They’re the questions on everybody’s mind about Michigan’s coronavirus crisis.

When will it end?

How will it end?

When will things get back to normal?

“Having a complete lockdown of the economy is not sustainable over the long term,” U.S. Sen. Gary Peters said.

It’s a widely held sentiment.

Senate Majority Leader Mike Shirkey is among those criticizing Gov. Gretchen Whitmer’s extension of the stay-at-home order as “destroying our health by ruining our livelihoods.”

But that concern runs up against a grim reality: Reopening the economy too quickly could easily backfire if coronavirus surges as a result, experts say.

“We’ve got to make sure that we avoid a cycle wave at all costs,” Whitmer said during a press briefing Monday. “That would be devastating for our economy.”

The problem, of course, is that this is an unprecedented situation, one with few road maps for politicians as well as public-health experts and economists.

It’s hard to overstate the uncertainty.

For the medical clinicians and scientists, there is still much they don’t know COVID-19, a completely new disease. There are still questions about how it’s transmitted, how long victims are contagious, how long infected people will maintain immunity. Doctors are just beginning to develop protocols for treatment, amid questions about the effectiveness of various drugs. A vaccine still seems more than a year off.

It’s been a huge learning curve for her and fellow doctors, said Dr. Anne Messman, an emergency room physician for Detroit Medical Center. Never before "has there been a treatment process where we have to change our practices on an almost daily basis.”

The crisis also is new ground for economists and business leaders. The economic implosion caused by the pandemic was stunning in its suddenness and terrifying in its extent. In Michigan, more than a million people are out of work, a quarter of the workforce, and businesses large and small are struggling for survival. The usual tools employed by economists to fix the economy aren’t applicable in a pandemic, where public health requires an almost total freeze of commerce.

“We know much more about fighting a financial crisis or an economic crisis and we typically have our quiver of arrows” for those scenarios, said Lisa Cook, a Michigan State University economist. “We have the formula pretty much down on what to do."

But the economic fallout from a pandemic "is a shock to most of us, if not nearly all of us,” Cook said about economists. “This is not something we’re used to addressing.”

Yes, Michigan is in a recession and quick recovery is unlikely

And for politicians, it seems an impossible dilemma: Should the priority be public health? Or rebooting the economy?

The best-case scenario: Coronavirus cases plummet over the next few weeks, thanks to social distancing. Stay-at-home restrictions are eased in May, although some social-distancing guidelines remain. The economy gradually gets back on track. Public-health officials and the medical community quickly identify new cases of coronavirus as they arise, isolate the patients and others who might have been exposed, and contain local outbreaks. Treatments improve and a vaccine becomes available sooner rather than later.

There are, unfortunately, multiple worst-case scenarios. The number of cases could plateau indefinitely at a high level, complicating plans to re-open the economy. Or the state could lift or loosen the stay-at-home order, only to experience a second huge wave of infections. Or the virus could mutate into an even more virulent strain, which is what happened in the 1918 flu pandemic. Or the development of a vaccine could take longer than expected.

There is general agreement the first step forward is getting the spread of disease under control. In that regard, Michigan doctors and other health experts say they’re beginning to see glimmers of light at the end of the tunnel.

The average number of new cases is going down. Hospitals are becoming a little less overwhelmed. Two weeks ago, epidemiologists and doctors at University of Michigan were predicting that caseload would peak in early May. Now, they’re saying it may already have happened.

For lots of people -- Whitmer, the U-M experts, hospital officials and doctors in the field -- the operative phrase right now is “cautious optimism.”

But they also say lifting Michigan’s stay-at-home order at this point would be foolhardy decision.

Extreme social distancing is the only way to bring coronavirus numbers down to the point where the economy can re-open; it’s the only tool available, absent a vaccine, said Dr. Paul Kilgore, Wayne State University physician and epidemiologist.

“I look at sheltering in place almost as a vaccine,” he said. “It’s our vaccine intervention for now.

