“‘Michigan is an outlier that’s profound,’ said Dr. Eric Topol, a professor of molecular medicine at Scripps Research in La Jolla, Calif. ‘This is a precedent in the country. It’s about plasticity, flexibility in responding, in being able to pivot.’ He added that tens of millions of doses were sitting unused across the country, and ‘in some states, you can’t even give them away…’ Vaccines could have been surged to Michigan weeks ago when signs of its new wave of infections were appearing, he said, like signs that are now showing up in other states, such as Minnesota. ‘We have this incredibly powerful tool, and we’re not using it…And it’s just an outright shame.’” The New York Times, April 13, 2021

            “Hi this is Michael Moore and this is an Emergency Podcast System episode… I appeal to my friends across this country and across this world: please stand for Michigan. Please come to our aid. The level of COVID cases has doubled, then it tripled, then it quadrupled…  We need to act immediately. This is a surge that’s out of control… Sadly the CDC has decided, the Biden administration has decided, not to give Michigan any more vaccines during this very sad turn of events. Now I think that’s wrong. And I think that we need to demand that the vaccine—the Pfizer vaccine that is made in Michigan, in Kalamazoo Michigan—that we get as many of these vaccines into as many arms as possible…to help put a stop to this UK variant. But if it gets ahead of the number of vaccinations…we may not catch up. And believe me there’s no Covid border around the state of Michigan. This…will happen where you live… So number one, the CDC needs to send more of the vaccine to Michigan, in hospitals, doctors, clinics, every pharmacy…This needs to happen in the next few days, not next week, not next month. The Governor of Michigan has to shut the state down…just for a little bit, this is not some long-term thing here this is just right now, immediately, to try and bring an end to this rapid, rapid epidemic in Michigan… Both are wrong; the CDC is wrong, the governor of Michigan is wrong. Let’s get this fixed right now. Please call your Congress people and your Senators at their switchboard on Capitol Hill 202-224-3121. Please contact the governors office…in Lansing, Michigan, and please go on WhiteHouse.gov and send a note to President Biden and ask him to please increase the amount of doses to the state of Michigan this week, right now, let’s not let this thing grow…it’s critical right now, this doesn’t need to happen… This just has to end. Everybody get your shot, everybody wear a mask, everybody keep your social distance and wash your hands. Be kind to each other. And politicians, the Governor, please, please…close it down just for a little bit. And the CDC: you’ve got to send us more vaccine…” Documentary filmmaker Michael Moore, Podcast #182, April 12, 2021

            “[Michigan] State Representative Steve Johnson, a Republican, said he doubted that many people would comply with a lockdown order. ‘For [Governor Whitmer] to try to continue those measures would have been political suicide,’ he said.” The New York Times, April 13, 2021

Dear Students,

The American Robin is the State Bird of Michigan, and it’s shown here singing its heart out on the graph of the new massive surge in the state. Michigan’s coal mines were tapped out decades ago, but there’s a saying about “the canary in the coal mine” that warns miners of toxic gas, not by singing but by dying.

Plenty of people in Michigan are doing that job for us in America, where we just keep digging ourselves deeper into a hole that the Michigan Robin is trying to warn us about. Of course, it’s just the Michigan population of the American Robin, just as the Michigan virus is part and parcel of good ol’ American SARS-CoV-2.

Michael Moore is right to say that Michigan’s Governor Gretchen Whitmer should ideally shut down the state again. But as that state legislator Steve Johnson points out, it would be political suicide.

If only that were the worst form of suicide it could be.

Last spring lockdowns led a Trumpist mob to stage an armed coup in the State Capitol building, a coup that actually succeeded in shutting down the legislature for several days. Obviously it was another robin in the coal mine, warning us of a similar coup attempt on our nation’s Capitol on January 6th. We have not seen the last of these.

But meanwhile, a group of deadly serious armed plotters were planning to kidnap Governor Whitmer, ending her administration, and some of them were planning to kill her. This planned assasination and coup was aborted by the FBI, but the next one may succeed. That doesn’t mean that she doesn’t have a duty to keep the people of Michigan safe, she still does.

But it’s pretty sickening when CDC Director Rochelle Walensky sits in the complete safety of her office in Washington and turns down a threatened and vulnerable Governor who is begging for vaccines. Walensky and President Biden have miserably failed the people of Michigan, and they will soon be failing much larger swaths of America, by insisting on a pigheaded policy of distributing vaccines exactly in proportion to a state’s population.

