# Michigan’s Gretchen Whitmer saves lives

Gretchen Whitmer, governor of Michigan, has been steadfast in fighting the COVID-19 epidemic. Even though some of her efforts have been thwarted by political opponents, she has triumphed in making social distancing and lockdown actually work.

Michigan was hard-hit, early. Urban Michigan (counties with population 1,000,000 or more) in particular suffered a crippling caseload by the beginning of April, well into what I call the “critical zone” of > 100 cases/day/million population. Even suburban Michigan (population 100,000 to 1,000,000) was climing to the top of what I call the “danger zone” (50 – 99 cases/day/million population).

But effective action by Michigan state government brought the curve down in urban Michigan, way down, kept the lid on in suburban Michigan, while keeping rural Michigan nearly infection-free.

Perhaps most important is the fact that Michigan has persevered, particularly during May. The result is that cases have continued to drop, in urban, suburban, and rural areas. Today in Michigan, the latest 7-day average caseload is below 50, outside the danger zone (but still in the 20-50 range that I call the “alert zone”). At this level, the disease is definitely still a problem but we can handle it. And: fewer people die.

When the curves lower, lives are saved. When the curves rise, lives are lost. Gretchen Whitmer is saving lives in Michigan.

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### 24 responses to “Michigan’s Gretchen Whitmer saves lives”

1. It’s true and it’s factual, but the anti-science crowd are contemptuous of facts and demonstrable truths, so I don’t know that knowing this and showing this accomplish much with that crowd.

It seems like with AGW and now, Covid, that the divisions in the US have hardened considerably along red/blue lines. The red president retweets something that says the only good democrat is a dead democrat to a population that is armed and angry. Police continue to believe they can snuff the lives of black folks with relative impunity. And the riots have started. We may be in for a long hot summer of unrest and riots like we had in 1967. Maybe history does not repeat, but it rhymes.

I think my question is how do we help the truths gain traction and drive good public policy today? How do we persuade our reddish friends to put down their guns and grievances and realize that our collective security derives from solidarity and mutual aid.

My answer to that question is that we demonstrate the security of solidarity and mutual aid. What does that look like? Maybe it looks like the Common Ground Collective that developed after Hurricane Katrina: https://en.wikipedia.org/wiki/Common_Ground_Collective

2. Susan Anderson

Gov. Whitmer is a study in courage!

3. I really worry that such successful states mask the rising problem in other states in the national average number of cases. In the German news there was a map with changes in new infections from one week to the next for the lower 48 states. Four of them showed a rise of more than 50%!!

I worry they will not respond in time locally thinking that they are not New York and that nationally the problem is not seen in time.

• I’d be really interested in seeing that map if you have a link.

• I hope this works. It are actually 3 state Arkansas, Alabama and West Virginia.

• Susan Anderson

It’s worse than that. Red state team-sport politicization of so-called “freedom” has led people to treat sensible precautions with contempt. They also regard anything to the left of Fox as part of the deep state. Sadly, their numbers are showing how stupid this is. Look at Brazil too.

4. @smallbluemike @Victor Venema

It doesn’t matter what They Who Won’t Learn will say or do. Gov Whitmer and other governors, notably New York’s Cuomo and Washington State’s , now have a base of knowledge on how to manage this virus which is indispensable.

And it is fortunate for the United States that they have, for the federal government, apart from relatively silent sectors of the national health apparatus, does not have this expertise.

So, when other states get into trouble, their path will be easier, resulting in lower loss of life than they would otherwise have experienced. Unfortunately, this was paid for, in part, by more-than-necessary loss of life in New York State, Michigan, and Washington State’s Inslee, and that, in turn, due to the abdication of responsibility by the present United States Executive, and little federal funding.

And the Gang of the Orange Mango is, IMO, typical of how to deal with “anti-science crowd”: It would be better if they were on board, but we can to some degree do without them.

On the science front, I’m also concerned about the fracturing of international dependencies and ties which are critical to scientific progress. Science is not a nationalist enterprise. And, fortunately, the American Association for the Advancement of Science (AAAS) is organizing a conference with what I believe is the Chinese Beijing Academy of Sciences (not sure I’ve got the name right) to underscore this.

5. I worry about what happens after lockdown. Here in New Zealand, we’ve virtually eliminated the virus, with only one active case and zero new cases for nine days in a row (and virtually no new cases for over two weeks). That was achieved by lockdown for 5 weeks (and partial lockdown for two weeks) and physical distancing. Another key contributor was the eventual elimination of imported cases by stopping all non-residents (apart from citizens) from coming into the country (with a few exceptions) and requiring all entrants to quarantine for 14 days, latterly in government managed facilities.

