5 things to know as Michigan COVID cases rise into the fall

• COVID is on the upswing in Michigan and elsewhere, though data is far from perfect with few people reporting positive cases 
• As cases climb going into the fall, over-the-counter tests can be harder to find, and now generally are not free 
• New variants are giving experts pause as Washington is poised to approve a newly designed booster

Sept. 11: New COVID shot clears FDA, may be Michigan-bound later in week
Sept. 6: COVID hospitalizations surge in Michigan. Doctors remain cautiously optimistic

As summer winds down, it seems increasingly clear that another kind of season is just ahead: COVID.

Heading toward its fourth autumn in Michigan, the virus behind COVID-19 which is now linked to nearly 39,000 deaths in Michigan seemingly has snapped into seasonal rhythms, with cases and hospitalizations on the slight incline in recent weeks, echoing increases nationally.

Those numbers are likely to increase as elementary classrooms and college campuses fill and colder weather drives social gatherings indoors.

Related:

• New COVID variant confirmed in Michigan. What to know about BA.2.86
• COVID cases jump in one week in Michigan. Experts downplay mini surge
• Michigan back-to-school COVID, flu vaccine requirements, and RSV too

Dr. Preeti Malani at the University of Michigan and Dr. Victor DiRita at Michigan State University, both infectious disease doctors, spoke with Bridge Michigan this week to update readers on the latest developments with COVID and how to navigate the virus that can still be deadly this fall.

Is COVID still circulating?

Short answer: Yes, even if it appears — for some people at least — “out of sight, out of mind” for now.

Four years of infection, coupled with vaccines, has built herd immunity against the virus, doctors previously told Bridge. DiRita and Malani said young, healthy people probably aren’t going to be seriously ill from an infection if they get one.

But — and it’s an important “but:”

“My worry is not that young, healthy people are going to have COVID — that's a given,” said Malani. “I want to make sure that people have the tools to make sure to protect those around them that are vulnerable. It may be their friend or maybe another family member.”

“It can still make you feel pretty crummy,” DiRita said.

Is it the same COVID as years past?

Yes and no.

The currently-circulating alphabet soup of variants — including EG.5 that replaced XBB.1.5 as the dominant variant —  are descendents of the omicron variant that fueled a deadly COVID surge in 2022. 

But in mid-August, Michigan was the first U.S. state to report a potentially worrisome new variant, BA.2.86, a version that has especially worried experts. The genetic building blocks of the variant’s spike protein — the virus’ key to entering human cells — are significantly different from previous versions of the virus. 

That has raised concerns it might dodge protection of the vaccine boosters now on the market as well as an updated vaccine expected to be released in the next few weeks. 

The World Health Organization is monitoring the variant following the discovery of cases in Denmark, Israel and the United Kingdom. The variant’s discovery by a University of Michigan lab — drawn from a sample from a Washtenaw County resident — prompted the U.S. Centers for Disease Control and Prevention to announce on Aug. 17 that it too had begun tracking the variant.

According to a CDC update Wednesday, 24 cases of the BA.2.86 variant have been detected globally. There have been three detected in the United States: one each in Michigan, Ohio and Virginia.

It’s too soon to tell how much to worry about BA.2.86. The variant probably had been circulating undetected for some time, according to epidemiologist Emily Toth Martin, part of the University of Michigan effort tracking COVID and other respiratory diseases.

Should I get a booster?

The booster now available was introduced last year. It was designed to protect against the original omicron variant. A new, updated booster, designed to protect against the XBB.1.5 variant, is expected in October.

If you’re healthy and think you have a robust immunity against COVID from past vaccines or infections, it’s best to wait for the updated booster since the current vaccine protects against the waning strains, doctors have told Bridge and others.

The CDC’s Advisory Committee on Immunization Practices will likely review the fall booster at its meeting Sept. 12.

But even if the new booster is not as effective as hoped against the even newer BA.2.86 variant, residents are far less vulnerable to future strains than they were early in the pandemic, DiRita, chair of the department of microbiology and molecular genetics at Michigan State University, told Bridge.

More than three years of vaccines and infections have built community-wide immunity to COVID, said DiRita, who leads MSU’s COVID surveillance efforts in western Michigan and Flint.

In a best case scenario, BA.2.86 could be an “attenuating” coronavirus, meaning it could replace current COVID variants while causing less severe disease, doctors previously told Bridge.

But Malani, of U-M, warned that people with chronic conditions or who are otherwise immunocompromised should take extra precautions, such as masking again. And children who have fallen behind on their boosters should get the current booster, in addition to the updated version when it’s available, according to CDC guidelines. (Full guidelines are here.)

I don’t feel good. Where can I get a COVID test?

COVID tests generally aren’t free now, or as easy to find.

A pandemic emergency rule requiring insurers to cover up to eight free tests a month for every beneficiary has ended, and big boxes of tests have disappeared from many pharmacy aisles.

Private insurers can choose whether they will continue to cover tests and, if they do, what cost-sharing they will require. Medicaid plans, under federal law, are required to cover both over-the-counter and more reliable lab tests through Sept. 30, 2024. Medicare Part B — the Medicare plans that cover some doctor’s visits and services — will pay for lab testing when ordered by a doctor. Some Advantage plans may do that as well.

Some at-home tests, provided by the state health department, remain available for free at more than 200 Michigan libraries. Another 100,000 have been ordered, Chelsea Wuth, a spokesperson with the Michigan Department of Health and Human Services, told Bridge in an email Thursday.

Additionally, dozens of community testing sites offer free tests, including Community Action Agencies throughout Michigan. You can also consult the  CDC’s no-cost testing locator.

I’ve tested. I’m positive. Now what?

First: Stay home.

It bears repeating, Malani and DiRita said: Stay home.

“It used to be ‘I can power through this,’” DiRita said. “Don’t do that anymore. 

“COVID isn’t killing people (at the same extraordinary rate) anymore, and that’s great, but it can still make you feel pretty crummy.”

If you feel especially sick, are older, or if you have other health conditions, talk to a doctor, DiRita and Malani said.

There are now three treatments for patients, with varying levels of efficacy and risk, said Malani, who last week wrote an update on outpatient treatment options in the Journal of the American Medical Association. The top ones require quick action once you display symptoms. 

The treatments are:

Paxlovid: Also known as nirmatrelvir-ritonavir, it is approved for people aged 18 years or older, but can be prescribed for children aged 12 to 17 years who weigh about 88 pounds or more. 

The five-day oral regimen should be started within five days of the first COVID-19 symptom. It should not be taken by people with severe kidney or liver disease, or those who take certain drugs such as amiodarone, statins, certain antiseizure medications and certain immunosuppressants. Some patients experience a return of COVID-19 symptoms after completing Paxlovid, a phenomenon known as a “rebound” case.

Remdesivir: Also known as Veklury, remdesivir is approved for nearly all ages. It is given intravenously each day for three days, and should be started within seven days of COVID-19 symptoms.

Because intravenous infusion is required, the drug is limited to patients who cannot take Paxlovid. It commonly causes nausea and diarrhea, but has also triggered allergic reactions and elevations in liver function tests.

Molnupiravir: Also known as Lagevrio, is the least effective outpatient medication for COVID-19 and should be given only to patients who are not eligible for treatment with paxlovid or remdesivir. It is authorized only for patients 18 years and older or those who are pregnant or attempting to become pregnant.