Almost 5,500 Michiganders have died in the coronavirus crisis, the fifth-highest death total in the county behind New York, New Jersey, Massachusetts and Pennsylvania. Per capita, Michigan ranks seventh among the 50 states.
Michigan’s death count equates to almost 10% of the state’s confirmed cases. That’s the highest percentage in the country.
Michigan also ranks first in the upper Midwest in coronavirus deaths.
Even as surrounding states are catching up in number of coronavirus cases -- and Illinois now has more than twice Michigan’s COVID-19 caseload -- Michigan still stands out for its high per-capita death rate. As of May 31, Michigan has had 550 deaths per 1 million residents compared to 421 per million in Illinois, 317 in Indiana, 185 in Ohio and 102 per million in Wisconsin.
Numerous researchers are looking at the reasons behind Michigan’s high mortality rate.
“We’re trying to figure that out,” said Dr. Matthew Sims, an infectious disease specialist with Beaumont Health in metro Detroit.
Multiple factors appear to be at work, said experts including Sims, who’s heading several studies on coronavirus. Those factors include the intensity of the pandemic here; the fact Michigan’s surge occurred as doctors were still struggling to develop treatment protocols, and the sociodemographics of Michigan’s hardest-hit communities. Yet another factor, experts say, is the way Michigan collects data on coronavirus deaths compared to some other states.
“It was like a tsunami of all of this coming together in a short period of time,” said Dr. Vikas Parekh, a University of Michigan internist who heads the Michigan Medicine team working on coronavirus forecasts.
It’s likely the sociodemographic factors that made metro Detroit an U.S. epicenter for coronavirus also are contributing to the high death rate, said Marianne Udow-Phillips, head of the Center for Health and Research Transformation at University of Michigan.
Outside of nursing homes, “we know where COVID-19 has been most deadly, and that’s been in the African-American population," for a variety of reasons, Udow-Phillips said.
Residents of Detroit -- a city where 78% of the population is African-American -- account for a quarter of Michigan’s coronavirus deaths.
“I don’t think it’s in any way that our health-care system wasn’t as prepared as elsewhere," Udow-Phillips said.
Still, she said, looking at why Michigan has such a high coronavirus death rate is “really quite important, so we can have the best informed strategy” going forward.
“A large percentage of deaths are in congregate living settings such as nursing homes and a large percentage are occurring in African-American populations,” Udow-Phillips said. “That informs us on where we need to take interventions; we need to do more to protect those populations, in particular.”
Here is a closer look at the various factors that Sims, Parekh and other experts have said likely contributed to Michigan’s high mortality rate for COVID-19.
Metro Detroit was hit hard and fast, which overwhelmed hospitals.
Michigan had one of the nation’s most dramatic surges in coronavirus cases, with the number of cases doubling every three days in late March and early April.That appears to be the most intense surge of any state to date, Sims said.
On March 23, the day that Gov. Gretchen Whitmer announced the shutdown order, Michigan had 1,328 confirmed cases of coronavirus. By March 30, a week later, it was 6,498; by April 6, 17,221.
About 80% of those cases were in metro Detroit, overwhelming the region’s emergency departments and intensive care units.
Coronavirus “wasn’t here one minute and then it was everywhere,” said Dr. Anne Messman, a Detroit emergency department physician. “It happened practically overnight and that’s not hyperbolic; it went from zero to 100.”
By mid-April, more than 3,400 people were hospitalized in the Detroit region with coronavirus, and ICE units in the hardest-hit communities were overflowing.
No question, that surge impacted the mortality rate, and it’s not surprising that states and regions with flatter curves have lower mortality rates, Sims said.
“A lot of it is just how many cases you get hit with in one time,” Sims said. “When you have to manage 20 cases minute to minute, you’re going to have better outcomes in general than if you have to manage 100 cases.”
Michigan’s surge came early, when doctors were scrambling to figure out treatment protocols.
Although Michigan was in the last group of states to have a confirmed case of coronavirus, the exponential growth in cases occurred almost immediately.That meant doctors in metro Detroit were not only overwhelmed by a flood of very sick patients; they were very sick patients with an disease than none of the doctors had treated before and where there were no established treatment protocols.