Taiwan managed it even better, without a formal lockdown but with similar border controls, physical distancing and face masks.

But at some point, the economy and borders open up again. We’ve opened the economy up a lot but retain the border controls. Eventually, the virus will get in again and start spreading. I don’t know what our government’s plan is for managing the risks and the inevitable second wave. We can’t go into periodic lockdown whenever the virus starts spreading again.

Presumably,the same would apply to Michigan, in terms of what happens when the economy fully opens and cases start to rise again. I’ve a feeling that mandatory face mask wearing (and a strong push to educate about mask hygiene and use) will need to be part of our future for a long time and, probably, physical distancing, disinfection and hand washing.

6. Mike, there’s some reason to think that with adequate testing and contact tracing, the ‘blunt instrument’ of lockdown can be avoided. Certainly in New Zealand you have a good chance of it; better than in the US, where state borders can’t really be closed. (Even the Canadian and Mexican borders haven’t really been closed–though ‘non-essential’ travel was banned, there’s a hell of a lot of ‘essential’ travel across both borders that never stopped.)

In this model, you are playing whack-a-mole with little brushfire outbreaks all the time, but if you can keep dancing fast enough, it’s possible to stay ahead. Eventually, we get either a vaccine, or herd immunity. But based on the past, it’s likely to take a couple of years.

• Doc, yes, we have pretty good systems in place for testing and tracing. In NZ, there are thousands of tests for each positive (in the US, about 1 in 10 tests are positive). I worry, though, that our initial strategy of flattening the curve got overtaken by a goal of elimination (which we seem to have achieved, for now). In hindsight, we probably should have relaxed the lockdown earlier and allowed a slow spread of the disease to really flatten the curve rather than eliminate the curve.

As for vaccine or herd immunity, it seems we don’t have enough information to know that either of those will happen (i.e. we don’t know if any vaccine can be produced, whether any vaccine will confer long lasting immunity of even a year, or whether contracting the virus confers long term immunity). It may be that we have to hope that enough immunity is provided by either route to just keep the virus simmering at a level that can be easily managed indefinitely.

• Mike, I think we can be pretty assured that one or the other or both *will* happen. It’s pretty much been the case for all past outbreaks of novel pathogens. But just when is uncertain. And it may be the case that it covid remains a lingering risk even after there’s herd immunity (either natural, induced, or a combination)–just as many ‘old’ diseases continue to be. Perhaps that’s what you meant, too, with your “indefinitely”?

• @Doc Snow,

There’s another possibility … It could be that SARS-CoV-2 is a recent innovation with a reservoir in a wild or semi-domesticated animal population which occasionally crosses to people. If so, the “China virus” idea may be completely out of whack, and the disease could have emerged in Europe, could have emerged anywhere, and spread rapidly because of international (air) travel. (Detailed balance principal: If it can infect readily from China to Europe by air, or China to the USA by air, it also can infect in the other direction just as readily.) Also, as improbable as it seems, it may have crossed from animals twice. We don’t know, and, as the interest gets focussed upon vaccines and the like, this line of research is not being pursued as strongly as it should, not only to learn more about SARS-CoV-2, but to learn something about the next pandemic possibility.

• “In hindsight, we probably should have relaxed the lockdown earlier and allowed a slow spread of the disease to really flatten the curve rather than eliminate the curve.”

FWIW & IMHO, I think you guys did the right thing. Allowing it to persist would have been tantamount to consenting to unnecessary deaths, and there is always the risk of losing control. Better, I think, to hit it as hard as you can, repeating as necessary.

• Well, Doc, yes, my “indefinitely” did refer to a lingering risk from Covid but also to the possibility that there is only limited immunity from having had it or from any vaccine, if one can be developed, so it could end up as a permanent threat, like a very bad flu virus strain.

I’m not sure we did the right thing, though. Lockdown hits a lot of people very hard, not just mentally but also in lost jobs and lost business. Governments can only provide financial help to a certain degree. The virus can be deadly but possibly only 1% or 2%, though the degree of permanent but non-fatal damage is unknown. That fatality rate amounts to a lot of people, to be sure, but if (and that is also a big unknown) the virus seems bound to come back and eventually spread through most of the population, even over several years, then the greatest challenge is to the health system if hospitalisation is needed at the same time for more than the capacity. So a policy of keeping the curve fairly flat and at a manageable level may have been better than a month long lockdown, especially if it has to be repeated often over the years.

Personally, I can live without international travel (though it, sadly, would mean no personal interaction with wider family), so would be relatively happy with permanent border controls, though I doubt most people here would agree, so those controls will go eventually (or at least be replaced by modest controls).