That means not only the Michigan surge but other state and regional surges to come will be ignored while millions of doses of vaccine sit unused. Biden and Walensky are already planning how to distribute internationally hundreds of millions of doses that will comprise a huge American surplus in a few weeks time.

Do I understand that vaccines take weeks to start working? Yes I do, and you know I do if you’ve been following what I’ve said all along about them. But that just means that Biden and Walensky failed Michigan weeks ago as well. Dr. Ashish Jha, one of the leading public health voices throughout the pandemic, tweeted on April 8, “This is very upsetting. Michigan is struggling. We need to be surging tests, vaccines to the state.” The idea that it is too late now is in my view absurd. Vaccines now could prevent millions of Michigan cases a few weeks down the road, even with one dose of a two-vaccine regimen.

What Walensky and others are saying to justify not doing this is a disgusting evasion. They are playing a political game. You can be that if this surge were in Texas or Florida they would not be withholding vaccine. Michigan is a blue state, like the color of the sky behind the robin. Biden’s people are afraid of seeming to favor Democrats, so they are letting Michigan and its Democratic Governor twist in the wind.

That’s the game—avoiding blame—instead of avoiding illness and death.

Walensky said, “The answer is not necessarily to give vaccine.” Not necessarily? What kind of mealy-mouthed answer is that? And, “The answer to that is to really close things down, to go back to our basics, to go back to where we were last spring, last summer, and to shut things down.”

So, Dr. Walensky, is your boss going to send troops to protect Governor Whitmer and her family? Are you going to stand beside her in Lansing when she faces another anti-lockdown mob that wants to kill her?

Michael Moore understands the value of “everybody wear a mask…keep your distance, and wash your hands.” He is also, like Governor Whitmer, begging, begging for a surge of vaccines for Michigan.

Dr. Eric Topol, whose twitter feed has been a vital source of information for me and thousands of others throughout the pandemic, thoroughly understands and promotes the tried-and-true precautionary measures, and knows, as I do, that they would be a faster response to the Michigan crisis than additional vaccines would.

He also said about extra vaccines for Michigan, “We have this incredibly powerful tool, and we’re not using it…And it’s just an outright shame.”

Where Dr. Walensky or anyone else gets the idea that vaccines and masks are substitutes for each other is beyond me. I do think however that we are watching a political game run by Biden in his Michigan vaccine-refusal gambit, just as we so often watched Trump play as President.

The irony is that Trump’s political game worked against blue states like New York and Biden’s political game is working against the blue state of Michigan.

Good News

1. Biden’s performance in rolling out the vaccination program nationally, despite my grave reservations expressed above, has more than met expectations. I criticized him for thinking at first that a million shots in arms a day was an achievement, at a time when experts were saying 3 million a day were needed. Biden deserves credit for getting to that number as an average, with maximums up to 4.6 million. We will have 200 million jabs by the end of Biden’s first 100 days, double his original goal.
2. Biden and his associates frequently wear masks in public and preserve social distance, setting desperately needed examples for the American people—examples which, very happily, are the opposite of what we had for the previous first year of the pandemic. Biden takes frequent opportunities to encourage these measures as well as thinking about ways to address the looming problem of vaccine hesitancy.
3. Data continue to emerge confirming the safety and effectiveness of the two mRNA vaccines, which represent a completely novel kind of vaccine science and one of the greatest achievements in the history of medical science. In addition to safety and efficacy, the mRNA technology afforded an unprecedented platform for speed in development of the original vaccines without compromising safety, and it will continue to provide a platform for speed in the relentless arms race against new variants of the virus, allowing for the development of variant-specific new vaccines and boosters with unprecedented speed. (Read the moving story of Dr. Kati Kariko, the brilliant and heroically self-sacrificing lab-science gypsy who helped lay the mRNA groundwork.)
4. Just in the last few weeks some uncertainty has been removed about whether fully vaccinated people can contract, carry, and pass on the virus asymptomatically. The answer increasingly appears to be, for the most part, no, even with the much more transmissable and more virulent UK variant. Also, current protection against hospitalization and death, at least with the UK variant and the main one preceding it, appears to approach 100 percent.
5. Monoclonal antibodies (aka passive vaccinations) have continued to prove themselves as useful if not magical. They still require intravenous infusions but are increasingly doable in outpatient settings, and they prevent early cases from progressing to hospitalization. Increasingly too, they are being introduced for people who have no symptoms but positive tests for active virus and even for people who just have known exposure. Vaccines are not much use in these situations. Research on intramuscular injection of monoclonals is under way, and if successful would greatly enhance the deployment of this lifesaving technology.

