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Tanzina Vega: This is The Takeaway, I'm Tanzina Vega. As we enter spring, an average of 2 million people in the United States are being vaccinated each day. It finally feels like there's an end in sight to the pandemic, but we're not out of the woods just yet. More than a dozen states have seen increases in their daily case averages.

In Michigan alone, there's been a 92% increase in COVID-19 cases in the past two weeks. In Europe, several countries have had to lock down again after a surge in cases. While many state governors are reopening businesses at breakneck speed to help struggling economies, experts say it's too early to forge ahead with increasing capacity for indoor dining, gyms, and other places where the virus can spread easily. New variants and increases in travel are also to blame for some of the concern among experts about a potential new wave of the virus. Here's Rochelle Walensky, the Director of the CDC.

Rochelle Walensky: This just at a time when we have still 50,000 cases a day, and we know our variants have traveled through these airports. We know that travel is a time when people bring these variants home, bring these variants to other places. We're balancing the fact that vaccinated people will likely travel with unvaccinated people. There is travel happening. We had surges after July 4th, we had surges after Labor Day, we had surges after the Christmas holiday, and we want to just make sure we're doing it safely. We're actively reviewing it right now.

Tanzina: Emily Martin is an associate professor of epidemiology at the University of Michigan. Emily, welcome to The Takeaway.

Emily Martin: Hi Tanzina. Thanks for having me.

Tanzina: Let's start with Michigan where you are. We saw a 92% increase in COVID-19 cases in the past two weeks. Emily, what is driving that?

Emily: Yes, we're definitely seeing an increase here around the state. The starkest increase appears to be in youth, in people aged 10 to 19, we're seeing a lot of increase in that age group. That's where our sharpest rises are happening, but we're also seeing rises in younger adults 20 to 29 and 30-year-olds as well starting to follow with that as well too. We're seeing a lot of outbreaks, not in school activities, but what I call school adjacent activities. Sports, gatherings, the types of things that kids participate in when they're out and moving about.

Tanzina: What kinds of policies has Michigan put into play? Before I even ask you that, this is sort of a surprise, I would say, in terms of who is driving this. We've been hearing a lot about how children, in particular, might not be as likely to contract COVID-19 or as likely to pass it on. Is this surprising to you as an epidemiologist?

Emily: Well, I think we've been sure for a while that children don't get as sick as often. They can get really sick, but it's less common. But the data is actually pretty strong that children can spread, certainly to each other, and possibly to the adults in their lives. We've seen this in other states that have had, I think, more active in-person school than we've had here in Michigan.

Recently in Michigan, we've seen a change towards more in-person school happening over the last couple of weeks and months, which is certainly really important for development and to support parents, but I think it's natural in my mind that we start to see more transmission around this group who, largely many of these kids have been home for the last year.

Tanzina: We heard also the director of the CDC at the very top before we brought you on, Rochelle Walensky, here say that some of this is also potentially happening as we increase travel. Are you seeing that happening in Michigan? Does increased travel-- We know that more Americans are traveling every week as more people begin to get vaccinated. Is that a concern as well?

Emily: Absolutely. I think we're seeing increased movement both inside the state and then more kind of vacation traveling happening as well. One of the things we do here at U of M is we take a look at, and monitor different sources of how often people are moving around the state, using various sources of cell phone data and whatnot. We're seeing that the movement looks a lot like it did even before the pandemic, like last year spring break, in terms of how much people are moving around.

Tanzina: We know that surges in the virus, or should we say waves of the virus or when the virus peaks, tend to happen after, as the director of the CDC mentioned earlier, tend to happen after large gatherings, so holiday weekends. We've seen them happen after Christmas and Thanksgiving and last summer. Are we expecting to see that same thing as we're now in spring break?

Emily: Yes. I think we're watching for that connected to spring travel, especially in the young adult age group, watching to see anything that might happen from spring break travel. Aside from the travel, it's recently gotten really nice here in Michigan. That's almost a holiday in and of itself. People are out and about, and they want to gather and they want to get out there in the nice weather, and so I think that's really going to see a lot of gatherings and then we run the risk of having to get more transmission tamped down after that.

Tanzina: Emily, aren't we okay if we're gathering outside, or is it that people are gathering and they're "forgetting" their masks? I say forgetting in-air quotes.

Emily: Right. There's a fatigue all the way through with keeping your mask on when you're gathering. It's one thing to gather outside, but then do you all move inside once we get to cold spring Michigan evening? We still have to take those distancing masking precautions to keep the numbers down.

