Mich. hospitals face new COVID-19 surge: younger patients, more variants

Michigan hospitals are responding to a third surge of COVID-19 patients since the pandemic began early last year that has been highlighted by a larger percentage of admissions of younger patients under 65 who are mostly unvaccinated.

Hospital admissions are up 51% since the end of March — increasing for all age groups and all regions — but are highest for those 50-59 years old. The numbers of COVID-19 patients in intensive care units also have increased 43%, the state Department of Health and Human Services said in its March 30 report.

Experts say the surge in hospital admissions was expected as positive cases started to creep up in early February, just about when the state relaxed restrictions on businesses and people started to go out and travel more. But few expected Michigan to lead the nation in positive cases per 100,000 people at 67 and hospitalizations per 100,000 people at 27, according to New York Times data. As of Tuesday, Michigan reported 16,297 confirmed COVID-19 deaths and 707,463 positive cases, MDHHS said.

Nationally, COVID-19 deaths have exceeded 556,000 with 30.8 million cases, Johns Hopkins University reported. Global deaths have topped 2.9 million with 132.5 million cases with Brazil, Mexico and India behind the U.S. in COVID-19 deaths.

At the Detroit Medical Center, Dr. Teena Chopra, the eight-hospital system's medical director of infection prevention and epidemiology, said Michigan is the epicenter of another wave of COVID-19 infections and hospitalizations.

"We are leading the nation in COVID cases and seeing a much younger age group including 30s, 40s and 50s" who are coming into hospitals, said Chopra, who also is a professor of internal medicine at Wayne State University School of Medicine.

"If you look around, about 68% of our of the elderly (65 and older) have been vaccinated and they have been somewhat spared because of the vaccine. What we are seeing now is these younger patients because they are more mobile and not vaccinated."

Another major factor in the new surge is that Michigan also has a large number (more than 1,200) of cases of the United Kingdom B.1.1.7 variant "that are more transmissible and can cause more severe disease," Chopra said.

"We expect larger numbers (after) the spring break, and the mobility of people, the lack of vaccination amongst younger people and the way we are ... are all factors that are causing the spread of this virus," she said.

Dr. Adnan Munkarah, chief clinical officer with six-hospital Henry Ford Health System, said the average age of hospitalized COVID-19 patients in a Henry Ford hospital is now 58, six or seven years younger than the fall surge.

In early March, Henry Ford had 65 inpatient COVID-19 admissions, a number that had been declining since December when it had about 200. As of Tuesday, Henry Ford had 366 hospitalized COVID-19 patients, a 463% increase from 65 in early March.

Dr. Jennifer Swiderek, medical director of the medical ICU at Henry Ford Hospital in Detroit, said ICU admissions have jumped to 50% of beds for COVID-19 patients on Monday from 15% a week earlier on March 29.

"We are seeing less elderly and a younger age group than in the previous surges — in the 40 to 60 age range. They are not vaccinated yet while the over age 65 were eligible earlier," Swiderek said, adding that the mortality rate hasn't increased yet.

"We might see it. Usually that is behind about two weeks," she said. "The (COVID-19) variants might have something to do with higher level of sickness (in the ICU). Those who may not be as sick, they can still spread it to others. They are more contagious."

Swiderek said Henry Ford isn't treating patients age 60 or younger any differently than those age 80.

Last year, COVID-19 inpatient treatment also included giving patients monoclonal antibodies. But studies have shown that it is best to give antibody infusion treatment on an outpatient basis to patients 65 or older or have a specific chronic disease who are COVID-19 positive 10 days or less.

"We are treating them differently now than in the spring because we know more. We are focused on early steroids and remdesivir, a strong antiviral," she said.

Current clinical management of COVID-19 consists of infection prevention, control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated. The FDA has approved only one drug, remdesivir (Veklury), for the treatment of COVID-19 in certain situations.

Swiderek said the work for ICU staff now is different than in previous surges.

