Opinion | Flattening the curve is not a winning strategy. Michigan must attack.

Larry Buege

Larry Buege is a retired physician assistant who lives in Marquette.

We are fighting a war with a virus—and flattening the curve is not a winning strategy. Examination of the now-famous bell curves reveals that both have the same area under the curves. Each outcome predicts the same number of people will be infected. With a fatality rate of 2 percent or more, it isn't acceptable. Instead of flattening the curve we must invert it.

To understand how to accomplish this we must introduce an infrequently mentioned statistic called R0 (pronounced R naught). R0 refers to the average number people infected by a single infected individual. The common flu has an R0 of about 1.3, which is the number of people infected by each person with the flu. This is a difficult statistic to quantify, but that does not stop epidemiologists from trying. Currently, they believe the novel coronavirus has a R0 of about 2.0, which makes it much more contagious than the flu. Measles has a whopping R0 value of 12-18 in an unvaccinated population (please vaccinate your children). 

We know a virus with an R0 above 1 will start a chain reaction and produce an epidemic. If the R0 is less than 1, it will wither and die. In a normal flu cycle, the virus with a beginning R0 of 1.3 will increase the number of infected individuals. The infected people will get better or die. Those that survive will be immune to the virus. With more and more people immune to the disease, it becomes harder to infect new individuals. The R0 drops below 1, and the flu epidemic subsides.  

With such a high mortality rate, we cannot allow the coronavirus to run its course. China, South Korea, Taiwan, Iceland and Singapore have proven this is possible. They have done so by going on the offensive. We hide from the virus, which is a defensive tactic. They attack the virus. In Taiwan everyone getting off a plane is tested on the spot. In South Korea you cannot board a bus without having your temperature taken. In all of these countries any new arrival is quarantined for two weeks and closely monitored.

The R0 value for the coronavirus is probably lower in the Upper Peninsula than it is in Wayne County. We have been practicing social distancing for centuries. Detroit residents are allotted a square 4 feet on a side for personal space. Yoopers are allotted a square 16 feet on a side for personal use. Our towns and cities are often separated by 20 or 30 miles of trees and swamp. Cities in Lower Michigan are separated by city limits signs. 

A few weeks ago the U.P. had no positive cases. Now about half of the counties have at least one. Most of the infections can be traced to outside contact. We have snowbirds returning to the U.P. and downstaters returning to summer residences. We also had prison inmates shuffling between prisons (this has stopped). We have been treating these infections like isolated brush fires. The county health departments squash them before they can spread.

Like the aftermath of any war, this war could leave our economy destroyed and the people devastated. If we are to avoid multiple bankruptcies and a severe recession, we must learn from nations that have conquered the virus. The one common denominator in such nations is that they aggressively tested everyone with a fever or cough. (We only test the most severe cases.) If a positive case is found, all the contacts are aggressively hunted down and tested, with or without a fever. Taiwan, Singapore, and Iceland have not even found it necessary to close schools or businesses. 

I am a retired physician assistant and a Yooper who has lived in Marquette for more than 40 years. I am used to being ignored. I can tolerate being left off the Michigan map. I am normally willing to allow Detroit and other large cities to wag the dog, but now Lansing is making devastating decisions that drastically affect our physical and economic survival. U.P. businesses are going bankrupt, and many of our hospitals will fail because they are not allowed to perform routine procedures. The coronavirus kills, but so do recessions. The one- size-fits-all solution to the coronavirus will drag all counties into recession, even those without coronavirus infections. Yoopers desperately need relief from the governor. These suggestions will help Michigan recover, one county at a time: 

  • Repeal the exemption that allows people to freely transit between infected counties and summer dwellings .
  • Close the Mackinac Bridge to all except essential traffic. We have already closed the bridges to Canada.
  • Take infrared temperatures of all individuals crossing the Mackinac Bridge.
  • Obtain infrared temperatures of all individuals arriving at Michigan’s commercial airports.
  • Test all inmates and prison employees.
  • Declare any county that has not had a positive test in two weeks  a virus-free county and exempt it from the current rules. Schools should obtain infrared temperature readings from students and staff daily. Hospitals and physician’s offices can reopen. Temperatures should be taken of all individuals entering a physician’s office, and patients should be provided a face mask.
  • Most rural counties only have a few major roads into the counties. Construction workers with their stop/slow signs should be posted on these roads and infrared temperatures taken of all travelers. Everyone entering a virus-free county should be requested to quarantine themselves for two weeks.
  • Quarantine means not leaving the house for any reason. Each quarantined family should have a volunteer “coach” who contacts them daily and grocery shops for them.