7. Thomas P

Doc, it’s unfortunately uncertain if immunity to Covid even lasts a couple of years. It doesn’t for the common cold which is another corona virus. For the same reason no one knows if you can make a vaccine that gives more than a short time effect.

Worst case, we are faced with ‘evolution in action’.

• Actually, the common cold is most commonly a rhinovirus, with coronaviruses a small minority.

• Yes, this is a “known unknown.” But evolution in action isn’t actually the worst case, in the sense that diseases generally evolve to be *less* lethal to the host species. It’s advantageous to the virus to have lots of live hosts, right? That’s likely why so many plagues have a zoonotic component: the pathogen and its host have co-evolved a certain level of tolerance, but when the pathogen jumps to humans (or some other novel host species) all bets come off, so to speak, since there is for that new host no history of exposure to confer even limited immunity.

• @Doc Snow,

… that diseases generally evolve to be *less* lethal to the host species. It’s advantageous to the virus to have lots of live hosts, right?

There may be a pattern here, but it is not always true. A notable case is bubonic plague where the flea vector actually dies from being a vector, since the mechanism for transmission to rats or people involves a flea bite followed by the flea regurgitating Yersinia pestis-infected blood into the wound. This happens because Yersina is a very large bacterium and clogs the flea’s gut.

It is also notable because there’s no evidence that Plague has gotten less virulent over time. The ups and downs of its occurrences have been studied mathematically for a long time …

See Brownlee (1918), “Certain Aspects of the Theory of Epidemiology in Special Relation to Plague“.

See Davis, et al (2008), “The abundance threshold for plague as a critical percolation phenomenon“, one I find fascinating.

See Monecke, Monecke, and Monecke (2009), “Modelling the black death. A historical case study and implications for the epidemiology of bubonic plague“.

See Mangiarotti (2015), “Low dimensional chaotic models for the plague epidemic in Bombay (1896–1911)“.

Finally, see Dubyanskiy and Yeszhanov (2016) for a thorough exposition.

I don’t know what the current read is, but some of the hypotheses offered for why Plague stops its spread in any breakout is that a major rat vector develops herd immunity for a time. That it takes herd immunity means the rats get sick, and also rats die. But, given the dynamics of the phase portraits of these systems, the end of the epidemic/pandemic might be determined near its start.

• Thanks for that comment, eq! Would you mind expanding on this phrase:

“…the dynamics of the phase portraits of these systems…”

I frankly don’t understand that, and expect I’m not the only one. But it sounds intriguing.

8. @Doc Snow and all,

All I really meant was that as soon as there are N interacting distinct biological populations, N>1, the state consisting of their numbers seen as an expression over time is a system of coupled differential equations, and its trajectory through the corresponding phase portrait depends upon initial conditions. See Chapter 12 (“Ecology”) of Hirsch, Smale, Differential Equations, Dynamical Systems, and Linear Algebra, and, in particular, section 2 of that chapter where they describe in detail what can and often does (“Predator and Prey”) for N = 2. Similar complexities arise for species competing for resources. And things get vastly more complicated for N>2.

That’s an introductory text. Similar discussions are presented in Chapters 2, 5, 6, and 8 of S. P. Ellner, J. Guckenheimer, Dynamic Models in Biology, with Chapter 6 discussing differential equation models of infectious diseases.

Then the most systematic treatment is J. Hofbauer, K. Sigmund, Evolutionary Games and Population Dynamics, where they drop the kid gloves and deal with the Lotka-Volterra equations in their full glory, including Hopf bifurcations, periodic orbits, and food chains. Part two of the book transitions to a discussion of evolutionary stable strategies as games, including the famous Hawks and Doves interpreted as a game, where most natural conflicts are settled without overt conflict, contrary the the stereotypical movies shown about “nature” on TV and in hunting lodges.

Parts three and four of Hofbauer-Sigmund go on to more complicated things, respectively, Permanence and Stability, and Population Genetics and Game Dynamics. Tucked in Chapter 16 in section 16.5 (of part three) is titled “An epidemiological model” where the strategy of parasites is considered.

Three problems (16.5.1, 16.5.2, 16.5.6) which, to understand, need the full context of the section, which obviously cannot be given here, suggest some of the complexities. Just their beginnings:

* 16.5.1: “Show that if the parasite can spread, then either the whole population becomes infected, or infected and uninfected hosts will coexist at equilibrium ….”

* 16.5.2: “Show that in the absence of horizontal transmission (i.e., for $\beta_{i} = 0$) the less virulent strain … always wins.” Horizontal transmission is infection from individual to individual. In contrast, vertical transmission is infection from parent to offspring.

