State’s Initial Epidemic Responses Guided By ‘Worst Case But Possible’ Scenario

Days before Gov. Gretchen Whitmer issued a COVID epidemic emergency stay-at-home order in March 2020, the state’s chief medical executive was offering advice based on a “worst case but possible scenario.”

Joneigh Khaldun, the chief deputy director for the Michigan Department of Health and Human Services, advocated in an email for the “most aggressive public health action” the state could take. The worst case, she projected, entailed nearly 7 million residents becoming infected with the coronavirus within “the next 2-4 weeks.”

“Based on some broad assumptions (worst case but possible scenario), we believe there will be about 6.9 million people in Michigan who become infected across all ages (70% of population), 1 million of those will need hospitalization, and 435,000 of those will require an ICU stay. A subset of the ICU cases will unfortunately die, but I do not have that estimate at this time,” Khaldun said in the March 21, 2020, email.

“This is estimated to occur over the next 2-4 weeks,” Khaldun continued, “and social distancing measures will bring this down regarding the acuity of the patients and the speed with which it spreads. My recommendation is the most aggressive public health action we can take at this time.”

From March 1, 2020, to July 13, 2021, there were 41,301 confirmed hospitalized cases of COVID in the state.

As of July 23, 2021, officials had reported 899,931 confirmed cases of COVID-19 in Michigan. The actual number would have been much higher if it included those who contracted the disease with few or no symptoms and were not tested. The Centers for Disease Control and Prevention estimated as of March 2021, that 1 in 4.3 COVID-19 infections had been reported.

Under that estimate, by late July 2020, Michigan had likely experienced about 3.9 million COVID cases.