Tanzina: We here in New York are hearing a lot of news about a new variant that has made its way here to the city. There's lots of news about variants, international variants that have come to the United States. What is the state of- is the current spread in Michigan from the original COVID-19 virus or have there been variants that have taken hold in the state?

Emily: Well, the reality is we have both. We're seeing rises in the original strains that we saw before. We also have a transmission of B117, which is the variant that was identified in the UK, we have that in Michigan. A lot of the B117s that have been reported have been from the defined situations. We've had a lot of cases identified in correctional facilities, unfortunately. We've had some clusters in educational settings. I guess the jury's still out in terms of how much variant is spreading throughout the general population. We know it's definitely here, it's probably on the increase, and so we're fighting both right now.

Tanzina: We're talking about COVID-19 and how we're not quite out of the woods yet here in the United States. This is The Takeaway. Emily, Michigan is one of the worst states in terms of increases. Has the state done anything in terms of changing its policy that may also have led to this spike in cases?

Emily: Yes. This is a really interesting thing that we're seeing, because we're one of the worst states in terms of increases right now, but we started out from a point that was a little bit below our peers, in terms of our neighboring states. We've recently had an adjustment so that our policies are closer to the neighboring states.

That's for things like youth sports, indoor dining has increased in capacity, we've had loosening of gathering restrictions and more allowances for doing large outdoor events in the state. We've definitely had a lot of movement towards re-engaging in Michigan, and it puts us more in line with what our neighboring states have in terms of policies, I think.

Tanzina: There have also been-- I'm wondering whether the state's efforts to reopen, we know that governors are under a tremendous amount of pressure from businesses. We're seeing that here in New York, we see it in states across the country, to reopen, and some of them are moving faster than experts say they should be moving.

There was recently efforts here in New York to increase indoor dining capacity to almost 75%. That effort has now been put on hold, as our mayor said we're going to stay at 50% because we want to be cautious. Are Michigan lawmakers being cautious enough in your medical opinion, about where we stand right now? Should things pause in terms of reopening efforts before they get worse?

Emily: I think they're in a really challenging situation because we know that economic stress is also a public health challenge that we need to pay attention to. Balancing both, it's a really tough thing to solve. I do like Michigan's recent focus on getting kids in the classroom as safely as possible, because that's one of the places where we see extending down on that for a while is going to have public health impacts, developmental impacts, and so I think that that's been appropriate.

Right now, the mitigation strategies that we really have available to us, these are the ones that are really hard to enforce, like distance when you're gathering, gathering safely, wearing masks. One thing we have done in Michigan that I like is that masking is still universal all over, and I think it is really important to keep that in place like we have right now, to sort of tampen some of these other openings that are happening.

Tanzina: As an epidemiologist, as you see these variants across the country, and at the same time, you see an average of 2 million Americans getting vaccinated, at least the first dose of the vaccine in some cases, or the second dose of the vaccine happening. There feels like there's a tension between and, we've heard this a lot, between the virus and the vaccines and the variants and who's going to win. Are we still in that race right now? It's a little too early for us to let down our guard, isn't it?

Emily: Yes, absolutely. I really like this analogy of being in a race with a variant. It's like you're in a race with a virus, but then suddenly the virus starts to run 50% faster. What we need to do is, we need to get ahead of this thing before that really happens, before the virus really speeds up its transmissibility. We have a much, much easier job of getting this under control with the vaccine if we do it now, versus if we do it afterward, contending with the variant.

Tanzina: I'm wondering, going back to children, the children are going to probably be some of the last groups to be vaccinated at the pace that we're going. What do you think about that? Given what we're seeing in Michigan, should children be prioritized for the vaccine if this is what we're seeing in terms of spread, or is it still too early? I know that some vaccine manufacturers are still testing the effects of the vaccine on children. Is it still too early? Where do we stand there, Emily?

Emily: Yes. Unfortunately, the vaccine is simply not available for children yet, especially children in the age group that we're really watching right now. What we need to do is focus on these other strategies we've been using: masks, distancing. Thinking about how we can have our children do some of these activities but in a safer way using testing, using masking as much as possible, in order to get them through until the vaccine is ready for them.

Tanzina: We've got less than a minute left, but should people hold off on travel and recreational travel? I know that the hard ask given that the summer is coming and spring is here, but what's your professional opinion on that?

Emily: I think still being conservative is a good idea. For spring break, my family, we're doing something just with the three of us, very limited. I think you can still think about how to do some of the activities that you like safely, and minimizing your engagement with the general public. I think it's still time to be a little bit conservative.

Tanzina: Emily Martin is an associate professor of epidemiology at the University of Michigan. Emily, thanks so much.

Emily: Thank you.

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