* 16.5.6: “Specialized antibodies can recognize specific loci (so-called epitopes) of pathogenic virus and mount an immune response. If the virus has two epitopes, each with two variants, this leads to the following eight-dimensional predator-prey equation …” The setup for these problems assumed there were but two mutually exclusive parasites, except, for instance, if one specializes in horizontal transmission and the other in vertical.

So, for Plague we have a parasite, Yersinia, hosts, variously, people, two species of rats, and fleas. There are initial and boundary conditions on the populations. There are various kinds of host immunity, including antibiotics and the like for people. This is clearly going to become a complicated phase portrait.

I’ve always been fascinating by this stuff, ever since, just out of graduate school, I discovered the monograph:

Peter Yodzis, Competition for Space and the Structure of Ecological Communities, Lecture Notes in Biomathematics 25, Springer-Verlag, 1978.

The fascination with the idea that seemingly deterministic structure was a byproduct of dynamics never left me.

The appreciation I have as a rudimentary scholar of this field for how complicated these get how quickly also gives me deep respect for the epidemiologists who offer models of epidemics like that for SARS-CoV-2. Note that not only is the basic problem complicated, but the responses of the virus in its phase space to various interventions, particularly as antibody treatments, vaccines, sheltering, and other measures are trotted out, each with varying degrees of effectiveness, can be varied, and trajectories can change. Not only will dynamics change, but the virus might adapt and target different organ systems instead of the typical, conditions might select for one of the varieties out there, etc.

So, given how outcomes so depend on how people as groups behave, criticism of misses, understatements, overstatements, and so on are grossly misplaced. The alternative is for policy people to be told, “We don’t know. Take your best shot.”

This is like predicting climate disruption when the primary determiner of future disruption is what humanity across the globe does and does not do.

• Thanks for that. I’m sure the original would have been mathematically over my head, so at least getting a flavor of what’s involved from your summary is much appreciated.

9. Susan Anderson

The Boston Globe did a superb article on C19 in Massachusetts. I don’t know if its paywall will be a problem, but it is too long to post more than this extract here. It is particularly poignant for me as I have historical ties to Biogen from my former day job. I was brought up avoiding “germs” but US culture cultivated ignorance of contagion as if it was subject to “belief”. Live and learn!
https://apps.bostonglobe.com/metro/graphics/2020/05/coronavirus-tale/
The virus’s tale: Track the coronavirus pandemic in Massachusetts to its roots and you find a story driven by heroics, ingenuity, error, pain, and a hard question: How could a state famous for health care excellence have suffered such a vast loss of human life?

Biogen’s chief medical officer, Dr. Maha Radhakrishnan, called the state’s Department of Public Health.
“There was a meeting of [175] people from all countries and 50 of them are symptomatic,” wrote the epidemiologist who took the call. “Caller has questions.”
But the initial answer to whether any of them could be tested was “No,” Biogen officials say.
Another alarm missed, and time for action squandered.
By then, the Biogen meeting had been over for days. Its attendees had roamed the city and then dispersed to every corner of the state and the globe, going to house parties, hugging family members, sending children to school with a kiss on the forehead. New infections tied to Biogen would soon spring up in Boston, in Cambridge, in Wellesley, in Norwood. On Wednesday, March 4, Baker and other state officials, after meeting with front-line medical workers, reiterated that the risk posed by the virus was low — a stance they would maintain for several more days, despite ominous signs of the Biogen cluster spreading. They said the state was prepared.

Biogen was 2/3rds of the spread, and caused clusters all over the world, including my other location, Princeton!

10. Susan Anderson

Re contagion, an anecdote. My mother, age 93, has been confined to a nursing home for several years, part paralyzed etc. Almost everyone at the nursing home (long story, not here), staff or patient, is positive. They finally tested her, and she showed up positive, so she’s been isolated in the COVID unit for quarantine. She continues asymptomatic, and our private aides (recommended if you can afford them, almost all nursing homes are badly staffed) have tested negative.

I have two possible theories as to what happened.
(1) Some people appear to have been immunized by one of the coronavirus colds that circulated within the last year or so
or
(2) The test was a false positive.

Clearly, the hygiene imposed by our aides is superior to that exercised by the nursing home, but I regard their continuing health as a small miracle!

• Wishing you and her the best, not to mention the caretakers. My mother in law turned 97 in seclusion in her assisted living facility. Our sister-in-law ended up taking her to her home to shelter in place there: while the seclusion was epidemiologically sound, it was proving so psychologically damaging that the alternative seemed clearly preferable both medically and in terms of quality of life.