“When you’re one of the first four states to be deluged with cases, the science and the clinical knowledge required to take care of those patients hasn’t evolved yet," said Dr. Bobby Mukkamala, president of the Michigan State Medical Society. “So the death rate has to do partially with being on the very first wave of it and not knowing the disease as well as we know now.”
For instance, he said, doctors initially were quick to put coronavirus patients on ventilators when their condition worsened; now, the protocol is to wait as long as possible before ventilating COVID-19 patients.
Another example is use of hydroxychloroquine, the drug which many hospitals began to use after it was promoted by President Donald Trump. More recently, the drug has been linked to higher mortality rates in coronavirus patients because it can induce cardiac problems.
“Absolutely, the clinical management guidelines were not easily available for providers” at the beginning of the crisis, Parekh said. “Every single day, new information was coming in, and what we thought we knew yesterday wasn’t necessarily true today. It was an evolving situation, not even day by day, but even by minute things were changing.”
The fact Michigan’s coronavirus surge came early also had another consequences, doctors say: Health-care providers and patients alike were often slow in identifying cases, both because of the extreme shortage of diagnostic tests and because less was known about disease onset.
For instance, it was initially thought people without a fever were unlikely to have coronavirus, and “now we know if you have a fever, (the virus) has been in you for awhile and wreaking havoc," Mukkakamala said.
That meant by the time Michigan’s first wave of coronavirus patients were diagnosed, they were much more likely to be in an acute stage of the disease and less likely to survive compared to those who catch the virus now.
Metro Detroit’s sociodemographics make it particularly vulnerable to coronavirus.
No question, a factor in Michigan’s high death rate are the sociodemographics of Detroit and its metro region, experts say.Nationwide, the virus has been particularly virulent in low-income communities and where there are significant numbers of adults with pre-existing health conditions such as diabetes, asthma, heart issues and obesity.
Michigan ranks below average in health indicators, according to an annual analysis by the Robert Wood Johnson Foundation. And Wayne County, home of Detroit, ranks dead last month Michigan’s 83 counties, making it Michigan’s most unhealthy county.
Experts also are honing in on the fact that coronavirus has proven particularly deadly for African-Americans. And in Michigan, the epicenter of the disease has Detroit, the nation’s largest city in regards to its poverty rate and proportion of African-American residents.
African-Americans comprise 40% of Michigan’s coronavirus deaths, even though African-Americans are only 14% of the state’s population.
Researchers are studying why African-Americans seem particularly susceptible to coronavirus.
One reason is likely economics. African-Americans are more likely to live in low-income households, and experts note that low-income residents are less likely to be able to follow social distancing guidelines because they rely on public transportation, more likely to live in communal housing and less likely to have jobs that can be done at home.
Another factor is health disparities: African-Americans are more likely to have health issues such as diabetes and heart ailments.
Yet a third issue is the growing recognition that stress related to institutional racism can undermine individual’s immune systems and contribute to health problems such as hypertension that make individuals especially vulnerable to coronavirus.
“We’re all aware of the racial disparities, and it’s given us a lot of a food for thought,” said Parekh, the U-M internist.
While there has been discussions for decades about the fact that African-Americans tend to have more health issues and shorter life expectancy than whites, “what has happened (with coronavirus) is really stark,” Parekh said.
“People already working on the issue of health disparities are going to work even harder now," he said. "But for people who didn’t really think before about how this would play a big role in a pandemic situation, this is kind of been eye-opening.”
High death rate among nursing-home residents.
More than a quarter of the Michigan’s coronavirus deaths involve residents of nursing homes.“It’s a high number of cases” although it tracks with a nationwide trend, Udow-Phillips said. Nationally, it’s been estimated about a third of the nation’s coronavirus deaths are linked to nursing homes.
Containing outbreaks of coronavirus was particularly challenging for long-term care facilities in March and April because of the nationwide shortage of personal protective equipment, such as masks, and the lack of access to coronavirus testing, said Melissa Samuel, CEO of the Health Care Association of Michigan, the organization that represents long-term care facilities.