“The more we do, it the more it will continue to be effective,”he said. “We really need to get to that flattening curve ASAP. It’s absolutely the No. 1 priority.”

Saving lives vs. saving economy?

Cautious optimism isn’t good enough for many Michigan residents tired of having their lives on hold.

Last week after Whitmer extended the stay-at-home order through April 30 and made it even more restrictive, a considerable backlash developed.

In many Michigan communities, the economic fallout of the stay-at-home order is painfully obvious. The public-health issues are less so, especially in areas of the state with only a few cases.

Cook, the MSU economist, describes the economic meltdown as a “hair-on-fire” situation. But the real problem is not the stay-at-home order, say she and others: It’s a virus that is highly contagious, highly virulent and lacks a vaccine and effective treatment.

Even with the extreme measures taken to prevent its spread, COVID-19 already has resulted in 1,921 Michigan deaths in one month. By comparison, 1,871 in Michigan died from influenza or pneumonia for all of 2018, the most recent year available.

While closing down businesses is painful, “people getting sick and dying is economically damaging, too," said Dr. Vikas Parekh, who heads a Michigan Medicine team modeling coronvirus forecasts.

“I haven’t heard any credible economist” say the choice is between protecting lives vs. saving the economy, said Cook, the MSU economist. The two goals are in sync, she said, since a premature end to stay-at-home orders could result in continuing the economic disruption.

If the social-distancing restrictions are lifted before the coronavirus outbreak is under control, numerous experts say the risks are considerable that increased social interactions would allow the number of COVID-19 to resurge. That could further cripple the state’s health-care system. Workplaces could re-open only to find their operations disrupted by people out sick and those fearful of returning to work. Workplaces and public spaces could face liability issues if they become a hotbed of infectious disease. Restaurants or stores could see their business crash if an outbreak is traced to their establishment.

“If the disease is still rampant and increasing around the country, people are not going to want to be out,” U.S. Sen. Gary Peters said. “People will make that decision for themselves.”

“This is a public-health crisis, first and foremost,” he said. "It’s also an economic crisis. But it’s difficult to solve the economic crisis if you have not first solved the public-health crisis.”

In the 1918 flu pandemic, most communities were shut down eight to 12 weeks. On the whole, those who maintained strict quarantine for longer periods saw a faster economic rebound, studies have found.

So the question now, Parekh said, is determining how soon Michigan can loosen the social-distancing restrictions while keeping coronavirus under control.

“There are a lot bright minds thinking about that,” he said. “But I don’t think there is a simple equation.”

So when will it end?

Like the rest of the world, Michigan is facing a short-term crisis related to the current lockdown of the economy and a longer-term problem in that coronavirus likely will impact everyday life until a vaccine is available.

Most residents are focused now on the stay-at-home order, which has shut down schools, businesses and workplaces across the state.

Currently, that order is in place through April 30. Whether it will be lifted in May depends on four factors, Whitmer has said:

Sustained reduction in coronavirus cases;

Increased ability to test for coronavirus and trace those potentially exposed;

Getting the health-care system back to more normal operations;

The development of workplace best practices to prevent spread of the disease.

The overall driving factor is the reduction of coronavirus cases, and specifically a reduction in the number of new cases reported each day.

“We want cases to be low enough so that we can test and trace people, and achieve local containment any time it comes back -- sort of hot-spot control," said Emily Martin, an University of Michigan epidemiologist who is working on coronavirus forecast models. “That’s what we want to get to. That’s our end game.”

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The good news: Michigan already may have reached its peak in the number of cases, especially in southeast Michigan, Parekh said. “It looks we’re hitting a plateau or a slow decline."

However, Parekh said, some areas of the state that are just now seeing a surge in cases, particularly the Flint-Saginaw region.

And even if Michigan has peaked, “we don’t know what the second half of the curve is going to look like,” Martin said. “We don’t know if it’s a sharp peak. It took us a long time to get up to the top of the hill, and may take this same amount of time to get back down.”

