Diners gather at a restaurant's outdoor seating are in Plymouth, Mich., on March 21. (Emily Elconin/Bloomberg)

Abdul El-Sayed, a physician, epidemiologist and former Detroit health director, is author of “The Incision” newsletter.

Rising coronavirus infection rates nationwide prompted Rochelle Walensky, director of the Centers for Disease Control and Prevention, to confess on Monday to a sense of “impending doom.” The state most responsible for such alarms right now might be Michigan. The CDC on Tuesday said Michigan led all states in new cases per 100,000 in the previous week. And hospitalizations had surged 53 percent, with 2,144 adults hospitalized, compared with a week earlier.

Cases are multiplying faster than they were last fall, when Gov. Gretchen Whitmer (D) instituted a “pause to save lives,” with measures that included stopping in-person high school classes and banning indoor dining. That intervention prevented more than 100,000 covid cases, a University of Michigan study estimated. No similar measures have been launched in the Wolverine State this time, but it isn’t too late for the governor, with the help of Michiganders, to rein in the rapidly increasing threat.

Is there something about Michigan this is prompting the spike in infections? No, it’s the same dynamics happening elsewhere. They just seem to be happening in Michigan first. Restaurants and bars are pushing their permitted 50 percent maximum capacity (capped at 300 patrons). Much of the clientele in those restaurants appears to young people — and young people are increasingly among the hospitalized in Michigan. From March 5 to March 27, more than half of all covid cases in Michigan were people under age 39. Anecdotally, I can report that people here have lately become much more casual about wearing masks.

It feels as though we haven’t learned the lessons of 2020. Or that the sense of coronavirus vaccines coming to the rescue has made us forget those lessons.

The novel coronavirus uses a number of tools to infect our cells and replicate. What we've learned from SARS and MERS can help fight covid-19. (Video: Brian Monroe/The Washington Post, Photo: Brian Monroe/The Washington Post)

Full coverage of the coronavirus pandemic

This time around, there are coronavirus variants involved. In mid-January, Michigan recorded its first case of B.1.1.7., the so-called U.K. variant. Although Michigan has had the highest per capita case rate of the variant for the past month, it has been observed in every state in the country except Oklahoma, its share of reported cases rising 7.5 percent daily. The proportion of U.S. coronavirus cases caused by this variant could thus double in just over a week.

Despite official optimism about vaccination programs nationwide, the country is still nowhere near the 70 to 90 percent inoculation rate needed to achieve the “herd immunity” needed to kill off the pandemic. Full vaccine coverage in Michigan is about 16.4 percent — similar to the national average. And there’s little room for error.

Vaccine hesitancy in Michigan is higher than the national average, according to a U.S. Bureau Census survey last month: Seventeen percent of Americans 18 and older say they “probably” or “definitely” won’t get vaccinated, compared with 25 percent of Michiganders. Vaccine hesitancy in Michigan is more common among people age 40 to 54, as well as Black residents, according to the survey.

Worse, inequity has marked the state’s vaccination program. Whether as a result of insufficient supplies, inadequate outreach or vaccine hesitancy — or a combination of all three — vaccination among Michigan’s Black residents is lagging badly. The Atlantic noted last month that first doses had been administered to 61 percent of Michiganders age 65 to 74, and 62 percent of those 75 and older, but just 28 percent of Black residents 65 and older had received at least one shot. The communities hit hardest by the pandemic starting last spring are yet again more vulnerable to this surge.

Michigan has retained its mask mandate, but in other ways the state has aggressively reopened since the beginning of the year. Gyms reopened on Jan. 16 (the day the first B.1.1.7 case was discovered). Eat-in dining reopened on a limited basis on Feb. 1. High school sports — connected to several outbreaks across the state — have been allowed to continue.

Whitmer faced dangerous threats last spring for her forceful measures to combat the pandemic last year. With coronavirus infections increasing in Michigan and many other states, she and other governors urgently need to consider putting the brakes on reopening. Guidelines should be established that firmly tie activities allowed — traveling, going to the gym, eating in a restaurant — to specific vaccination rates. That would create the kind of benchmarks that both explain what the “right thing” is and incentivize public officials and the public to make it happen.

If there is good news about the current outbreak, it is a truly silver lining: Older Michiganders, the most vulnerable population throughout the pandemic, are experiencing far lower rates of hospitalizations. That has happened because of the extraordinary push to vaccinate them first. Vaccines by the tens of millions will be distributed in the coming weeks. We just have to hold on — and not abandon measures and behaviors that kept people safe until now, in Michigan and all across the country.

Read more:

Alyssa Rosenberg: Venturing out into the post-covid world is definitely weird — and completely worth it

Drew Altman: Websites are the weak link in getting Americans vaccinated. They must change.

Leana S. Wen: I got the placebo in the Johnson & Johnson vaccine trial. Here’s my full journey.

Harald Schmidt, Lawrence O. Gostin and Michelle Williams: Vaccines are about to become a free-for-all. Here’s how to ensure it’s done equitably.

Sergio Peçanha: Why the ship that got stuck in the Suez Canal is like the long journey to a covid shot

Coronavirus: What you need to know

End of the public health emergency: The Biden administration ended the public health emergency for the coronavirus pandemic on May 11, just days after WHO said it would no longer classify the coronavirus pandemic as a public health emergency. Here’s what the end of the covid public health emergency means for you.

Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.

The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.

New covid variant: A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization. The latest omicron offshoot is particularly prevalent in India. Here’s what you need to know about Arcturus.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

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