"We know how to treat patient now, but it is more difficult because more of our patients are parents and have young children. It's tough for staff," she said. "The staff is mostly vaccinated, so there is less fear now. But it's been a year now from when we hit the first surge. Staff are tired. No one expected to be going through another surge."

At Beaumont Health, Dr. Nick Gilpin, the eight-hospital system's medical director of infection prevention and epidemiology, said the average age of hospitalized COVID-19 patients has dropped at Beaumont hospitals the past several weeks to about 50 from the low 60s.

As of Tuesday, Beaumont had a little more than 700 hospitalized COVID-19 patients, slightly lower than the second wave last winter of nearly 800, but much lower than the more than 1,200 daily peak of hospitalizations in the first wave last April.

"We are seeing a slightly younger demographic of patients the past several months. That makes sense because we are hitting on vaccines hard on the over age 65 population and just starting on 50- and 40-year-olds," Gilpin said.

"Admissions over age 65 is still a significant proportion of patients, but it has really gone down to the 50-54 range. We are seeing a rise in 40s, even in 30s."

Gilpin said he believes higher vaccination rates of those ages 65 or older combined with younger people frequenting bars and restaurants and socializing more is the reason for the drop in hospitalized patients' ages.

COVID-19 patients in Beaumont ICUs have increased the past two weeks to about 11 percent of beds, up from 7 percent, he said, adding he expects those ICU admissions to increase.

"I can see the data (on hospitalized COVID-19 patients) broken down by age and acuity levels," Gilpin said. "The average length of stay has gone down the past month (indicating a younger and less sick patient). The percent mortality with COVID has gone down, the average use of ventilators, how sick people are, all the indicators are down."

Gilpin said those clinical indicators make sense because of the declining average age of COVID-19 hospitalized patients.

"We are not doing any different protocols. We are still hitting patients with the standard cocktail of steroids, other medications and antiviral meds," Gilpin said.

One factor that may be contributing to an increase in ICU and hospitalized patients is that the main COVID-19 variant, B.1.1.7, now represents an estimated 50% of all of Beaumont's positive cases. Statewide, MDHHS said the U.K. variant could represent as much as 70% of all new cases.

"We don't tailor our approach, but we do know the literature presents this with a more severe disease, more higher risk of mortality," Gilpin said. "We have not seen this so far in our patients."

Chopra said DMC's adult hospitals are seeing similar trends as Beaumont and Henry Ford: an increase in COVID-19 inpatient admissions, average age of about 50, but ICU admissions of just 11% of total beds.

Detroit's COVID-19 seven-day average positivity rate is nearly 18% with more than 2,200 positive tests per day as of early April. The city's positivity rate has increased from 3.2% on March 5 to more than 17.9% on April 2, the Detroit Health Department reported.

Chopra said DMC limited the spread of COVID-19 by not relaxing visitor restrictions as did some Southeast Michigan hospitals.

"We have maintained our restrictions and have done a really good job at preventing the spread. We are admitting more patients to the hospital than the ICUs. That is something I am very proud of," Chopra said. "Our younger patients have better recovery than the older patients who have co-morbidities, but we treat them all the same."

While Chopra said Michigan and Gov. Gretchen Whitmer have done a good job rolling out what vaccines it receives from the federal government, the COVID-19 surge in hospital admissions has got her puzzled.

"We relaxed our restrictions on business (including bars and restaurants) a little bit too soon in Michigan," Chopra said. "The governor is doing a great job in the vaccination campaigns and expanding vaccinations in the state, but these two things (vaccinations and positive cases) at odds. We are at war with the virus and we have to slow down on the openings after you have gained some momentum on vaccinations."

Chopra said the balance between getting ahead on vaccinations and keeping people away from each other with business restrictions is out of whack.

"Vaccines are clearly working. It is the silver lining," she said. "We should have waited a little bit longer before opening up the restrictions."