Opinion | Reopening Michigan: Policies ignore how vulnerable Americans really are

Scott L. Greer is a political scientist and professor, Katarzyna Klasa is a Ph.D. candidate and Neil Mehta is an assistant professor in the Department of Health Management and Policy at the University of Michigan.

Governor Whitmer’s decision to extend stay-at-home orders to limit the spread of the novel coronavirus has broadly worked. People did not just support it; they actually stayed at home to a degree beyond what analysts expected, allowing us to avoid the worst health outcomes that were projected. 

But what comes next? Now that we are "flattening the curve," voters and politicians are looking to reopen local economies while telling vulnerable people to stay at home. Most recently, Whitmer published the MI Safe Start Plan, detailing the six stages of reopening from "uncontrolled spread" to "post-pandemic" with progressively fewer limitations on social activity at each stage. It improves significantly on the White House’s cruder “Guidelines on Opening Up America Again,” which presented a three-phase approach to resuming normal social and economic life. Michigan’s plan is vastly more sophisticated and balanced than the reckless policies of other state governments that are already opening up without clear metrics or rationale.

The idea is alluring: if states can get younger, healthier people back to work and keep those at high risk (i.e., the aged and the sick) sheltered-in-place then we can minimize COVID-19 deaths and provide a much-needed boost to our economies. Thus, the White House has "vulnerable individuals" sheltering at home until Phase Three. The MI Safe Start Plan has similar advice, which applies until we enter the last, post-pandemic, phase:

"All at-risk individuals should continue to shelter in place. Members of households with at-risk residents should be aware that by returning to work or other environments where distancing is not possible, they could carry the virus back home. Precautions should be taken to isolate from at-risk residents. Businesses should strongly consider special accommodations for personnel who are members of an at-risk population."

Here's the catch: The majority of Michiganders, and in fact American adults, are at risk for severe illness from COVID-19. Telling vulnerable individuals to stay home and avoid the newly open bars and restaurants means telling about two thirds of Michiganders to continue to shelter in place, leaving businesses to either operate with limited customers and staff or knowingly endanger them. In contrast, Switzerland mandates that employers must allow high-risk employees with a medical certificate to work from home, or be put on paid leave.

"Vulnerable individuals" (or the at-risk) are not a minority or economically marginal. The majority of American adults are vulnerable. The White House defines “vulnerable individuals” as anyone who is an elderly individual or who has a “serious underlying health condition” such as high blood pressure, chronic lung disease, diabetes, obesity, asthma, or are immunocompromised. 

The MI Healthy Start plan doesn't define "at-risk" individuals populations or spell out all the accommodations, but the Whitmer administration will want to do so in coming days. They need to do better than the White House, though, matching policies to the scale of vulnerability. By the White House definition, about 63 percent of American adults are vulnerable, according to our analysis of 2017 data from the CDC's BRFSS dataset. By adding smokers and people with heart disease, that number increases to 68 percent. The most at-risk state is West Virginia, where 74 percent of the adult population is vulnerable. Meanwhile, in the healthiest jurisdictions, Utah and the District of Columbia, 55 percent of their adult population are vulnerable. In Michigan, it’s 66 percent.

Even if we exclude senior citizens and only include working-age adults, our analysis finds that the majority are vulnerable. Approximately 56.4 percent of Michigan adults under the age of 65 have at least one condition on the White House list (compared to 54 percent of American adults overall). A shocking 32.6 percent (compared to a national 29 percent) have more than one, if smoking and heart disease are included. High levels of vulnerability are not limited to poorer states or socioeconomically disadvantaged Americans—51 percent of adults under age 65 in America’s five richest states, and 46 percent of those with a college degree nationally, are considered vulnerable under the White House definition. Vulnerability to COVID-19 complications is the norm in our society, not an exception.  

Neither politicians nor the public seem to appreciate how many of us are at risk of dying or being hospitalized from COVID-19. It is not just a few people with esoteric diseases that society needs to be concerned about. It is most of us, from our employees to our neighbors to our families to the guy on the next treadmill at the gym when it reopens and, for a majority of Michiganders, ourselves. Policies that assume the vulnerable are few, sparse and marginal ignore the simple and shocking fact: the majority in America is vulnerable.