On Wednesday, April 15, the state reported 1,058 new cases. Parekh and Martin say is the numbers needs to be much much lower before Whitmer can safely lift the stay-at-home order.

“We need a sustained period -- two weeks, perhaps - of very low or, ideally zero new cases, although you may not get to zero,” Parekh said.

It’s possible the state could take a more regional approach, he said. “I think there’s some strength in talking about a regional strategy because the patterns may be different in different regions.”

The big downside is that people moving between different regions can easily spark an outbreak, Parekh said. “Because of the world we live in, it’s really hard to understand how you could do a regional strategy without the risk of spread from one community to another."

But, he added, “That would be a concern regardless, because whatever we do in Michigan, if other states have different policies and protocols and travel increases, we still risk reintroduction from other areas.”

How will it end?

Getting back to normal will be a slow process, experts say.

It’s likely restrictions will loosen in May or June, but they likely will loosen gradually.

“We don’t want to go from the spigot totally off to totally on," Martin said.

“What people can expect is some sort of staged recovery effort,” she said. “What we’ve seen in other countries is that everybody can’t go back to normal at the same time."

That may mean when people go to work, they’ll have to wear masks and follow social distancing guidelines. Restaurants and bars may be allowed to resume dine-in service, but with new restrictions on capacity. Stores may require masks for customers. There likely will be new rules for public spaces.

“I don’t know what summer is going look like yet,” Martin said. “But it’s not going to look like a normal summer.”

And that could continue into the fall, she added.

“I’m having trouble getting a bead on when we’ll be able to be with 100,000 of our closest friends” at University of Michigan’s Big House, Martin said, adding, “and I say that as someone who had just renewed her season tickets.”

Because coronavirus is so contagious and can result in critical illness or even death in some people, a crucial part of reopening the economy will be widespread testing to identify those who have the disease as well others the patient may have infected.

An ongoing problem for the United States has been lack of coronavirus tests and testing supplies. The disease has spread so fast in the U.S. that manufacturers can’t keep up with the demand for coronavirus test kits. Test supplies such as throat swabs also have been in short supply because of high demand and the fact that many of those supplies are made overseas -- and the pandemic has disrupted supply chains.

Whitmer says that reopening the economy is contingent on having a robust testing program.

Ideally, that would include testing all individuals with symptoms as well as asymptomatic individuals with potential exposure to the virus, such as contact with a coronavirus patient or travel to a country with many cases, said Lynn Sutfin, spokeswoman for the Michigan Department of Health and Human Services.

Testing should also include a sampling of asymptomatic individuals with no known exposure, to monitor for potential spread of the disease in the community, Sutfin said.

Michiganders are likely to be living with some sort of social-distancing rules and rigorous monitoring of coronavirus for at least a year or two, until a vaccine is developed, many experts predict.

The extreme social-distancing rules in place are designed to slow down spread of the disease, Pakekh said. But it’s not making the virus go away.

So once the economy reopens, “it becomes a very challenging scenario,” Parekh said. “If you loosen (the restrictions) and see a spike in cases, what do you do? Do you tighten again? How long can you do that?"

“Many of us hope that we’re buying enough time and reducing enough of these infections to get us to a rapid vaccine,” he said.

Dr. Teena Chopra, an infectious disease specialist for Detroit Medical Center, predicts that life won’t return to normal for a long time.

“It’s not just about this summer,” she said. “I think the world is going to be rebooted and everything is going to be different.”

She is specifically concerned about waves of coronavirus outbreaks until a vaccine is available.

“My concern is that when the numbers go down, people are going to start mingling” and coronavirus will resurge, she said. “And outbreaks will happen again and again as people will take their guard off.”

Whitmer said that she wants to make sure that doesn’t happen.

“We can’t afford a second wave" of infections, Whitmer said Monday. “It’s going to be incredibly important that we do this right.”

PREVENTION TIPS

In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus. Health officials say you should be staying at least 6 feet away from others and working from home, if possible. Carry hand sanitizer with you, and use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and when you go into places like stores.

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