Bad News

1. The Johnson & Johnson (Janssen) vaccine has been halted because of a blood clotting problem affecting about one in a million vaccinated people (6 in the US; one died and one is gravely ill). This is a similar adverse effect to that suspected with the AstraZeneca vaccine. In both cases the nature of the clotting disorder is unusual, and so unlikely to be part of the background clotting problems expectable in such a large population. The J&J patients were women of reproductive age, suggesting an immune system problem. The halt, if it has to continue, removes a single-dose vaccine from the toolkit, a loss for the US but a much more important loss for the world.
2. 200 million doses in American arms by the end of April (Biden’s 100 days) means 100 million people fully vaccinated, approximately 30 percent of the US population, or less than half of the level needed for herd immunity. Even adding the immunity of people who’ve had the virus doesn’t get us near herd immunity, which is at best months away—without taking the newest variants into account, with their potential for resistance against immunity and vaccines.
3. Vaccine hesitancy, particularly common among Republican men, will play an increasingly large role as more of the country is vaccinated. Children will not even begin to be vaccinated until late summer at the earliest. Herd immunity is not a slam-dunk; it will be an increasingly uphill slog as long as vaccine acceptance is politicized.
4. I have become increasingly convinced, thanks to Michael Osterholm who along with a few others has been arguing this for months, that we should be using our vaccine doses very differently. Namely, we should administer twice as many first doses of the two-dose vaccines rather than insisting that people get a second dose within a few weeks of the first. As Osterholm cogently argues, using two doses to give two people first doses results in 80 percent protection for both, while giving two to one person and none to the second person results in an average of 47.5 percent protection, since the two-dose person has 95 percent protection and the other has zero. Mathematical models easily show that Osterholm’s strategy gets to herd immunity faster.
5. Last, and most important, the pandemic is not an American problem or a developed world problem but a global one, including a general threat of global instability. We have not even begun to fight the global war against the virus. Herd immunity for the world will take years to achieve. You don’t need to care about humanity, just the long-term repercussions for you. The virus loves the global stage, which is its evolutionary playground. We already have growing numbers in our country of the South Africa variant (B.1.351) and the Brazil variant (P.1). What new variants will evolve in the slowly vaccinated populations of poor countries and bounce back to us in ’22 or ’23? Stay tuned.

Michigan, the robin in the coal mine, represents what much more of America will be facing in the months ahead. If the Biden administration does not drop its political games and surge vaccine supplies to states and regions that have surging virus—whether blue or red—we will be wasting time and vaccine doses and causing preventable deaths. The time may come soon to tally up the deaths cause by the Biden administration’s sometimes willful errors, just as we have done with Trump. They won’t be as many, but they will be substantial. Biden doesn’t get a pass on a bad decision because it followed two good ones.

Also, we need to look at the evidence for Osterholm’s claim that vaccinating twice as many people once would save many thousands of lives. We only found out recently how much protection one dose of the two-dose vaccines gives us. As Dr. Topol said, “It’s about plasticity, flexibility in responding, in being able to pivot.” New knowledge brings new responsibility.

Old knowledge helps too. Mask up. Keep your distance. Avoid gatherings. Use caution until we see what the new variants can do. This is not over, not even close.

Stay safe,

Dr. K

PS: Please don’t just rely on me. The most important recent addition I have is Dr. Michael Osterholm’s weekly podcast from CIDRAP, the Center for Infectious Disease Research and Policy of the University of Minnesota; it drops on Thursdays. He combines realistic assessments and warnings with uplifting stories about how people are finding light and small victories in the pandemic. The best resource on what is happening specifically in the state of Georgia is Dr. Amber Schmidtke’s Daily Digest. More generally, I recommend the following: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; for the science of viruses, especially the new coronavirus, This Week in Virology (TWiV) podcast; Dr. Sanjay Gupta’s podcast, Coronavirus: Fact vs. Fiction; COVID-19 UpToDate for medical professionals; and for the current numbers: Johns Hopkins University (JHU); Institute for Health Metrics and Evaluation (IHME); Our World in Data (OWiD); The New York Times Coronavirus Resource Center (NYT). For uncannily accurate warnings, follow @Laurie_Garrett on Twitter. I also recommend this COVID-19 Forecast Hub, which aggregates the data from dozens of mathematical models, and this integrative model based on machine learning. For an antidote to my gloom, check out the updates of Dr. Lucy McBride, who doesn’t see different facts but accentuates the positive.