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Comments

Bill
Mon, 05/11/2020 - 10:18am

"Policies that assume the vulnerable are few, sparse and marginal ignore the simple and shocking fact: the majority in America is vulnerable."

Yeah.

I'm staying home.

Matt
Mon, 05/11/2020 - 4:16pm

That's the great thing here. If you are concerned about this or anything else you should and do have the total right to stay home or wear protective gear, not get within 20' of anyone else or use wipes on everything you see. Totally your right and choice. I believe motorcycles and cigarettes are incredibly dangerous so I don't ride or smoke them.

J Hendricks
Mon, 05/11/2020 - 10:29am

Got it. We are all vulnerable. Might as well just hang it up and wait, what, two years? until the last possible case appears?

Must we be reminded of:
•1957-58 "Asian flu" - this H2N2 virus caused roughly 2 million deaths worldwide. Yet no lockdown. pretty much business as usual.
• 1968-69 "Hong Kong flu" - . This H3N2 virus killed around 1 million people globally, with those over 65 most vulnerable. (H3N2 viruses still circulate today. ) Yet no lockdown. pretty much business as usual.

But Covid-19? Close the barn doors! Cede excessive authority to wanna-be autocrats who will micro-manage you (for your own protection!) until when? June? July? August? December? June 2021? ???

The breakout is coming - whether Gretchen and her minions want it or not.

A Yooper
Mon, 05/11/2020 - 10:43am

Well researched and to the point. The reference to smokers is spot on. Their lungs are already compromised. They won't agree with this, but their coughing after lighting up and while smoking is telling to everyone but them, and medical reports indicate they will struggle on respirators. Not to mention, how far their exhaled smoke travels to those in their immediate vicinity. If they have the virus and aren't aware yet, further spreading is inevitable within their ranks.

Matt
Mon, 05/11/2020 - 2:14pm

How about just giving the infection rate, rate of complications and deaths for various groups and let folks make up their mind and act from there? Afterall, warnings for smoking\tobacco, obesity, motorcycle riding and other bad/risky behaviors have worked so well!

Maureen
Tue, 05/12/2020 - 10:30am

I totally agree, Matt, that we have been given info, but not the right info. We should know ages and places of people who got sick. Are they deliberately not giving out that info? It does not break any privacy rules - no names would be given. I bet if we were given that, we would see that the deaths/sicknesses are mainly from the elderly with underlying conditions, with many in nursing homes.

Kevin Grand
Mon, 05/11/2020 - 5:51pm

Yet another example of moving the goalposts to promote a narrative.

News Flash: Life itself is inherently dangerous.

You can get killed driving down the road, walking down the sidewalk or getting bitten by the wrong type of insect (just to name a few).

The actual function of government is to protect our rights and a few specific tasks.

If you want 100% safety, 100% of the time, then just check yourself into the nearest prison, because that is the closest you're going to get towards reaching that unacheivable goal.

Marshall
Mon, 05/11/2020 - 10:06pm

All people are at risk for severe Covid 19 disease. It’s just that some are more at risk than others. Vulnerability is really a continuum rather than the yes/no choice these authors seem to present. They offer critique but no solutions. Why not, as others have suggested, let the individual determine his own acceptable level of risk? Flattening the curve was intended to prevent the overwhelming of our ICU capacity. Completely stopping transmission was never a realistic goal. Collapsing our economy will also kill some and harm many.

PeterW
Thu, 05/14/2020 - 9:22am

How utterly delightful to read commentary from people who clearly understand what they are talking about and are not afraid to say what will be unpopular with many politicians and too many of the public.

Unless/until an effective vaccine or highly effective therapeutic treatment is available, EIGHTY PERCENT of deaths will CONTINUE to be in an age cohort over 60 years of age. (In fact, the percentage will rise if younger people do develop some form of “herd immunity”.)