These may seem like draconian measures, but such measures will be needed to protect virus-free counties. We are at war, and like war, success is measured in captured territory. We must reclaim our state one county at a time.

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Comments

John S Walker
Tue, 04/07/2020 - 4:56pm

Amazing commentary Mr. Buege,
I have been following this very closely, and advocating for our fast-food & 14-17 year olds who are still working.
Your strategy is very sound and proactive, I sincerely wish wellness check points could be accepted by our population.
I also wish folks would pay attention to the fact that the sanitizers used in most restaurants will not kill this novel coronavirus.
Best to us all,
A troll living in Norvell :)
John S Walker

David
Tue, 04/07/2020 - 7:38pm

This is just a commentary on how to protect the UP. I think all of these make sense and some of it even applies to non rural areas, but considering the outbreak is crushing the metro area, this hardly seems like a plan to help out the state as a whole.

JLK
Tue, 04/07/2020 - 7:52pm

You're overlooking the fact that there aren't enough tests to go around, which is why they're limited to those with severe symptoms at the moment. Also, this does very little to stop all the folks driving into the UP from Wisky. That's a big ole border line to try and control with limited resources. Also, if you're going to force people into a quarantine-like setting for 2 weeks, there's no point in slowing everyone down with temperature taking. We know that the virus can be transmitted by those showing no symptoms (including the lack of a fever or even slightly elevated temperature). Not to mention fever is a symptom of thousands of viral illnesses, not just COVID-19, so that alone tells very little.

Katrina Gauld
Thu, 04/09/2020 - 9:54am

Quarantine for those diagnosed. They were still being allowed to travel as long as no symptoms even tho testing positive. That is epic failure.

Pat Nelson
Wed, 04/08/2020 - 8:55am

Unfortunately, we lack the tests (at this point). In low-infection areas, we could still be pursuing contact tracing. I hear nothing about county health departments' actions on this.

M Conaghan
Wed, 04/08/2020 - 11:02am

I really like this plan, and especially the idea to create sectional rules. It would work, for instance in the UP if it were treated as one section. Lower Michigan could be regulated better by separating the ravaged counties in the southeast. The middle could be regulated down to one-three separate sections. If only we had the local infrastructure and national leadership to enforce and carry out required tests. It is a plan that has worked.

Steve
Wed, 04/08/2020 - 5:23pm

This is great. But, do we finally have the tests and masks that would allow this kind of plan to be possible?

Ramona
Wed, 04/08/2020 - 5:36pm

At first look, your plan has merit, but as others here have already commented, it won't work. Interstate travel cannot be constrained and the UP has a long border. We do not have a fraction of the tests we need to canvas a population. Everyone would need testing as symptoms do not appear in everyone who is carrying COVID-19. Be glad you have few infections. Pressure the Federal government to make tests available everywhere in quantities large enough to evaluate a population, not just those showing severe symptoms. Even New York doesn't have nearly the tests it needs to determine how many have actually died of COVID because they are dying at home. Statisticians will have to look at the numbers after the fact, comparing the average death rate during a month with the actual. The difference would demonstrate deaths by COVID. We have a long way to go, unfortunately. Ask yourself why the USA has more cases than any other country including China. A lot of things went wrong, but who is responsible for those missteps? In comparison, California is bending the curve despite being the touchdown point for many infected people arriving on the West coast. The governor shut down the state before any other. This is horrific in every way, but we need to let the epidemiologists tell us when and how to reopen.

Katrina Gauld
Thu, 04/09/2020 - 9:59am

We can limit travel in the state. Why would you say we cannot? Long boarders. The only crossing into the UP that is not regulated is from Wisconsin. The other boarders are International and already have check points.

Katrina Gauld
Thu, 04/09/2020 - 9:51am

I so agree with a large portion of this. Our governor has helped this grow by not quarantine Ong those with the virus and by allowing continued statewide movement.

Olive Gomoll
Tue, 04/14/2020 - 12:39pm

Open our greenhouses with the same guidelines as supermarkets!