exposed to the virus, communities will achieve "herd 'immunity"--the point at which so many people have antibodies that the virus can no longer easily find new hosts. But Markel calls that "a concept, not a reality."

"I wouldn't say that any of us in public health were too optimistic about that 'being the goal," says county health department information officer Susan Ringler-Cerniglia. "Many of us have started to talk about this in another way: we'll start to have to learn to live with this virus."

---

Both people and institutions already are accepting more risks. After going almost entirely remote last winter term, U-M is holding more than 90 percent of fall classes in person--and the football stadium has been packed with fans.

"That's just crazy," exclaims Markel. "It shows that the almighty buck and sports are so important [they] take over good, common sense." He advises people to "watch it on TV instead of being crowded together with the 110,000 other people who are not wearing masks, and they're shouting and screaming."

"It's probably not smart," says Ringler-Cerniglia, echoing National Institute of Allergy and Infectious Diseases director Anthony Fauci's comment on attending football games. But as of mid-September, the department had not found "evidence that that first game was a super-spreader," she says. While "about thirty-five student cases" were associated with the first home game, "many of them are also associated with other social events."

The return of K-12 students to the classroom also is swelling the fourth wave. In the second week of September, 12 percent of local Covid infections were among people under eighteen.

Markel is torn about the Ann Arbor Public Schools' decision. "As a pediatrician, I fully understand [that students are] not learning as much at home," he says. "But at the same time, as a doctor and as somebody who studies epidemics, I'm nonetheless nervous. And I have a daughter [who] is now at Pioneer."

"We're not yet seeing--crossing my fingers here--a lot of in-school transmission," says Ringler-Cerniglia. "We're doing everything we can to keep that in-school transmission low and to hopefully preserve in-person learning."

Vaccinating kids under twelve would help. The feds haven't announced when that will happen, but in September, an FDA advisor speculated that one vaccine might be approved by the end of October.

Getting as many people as possible vaccinated "is still our best tool," Ringler-Cerniglia says. She's encouraged that the department is seeing "a pretty steady uptick of vaccinations. We went from a low of roughly a hundred doses given [per week] in mid-July, then these last weeks, we've seen it creep to more like 300." But they'd like to see it get to 500.

Though President Biden has called for vaccine booster shots to enhance immunity, an FDA panel in September voted not to recommend them for most people.

An additional vaccine dose is available, Ringler-Cerniglia says, to "folks with specific immune-compromised conditions--that includes folks getting active cancer treatment, having received an organ transplant, or taking medication for suppressing the immune system." But "we cannot schedule [boosters] for the general public. None are available."

---

While some people are eager for additional vaccine doses, others are determined never to take the shots--a division that often breaks down on party lines.

"It should have never been political," says county commissioner Katie Scott, a U-M ICU nurse. "Vaccination [has] been part of this country's history from the very beginning. George Washington required the troops to be inoculated for smallpox." But instead of the vaccine discussion being "about protecting a community," she says, "it became a discussion about individualism."

"The masks have also become political," says Markel. Refusing to wear one, he says, has "become like the symbol of the libertarian movement: 'You can't tell me what to do.'"

He advises vaccinated people to continue to mask when out in public, if only to show "other people walking down the street that you care and that you're part of the effort to prevent or lower the spread, as opposed to increase the spread."

Like Ringler-Cerniglia, Markel says that Covid is here to stay. "This disease is going to become endemic, and it's going to keep popping up like whack-a-mole, here, there, everywhere, causing havoc to those people who did not get vaccinated.

"You get very, very ill with Covid. You can't guarantee that your case would be a mild one. So for now, the best medical advice I could give is to avoid it entirely." The alternative, he says, "is getting sick and going mano-a-mano with the virus--and you either survive, or you don't."

"If we want to continue to be able to have this way of life that offers us a certain amount of freedoms," says Scott, "you do have to do things like try to protect other people around you by getting vaccinated and most definitely wearing a mask. Maybe then at some point we can have an end to this being an epidemic in our community and get back to life quote, unquote, as normal."

"The virus still has lots of opportunity to spread," says Ringler-Cerniglia. "Controlling that spread is also key to controlling it overall and reducing that impact. Because the more it spreads, the more it has that opportunity to change. And there's concern that the next variant won't be as susceptible to the vaccine. That's my pessimistic look forward.