That meant that nursing-home staffers who had coronavirus but were asymptomic could unintentionally bring into a nursing home, filled with residents whose age and health conditions made them especially vulnerable to COVID-19, Samuel said.
“When you have a significant amount of COVID in the community, it’s just absolutely impossible to to really keep it out of congregate settings,” she said. “And this virus is most unmerciful to the residents that we care for.”
Udow-Phillips said the pandemic has highlighted ways to better protect nursing-home residents, including better design of facilities.
“We’re learning one reason why nursing homes are so vulnerable is because just their physical structure, with shared rooms with a shared bathroom,” she said. “The nursing homes that have done better are those with a low density of population.”
Conservative media has been highly critical of an April 15 executive order issued by Whitmer that told nursing homes they had to readmit residents recovering from COVID-19 after they were discharged from the hospital. A similar mandate in New York has been linked to the spread of coronavirus in nursing homes.
However, that initial policy -- which has since been revised -- was never enforced in Michigan, according to Samuel.
“When the executive order was first issued, we had significant concerns with it, and we expressed those immediately to the Department of Health and Human Services and the administration,” Samuel said. “In conversations, it was expressed they were going to put out a clarification and we kind of stood down from implementing everything until that clarification came out.”
That “clarification” came in the form of a new executive order on May 20 that allowed nursing homes to refuse to readmit a COVID-19 patient if the facility lacked the resources to properly quarantine the resident.
“If you can’t appropriately care for the individual for whatever reason -- lack of PPE, staffing, not able to isolate safely -- you can say no,” Samuel said.
Asked if she thought the initial policy was a factor in Michigan’s nursing-home deaths, Samuel said, “No," because nursing homes held off on implementation until the revised policy came out.
Differences in how states count coronavirus deaths.
One issue is simply that states have set their own reporting standards when it comes to coronavirus numbers, which complicates comparing numbers between states.“There’s a problem with some comparisons between states because some states are not reporting accurately" or in a timely manner, said Marianne Udow-Phillips, head of the Center for Health and Research Transformation at University of Michigan.
As an example, as of May 31, Michigan had slightly more confirmed coronavirus cases than Florida but more than twice as many deaths.
But Michigan has been more aggressive in collecting those numbers; or, as MDHHS spokeswoman Lynne Sutfin said, the state has “enhanced reporting that may not be happening in other states." Meanwhile, the person who designed Florida’s coronavirus website says she was fired for refusing to “manipulate” data.
Here are three ways in which Michigan has been more aggressive than Florida in counting coronavirus deaths.
- In both states, the coronavirus death count includes anyone who tests positive for the virus, regardless of cause of death. But Michigan also has encouraged health officers to list “presumed” coronavirus if the person had symptoms of COVID-19 even if the person did not test positive.
- Coronavirus deaths in Michigan must be reported to county health officials within 24 hours. Florida’s coronavirus website acknowledges that can be “significant delays” in reporting coronavirus deaths since they wait on filing of the death certificate. That means Michigan numbers are much more up-to-date.
- MDHHS compares death certificates with the list of people who tested positive for COVID-19. If there’s a match and the death certificate doesn’t list COVID, that death is added to the coronavirus death count. As an example, 37 of the 57 coronavirus deaths reported on Saturday, May 30, were identified through that matching process.
As bad as Michigan’s numbers are coronavirus deaths, it could have have been much, much worse, considering how fast the virus was spreading in metro Detroit in March, said Sims, the infectious disease specialist at Beaumont Health.
“The executive orders that flattened our curve are what saved us,” he said. “Because if that hadn’t happened, our death rates would be three, four or five times as high.”
COVID-19 PREVENTION TIPS
In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus.Health officials say you should be staying at least 6 feet away from others and working from home, if possible.
Use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and carry hand sanitizer with you when you go into places like stores.
Michigan Gov. Gretchen Whitmer has also issued an executive order requiring people to wear face coverings over their mouth and nose while inside enclosed, public spaces.
Additional information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.
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