"More optimistically, if we can really get everybody who is eligible vaccinated, as well as expand that eligibility as soon as possible, as well as continue to use the nonmedical interventions, [we can] do a lot to keep those trends lower. And if those stars align, we can get to a place where we're cohabitating with this virus better."

---

At the Blind Pig, Jason Berry sees how urgently people want to get their social lives back. "Demand is such that we've become essential workers, more or less," he emails. "And by 'we' I mean live music staff and live musicians themselves, all over the Earth. Patrons are exposing us all to Covid on a nightly basis."

He thinks that tests are "the only logical solution" for a truly safe show. "I am annoyed at the industry's new trend toward 'vax only' shows," he emails. "Sounds great on paper. But the vaccinated (patrons) still transmit the virus. The vaccinated (musicians/staff) still catch the 'virus. The infected musicians eventually say 'fuck this' and cancel their tours."

What can we do? "Wait for things to calm down and get more rational," Berry replies. "If I ruled the world, when you bought a concert ticket it would come with a Covid test. Crack it open 72 hours before the show. If you're negative, come on down. If you're positive, sell the ticket, give it to a friend, or get a refund. Better luck next time. Everyone in the Pig will be Covid-negative, though, and we can actually party like it's 1999."

But to be safe, the grand reopening show is now the New Year's Eve show.

---

Breaking Through

Despite being fully vaxxed, U-M art and design major Adelle Sievert caught Covid. The junior got both shots through the university last spring-but at the end of August, she tested positive anyway.

"I had come back, and I was like, 'I'm vaccinated; I'll go out'," she recalls. "I thought it would be OK. And then I started not feeling well. So I tried to wait a day or so, and then I got a migraine, which is kind of abnormal for me. So the next day I went and got a rapid test through the Ann Arbor Urgent Care, and it came back positive." Sievert figures she got it "at one of the Welcome Week parties."

"I had a little bit of like a congestion [and] felt like a little gross physically, but not terrible," she remembers. "Emotionally, I just felt like a little bit disappointed because it was the day before classes started. I put myself in that position. I went out anyways knowing that it was still a possibility."

Quarantined in her room for ten days, Sievert says her symptoms "lasted maybe five days. The worst symptom for me was not being able to taste and smell. I tried to eat a yogurt. And yogurt is so gross when there's no flavor. It's just mush!"

Sievert recovered fully and says it's "great" to be back in class again. "The interaction is awesome, and I feel like I learned a lot better. I did not realize how much I missed people!'

---

A Nurse's Soul Searching

"We're doing a lot of soul searching about our profession and how much longer we can continue to do this work," says U-M ICU nurse Katie Scott. "How long [will] we be seeing people who are just going to be suffering and sick with this? And how much of that moral distress can we continue to take?"

While doctors, nurses, and other hospital workers are retiring in greater-than-usual numbers nationally and across the state, Scott says she has "not seen evidence of that happening here. But people are saying, 'I'm leaving bedside [care]. I'm going to go work a call center.'"

While 96 percent of the country's doctors are vaccinated, only 88 percent of the nurses are. "I cannot explain why nurses have a lower rate of vaccination than physicians, because I'm not one of those nurses," says Scott, who got her first dose last December. "I feel disappointed by it--and frustrated."

The state's nurses' union is against mandating the vaccine, saying it will cause nurses to leave the profession. "It's hard for me to say this, but I don't agree," says Scott, an official in the U-M union. "That seems totally antithetical to what our role is as health care providers. The last thing you need to worry about [as a patient] is 'has my nurse been vaccinated?'"

There's a nursing shortage nationally, and some speculate that the U-M isn't pushing vaccination for fear of losing staff it can't replace.

"No," replies Scott emphatically. "The university is definitely trying to encourage us to be vaccinated." In September, it sent out "a very personalized message ... from the chief nursing officer encouraging nurses to be vaccinated. They're recognizing that there very well could be a nursing shortage if people don't get vaccinated."

As the fourth wave builds, "the hospital has been getting more Covid patients," Scott reports. "We're taking off a little bit steadily every week. And the last update I heard is that we were going to look at maybe a peak around the first week of October."     (end of article)

[Originally published in October, 2021.]

 


 
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